Plaque Surgery for Peyronie’s Disease involves either incision and grafting for Peyronie’s plaque or excision and grafting for Peyronie’s plaque. A brief introduction: In Peyronie’s disease, in-elastic fibrous tissue is deposited on the walls (tunica albuginea) of the erection cylinders (corpora cavernosa). The fibrous tissue deposits are called “Peyronie’s Plaques”. Peyronie’s plaques cause penile curvature and shortening.
In men having moderate to severe penile curvature but with good erection, the plaque may be cut / incised to release the contraction and extend the curve ( Peyronie’s plaque incision ) or removed all together ( Peyronie’s plaque excision ). This leaves a gap that must be filled; “grating”. A graft is a piece of tissue that is applied to fill up the gap.
Time needed: 1 hour and 30 minutes
Peyronie’s plaque incision and grafting / Peyronie’s plaque excision and grafting /
Either general or spinal anesthesia is suitable for Peyronie’s plaque surgery.
Skin is sterilized from the umbilicus to the knees using alcohol-based media. Surgical drapes are applied
- Skin incision for Peyronie’s plaque surgery
The most commonly used skin incision is the sub-coronal degloving incision. This incision is cut beneath the glans penis in a circumferential manner. Skin of the penis is degloved (pulled down) to expose the corpora cavernosa (erection cylinders)
- Determining the point of maximum penile curvature
Artificial erection is induced by the injection of PGE1 into the corpora cavernosa. The point of maximum penile curvature is determined.
- Mobilization of the Neuro-vascular Bundle or urethra
The Neuro-vascular Bundle is the bundle of blood vessels and nerves coursing on the upper surface of the penis, over the erection cylinders (corpora cavernosa). In order to gain access to the Peyronie’s plaque which is in the walls of the corpora cavernosa, either the NVB or the urethra are mobilized (set aside) at the point of maximum curvature, depending on the site of the Peyronie’s plaque.
- Peyronie’s plaque incision / Peyronie’s plaque excision
Peyronie’s plaque is incised (cur) to release the contraction and correct the curve in the penis. If this is not enough, Peyronie’s plaque may be excised (removed all together).
Incision of Peyronie’s plaque or Excision of Peyronie’s plaque will most certainly leave a gap in the wall of the corpora cavernosa. This gap needs to be bridged with a graft. Grafts can be autologous (from the man’s body) such as dermal grafts from underneath the skin, or ready-made (eg: bovine pericardial grafts).
- Double checking that the curve in the penis is corrected
Artificial erection can be re-induced to check that the curve in the penis is fully corrected.
The neurovascular bundle or urethra are returned in place. Skin is closed in absorbable stitches that do not require removal.
” Incision and grafting for Peyronie’s plaque ” or ” excision and grafting for Peyronie’s plaque ” is a one-day surgery, requiring hospital stay for only a few hours. The patient is mobile the same day of surgery.
Success rate and outcome of incision and grafting for Peyronie’s plaque:
Peyronie’s plaque incision or excision will usually straighten the curved penis and restore length to a fair extent. Scientific reports on Peyronie’s plaque surgery indicate that the outcome is satisfactory in 70% of cases.
Complications of incision and grafting for Peyronie’s plaque
In 30%, the following complications may occur:
- Contraction of the graft, leading to some degree of recurrence of curvature. Recurrence up to 30 degrees is acceptable since it will not hinder intercourse.
- Some decrease in the sensitivity of the penis may occur, but it commonly reverts to normal in most patients, in a few months
- Erectile dysfunction may occur in 30% of cases. If this happens, medical treatment for erectile dysfunction may be started. If the patient does not respond, a penile implant will restore excellent erection.
Which Peyronie’s Curvature Cases are Suited for Peyronie’s plaque surgery ?
Severe Peyronie’s disease may cause severe penile curvature, deformity, shortening of the penis, a hinge effect, and is commonly associated with ED. In such cases, penile prosthesis implantation may be recommended along with Peyronie’s plaque incision and grafting.
In milder cases, where erection is normal or close to normal, and penile deviation is not severe, Peyronie’s plaque incision and grafting without a penile implant may be recommended.
Prof.Shaeer has invented a new technique that has revolutionized Peyronie’s Plaque surgery in cases that will require concomitant penile prosthesis implantation: Shaeer’s Punch Technique