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Here at PeyroniesAssociation.org we feel that you should stay informed. Below are some clinical trials and treatment options.
Surgical Treatment
The subject of surgical intervention in the treatment of Peyronie's Disease elicits a variety of responses from those men who suffer with the disease. It ranges from “lets do it” to “Never!” By some, it is viewed as a way to cure the disease and regain the look and length it had before. To others, just the thought of surgery, is so repugnant that the option is discarded when it may be the only way to restore sexual function.
The facts about this option lies somewhere in the middle. Informed consent and examination of motivation plays a major part in dealing with Peyronies Disease. Surgery is an option that needs to be evaluated from all perspectives. Physical and Emotional.
Surgical intervention should only be considered on the advice of an experienced and knowledgeable physician. The following explanations have been written by Dr Martin K. Gelbard M.D. and are excerpts from his site at www.peyronies.org.
Who should consider an operation?
Candidates for surgery should fulfill four basic criteria. First and foremost is severity. The risks and expense of an operation only make sense when bending or deformity is severe enough to seriously interfere with sexual function. Secondly, natural healing or spontaneous resolution should have been given an opportunity. This is usually accomplished by deferring the decision for surgery at least twelve months from the time of onset. During this time the third criteria can be satisfied - an adequate trial of some form of medical therapy. Finally, no operation should be done on a man whose condition is changing, either for the better or worse. The best surgical outcomes are in men with stable (unchanging) condition.
What are the risks of surgery?
Unfortunately, surgery does not offer a cure for Peyronie’s disease. The scarring in men with deformity severe and persistent enough to warrant an operation represents an irreversible loss of connective tissue elasticity. Though surgical restoration of sexual function can be both effective and reliable, potential candidates need to understand the compromise inherent in this approach.
Each surgical procedure has its own specific risks. It is possible, however to review the more common risks in broader terms, as they apply to surgery for Peyronie’s disease in general. The loss of elasticity or extensibility that occurs with the disease can reduce the length of the erection, and postoperative changes can do the same. Surgery cannot completely restore the penis to its former length or condition. Some procedures shorten the penis more than others. Likewise, some surgical options are more effective in completely straightening curvature. Still, every operation carries the risk of less than perfect straightening. Due to the anatomical location of sensory nerves in the penis, surgery can interfere with skin sensation. While temporary changes in sensation are common, permanent sensory loss is rare. Finally, by disturbing either blood inflow or outflow, surgery can produce either loss of erectile rigidity (hardness) or inability to maintain an erection (impotence).
Surgical Options:
- The Nesbit procedure
This operation, or its various modifications, corrects bending by plicating (gathering) the convex or outer side of the bend. Counteracting the relative shortage of tunica albuginea on the concave side straightens the penis, though length is reduced slightly as a consequence. Still, this procedure is less likely to cause erectile dysfunction than tissue grafting, and remains the first choice for moderate bends without associated diameter reduction. It is the best way to surgically correct congenital curvature.
- Tissue Grafts
These procedures involve the replacement or expansion of scarred tunica albuginea with grafts of healthy tissue from another site. Originally, grafts were used to repair the defect that remained after excision of a Peyronie’s plaque. More recently, surgeons have been using grafts to expand the contracted scars (or plaque) without excising them. Though some calcified plaques still require removal, this non-excisional approach seems less disturbing to erectile function, and less likely to cause postoperative impotence. Despite this risk, grafting remain the most versatile reconstructive technique, particularly suited to correcting severe bending and/or diameter constriction.
- Implant Surgery
Penile implants are biocompatible plastic cylinders, either solid or inflatable, that are surgically implanted into the corpora cavernosum to produce a functional erection. At one time they were a first choice for Peyronie’s patients who had trouble keeping an erection. Now, with all the effective medical remedies for erectile dysfunction, they are used less frequently. In men who don’t respond to these drugs however, they remain an excellent option.
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