Does any Urologist perform a needle aponeurotomy for Peyronies disease?

Needle aponeurotomy for the hand is all I see online. I am a Kaiser Permanente subscriber and even at that, I don't see anywhere online where needle aponeurotomy is performed on a penis…Got any suggestions? Do you know of any Urologist in my medical plan who does needle aponeurotomy for Peyronie?

Sincerely,

Martin Carroll, Jr.

Greetings Martin,

Well, you are certainly an adventurous person. Here you are a layperson and you are thinking outside the box about your Peyronie's treatment, but you are in a risky area. The problem is that this idea of using a needle to tear up the fibrous Peyronie's plaque without having to cut the penis shaft open has already been explored.

As you know, needle aponeurotomy is a type of surgery done on the palm of the hand to surgically reduce the cords that develop in Dupuytren's contracture. It is a less invasive hand surgery performed by inserting a needle under the skin of the palm, and then blindly slashing and tearing at the cords and contracted fascial tissue since the skin is never opened by the surgeon so he/she never actually sees the tissue that is being cut and torn. The purpose of this procedure is an attempt to weaken and reduce the cords that develop under the skin in Dupuytren contracture to the point that the surgeon can eventually break or snap the weakened Dupuytren cords. The recurrence rate of the Dupuytren nodules and cords returning after needle aponeurotomy is fairly high, about a year or two faster than conventional hand surgery. Even though they return after this kind of hand surgery, the real caution and reason many people do not get this surgery is that when the Dupuytrens comes back in that year or two it will come back worse than the first time around. This is common for many of these Dupuytren hand surgeries and a good reason to think long and hard about getting started with the first one.

There are many hand surgeons who are proponents of this technique, and others who are not. No surgical technique is perfect, and they all carry risks. You might want to read more about these drawbacks and apply that thinking to what might happen if that same kind of technique was done for Peyronie's disease.

This same technique in which the tip of a large gauge needle is used as a cutting tool to reduce the Peyronie's plaque while the actual slashing and tearing of the tissue is not directly observed by the doctor who is doing the penis surgery is called the Leriche technique for Peyronie's disease. But it is not called an aponeurotomy because there is no aponeurosis in the shaft of the penis; that is why you were not able to find any information using the terms you were searching. If this surgery for the penis was to be named in a way similar to what is being done in the hand, it might a name like Needle Tunicotomy. This term would be applicable because it is the tunica albuginea of the penis that would be surgically cut by the needle tip and left in place, just as it is the aponeurosis of the palm that is cut with the needle in Dupuytren's contracture. You will not find this term anywhere but here because I coined it. to read more about this procedure, click on “Leriche technique for Peyronie's surgery.”

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There are many more conservative ways of trying to correct your Peyronie's disease than having the internal scar blindly being cut to shreds. I suggest you consider avoiding that kind of risk and look at some of the less risky non-invasive Alternative Medicine options that are on the PDI website. TRH

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Peyronie’s Disease Surgery

Surgical Peyronie’s treatment has many limitations

The Peyronie’s Disease Institute is not against Peyronie’s disease surgery.

The Peyronie’s Disease Institute is against the abuse of surgical treatment of Peyronie’s disease. Considerable surgical risk exists for any man with PD who has an operation to attempt correction of penile distortion.  Adverse outcomes and worsening of the original problem are associated with even a small incision (or injection) made to a penis that already has demonstrated the tendency to create excess Peyronie’s scar formation.

