Peyronie's disease

Penile plication is a surgery to correct curvature with erections or Peyronie’s disease.

What causes penile curvature?

Traumatic bending during intercourse can damage the deep tissues of the penis. The resulting scar tissue at the site of injury causes a shortening, which causes the penis to curve when erect.

Who should get curvature treatment?

The treatment is appropriate for anyone with curvature that causes bother, in particular difficulty with intercourse, pain with erection or intercourse, or pain for a partner during intercourse. This often occurs for curvature greater than 30 degrees in any one direction or curvature in multiple planes.

What non-surgical treatment options are available?

Oral medications are not very effective for Peyronie’s disease. Xiaflex is a collagenase treatment that that is injected into the penile plaque (scar tissue) to break down the scar tissue. A patient receives 2 injections a few days apart, followed by manual stretching of the penis to break up scar tissue. This cycle of treatment can be repeated up to 4 times with 6-week intervals in between treatments.

Plication versus Xiaflex:

Penile plication is a single procedure that corrects the curvature to less than 10 degrees in over 95% of patients. With Xiaflex, 40% of men reduce curvature to less than 20 degrees after treatment. Xiaflex is not recommended for men with curvature greater than 90 degrees, curvature in multiple planes, or those with a circumferential plaque. Xiaflex has a 1.5% risk of rupture of the fibrous lining of the erectile bodies, which requires surgical repair.

Plication versus grafting:

Peyronie's curvature can also be treated by excision of the penile plaque with grafting. Risk of erectile dysfunction after grafting is 20 to 30%, and therefore requires careful consideration for those with existing ED. Additionally, graft of a dorsal curvature (bending back to patient’s abdomen) risks injuring the vessels and nerves of the penis, causing loss of sensation.

What is the treatment for Peyronie’s with erectile dysfunction?

For patients with penile curvature and trouble with erections, penile implant with curvature correction is generally the most reliable option with the highest satisfaction outcomes.

What is Plication surgery?

Plication is an outpatient surgery to place sutures on the side opposite of the curve to correct the curvature.

What is the Recovery?

The patient's penis is in a bandage that remains in place 48 hours after surgery. The bandage is then removed and reapplied daily for the next 7 days. The patient may not have intercourse or masturbate for 4 weeks after surgery.