Peyronie’s disease is characterized by a noncancerous plaque, or hard lump, that forms in the penis. Depending upon where on the shaft the plaque develops, the penis will bend either upward, downward or to the side. In some cases, the plaque develops on both the top and bottom of the shaft, leading to indentation and shortening of the penis. Peyronie’s disease can be accompanied by impotence, either because of restricted blood flow to the penis or the stress that accompanies the disease.
Reconstructive surgery for Peyronie’s disease provides a successful outcome for the majority of men presenting with disabling penile curvature. In men with stable disease and adequate erectile rigidity and maintenance, options include modified corporoplasty or plaque incision/excision with graft inlay. Several factors are assessed in determining which of these procedures is optimal:
Most of the above items can be evaluated during the history and physical examination. Photographs obtained by the patient are also very helpful. Assessment of erectile function is integral to this process, as studies have clearly shown a relationship between preoperative erectile function and postoperative results following graft inlay procedures. We obtain NPT testing and a duplex ultrasound to obtain objective information about erectile function prior to surgery. The ultrasound also allows one to directly visualize erectile configuration and to look for any collateral vessels from the dorsal artery of the penis to the cavernosal system, as these could be damaged during mobilization of the neurovascular bundles.
Modified corporoplasty involves operating on the tunica albuginea opposite the curvature, creating longitudinal tunical incisions which are closed transversely. This results in excellent penile straightening with minimal to no effect on sensation or erectile function. The major drawback is the additional penile shortening which occurs as a result of shortening the “long side” of the penis for straightening. Alternatively, plaque incision is carried out on the “short side” of the penis, expanding the tunical scar in that location. The tunical defects are closed with a graft of cadaveric pericardium or dermis. This procedure helps to preserve remaining penile length, although patients may not achieve their premorbid length even with a successful operation, due to more diffuse tunical changes. It is a more extensive procedure, and the risk of postoperative erectile dysfunction is somewhat greater than with modified corporoplasty. Temporary changes in sensation may occur due to mobilization of the neurovascular bundles. There is some early evidence that plaque incision may result in a lower incidence of erectile dysfunction than plaque excision with equal straightening capability, and therefore plaque incision is our current procedure of choice if technically feasible.
It is essential to carefully counsel patients prior to any operation for Peyronie’s disease, in order to allow them to make a treatment decision that they will be comfortable with. Psychological evaluation prior to surgery is very valuable and may also be offered as an aid in the rehabilitative process after surgery, if needed.