The overuse and abuse of Peyronie’s surgery should be suspected when the treating doctor does not follow reasonable and conservative guidelines to consider a patient a surgical candidate.   A good surgeon will know that a man with Peyronie’s disease should fulfill these basic points before suggesting surgery:

  1. Severity, the most important indicator. The deformity must be severe enough to seriously interfere or stop sexual intercourse.
  2. Adequate time for healing and spontaneous recovery must be given. Usually thought to be from 12-18 months from the time of onset of PD.
  3. Non-responsive to a fair trial of medical therapy. In practice, many doctors attempt only one form of medical treatment.  When that fails the patient is told surgery is the only other option.  It appears that doctors know the poor results achieved by medication to make a difference with Peyronie’s disease that they are quick to want to skip this step and proceed to the operating room.   When vitamin E is offered as a therapy option, it is done so reluctantly and with little hope for success.  Further, no instruction is offered for the correct use of vitamin E, or information about the eight different members of the vitamin E family.  Since no real help is offered to assure that the patient will use vitamin E correctly, it is no wonder that so many men fail.   There is a large body of information available that can assure a man is more successful with vitamin E therapy for his Peyronie’s disease.  Using the correct type of vitamin E, and using it correctly in conjunction with other forms of therapy that work synergistically with it, would only increase the chance of success.
  4. Stable and unchanging scar.   This can mean changing for the better or worse. Since so few doctors, and the men with PD, even locate the PD scar, it is doubtful that this criteria is seriously considered.

For information about the Leriche surgery technique for Peyronie's disease.

Risks of Peyronie’s surgery

Surgery is not a Peyronie’s cure. Because of the unique anatomy and physiology of the penis, the risks of surgery to this area are a little different than other tissues.

  1. Additional scar formation and possible worsening of PD.  Because any man attempting a surgical correction of PD who already has massive scarring, must expect more scarring to develop as a result of that surgery. It is a known fact – seldom discussed with a PD patient before surgery – that surgery for PD will result in more PD, sooner or later.
  2. Loss of penis size. Extensive scar tissue that is severe and persistent enough to cause a deformity serious enough to justify Peyronies surgery, represents a large mass of internal scar tissue. Surgery will remove a large and irreplaceable loss of connective tissue and loss of elasticity of the tissue that is not removed. If it is not bad enough that surgical correction and return of sexual function cannot be guaranteed because of the possibility of complications, every surgical candidate must understand that there will always be a loss of length and diameter of the penis.   Many men tell me that this secondary consequential loss of penis size is hardly discussed before surgery. Most men learn about the loss of penis size after it is too late.
  3. Incomplete straightening, no change, or worsening of the original PD deformity.  Loss of elasticity, additional scarring, and damage to the veins of the penis that can occur as a result of surgery, can also reduce or prevent correction of the original PD problem.
  4. Loss of sensation.  Due to anatomical location of important sensory nerves of the penis, PD surgery can slightly, or greatly, or totally, reduce skin sensation and  pleasure associated with sexual activity.  Temporary reduction of sensation is very common, and permanent sensory loss is less common.
  5. Loss of erection strength.  Surgery cannot help but alter both the inflow and/or outflow of blood to the penis.   By disturbing the pneumatic mechanism that creates an erection it is not uncommon for men to report either loss of erectile rigidity (hardness) or inability to maintain an erection (impotence) – and sometimes both.

If a surgeon has been attempting to get you to undergo PD correction surgery, and you were told the surgical outcomes are “good,” I strongly suggest you get a very clear and detailed explanation for what the surgeon means by “good.”  You might think “good” means that you will be perfect again, that your PD will be gone, that you will feel like a teenager.  The surgeon might be thinking that “good” means only a one or two inch loss of length, only a 50% chance of loss of penile rigidity, only a 50% loss of skin sensation, and restoring your curve from 90 degrees to only 30 or 40 degrees.   It is not an easy thing to determine how to straighten a curved penis.

If your surgeon tells you these things are not true, and that surgical results are “excellent” you might want to ask him what he means by excellent.  If he says you are worrying too much about such a safe and simple operation, ask the surgeon to put that in writing.  Ask the surgeon to guarantee that the surgery will not result in impotence, loss of skin sensation, that you will have a completely straight penis, and that your Peyronie's penis will never return.  You will not get that guarantee because no one can say what will happen to you as a result of PD surgery.

This blog post is not anti-surgery.  This blog post is all about getting a clear and honest idea about reasonable expectations after Peyronie's surgery.  It is my experience that most men are led to believe that their surgery results will be far better than the surgeon and reality can deliver.

