Penile curvature (also known as Peyronie’s disease) is one of the most challenging problems facing urologists today. Our understanding of the disease is the topic of much research, but remains largely unknown. However, our physicians are providing leading-edge care using the latest treatments available.
For those with a recent onset of Peyronie’s disease, treatments provided in the office might be successful. However, patients who have a long history of penile curvature often require surgical intervention. Whatever your needs, we provide all of the options available.
Today, we had a patient who had what we call Peyronie's Disease. It's a disease that have abnormal scarring of the penis. What it actually causes is an abnormal curvature of the penis. So, today we performed a penile plication. This particular patient had a curvature of approximately a 30 degree angle to the right, and basically it puts a hook in the penis, which can create a problem for the patient. This can be difficult for sexual intercourse for both him and his partner. Basically, it makes it difficult in order to perform vaginal penetration. It can cause discomfort during intercourse and essentially make it a problem to be intimate with his partner.
This particular patient had a relatively mild form, in which we were able to correct with a simple plication surgery. Basically, the gist of that operation is that we take sutures on the lateral aspect of the penis. This patient's penis curved to the right, therefore out sutures were placed on the left, and by simply placing these sutures on the undersurface of the penis, we were able to correct the curvature and perform a penile straightening. The advantages to this operation is that it can be done as an outpatient basis. In addition, the sutures cause very little cosmetic changes. The patient also has low risk for erectile dysfunction and some of the other complications that can occur with complex Peyronie's surgery.
What we've done here is we've induced an artificial erection, and so this demonstrates the patient's curvature. What he's developed is a scarring process on the right side of his penis, causing a bend. The left side's largely unaffected, and so he gets approximately a 30 degree curvature to the right. Our goal today is to do a straightening procedure, where we'll essentially be able to correct this curvature and allow him to have a more straight penis. What we're going to do is go through the patient's old circumcision scar.
So, what we've essentially done here is made an incision circumferentially around the penis through the patient's old circumcision scar. If you look here, there's a little bit of vascularity or bleeding. That's normal for a good, healthy penis. This is the main vein running here on the dorsal or the top part of the penis. This is the artery. This is the other artery. There's a whole network, which is probably difficult to see on camera, of nerves that run through here. We're trying our best not to manipulate or damage these nerves, because they're what allows the penis to have sensation. If we were to cut or transect these, the patient wouldn't have any feeling on the head of their penis, which would obviously be problematic.
What we're going to do now is ... There is a little bit of an indentation or curvature on this side, and this is the area that we're looking to correct. What we're going to do is go to the opposite side of the curvature and make a series of stitches to correct this side of the penis. [inaudible 00:03:23] What we're incising here is Buck's fascia. This is another protective layer of the penis and kind of the final layer, until we get to the tunica albuginea, which is the layer in which the scarring occurs. You'll see as we get this further exposed ... I'll show it to you here in a moment. It's white tissue underneath, which we can see. What we're doing here is we're just marking the point of maximal curvature to give us a reference line on where we need to put our sutures.
Go ahead and hold this up. So, this is what the sutures look like once in place. You'll see how the purple line begins to disappear as we're infolding that or shortening this side of the penis. What that does is ... This is what I refer to as the long side of the penis or the outside of the curve. The short side is on the inside of the curve. Essentially what we're doing is making the penis equal length on either side. Once these sutures are in place and tied, the nice thing about this operation is that if we're not happy with the surgical correction, we can take these sutures out and replace them as needed. So, here you can see the patient's overall curvature has improved. He still has a little bit of right work curvature. Here you'll notice that there is a divot or defect here. This can't be corrected through plication surgery. A more intricate surgery could potentially reduce or remove this scare tissue. I think the patient may benefit from one more suture to complete the correction. The sutures that are placed in conjunction with another add a second strength layer. We're just putting some smaller stitches in this to correct the curvature and to get a nearly straight finish. Go ahead. The degree of erection's been corrected, and things look fairly appropriate.
Here you can see we've corrected the patient's penile curvature. He has a relatively straight penis and much more functional than previously, preoperatively.