Most experts recommend against surgery during the early inflammatory phase of Peyronie’s disease. Doctor might suggest surgery if the deformity of your penis is severe, especially bothersome, or prevents you from having sex. Surgery usually isn’t recommended until the curvature of your penis stops increasing.
Surgical methods include:
- Suturing (plicating) the unaffected side.A variety of procedures, such as Nesbit plication, can be used to suture (plicate) the longer side of the penis (the side without scar tissue). This can straighten the penis, but it might result in actual or perceived penile shortening. In some cases, plication procedures cause erectile dysfunction.
- Incision or excision and grafting. Generally used in cases of more severe curvature, this procedure is linked to greater risks of worsening erectile function compared with plication procedures. The surgeon makes one or more cuts in the scar tissue, sometimes removing some of that tissue, allowing the sheath to stretch out and the penis to straighten. The surgeon may sew in a piece of tissue (graft) to cover the holes in the tunica albuginea, a membrane within the penis that helps maintain an erection. Various type of grafts which can be used are:
- Autologous tissue grafts: These are grafts made of tissue taken from another part of your body during surgery. Some sources of grafts used for Peyronie’s disease are a vein from your leg (saphenous vein) or skin from behind your ear (temporalis fascia). Since autologous grafts are living tissue, they often grow into the surgical site much better than some other materials. A drawback to using an autologous graft is that the surgeon must make a second cut to harvest the graft.
- Non-autologous allografts: These are sheets of tissue that are commercially made from human or animal sources. Before use, they are sterilized and treated to remove anything that could cause infection. These grafts act as supports for your body to grow fresh, healthy tissue on while they are slowly absorbed by your body. Allografts are strong, easy to work with, and well tolerated by most patients. Man-made materials such as Dacron® mesh or GORE-TEX® aren’t often used for Peyronie’s surgeries now. These materials can cause fibrosis that can make the deformity worse.
- Penile implants. Surgically inserted penile implants replace the spongy tissue that fills with blood during an erection. The implants might be semirigid — manually bent down most of the time and bent upward for sexual intercourse. Another type of implant is inflated with a pump implanted in the scrotum. Penile implants might be considered if you have both Peyronie’s disease and erectile dysfunction.
The type of surgery will depend on your condition. Your doctor will consider the location of scar tissue, the severity of your symptoms and other factors.