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 than others. Every surgery carries the risk of less than perfect straightening, and even worsening of curvature and distortion. . Excess scar formation can occur from this kind 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 that makes sexual pleasure a thing of the past.
April 1, 2012 PDI Newsletter – Peyronie’s disease research project; Peyronie’s surgery: Leriche technique
Greetings to all PDI Warriors,
Welcome to this April 2012 PD Institute newsletter, and to our Dupuytrens readers. I trust all are doing well. How nice to have spring arriving so quietly here in the Midwest.
The first part of this newsletter will be a call for volunteers for a research project by the Peyronie’s Disease Institute – our 5th since 2002. (If this particular Peyronie’s project goes well, we will do something very similar within the Dupuytren’s Contracture Institute.) Next, I will discuss a new surgery for Peyronie’s disease, the Leriche technique that is very similar to a frequently used Dupuytren surgery that is showing signs of losing popularity.
PDI Peyronie’s Plaque (Scar) Research to Test a New Location Method – 2012
Anyone who has read my posts and articles about Peyronie’s disease treatment understands the critical need to clearly and accurately define the size, shape, density and surface features of the Peyronie’s plaque material. The importance of focusing attention on the PD plaque is simply because the fibrous plaque or scar is the central issue of Peyronie’s disease. Even though the bent and distorted shaft gets all the attention and emotional response, it is the plaque that causes this abnormal condition of the previously straight shaft. I have at length, and repeatedly, explained that in order to determine if a Peyronie’s (or Dupuytren’s) treatment plan is effective or is not effective can be easily determined by evaluating the plaque (or palm lumps and cords) after just a few weeks of treatment; long before the shaft distortion improves the plaque will change (or long before the bent fingers move away from the palm, the nodules and cords will respond by softening and changing tone).
If the target tissue is changing there is no need to modify the treatment plan; if the target tissue is not changing the plan must be modified until such time that changes are noted. It is the condition of the plaque (or palm nodules and cords) that determines how the treatment plan should be conducted. But it all begins by knowing the size, shape, density and surface features of every plaque (or palm cord and lump) that can be located. Without that knowledge Alternative Medicine treatment is only a guess.
The presence of a curved or distorted penis means you have one or more plaque formations in the tunica albuginea layer of the shaft, whether you can find it or not. If it was not present in the shaft you would have not be bent or have the dents or bottle-neck or hour-glass deformity you do. For that matter you would also not have lost size (length and girth), as well as having a poor quality erection that are a common part of Peyronie’s disease. All of these things happen because of the plaque you cannot find.
However, a great treatment problem arises when a man cannot find his Peyronie’s plaque. Perhaps both he and his doctor have been unsuccessful in locating it. In this situation treatment will suffer without a good way to determine if the plan is actually affecting the plaque structure.
I continually spend a considerable amount of time writing and talking to men to teach them how to locate their PD scar or plaque. Most find it after we spend time working together, but there are those who never locate it. This is what brings us to the need for this PDI research project to test another method I have developed to locate the PD scar or plaque.
During the past month I have developed an original and unique way to locate the PD scar that has never been used anywhere before. Because this is such a new concept I have instructed only four men how to use this new technique. At this time only brief and sketchy positive information has been sent back to me by two of the four I have shared it with. Now I need to have a larger assortment of men use this information and report back with details of how this idea is working, or not. Testing will determine if this is a good way to locate PD plaque.
I need 20 men to volunteer who absolutely have tried everything to find their PD scar and still cannot do it. No cost will be involved and no equipment will be needed; this is a strictly “hands on” method that is simple, safe and fast to perform.
Not everyone who volunteers will be accepted for this research project since we must have follow limitations and guidelines created for participants.
