Peyronie's disease (bent penis) - surgery
- dr Nikola Stanojević
- Apr 19
- 11 min read
IPP - Peyronie's disease - Bent penis - Mb Peyronie
Waiting for Peyronie's disease to go away without treatment?
Have you already tried to find a solution, were disappointed by treatment with injections ( vitamin K, verapamil ), scar creams, or any of the many useless and ineffective drugs that are sold?
WARNING
A common surgical technique for treating Peyronie's disease results in a significant reduction of the penis. The most popular among urologists is the Nesbit method (Nesbit), the procedure that significantly reduces the size of the penis, after which sex becomes almost impossible.
WARNING
If the penis has just started to curve, i.e. if Peyronie's disease has just appeared, ASAP get a vacuum device for the penis (vacuum pump) and do daily penis stretching exercises. In this way, you can avoid further shortening and bending of the penis.
If you have already had an unsuccessful operation to treat Peyronie's disease - in most cases, a penile shortening surgery, the procedure can be reversed, and the length and width of the penis can be restored.
Loss of touch and sexual sensation in the penis is often encountered in unprofessionally performed surgeries. Rough operating techniques lead to nerve damage and penile numbness.
If the surgeon is not experienced enough, the biggest problem that can occur during Peyronie's disease surgery is the loss of part of the glans or the loss of the entire penis. This happens if, during the surgery, the surgeon damages the vital blood vessels that feed the penis - the neurovascular pedicle of the penis. Perhaps this sounds like a crude marketing trick, but unfortunately it is the reality after an amateur approach to a delicate surgical problem - the reconstruction of Peyronie's disease.
In order to avoid such situations, it is important to evaluate the experience of the doctor in the field of genital reconstructive surgery and see if the doctor-surgeon has warned the man about possible problems after the operation. The only option that restores a normal love life is the procedure that simultaneously corrects the curvature of the penis and restores the original length and girth of the penis.
Thanks to his long-term work with Academician Prof. Dr. Sava Perovic, Dr. Nikola Stanojević, specialist - urologist - andrologist, became known as one of the leading experts in the field of urogenital reconstructive surgery, specializing in the treatment of all types of genital deformities. He has published many scientific papers on the subject of Peyronie's disease. He is the winner of two international awards on the topic of surgery for a crooked penis (2018 and 2020). In 2020, the European Association for Sexual Medicine (ESSM) awarded the award to Dr. Nikola Stanojević for the best surgical technique in the treatment of Peyronie's disease. The main advantage of the new technique is that the entire surgery is performed through a small incision under the penis, towards the scrotum, and thus does not disturb the natural flow of lymphatic and blood vessels of the skin of the penis and the neurovascular pedicle responsible for the glans of the penis. The technique published by Dr. Nikola Stanojević preserves the natural appearance and natural sensitivity of the penis while avoiding all the complications that occur when using the classic technique of cutting under the glans of the penis and removing the skin before correcting the shortening and narrowing of the penis (penile degloving).
What is Peyronie's disease?
It is an acquired curvature of the penis that most often occurs in middle age. Curvature is usually caused by an injury or a series of minor injuries to the penis during sexual intercourse. The disease is recognized by a scar on the inner membrane of the penis (tunica albuginea). Over time, the scar increases and turns into a fibrous plaque that leads to reduced elasticity and deformity of the internal structures, and thus to serious deformities in the form of curvature, narrowing and shortening of the penis. Because of the disease, sexual intercourse is difficult, and in the most severe cases, impossible.
Officially, Peyronie's disease occurs in 10-15% of men over the age of 40, although the disease is more common and can occur at any age.
Unfortunately, a large proportion of men with Peyronie's disease have significant psychological stress and even signs of depression. Many hesitate for too long to turn to a specialized expert - an andrologist, due to a sense of shame, embarrassment and the assumption that there is no more help for their sex life, unaware that there is a solution for a healthy and happy sex life.
Most often, a man suffering from Peyronie's disease will first notice a suspicious nodule on the penis (fibrous scar) and a curvature of the penis to one side during erection. In addition, pain, the initial phase of erectile dysfunction, shortening and narrowing of the penis may occur.
Symptoms:
Pain in the penis during erection
A lump (or lumps) on the penis
A crooked penis that prevents normal sexual intercourse
Shortening of the penis, narrowing or twisting along the longitudinal axis
Impotence as an associated symptom
The possibility of sexual intercourse only in certain positions with limited movements during intercourse
Peyronie's disease: bent penis - shortened penis
It is very important to remember that Peyronie's disease always results in loss of penis size. A crooked penis is the result of shortening of the penis on the side where Peyronie's disease occurred. This requires more attention during the initial assessment of the condition of the disease, because the goal is not only to straighten the penis, but also to restore the lost length of the penis.
Men whose penis is curved and shortened have difficulty finding an adequate doctor for proper diagnosis and treatment of the disease. A specialist in genital reconstructive surgery is the only doctor who can properly assess your condition and suggest realistic options for treating Peyronie's disease.
Before you come for a consultation with a doctor - andrologist, you need to take photos of your penis in full erection from several angles in order to better assess the degree of deformity. Photographs are crucial in the assessment of penile deformity.
