Will this surgery work to correct my Peyronie’s disease?

I have peyronies a year and a half now with a 45 degree bend when erect.i have consulted my doctor.i have seen a surgeon and I am not satisfied with his straightening method.he just wants to put a slit in it and sew it back.i don't believe this would would work.i need a second opinion.i am on medical card and live in county roscommon in the west region of Ireland. i need a surgeon who is prepared to carry out the full and proper treatment I would be very thankful for your assistance doctor and advice.i am only 39 and this is ruining my relationships and I am depressed. please help me.


Greetings,

Are you sure you heard and understood everything that was told to you about this penis surgery?

I cannot directly comment about what your surgeon explained about the Peyronie's surgery he or she proposed because I was not there to hear the explanation you were given, and you were. However, as I understand penis surgery to correct a penile curvature caused by PD, the typical procedure is much more complex than simply putting a slit in the shaft and closing it up.  

If you are positive you were given this exact explanation, I suggest you contact another urology surgeon who will take your case more seriously for a second opinion.  Using the information that follows I propose that this next time around you be prepared to ask many questions and demand answers.  You should fully understand what is being proposed to you so you can make an intelligent and informed decision.  I also suggest that you spend some time on the Peyronie's Disease Institute website to learn about the possibility of using non-drug and non-surgical treatment to increase your ability to eliminate the Peyronie's plaque naturally.

I am sensitive to what you are asking and I understand your concern about penis surgery.  However, I have no way to know what is the full and proper surgical treatment for your particular problem, and frankly neither do you.  Something as vitally important and final as surgery requires a great deal of trust in the skill and competence of the surgeon in an area that a layperson does not have enough knowledge or skill to judge what needs to be done. Having said that, I think you might be correct to want to talk to another surgeon if only because it is not correct or proper that you were allowed to leave that office without a better understanding of the proposed surgery.  In my opinion, a half-hearted explanation is no explanation, and does not bode well for the kind of surgery that a doctor like that would provide.

There is always the possibility you misunderstood what was explained to you, but it is still the responsibility of the doctor to make sure you do fully understand so you can give informed consent to a surgical procedure.  There is also the possibility the doctor did not want to give you all the (somewhat gruesome) details of the surgery, since it might scare off someone with a squeamish stomach. Another possibility is that the doctor simply did not want to take the time from a busy office schedule to explain what would happen in the proposed surgery.  It has been my observation that many times a surgeon will greatly limit or modify the truth about some aspect of a proposed surgery (risks, chances for recurrence, changes for failure, degree or frequency of complications or side effects) so that the patient is more inclined to accept the idea of the surgery, and agree to have the surgery done.  It is somewhat of a "selling job" that is done.  It is not appropriate, it is not correct, and it is not legal, but it is done.  Perhaps something like this happened in your case.  Whatever was the reason that you thought the doctor was going to "put a slit in it and sew it back," it is the fault of the doctor for that notion and possible misunderstanding to remain.

More than likely, and I could be completely wrong since I was not there, the doctor proposed to do a Nesbit procedure for your curved penis.

For the most men the Nesbit procedure is the most common, easiest and most direct way that a surgeon can address the penile curvature of  Peyronie’s disease. However, it causes shortening of the erect penis by 2.5 to 6 cm (one to two and a half inches), and this is the greatest drawback of it.  The operation is performed under a general anesthetic and takes 40 to 60 minutes.  Men usually go home the day after surgery, or even the same day.

Basically, in the Nesbit operation the main idea is to make an elliptical incision to remove some of the shaft tissue and tunica albuginea from the long side of the bent penis (on the side opposite the inner curve of the bend), in an effort to straighten the curvature.  This tissue removal is responsible for the overall effect of penis shortening when the long side is reduced. The rule of thumb is that for every 25-30 degree of curvature that is present, a loss of approximately 1 to 1.5cm penis (about half to one inch) length at erection will occur.

