Plication Surgery
For Men With Peyronie's Disease
Plication surgery is relatively straightforward surgical procedure aimed to straighten penis curvature, one of the main symptoms of men with Peyronie's disease.
Penile plication is not suitable for all men with Peyronie's disease. The ideal candidate has good erectile function, adequate penile length and moderate penile curvature without any associated deformity.
What Is Penile Plication Surgery?
Penile plication is a group of surgical procedures aimed to straighten curved penis. One of them is the Nesbit procedure, the original tunical shortening procedure.
There have been several modifications on the Nesbit procedure over the years, aimed to limit the risk of post-operative erectile impairment. The so-called simple plication approach is now preferred over the Nesbit procedure to treat men with Peyronie's disease.
Penile plication is a tuck procedure on the side opposite to the plaque (scar) thus shortening the long side of the penis.
Trying to explain this simply - think of bent penis. The curvature is because one side of the penis is longer than the other side. The short side is inside the penis, i.e. where it bends. The long side is the outer side of the penis. By shortening the long side (by pinching together the tissues on the outer side of the penis bend), the penis is kind of “hauled” back up.
The outcome is straighter, but usually a shorter penis.
If you have already had, or are planning to have, plication surgery, then you should consider using traction device to prevent post-surgical penile shortening.
Who Is Ideal Candidate For Plication Surgery?
The ideal Peyronie's candidate can achieve erection, has adequate penile length and simple penile curvature, i.e. without any associated deformity like hour-glass effects, hinge or waisting.
Most Peyronie's specialists prefer the penis curvature to be less than 60 degrees to qualify for plication surgery (some even insist on less than 40 degrees). Grafting Surgery is more suitable for men with more severe penis curvature, as well as those that have narrowing penis deformity.
There is also substantial risk of penile shortening after plication operation. Men with stretched penile length under 10 cm. might therefore prefer to have grafting surgery.
Any penis surgery can result in penis shortening but the risk is less for those that undergo grafting surgery, i.e. lengthening the shorter side (grafting) vs. shortening of the longer side (plication).
Finally, to qualify for plication operation, the patient must also be able to achieve and maintain erection (even if assisted with Viagra or other virility medication). Men with Peyronie's disease that suffer from erectile dysfunction will have to have Penile Implants.
What Are The Benefits Of Peyronie's Plication Surgery?
Penile plication benefits include the simplicity of the procedure. Plication is usually performed on a patient under local anesthesia, which reduces the operation risk (less potential morbidity).
Plication also offers excellent results (straightening bent penis) and high patient satisfaction.
What Are The Downsides Of Plication Peyronie's Surgery?
Peyronie's surgical treatments are the most expensive treatment options available. However, in some cases they are the only option. Surgery is the most reliable way of correcting penis deformity but unfortunately, the side effects can be substantial and severe.
Men undergoing any penile surgery cannot resume sexual activity immediately after surgery. It varies how long it takes but usually up to 2-6 months to recover enough for full intercourse to take place.
However, the biggest downside of plication surgery for most men is the penile shortening. This is due to the nature of the process. Plication makes the long side of the penis shorter, resulting in shorter penis (0.5cm - 1.5 cm shorter).
What Are The Possible Side Effects?
There are number of side effects. The most serious one is the inability to achieve or maintain erection, i.e. the risk of becoming impotent. Penile shortening is though more common side effect, been reported in between 41 to 90% cases (various studies).
Other possible plication side effects include loss of penile elasticity / sensation and permanent palpable penis lumps.
Does Plication Operation Involve Any Health Risk?
All surgery is an invasive procedure and therefore involves some level of risk. This risk is somewhat reduced as plication can usually be performed under local anesthesia.
There are no major complications associated with the plication procedure as such but there is a real risk of erectile dysfunction or becoming impotent.
Results Of Using Plication For Peyronie's Disease
Penile plication surgery has shown reliable results in straightening curved penis and improving sexual function in appropriately selected Peyronie's patients. Many patients have achieved near complete correction of their penis curvature.
Furthermore, the long-term results have been promising, with low rate of penile curvature recurrence. Few Peyronie's patients have therefore needed second surgery.
There has also been high patient satisfaction with the cosmetic results achieved by the surgery.
Find out what Dr. Levine, one of the best known Peyronie's specialists in the world today, has to say about the benefits, side effects and results from the different Peyronie's surgeries.
Scientific Support
For Plication Surgery As Peyronie's Treatment
There are numbers of studies and reviews available that confirm that plication is a good option for appropriately selected Peyronie's patients. Like this ten years outcome analysis concludes:
“Corporeal plication is an effective surgical option for the correction of penile deformity in patients with Peyronie's disease, with good cosmetic results and acceptable functional success rate in the long-term” (Int Urol Nephrol. 2007
)
Laurence A. Levine, MD, is one of the best-known Peyronie's experts in the world today. He views plication as the optimum surgical technique for a man with curvature less than 60 degrees and without narrowing resulting in hinge effect (Peyronie's Disease; Page 151 ).
Various studies have as well confirmed the side effects and risk previously described. Various studies report penile shortening in between 41 to 90% of cases.
While sexual dysfunction after plication has been reported in between 7 to 40% of the time. The main reasons for functional failure have to do with penis pain, erectile dysfunction and / or persisting penis deformity.
Other reported plication side effects include loss of penile sensation (3-48% of patients) and permanent palpable knots reported as “bothersome” (12-18% of patients). (Adv Urol. 2008 )
My Personal Experience
And Opinion Of Plication Surgery
I have no personal experience of penile plication operation. Surgery is always the last Peyronie's treatment option in my mind.
Surgery is never performed until your Peyronie's disease has reached the stable stage, so you should use the time during the acute stage to try other Peyronie's treatments available to you. And hopefully like me, you will not need Peyronie's surgery.
However, if you need Peyronie's surgery, which surgery to go for depends more on your Peyronie's condition than your preference. Plication is the right option for men with mild or moderate penis curvature that can achieve erection and have adequate stretched penile length and no narrowing deformity.
If you do not fulfill those criteria, then plication is not the right surgery for you. But if you do, and you have tried other things without satisfying result, than plication surgery might be what you are looking for.
Have you undergone penile plication operation?
If so, please use the form below and leave your Comments, or relevant practical advice to other Peyronie's sufferers.
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