In the conversation with the doctor, state the cause of the occurrence (injury or spontaneous occurrence), the duration of the disease, situations that cause pain in the penis, whether penetrative sexual intercourse is possible and whether the curvature, narrowing or shortening worsens or not.
During the examination, the doctor will determine the size of the fibrous plaque, the appearance of calcifications, the elasticity of the tissue, the quality of the blood vessels of the penis and, of course, how curved or shortened the penis is. As much information as possible is needed so that the doctor has a detailed picture of the disease before suggesting clinical conservative therapy or direct surgical treatment.
Why surgical treatment? Is that the only option?
Clinical treatment of Peyronie's disease with conservative methods is successful only in the initial stages when dramatic curvature and shortening have not yet occurred.
Tablets, gels, shock waves (LSWT) are used to reduce pain, injections with serum enriched with activated platelets and hyaluronic acid (PRP+HA) are used to stop scar formation, while traction and vacuum devices are used to correct curvature.
By giving injections of the enzyme collagenase (Xiapex, Xiaflex) isolated from the bacterium Clostridium histolyticum (C.histolyticum) in order to break down the fibrous scar and correct the curvature of the penis, they are successful in mild forms of the disease. Xiapex (Xiaflex) is no longer available in Europe since December 2019. The product will remain registered only on the territory of the USA and Canada.
However, due to other factors that appear in addition to curvature, erectile dysfunction and loss of penis size, the simple use of drugs and injections brings only relative results, which do not completely cure the disease.
Clinical treatment is indicated only for the initial inflammatory phase of the disease, when the deformity of the penis is not excessive. Conservative clinical treatment can prevent pronounced curvature and loss of penis size, and in some cases can stop the disease in its earliest stages and thus avoid the need for surgical treatment.
After stabilizing the penile curvature, the use of drugs, injections and vacuum devices will not bring significant improvement.
When Peyronie's disease reaches a stable stage, also known as scarring, clinical treatment no longer has an effect and in that case direct surgical treatment is the only option. The goal of surgical treatment is to permanently resolve the consequences of Peyronie's disease.
The surgical method is based on the geometric principles of lengthening and recovery of the largest possible size and diameter of the penis up to the maximum stretch limit of nerves, blood vessels and urethra. There is more than one technique, called penile reconstruction in surgical jargon. For this reason, the surgeon's experience is most important in the process of planning and choosing the most appropriate set of techniques for each patient.
The innovative surgical technique, developed by Dr. Nikola Stanojević in cooperation with his international team of experts, involves the least possible trauma to the noble tissue of the penis during the surgical intervention itself.
The surgical approach used by Dr. Nikola is a little unusual, the complete reconstruction of the shape and size of the penis with the installation of a penile implant is performed through a small incision towards the scrotum. With this approach, a completely natural appearance is obtained after the operation, and no one can recognize that the man has had an operation.
This approach is very different from the classical urological approach, which radically separates the tissues of the penis with the removal of the foreskin (circumcision) and destruction of the skin of the penis.
With full respect for the solutions offered in the past, we believe that the minimally invasive technique is a modern approach that satisfies both the functional and aesthetic part of the treatment. In this way, great patient satisfaction is ensured after surgical intervention, because it is rare to meet a man who does not mind a reduced penis, visible scars and reduced sensation in the penis after surgery.
Treatment without penis size reconstruction? Bad idea.
Peyronie's disease, in addition to curvature, is always associated with reduced penis size. A classic urological surgical technique, the Nesbitt procedure, straightens the penis by shortening the longer, healthy side of the penis. Therefore, if the doctor corrects the curvature of the penis, relying on the shorter side when straightening the penis, it is almost certain that the patient will be dissatisfied with the treatment when he realizes that his penis has shortened significantly after the operation. It is common to hear reports of men who lost three to five centimeters in penis length through surgery and were dissatisfied with the result of the surgical treatment. Some also complain that their penis is thinner and not strong enough for penetration after surgery that did not reconstruct the size and shape of the penis with the installation of a penile implant (penile prosthesis).
Restoring the size and shape of the penis is imperative in all surgical interventions performed by Dr. Nikola Stanojević with his expert team of urologists and andrologists. Dr. Nikola owes his knowledge in the field of genital reconstructive surgery to long-term work with the eminent Prof. Dr. Sava Perović, a world legend of genital surgery. Relying on the experience gained with Prof. Perović, improved with modern, new techniques, which achieve maximum satisfaction for patients, the shortened, diseased side of the penis increases and equalizes with the normal, longer side of the penis. In this way, the length of the penis is achieved as before the onset of the disease.
Penile implant and Peyronie's disease
Just as important as correcting the curvature is addressing the lack of firmness in the penis. As we have already mentioned, penile fibrosis and pronounced curvature of the penis are directly related to impotence.
In order to guarantee patient satisfaction with the treatment outcome, it is important to consider implant placement during penile reconstruction surgery. Fitting a penile prosthesis plays a very important role in the treatment of Peyronie's disease.
