I have had Peyronie’s disease for about 5 years, my curvature is about 60 degrees, and intercourse is still possible. I have tried everything and am considering surgery. What is recommended in this type of case?

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Surgery is typically reserved for men who meet one or more of the following criteria (i) difficulty or inability to achieve penetration (ii) pain for himself or his partner during attempts at penetration (iii) psychological distress at the presence of penile deformity and (iv) stable plaque that will not improve or worsen in the future (this typically means that a man should have Peyronie’s disease for at least 12 months). Generally speaking, curvatures of more than 45 degrees dorsal (upward) or lateral (right or left) lead to great difficulty penetrating. Curvatures of more than 30 degrees ventral (downward) lead to difficulty with penetration. Thus, there are many men who have 30 degrees of penile curvature in a dorsal direction who can penetrate with ease. 2 other factors impact upon the ability of a man with penile curvature to penetrate. The first is penile rigidity (hardness); some men with curvature are capable of penetration until they develop erectile dysfunction (loss of penile rigidity) and only then do they have difficulty with penetration. One of the treatments for such men is to use medications to increase their penile rigidity before considering surgery. The other factor that can make a man with minimal curvature have difficulty penetrating is the presence of “waisting” or “hinge-effect” at the site of the curvature. This associated deformity can lead to great instability where the penis buckles during attempts at penetration.

There are 3 types of surgery used in the correction of penile deformity. No one procedure is correct for every Peyronie’s disease patient. A Peyronie’s disease surgeon should be capable of performing all 3 operations (see Dr. Mulhall’s article on How to Choose a Physician for Peyronie’s Disease). The 3 procedures are (i) plication (also known as corporoplasty) procedures. There are a variety of modifications of this procedure including Nesbit surgery, the Essed-Schroeder technique and the Yacchia procedure (ii) plaque incision and grafting procedures and (iii) penile prosthesis (implant) surgery. For a surgeon there are generally 4 factors that help him/her decide which operation is best for the patient (i) the nature of the deformity (is it a simple curvature or a curvature associated with hinge-effect?) (ii) the magnitude of the deformity (is it 30 degrees or 90 degrees) (iii) the penile length (as corporoplasty surgery may lead to loss of penile length, this is a significant factor in deciding the appropriate operation) and (iv) erectile function (the presence of ED may impact significantly on the choice of operation). Most authorities recommend that all men undergoing penile reconstructive surgery (not necessarily penile implant surgery) have an erectile function test (penile ultrasound, cavernosometry) prior to undergoing such surgery.
For the patient above who posted the question, at 5 years into his condition his deformity is stable, he admits to being able to penetrate which is somewhat surprising given his 60 degrees of curvature. Thus, he does not HAVE to have surgery to continue having sexual intercourse. He must decide if his relations are satisfactory. If yes, then he may continue to have relations in his current state. If not, then he should have a comprehensive discussion with a Peyronie’s disease surgeon about the various options as listed above.

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