Progress of the operation
After exposing the corpora cavernosa through a subcoronal incision (with temporary shifting of the skin), the surgeon induces an artificial erection with saline and accurately determines the angle. On the convex side opposite the plaque, non-absorbable sutures are applied (according to Nesbit - with excision of the ellipses of the membrane, according to Yabuk or the 16-point technique - without excision), the erection is repeated until complete straightening. The skin returns to its place. After 4–6 weeks, sexual activity is permitted; shortening by 1–2 cm is the price of straightening, which is warned in advance.
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.