Due to a lack of information or even prejudice, many men have a bad attitude towards penile implants, but it is this implant that will allow the penis to function fully, and the man to return to an active and healthy sexual life. The prosthesis is implanted during the same surgical procedure used to treat penile curvature due to Peyronie's disease, so it does not bring more discomfort and does not require more time for postoperative recovery. It is also important to point out that there are different types of prostheses: semi-rigid, articulated or hydraulic-inflatable and the urologist will specify the most suitable model after a detailed face-to-face assessment and discussion of the patient's needs and wishes.
If your doctor has suggested surgical treatment, and you are emotionally and physically prepared for surgical intervention, just arrange a date for the operation and wait.
If you are a smoker, the doctor will explain to you why it is important to give up the use of nicotine at least four weeks before and forever after the operation. This is the first step in treatment, if you continue to smoke the doctor may refuse to operate on you.
It is important that glucose levels are monitored regularly to prevent postoperative healing difficulties. If you have diabetes, the three-month HbA1c must be below 7.9%
On the day of the operation, you will be placed in a comfortable hospital suite where you will have the opportunity to ask your doctor all your questions before going to the operating room.
The procedure of straightening the penis with the installation of a prosthesis takes 3 to 4 hours. It is mostly performed under general anesthesia, but according to your needs or wishes, it can also be done under regional anesthesia with or without sedation. After the end of the intervention, you will be accommodated in one of the modernly equipped hospital suites, and your urologist - andrologist will inform you about the course of the surgical intervention, and will explain the expected result.
During your stay in the hospital, you will receive all the necessary medicines for the fastest possible recovery from the operation.
You leave the hospital 2 days after the operation. You are obliged to stay in close contact with your doctor and after leaving the hospital, you will come for regular check-ups with dressings and replacement of specific bandages. The doctor will prescribe the necessary medicines that you will take yourself during the outpatient recovery.
When can I go back to work? Training? Sex life?
Depending on the type of work you do, you can return to work 10 days after the operation, after 6 weeks you can resume physical activities (training, gym, but not the pool, and not the sauna).
You will wait for your doctor's permission to start having sex, usually 5 weeks after surgery.
The recovery process is further simplified by the use of resorbable sutures during surgical intervention. Threads placed externally on the skin disappear in two weeks, and internal threads dissolve naturally no later than two months after the operation.
Six weeks after Peyronie's surgery, there are no signs of surgery.
Publications:
1. Penile Length and Girth Restoration in MB Peyronie's: Less Invasive Approach for Complex Composite Graft Corporplasty and Implantation of Inflatable Penile Prosthesis - INTERNATIONAL JOURNAL OF SEXUAL HEALTH, (2019); Stanojevic Nikola, Ruffo Antonio, Lopez Rodriguez Javier Alonso
2. New Protocol for Peyronie's Disease: Combination of Platelet Rich Plasma (PRP) Injections with Vacuum Device Physiotherapy - INTERNATIONAL JOURNAL OF SEXUAL HEALTH, (2019); Ruffo Antonio, Riccardo Filippo, Iacono Fabrizio, Nikola Stanojevic, Franco Marco, Lopez Rodriguez Javier Alonso
3. Penile augmentation in a patient with Peyronie's disease. How to improve penile length and width with circular and longitudinal grafting and penile implant - Journal of Sexual Medicine 07/2018; A. Ruffo, N. Stanojevic, F. Iacono, G. Romeo, L. Romis, G. Di Lauro
4. Treatment of Peyronie's disease: Restoration of penile length and girth using albugineal grafting and penile implant - Journal of Sexual Medicine 04/2017; A. Ruffo, N. Stanojevic, G. Di Lauro, L. Romis, G. Romeo, F. Iacono
5. Real penile lengthening and widening in Peyronie's disease: Circular and longitudinal grafting with simultaneous penile implant - The Journal of Urology 04/2016; Rados Djinovic, Nikola Stanojevic, Vladislav Pesic, Milja Mitrovic, Marta Skrodzka, Antonio Ruffo, Salvatore Sansalone
6. Post-surgical management of Peyronies disease: How to prevent erectile dysfunction, penile shortening and curvature recurrence combining vacuum erection device therapy and Tradamixin (R) - Journal of Sexual Medicine 05/2015; N. Stanojevic, V Pesic, M. Tanasic
7. Combined therapy using vacuum erection device and a nutraceutical compound (Tradamixina) in the early stages of Peyronie's disease - Journal of Sexual Medicine 05/2015; N. Stanojevic, V Pesic, M. Tanasic, A. Ruffo
8. Total penile size and shape restoration in different deformities caused by IPP 98 patients - The Journal of Urology 04/2011; Rados Djinovic, Sasa Tomovic, Salvatore Sansalone, Marko Milosavljevic, Vladislav Pesic, Nikola Stanojevic, Miodrag Lazic
9. Reimplantation of penile prosthesis: The role of artificial grafting materials - European Urology Supplements 04/2010; Sava V Perovic, Nikola I. Stanojevic, Rados Djnovic, Vladislav Pesic, Sasa Tomovic, Marko Z. Milosavljevic