Surgical Treatment for Peyronies Disease

What is Peyronie's Disease? Definition and Basic Functions

Peyronie's disease is a progressive, chronic, and challenging condition to manage that occurs due to inflammation of the tunica albuginea, the membrane surrounding the penis. This disease is characterized by the formation of plaques on the tunica albuginea, erectile dysfunction, pain, penile curvature, deformities, and even penile shortening.

The tunica albuginea plays a crucial role in the anatomical structure of the penis and has three basic functions:

Determining the length of the erect penis,

Allowing the penis to stretch to a certain extent,

Generating high pressure during an erection.

Therefore, the main symptoms seen in Peyronie's disease are usually related to the impairment of these functions.

The Necessity of Surgical Treatment and Approach in Peyronie's Disease

Peyronie's disease typically consists of two phases: the acute phase and the chronic phase. The first 6-12 months are referred to as the acute phase, during which the disease has not yet progressed, but pain is significant. Therefore, surgical treatment is strictly not recommended during this phase. In the chronic phase, surgical treatment may be considered.

In the chronic phase, when surgical treatment is necessary, patients are usually asked two fundamental questions:

Do you have a curvature?

Do you have erectile dysfunction?

Based on the answers to these questions, a suitable treatment plan is devised for the patient. Essentially, there are two surgical techniques:

Penile Plication (Nesbit Technique): Suitable for a curvature of 30-60 degrees. The main goal here is to geometrically correct the shape by removing tissue from the longer side. However, there is a risk of penile shortening with this technique.

Incision and Venous Patch: Can be applied if the curvature is over 60 degrees, or if the curvature is between 30-60 degrees and there is concern about penile shortening. In this technique, venous patches are added to the shorter side. However, there is a risk of developing erectile dysfunction with this method.

Treatment Scenarios and Approach

It is important to create an individualized treatment plan for each Peyronie's patient. Below are some scenarios and treatment approaches:

No or less than 30-degree curvature, no erectile dysfunction: You can be monitored in your current condition, and some medication treatments can be initiated. Surgical treatment is not necessary.

30-60 degree curvature, no erectile dysfunction: Curvature-correcting surgery should be performed. If the patient is concerned about penile shortening, the incision venous patch technique can be applied.

30-60 degree curvature, erectile dysfunction: If erectile dysfunction has developed in Peyronie's patients, the correct approach is to combine a penile prosthesis to solve both the erectile dysfunction and the curvature. In these cases, penile prosthesis + Nesbit surgery and incision venous patch surgery can yield satisfactory results.

Over 60-degree curvature, no erectile dysfunction: The most appropriate approach for these patients is the incision venous patch surgery. However, it should be noted that erectile dysfunction may develop after surgery.

Over 60-degree curvature, erectile dysfunction: This is the most complex case of Peyronie's disease. The best approach is to combine penile prosthesis surgery with the incision venous patch technique.