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:
- Severity, the most important indicator. The deformity must be severe enough to seriously interfere or stop sexual intercourse.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.