Excision Peyronie\’s Placque
- What is Excision Peyronie\’s Placque?
- Effects of Excision Peyronie\’s Placque
- Candidates for Excision Peyronie\’s Placque
- Your Consultation
- The Excision Peyronie\’s Placque Procedure
What is Excision Peyronie\’s Placque?
Excision Peyronie\’s Plaque is a kind of surgical treatment for the correction of Peyronie\’s disease which involves elongating the concave side of the tunica albuginea of the penis either be incision or excision of the plaque and graft placement.
Effects of Excision Peyronie\’s Placque
This procedure is able to treat patients suffering from Peyronie\’s disease. Peyronie\’s disease is a condition which causes pain on the penis during erection, erectile curvature, pain during intercourse, erectile dysfunction, and a corpus cavernosum indurated plaque.
Candidates for Excision Peyronie\’s Placque
Ideal candidates for this procedure include patients whose erections are suitable for sexual activity but have reduced function due to the presence of Peyronie\’s disease or a curvature or hourglass deformity. On the other hand, a penile straightening procedure may be considered.
Before undergoing the procedure, patients are injected intracavemosally with 30 mg of papaverine in order to stimulate an erection so that penile curvature may be demonstrated before doing the correction.
The Excision Peyronie\’s Placque Procedure
If excision is selected, complete penile straightening is ensured by doing relaxing incisions at the four extremities of the excised defect. The area of defect is cautiously measured once the incision or excision has been carried out, then the cadaveric pericardial graft is customized. In order to reconstitute its flexibility and compliance, the graft is immersed in an antibiotic solution. For ample penile straightening, the graft is measured approximately 20% larger than the defect measured. Once the graft is measured, tailored, and placed over the defect, the graft is held in place with running, locking suture of 4 or 5-0 PDS. At the end of the placement of the graft, additional artificial erection is done with securing of the graft in order to prevent damage.
Postoperatively, the suction drain is detached the morning after the procedure and application of ice is sustained. In order to limit postoperative nocturnal erections for 2-3 weeks, medication is given for control of pain and to improve possible surgical outcomes. Approximately 3-4 weeks after the procedure, the erection status of the patient is reviewed. If there are consequent mild curvature or noteworthy graft induration observed on examination, consideration of application of a series of vacuum erection device is done. This device is used twice a day for about 10 minutes without the use of a constriction ring. This will lead to extension of the graft and improvement of the mild curvature seen postoperatively in some patients. Satisfactory postoperative results may be expected.
Complaints of reduced rigidity of erection, as well as impotence after the surgery are usually related to excision of the plaque. These complaints have been related to erectile nerve damage during penile surgery.
What is Peyronie\’s disease?
Peyronie\’s disease or PD is a localized disorder of the penis which is distinguished by collagen composition changes of the tunica albuginea. This results in a fibrotic plaque containing excessive collagen. Men suffering from PD complain of penile plaque, painful erection, penile shortening, penile curvature, and erectile dysfunction or ED. Peyronie\’s disease is typically found in men between ages 40 and 70 years.
What are the causes of Peyronie\’s disease?
In Peyronie\’s disease, penile curvature is caused by an inelastic scar or plaque that shortens the involved part of the tunica albuginea of the corpora cavernosa when erection happens. In about one third of patients, scarring involves the dorsal and ventral aspects of the shaft. The offsetting plaques may make the penis straight but shortened or may have a lateral bend.
Who are the candidates for this procedure?
The perfect candidates for this procedure are men with shorter penile length, regardless of the degree or complexity of the curvature whose erectile function is normal prior to the procedure. Plaque incision and grafting is best for men who have hourglass deformity or waisting.
What happens during the procedure?
Excision of the plaque is done in this procedure together with “patch grafting” of the defect due to the excision. The material used in the graft is usually taken from the scrotal tunica vaginalis or from the skin of the forearm that does not have hair. Gortex, which is an artificial graft material may also be used although there have been mixed results with its use. This is generally less elastic and therefore does not allow sufficient stretch of the corpora during erections. Besides these techniques, penile prosthesis and plication of the tunica albuginea may be used.
What are the pros and cons of this procedure?
The benefit of this procedure is that it is usually not related with loss of penile length. On the other hand, its drawback is that postoperative erectile dysfunction may develop in men who have poor erectile function prior to the procedure. Also, in approximately 10% of men, prolonged loss of sensation in the penis may occur.