Our Approach & Peyronie’s Disease Surgery Results

The following slideshow demonstrates the technique of correcting penile curvature with Peyronie’s disease plication surgery. In general, this method provides excellent Peyronie’s disease surgery results, with the surgery correcting penile curvature.

Peyronie’s disease plication surgery begins with a skin incision. In the picture above, the skin is marked in the location that the incision will take place. The marking is made circumferentially, approximately 1 cm below the area where the head of the penis (glans penis) meets the shaft (coronal sulcus).

The next step is to make the incision, as pictured above. This is called a circumcising incision, even though an actual circumcision (removal of the foreskin) is not performed with this incision. Peyronie’s disease plication surgery is performed under general anesthesia to prevent any discomfort for the patient.

After the skin is incised, the penile skin is “degloved” and brought down to the base of the penis in order to get the best possible exposure to help insure the best possible Peyronie’s disease surgery results. The above picture was taken after the skin is degloved, allowing for the urethra (surrounded by a structure called the corpus spongiosum) and the erectile bodies (called the corpora cavernosa) to be seen.

In the above photograph, saline is used to create an “artificial erection”. Saline is rapidly infused into the penis and the base of the penis is compressed, creating an “artificial erection”. This allows for the abnormal area where the penis is crooked to be easily seen. Plications are then performed on the opposite side of the penile curvature. If there is upward penile curvature, then plications will be performed on the undersurface of the penis.

After the penile skin is degloved and the area of penile curvature is identified, the neurovascular structures (that contain nerves to the glans penis) must be moved to the side, exposing the tissue to be plicated to straighten the bent penis. This tissue is called the tunica albuginea. We perform this dissection under optical magnification without the use of a tournequet, and expertise is required to avoid damaging the sensitive nerves.

A pen is used to mark the exposed tunica albuginea to be plicated. The removal of the tissue between the yellow lines will shorten the penis in that area by an amount corresponding to the distance between the lines. When there is penile curvature, the long side is shortened to tilt the bent penis straight.

In this Peyronie’s Disease surgery photograph, the neurovascular bundles have been mobilized on the right side of the undersurfase of the penis (ventral-lateral) which is on the left side of the picture, and the area to be plicated is marked. This picture demonstrates the comparison of the appearance before and after the mobilization.

When upward penile curvature is corrected, we plicate along the undersurface of the penis on both sides of the urethra. In this photo, the neurovascular bundles have been lifted off the tunica albuginea. The urethra is in between the areas to be plicated. Curvature could also be corrected by mobilizing the urethra and performing a midline plication. However, it is our preference to not disturb the urethra to best protect the urethra from possible injury.

Before actually making a permanent change to the penis, we first perform a temporary plication using suture to pinch the area. In this photograph of penile plication surgery for Peyronie’s Disease, the suture has been placed but has not yet been tied.

After the temporary plication suture is placed, the suture is tied. An artificial erection is then performed to confirm that the plication of this area will help straighten the bent penis. Once confirmed, we remove the temporary suture and perform a permanent plication to correct the penile curvature by performing an oval shaped excision of tissue and a 2 layer closure with absorbable suture.

Plications have been performed with one plication on each side of the urethra along the undersurface of the penis. Our preference is to use absorbable suture that will eventually dissolve so that the patient does not feel the knots of permanent sutures and there is not a risk that a suture will "pop" leading to a recurrence of penile curvature.

When there is severe penile curvature, multiple plications are needed to fix a curved penis. In this patient where the penis is abnormally bent upwards, there was only partial correction of the curvature after a single plication on each side of the urethra. We then performed one more plication on each side, and this completely straightened the penis.

Another cause of an abnormal penis is Congenital Penile Curvature. Men who report life long curvature, especially to the side, are born with unequal development of the tunica albuginea of the penis. During an erection, one side is abnormally longer than the opposite side, and this causes a bent penis. In this photograph, plication is performed to fix the penile curvature. In general, congenital penile curvature is best managed with plication and medical management options and stretching devices are of no value.

When there is downward penile curvature, which is less common than an upward bent penis, the plications are performed along the top of the penis to tilt the penis back upward. This is an especially delicate dissection as important nerves and arteries are mostly along the top part of the penis. In this patient, 3 plications were required. Prior to surgery, he had disabling 90 degree downward penile curvature. After surgery, his penis was straight, and he was able to resume sexual intercourse.

After the plications are all performed and the penis is straight, the neurovascular bundles are then replaced to again cover the tunica albuginea. In this Peyronie’s Disease surgery picture, on one side, the neurovascular tissue is being repositioned to cover the exposed tunica albuginea as it did before the surgery.

Before the skin is closed following penile plications, a final artificial erection is performed to confirm the fix of the Peyronie's Disease curvature. In this photograph, the artificial erection revealed that the penis is now completely straight.

The skin incision here has been closed with absorbable sutures. These sutures do not have to be removed. Eventually, they dissolve. We leave a small tube under the skin for less than 24 hours to drain any blood. However, bleeding after surgery is rare and to date, we have never had the complication of significant bleeding after penile curvature correction surgery.