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Tired of enduring? Peyronie's disease: surgery as a panacea

In this article, we will look at the operations of Peyronie's Disease. One of the reasons for the curvature of the penis of varying severity may be Peyronie’s syndrome (Parziba’s disease, fibroplastic induction of the penis), which approximately 3-5% of the total male population suffers. The reasons for the development of the disease are not fully understood by modern science, preventive measures are also not developed, this condition can develop in any man (often this happens at the age of 30-50).

In Peyronie's Disease, presumably due to microtrauma of the protein coat of the corpora cavernosa, inflammation and pain develop. Further, at the site of inflammation, the connective tissue gradually forms a fibrous plaque, which ultimately leads to curvature of the penis and other problems, up to the absence of a normal erection and sexual dysfunction (in about 30% of cases). Interestingly, in the early stages of the disease, cases of spontaneous improvement are possible, but if the disease is started, and the plaque has calcified, then such an improvement is unlikely.

Most often, Peyronie's disease is treated operatively. For the first time, such operations began to be carried out in the 70s of the last century, and since then about a hundred surgical procedures have been developed for this disease. The choice of method depends on the degree of deformation of the penis, the location of plaques, their number, individual characteristics of the patient’s body, and so on. The effectiveness of surgical treatment varies from 70 to 93% - depending on the methodology of the intervention and the qualifications of the surgeon.

Protein coating

The essence of the method is the same as the operation of Nesbit, but the protein coat is not violated. On the back (from the plaque) side of the penis, special folds are created to compensate for the curvature of the organ.

The method is also indicated for patients with a small angle of penile curvature and a slight violation of the erection or the absence of such violations. The operation also refers to shortening interventions, which the doctor must warn the patient about.

The cost of plication of the penis in the capital's clinics is from 63 to 300 thousand rubles.

IMPORTANT! Sometimes, by “plication techniques” in clinics and even in scientific publications, we understand the dissection of penis tissues in several longitudinal sections and their subsequent suturing with transverse sutures. Other sources refer to this method as one of the modifications to the Nesbit operation. Therefore, the patient needs to know exactly how the operation will be performed in a particular medical institution where treatment is planned.

Excision of fibrous plaque and grafting

Unlike the methods described above, in this case, the plaque on the penis is removed completely or dissected, and the resulting defect is closed with a graft - a flap of synthetic or natural origin. Most often in clinics for this purpose a fragment of the mucous membrane of the cheek of the patient is used.
Interestingly, complete excision of the plaque is rarely practiced, since with such an intervention there is a high risk of developing erectile dysfunction, so most surgeons prefer to perform only dissection of the plaque, without removing it.
This type of intervention is recommended for significant curvature of the penis, its short length, severe deformation and chronic pain. The cost of the operation is from 60 thousand rubles.

Implant implant with deformation correction

The installation of the prosthesis allows you to eliminate the deformation of the penis, as well as return the patient to a normal erection. Typically, this method is used in cases where drug therapy does not give the desired effect, as well as with significant organ deformities.

The cost of falloprosthetics for Peyronie's disease is from 119 to 500 thousand rubles.
In this case, the price depends on the choice of prosthesis. Rigid (rigid) dentures that simulate a constant erection are considered the most inexpensive. The patient’s most expensive cost is a hydraulic three-component prosthesis, which allows for normal sexual life without any inconvenience.

In what cases are surgical methods used for treatment?

If seals appear on the penis, pain and discomfort are felt during intercourse, as well as if the penis is curved when excited, you need to contact a urologist or andrologist. When diagnosing Peyronie’s disease, the patient will be prescribed non-surgical treatment (medications for oral administration, injections, physiotherapy).

If non-surgical therapy has not helped for a year (plaques do not soften, increase in size, new areas of scarring appear), the patient is sent to the surgeon for the operation. If a man came to the initial appointment with an already developed, started Peyronie’s disease, then surgery is prescribed immediately, without prior drug therapy.

Possible postoperative complications

Despite the fact that most of the operations for Peyronie’s Disease have been performed for more than a decade, and the methods have been sufficiently developed, no surgeon can guarantee that the patient will not encounter complications after the intervention. This is due, inter alia, to the individual characteristics of the organism of each individual person.

