In men who have severe curvature or hour glass deformity, will the grafting procedure cause a further loss of length or width? If so, do you recommend the vacuum pump after surgery and does it help with length or width?

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This question pertains to men with severe disease, that being greater than 60-70 degrees of curvature and/or with destabilizing indentation or hinge. To be a candidate for a grafting repair the man must have good quality erections preoperatively with or without PDE5 inhibitors, such as Viagra, Levitra, or Cialis. It is critical that the patient have good preoperative erections as the primary risk of this operation is post-operative erectile dysfunction which has been reported to occur following this operation in 5-50% of men. In those who have very good quality erections, the new ED rate is in the 5-10% range. The goal of all operations for Peyronie’s disease is to straighten the penis and make it more sexually functional. Regaining lost length and girth is an added benefit, but can not be expected routinely. By and large the grafting operation will result in a gain of 1-3 cm in the area of maximum deformity. That is to say, if the curvature is upward with a 90-degree bend, by incising or partially excising the scar tissue the length of the top surface will increase allowing all dimensions of the penis to be equal, thus making it straight. As part of the grafting operation, areas of indentation may also be corrected with the partial plaque excision; the graft will then provide of a more normal caliber penis, thereby enhancing width in that area only.

With regard to post-operative care, there is little evidence that the vacuum device will enhance length and girth post-operatively. On the other hand there is one abstract and increasing experience amongst experts in the field that when daily traction therapy is applied to the penis, that further loss of length can be prevented and possibly lost length before surgery can be regained. This is measured as 1-3 cm (1/2-1¼ inch) after surgery beginning two-three weeks post–operatively, when the wound is capable of taking some pressure. Traction must be applied on a daily basis for a minimum of two, but better with four to eight hours per day. The key to traction therapy is the daily use. In addition, those men who apply the device for a longer period of time each day do better than the men who apply it only two hours per day. The current traction devices are available for purchase online, and at this point although FDA approval is being sought, insurance companies are not covering the costs for this device.

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