Keep in mind that what is good for the surgeon might not be good for the man with Peyronie’s disease.

Leriche Technique for Peyronie’s Surgery

Peyronie’s disease surgery with Leriche method carries risk

The Leriche technique is a new surgical treatment of the stable phase of Peyronie’s disease.  At this time 10 cases are reported in the literature, and they were followed for only three months post-surgically.  While many more Leriche surgeries have taken place, primarily in France, they have not been reported in the literature for review. For this reason any man considering this technique must realize not much historical data has been collected to prove the effectiveness of this new procedure to reduce the curved penis of Peyronie’s disease, or evaluate for complications.  If a man wishes to volunteer to be one of the first for a new surgical approach, this would be that opportunity.

It is important to remember the Leriche technique is a different kind of penis surgery, but it is surgery nonetheless.  In all other Peyronie’s disease surgery techniques – like Nesbitt – there is ALWAYS more scarring that occurs as a result of surgical intervention.  In this new technique patients are operated on an outpatient basis under local anesthesia, after identification of the Peyronie’s plaque is made by ultrasound examination.  In the Leriche technique multiple tears (plication) of the PD plaque are made with an 18 gauge needle almost as though the surgeon was trying to shred the plaque, with the idea that it will be enlarged, spread out and flattened.

Leriche surgery by comparison to the Nesbit technique is minimally invasive, and solely for this reason might have a better range of outcomes. It is suggested following the Leriche surgery that the patient must engage in early and daily sexual activity for at least one month to obtain a good outcome.  Early reports suggest 30 percent of men who undergo the Leriche procedure are cured; however this opinion is based on limited post-surgical follow up of three months.  Another 50 percent gain sexual function after two or more additional Leriche surgeries.  For the 20 percent of men who do not respond well to the Leriche approach, the technique will not interfere with additional surgery or penile implant.

Time will tell how truly effective the Leriche technique is for correction of the Peyronie’s problem.

Penis surgery always carries risk

Most other types of Peyronie’s surgery are performed on an outpatient basis under general anesthesia, and can last up to two and a half hours. A second doctor, a plastic surgeon, may be needed when specialized grafting techniques are used. Surgery for Peyronie’s disease is a major event to a very sensitive part of the body with a large nerve supply, so there is never an easy walk in the park no matter what kind of surgery is performed.

Martin K. Gelbard, MD, world-renown Peyronie's disease expert, states, “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.” Compromise means that after surgery some degree of the old problem and limitation usually remains, and new problems (more scarring, reduced sensation or numbness, new bends, more pain) will occur in spite of the best effort of the Peyronie’s disease surgeon.

Every surgical procedure has risk; none are totally safe or foolproof.   No Peyronie’s disease surgery can restore the penis to its former condition. Some surgery shortens the penis more than others. Some are more effective in straightening curvature. Every surgery carries the risk of less than perfect straightening, and sometimes the curvature is worse after corrective penile surgery because excess scar formation can occur from the trauma of surgery. Lastly, surgical side-effects are possible resulting in loss of rigidity (hardness) or inability to maintain an erection (impotence), due to permanent surgical alteration of blood flow in the penis, pain greater than before surgery, as well as permanent loss of sensation (numbness) that makes sexual pleasure a thing of the past.

Please keep this in mind:  You have PD because your body made a foreign scar in your penis as an over-reaction process – usually to some type of trauma.  Any surgery – like the Leriche technique – involves cutting holes into and tearing the internal tissue of the penis.  This kind of trauma often results in more scars in a man who has already shown he is capable of creating excess scar formation after any level of injury to the penis.

What will probably happen is that the researches will find 6-12-24 months after the Leriche surgery that men will develop more scars, like they do after other penis surgeries when done to men who already make too much scar material after injury, and the technique will fall out of favor.

Please ask a lot of questions and be very slow to submit to penile surgery if you already know you make more scar than the average man.  For this reason it might be worthwhile considering using a more conservative Peyronie’s disease natural treatment with Alternative medicine.