An incision is made all the way around the shaft, a few millimeters behind the edge of the head (glans) of the penis.  The cut skin of the penis is rolled back down (like rolling or peeling your socks down off your leg), exposing the two corpora cavernosae so the one corpora cavernosa that is opposite the bend and the Peyronie's plaque can be shortened.  This is done by either removing tissue of the corpora with removal using an elliptical incision or simply by drawing it tighter with internal stitches.  After this is done the foreskin usually has to be shortened also so that it matches the new shorter length of the penis.  As in any operation, infection of the incision lines can be a problem and the foreskin, if left behind, sometimes becomes swollen after surgery; for this reason many surgeons will also perform a complete circumcision to prevent this complication. Otherwise direct surgical complications are not common, but occasional to infrequent side effects after surgery of erectile dysfunction, permanent numbness and penile pain can occur.

Hopefully, this explanation of the Nesbit procedure is helpful.  Keep in mind that this is the simplest Peyronie's surgery.  You can see Peyronie's surgery is a lot more complex than what you thought.  TRH

After Nesbit Peyronie's surgery the curved penis came back – now what?

Hi Dr Herazy,

I was diagnosed with Peyronie's disease in Oct 2009. the urologist put me on potaba which did nothing. I then tried neprinol that did nothing. I saw the uro again and he put me oh high doses of oral Vitamin E and said I was to start VED therapy. My penis curve did not improve at all and in fact became worse. I was then also put on pentoxifylline which again did nothing. After no improvement and the curve to my penis being 40 degrees upward he told me the only solution was Nesbit surgery which I underwent out of desperation in May last year 2011. All was fine, my penis was very straight but shorter by about an inch but then in Sept.Oct the same year I began to notice my penis curving up again! Now in August 2012 it is really back to where I was in 2009 with an upward curve of 40 degrees. Very depressing as same curve just shorter penis!

What do you suggest in light of my previous drugs and treatment to try and cure this myself as I am beginning to give up on the uro's and certainly do not want more surgery after the first one failing me! What do you think about this if I order: DMSO, Super CD Serum, Vitamin E unique Oil, stretching video, Scar-X and Acetyl-L- Carnitine? I am in the UK. Hello, please help as I am now desperate and depressed.

Gary

Greetings Gary,

I commend you for your tenacity and strength to continue to work to help yourself in view of all that has happened to you.

It appears that you have now spent some time reading a few ideas presented on the PDI website about Alternative Medicine treatment of Peyronie's disease. It sounds like when you earlier used Neprinol by itself you did not receive any good advice and you wasted that opportunity to do something positive and helpful for your curved penis. That is always the problem when buying Neprinol from people who do not know how to use it correctly.

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Please do not evaluate Neprinol based on using it by itself. In my opinion that is not the best way to use Neprinol. It is a great therapy product but it must be combined within a well balanced Peyronies treatment plan that addresses other aspects of this complicated problem. You did the best you knew how to do, but you just did not receive good information. Neprinol cannot do it all by itself, but then again, no other therapy product can either; they all must be combined for greatest effectiveness.

If you read about the Nesbit Peyronie's surgery procedure and outcomes on the PDI website you will learn that it is not uncommon for Peyronie's disease to return within a few years; sometimes sooner and sometime later, but it will always return. The surgeons do not like to discuss this aspect of their work because it does not do a lot for their business prospects. In this regard I strongly suggest that you consider putting yourself on an aggressive support plan to minimize the potential of fibrous tissue return. The outline that you suggest is not a bad one and could be helpful in your situation. If it makes sense to you, as apparently it does, I suggest you put yourself of this plan you designed and try it for a month to see if it makes a difference in the size, shape, density and surface features of your scars – no plan can be evaluated on paper; it is only by applying it and evaluating how it affects your PD scars will you know if it is actually effective for you.

Please let me know if I can be of help to your effort. TRH

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Peyronie’s Surgery

Finding a surgeon for your Peyronie’s surgery

There are those times when Peyronie’s disease surgery must be done. If you sincerely feel you have faithfully and honestly used all possible drug and non-drug options to avoid Peyronie’s surgery, and they have all been unsuccessful, and now you cannot continue with the pain and limited sexual ability that started with Peyronie’s disease, then you should carefully consider penis surgery.

From my experience in talking and emailing to many hundreds of men each year since 2002, I have only occasionally found men who are happy with the results of their Peyronie’s surgery. Am I saying that most Peyronie’s operations are failures? Not necessarily. All I can say is that of those men to whom I speak, the great majority are not pleased with their results to restore the penile curvature of Peyronie’s disease.