I am interested in having anyone participate if all of these requirements apply to you:
1. You have been given a diagnosis of Peyronie’s disease after a medical examination by an MD; no self-diagnosis
2. You have read and followed the information found in my article When Peyronie’s Scar Not Easily Located
3. You absolutely cannot find your PD scar
4. You have one or more of the following distortions:
a. Curve greater than 20 degrees
b. Bend greater than 10 degrees
c. Bottle-neck deformity that affects at least 30% of the width or circumference of the shaft
d. Hour-glass deformity that affects at least 30% of the width or circumference of the shaft
e. Hinge or depression or dent deformity of at least 1/16 inch (1 mm) depth
5. You are 30 years of age or older
6. Your English communication skills are excellent so there is no problem understanding the instructions provided and you can write a simple report of your findings after following the technique instructions you are given
7. You have had Peyronie’s disease for one year or longer
8. You have not had any penile surgery
9. You will allow your name and place of residence to be identified as a study participant, not for general and wide use but only for use to prove your participation for research validation
If you are interested in participating in this program please contact me by email at email@example.com giving me your name, a clear statement in the email that “I fulfill all nine PDI research requirements to test the new plaque location method,” your phone number and a good contact time to call you. I will personally work with each man individually to make sure he has all the help he needs to understand and use this new method of scar location. All I ask in return is detailed information from each volunteer how the method worked to find scars that are otherwise not found, and what you found when you used the PDI scar location method.
Not only will this information be helpful for the large community of PD men around the world, but it will be a great chance for you to learn another method to locate you Peyronie’s scar.
Please help in this project if you satisfy the eight requirements.
Peyronie’s surgery with the Leriche technique
In the last few months several people have emailed to me, asking my opinion about Leriche surgery for Peyronies disease. For this reason I am offering my comments here for all to see.
The Leriche technique is a relatively new Peyronies surgery, with only 10 cases reported and they were followed only for three months. Although I am sure there are many more than 10 that have been done, only this small number is noted in the research data available. The Leriche technique is intended to be used only during the stable phase of Peyronies disease.
In all surgical techniques for PD – like Nesbitt – there is ALWAYS more scarring that occurs afterward as a result of surgery. While the Leriche technique is a different kind of surgery, it is surgery nonetheless and will likely result in greater scar formation over a period of time.
In this new technique patients are operated on an outpatient basis under local anesthesia, after localization of the plaque by ultrasound of the penis. In the Leriche technique a tear, ripping or shredding of the PD plaque is performed using an 18 gauge needle. The major feature of the Leriche technique is that no large surgical incision is made to gain access to the Peyronie’s plaque, only the small hole for insertion of the needle. But what the needle does below the surface is very aggressive, although it is not seen directly since it is done below the unopened skin surface. The unseen cutting and slashing of the Peyronie’s plaque below the surface must be extensive enough to weaken and tear the plaque so that it allows the fragmented plaque to be stretched out. This blind surgery allows unintentional damage to other tissues (nerves, veins, arteries, supporting tissue) to occur and for additional scar formation to result.
For those readers with Dupuytrens contracture, the Leriche technique is similar to Needle Aponeurotomy in which a hypodermic needle is slid under the skin of the palm and used to tear and slash and weaken the fibrous cords tissue below the surface while not being able to see it directly.
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.
Lastly, keep in mind: If you already have Peyronie’s disease it is because your body created a mass of foreign fibrous scar material in your shaft as an over-reaction during the healing process – usually to some kind of trauma. Any surgery – like the Leriche technique – involves the trauma of putting holes into and tearing the internal tissue of the tunica albuginea of the penis. This kind of trauma can result in more scars and larger scars for a man who has already shown he is sensitive to any injury of this delicate tissue.
What will probably happen is that the researches will find that 6-12-24 months after the Leriche surgery has been done that men will develop more scars, like they do after surgeries, and the technique will lose 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.
Please contact me if you qualify and are interesting in participating in the latest Peyronie’s Disease Institute research project, testing a new manual method to locate the elusive Peyronie’s plaque or scar.
See you next month. Stay in touch and send your treatment questions to me so I can give you some ideas to work with.
Theodore R. Herazy, DC, LAc