Penile reconstructive surgery
The technique depends on the deformity and quality of erections.
Assessment and indication
Peyronie's disease can cause acquired curvature of the penis during erection, in addition to narrowing, deformities or loss of length perceived by the patient. In some cases, these changes make sexual intercourse difficult or impossible. The choice of treatment depends on the deformity, the quality of erections and the impact the condition has on the person's life.
01
I start with the history of the disease: when the curvature appeared, has it changed over time, is there pain during erections and what difficulty it causes during sexual intercourse. I examine the penis and evaluate erectile function.
I also need to understand the deformity during erection. Photographs taken by the patient themselves, following instructions given during the consultation, can help with this assessment. In specific situations, I request an examination with induced erection and penile Doppler ultrasound to clarify the anatomy and vascular function.
02
In general, I consider surgical correction when the disease is stable, that is, when the curvature has stopped progressing, and the deformity compromises sexual intercourse. Pain alone, especially while the curvature is still changing, is not usually a reason to operate.
Before deciding, I talk about what the patient expects from surgery and the limits of each technique. The objective is to obtain a shape that allows sexual intercourse, but the procedure does not necessarily return the penis to the appearance or length it had before the disease.
03
There is no single operation for all cases. The main possibilities are:
uses sutures on the side opposite the curvature to straighten the penis. It may be an option when erectile function is preserved and the deformity allows this type of correction. It is important to talk about the possibility of a noticeable reduction in length.
it can be considered in more complex deformities or when plication would produce a loss of length considered important. It requires careful assessment of erectile function, as this technique can affect it.
considered when, in addition to Peyronie's disease, there is erectile dysfunction that does not respond adequately to clinical treatments. This possibility is explained in detail on the Penile Prosthesis Placement page.
The choice depends on the curvature, the presence of strictures or other deformities, the penile length, the quality of erections and the patient's goals. I explain why I propose a specific technique before scheduling the surgery.
04
The operation is carried out in a hospital environment, under anesthesia. During the procedure, I evaluate the deformity and make the planned correction. Access, need for a graft and surgery time vary depending on the technique and complexity of the case.
Therefore, I prefer to provide an individual estimate of duration in the preoperative assessment, after defining which procedure will be performed. The need for same-day discharge or hospital observation is also discussed in this planning.
05
Some swelling and discomfort is to be expected in the first few days. I guide care with the dressing and monitor healing and the evolution of erectile function during return appointments.
Returning to work depends on the procedure and type of professional activity. After a plication, many patients need approximately a week before returning to work; More complex surgeries may require more time. Sexual activity is usually suspended for around six weeks, with release after assessment of healing. These are general references, adjusted to the operation performed and the recovery of each patient.
The most important conversation takes place before surgery: which changes we want to correct, which technique offers the best balance for that case and what changes the patient can expect after recovery.
Consultation and planning
During the consultation, I evaluate the diagnosis, explain the alternatives and organize treatment and follow-up according to the needs of the case.