When I get to speak to someone who has good things to say about his Peyronie’s surgeon and the results of the operation, I always make it a point to ask a lot of questions about the surgeon’s name and location, his credentials, and the interpersonal issues and insights that develop while working with the surgeon.

Here is some advice in helping you select a Peyronie’s surgeon, or any surgeon, because it all comes down to the same traits and characteristics that make someone a good surgeon:

1. Do your research. While many physicians can claim to do surgery, or be someone who specializes in being a Peyronie’s doctor, you should only consider using a doctor who is a board certified surgeon in the area of specialty you need the care. You definitely do not want to have surgery performed by someone who comes to you randomly, without experience in working with Peyronie’s disease. The need to have experience and site-specific and disease-specific training cannot be emphasized too much. After all, it is your penis that is going to be cut on, and you want the best you can find holding the knife above you.

2. There is no need to rush into anything. Plan on spending at least six months doing your research. No need to rush into anything. The more time you spend the fewer mistakes you will likely make when you must decide. If it takes you a full year to collect information, all the better you will feel and all the better your results will occur.

3. Your doctor should be a Board Certified Urologist with a sub-specialty in genitourinary surgery, or a Board Certified Urologist with a sub-specialty in surgery that does exclusively genitourinary surgeries. For example, a surgeon might be a board certified urologist with a subspecialty in genitourinary surgery, but might also further specialize in operating only on male patients. Whether this surgeon might do male urogenital surgery on the elderly (geriatrics) or male children (pediatrics) only makes his experience more valuable.

4. Generally, using a plastic surgeon is not a good idea. While a plastic surgeon might be skillful in facial work, and have a good technique and a good hand for

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doing the fine details around the face, that does not mean these skills will carry over into removal of the PD scar material. If your primary Peyronie’s or genitourinary surgeon wants to use a plastic surgeon for one particular phase of the PD surgery, and that primary surgeon will stay at the operating table the entire time, that is fine. It all comes down to training and experience in the area of the penis, especially removal of the PD scar.

5. Your surgeon should have vast experience with Peyronie’s disease, having performed at least 25 prior surgeries of the specific type you need – usually the Nesbit plication, or others. The larger this number, compared to others, the more likely you should consider this doctor. Someone who has done 10 Nesbit surgeries does not know as much as someone who has done over 100. You want someone who has seen it all, done it all, knows what to do in all circumstances, and will not be surprised while you are under the knife – or later.

6. While this might seem to be a small and superficial consideration, I suggest you employ a surgeon with a meticulous office and very neat appearance, and a clean non-cluttered desk –you want someone who is really meticulous and highly motivated for fine detail work to be doing your Peyronie’s surgery for you. You want a neat-freak, someone who is “anal” doing this kind of work, cutting into your one and only manhood.

7. Good eye contact and warm personality – two reasons: not only will this be what he/she will be like when you are under his/her knife, but how you will be treated in discussions and after surgery care – not ignored or forgotten. You want someone who will be open and friendly and a good communicator before surgery, because these are great doctor skills after the surgery when you need it the most.

8. If you have a friend that is a nurse in area, ask her to ask around for you about the surgeon you are thinking about using. I worked for orthopedic surgeon who was the rave of the hospital and all the nurses who worked in that hospital brought their kids for broken bones and for their husband’s bad backs. Nurses are more likely to know, and talk about, the bad stuff and the good stuff concerning doctors in your area. It is a high recommendation when you know that nurses like work of the doctor you want to use.

9. Go to the internet to Google your surgeon professional work history with your state board of medical review to see if any disciplinary actions have been taken against this doctor. This is important because it will give you a strong indictor about the skill and ability he/she possesses. If your doctor has been sued three times for malpractice, and there are two others who have never been sued, the decision becomes much easier to make.

However, it is always best to avoid any surgery, especially Peyronie’s surgery, if at all possible. That is what the Peyronie’s Disease Institute is all about. Helping you to naturally treat Peyronie’s disease by helping your body to heal and repair so you can eliminate the scar and avoid getting cut on in the first place. Look at a few of the testimonials about our Alternative Medicine treatment for Peyronies.

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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.