Grafting: maintain length
After exposure of the cavernous bodies and artificial erection, the plaque on the concave side is dissected in an H-shape or partially excised with mobilization of the neurovascular bundle (in the case of a dorsal plaque), the resulting defect is closed with a patch - a segment of the great saphenous vein or a flap of the buccal mucosa, which take root well and are extensible. A control erection confirms straightening. The operation is technically more difficult than plication; the risk of deterioration of erection is 10–20%, numbness of the head is temporary. From 3–4 weeks, stretching and vacuum therapy are prescribed to prevent scarring of the graft; Sexual life - after 6 weeks.
When is surgery needed?
Peyronie's disease is the formation of a dense plaque in the tunica albuginea, causing curvature, shortening and pain during erections. In the acute phase (6–18 months), conservative treatment is used; The operation is indicated in the stable phase with a curvature of more than 30°, which interferes with sexual activity, an hourglass deformity and a preserved erection. When combined with severe erectile dysfunction, penile prosthesis with straightening is preferable.
Plaque plication or excision
Plication (Nesbit's operation and its modifications) shortens the convex side with sutures - reliably, quickly, with minimal risk of erectile dysfunction, but shortens the penis by 1-2 cm; indicated for curvature up to 60° and sufficient length. Excision of the plaque with replacement of the defect with a graft lengthens the concave side, maintains length and corrects severe deformities, but is more complicated and carries a 10-20% risk of deterioration of erection. The choice is up to the surgeon regarding the angle, length and quality of the erection.
