Surgical Treatment of Peyronie’s Disease

Surgical Treatment of Peyronie’s Disease



Peyronie’s disease (PD) is a scarring disorder of the tunica albuginea leading to penile deformity (Fig. 67.1). PD is a completely clinically established entity; still, its etiology is uncertain. Several theories have been proposed since its first description in the mid-18th century, but none has been confirmed yet (1,2,3). To the authors’ knowledge, the development of PD is related to the unique anatomy of the tunica albuginea and its relationship to the septal fibers. The most accepted etiology seems to be the occurrence, in genetically susceptible individuals, of repetitive minimal trauma during sexual life. Unidentified buckling injuries of the penis will eventually lead to scarring and penile deformity (4). Only a few patients relate the onset of symptoms to a specific penile injury during sexual intercourse.

The incidence of PD has recently been estimated at up to 3% or as high as 7% to 9% of the general male population (5,6).

FIGURE 67.1 Cross-sectional penile anatomy with dorsal Peyronie’s plaque.


The most frequent presentation is the development of penile curvature, but decrease in penile length, indentation, hinge deformity, and erectile dysfunction are very common complaints (Fig. 67.2).

Clinically, PD has two phases. The first, an active phase, is commonly associated with painful erections and changing deformity of the penis. It is followed by a quiescent secondary phase, characterized by deformity stabilization, disappearance of painful erections, if they were present, and, in general, stability of the process. Up to a third of patients, however, present with what appears to be sudden “overnight” development of painless deformity.


A frank discussion of treatment goals with the couple is imperative. The patient should be assured that the process is not malignant or life-threatening. The goal of surgery is to straighten the penis and maintain erectile function so that satisfactory intercourse can be achieved.

Couples must be aware that preexisting penile shortening and erectile dysfunction will not be improved by straightening procedures. Rigidity may be improved by straightening the penis, but truly improved erectile function does not occur. Evaluation with a sex therapist can help patients and partners adjust to these new sexual expectations.

Surgical candidates must have stable and mature disease, which includes resolution of pain and stabilization of curvature or other deformity. Fortunately, only a small proportion
of patients with PD have deformity requiring surgical intervention. Surgical intervention should be regarded as palliation of the deformity only and not as cure.

In essence, one can correct the penile curvature by “shortening” the long aspect of the curve or by “lengthening” the short aspect of the curve. Additionally, in those patients with PD and associated severe erectile dysfunction, the option of a penile implant with plaque modeling or incision with or without grafting is valid.

Several surgical techniques have been described to correct penile curvature associated with PD, including plication of the opposite aspect of the lesion and incision/excision of the plaque and grafting. The tissues and materials applied to graft the corporal defect include dermis, tunica vaginalis, cadaveric dura mater, temporalis fascia, veins, cadaveric pericardium, and porcine small intestine submucosa (SIS) (10,11,12,13,14,15,16).


Skin Incision

At our institution, we perform all Peyronie’s corrective procedures in supine position and use either a circumcising incision and penile degloving or an optional ventral midline incision for ventral plications. If the patient has been previously circumcised, then the incision should be performed through the circumcision scar. Once the incision has been made, an artificial erection is created with a pressure infuser device or butterfly needle and syringe with injectable 0.9% normal saline. We tend not to employ the use of a tourniquet to control bleeding or maintain an artificial erection because it is unneeded and tends to distort the presence of a proximal curvature. Some authors use vasoactive substances, such as papaverine or PGE, for this purpose.

Corporoplasty or Corporoplication Procedures

Several techniques and modifications have been published that describe methods of plication, or shortening of the convex side of the curvature. The techniques fall into (a) nonincisional plication, (b) incisional plication, or (c) excisional plication categories.

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Apr 24, 2020 | Posted by in UROLOGY | Comments Off on Surgical Treatment of Peyronie’s Disease

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