The most common complications are:

  1. damage during surgery of the urethra and neurovascular bundle
  2. postoperative bleeding and infections
  3. cavernitis (inflammation of the corpora cavernosa) and scarring
  4. decreased sensitivity of the penis head
  5. penile shortening
  6. development of granulomas (cystic formations) at the ends of non-absorbable suture threads

There is also the possibility of re-development of fibrous plaque, which can lead to re-curvature of the penis and the need for new surgery. But the most traumatic complication for a man can be a decrease in the quality of an erection after surgery, up to serious violations. Complete impotence occurs extremely rarely, but such cases are recorded in medical statistics.

Surgical interventions to straighten the penis according to the compulsory medical insurance policy

Surgical manipulations for this disease are done for free, according to the policy of compulsory medical insurance (MHI). For this, the patient must be registered with the state polyclinic and undergo treatment there. Surgical treatment according to the compulsory medical insurance policy includes the following steps:

  1. The initial dose (or the next dose after a course of non-surgical therapy).
  2. Obtaining directions for laboratory tests, ultrasound, if necessary - MRI, CT.
  3. Testing, ultrasound, other hardware examination methods.
  4. Appointment with a doctor, getting directions to the selection committee in a medical institution.
  5. Passing the selection committee.
  6. Reception by the surgeon after the commission, receiving referrals to the surgical department of the hospital.
  7. Testing required for placement in the surgical department.
  8. Hospitalization in the surgical department of the hospital.
  9. The operation.
  10. The rehabilitation period in the hospital.

If the patient’s condition does not require urgent surgical intervention, and there are many patients awaiting treatment, the operation may be delayed for some time (but no more than 6 months). After the waiting time, many tests will have to be retaken.

Treating Peyronie's Disease Without Surgery

Given the potential complications, doctors prescribe surgical treatment for Peyronie's disease in cases where other methods of therapy do not give the desired effect. Fortunately, in the early stages of the disease, with not very pronounced deformation of the penis, conservative alternative treatment is justified - drug therapy, physiotherapy, orthopedic devices for straightening the organ. The latter includes Andro Ortez, developed in 2008 by American scientists. The advantage of this device is that it can be used at home at any time convenient for the patient.

Manipulations in private clinics

Private clinics conduct a comprehensive examination of patients, do all the necessary tests and a hardware examination. Clinics licensed for surgical operations have an inpatient department.

The time spent by patients in a private hospital is usually less than the time spent by the patient in a public hospital. So, in the absence of complications, the hospitalization time after surgery is one day.

Total costs include cost.:

  • primary and planned receptions,
  • Ultrasound, CT, MRI,
  • laboratory research
  • surgery
  • Supplies,
  • postoperative treatment
  • hospital stay.

Clinics that perform surgical treatment of Peyronie's disease are in all regional and regional centers of Russia. You can make an appointment on the Internet, for appointing an initial examination, a man is offered, in addition to personal data, send a photo of the penis (in an excited state), which shows the curvature of the body. The cost of treatment depends on the complexity of surgical treatment and ranges from 70 to 100 thousand rubles. The price of the operation itself is one third of this amount.

Member Curvature Correction Operations

Surgical treatment is indicated with the complete abatement of the inflammatory process in and stabilization of the fibrous plaque. The operation is done when the plaque has ceased to increase in size., and the curvature of the erect penis is 30 degrees or more. With less curvature of the penis, surgical treatment is not considered appropriate.

During the formation of a plaque (acute period), a man experiences pain during intercourse and when the penis is excited. At the end of the formation, the plaques of pain pass. From the complete disappearance of inflammation before surgery, at least six months must pass.

The degree of circulatory disturbance in the organ, the direction of the curvature, the number of scar plaques affects the choice of the type of surgical technique. To straighten the penis, three types of operations are performed.

  1. Straightening the penis without excising the plaque. The tissue on the side opposite the curvature is excised and sutured, as a result, the penis straightens. Surgical treatment is indicated with a curvature of more than 45 degrees and a sufficient length of the penis, since as a result of surgical intervention, the length of the erectile organ decreases by 1-2 cm.
  2. Penis straightening with plaque excision. After excision (or dissection) of the plaque with a scalpel, the patient’s own tissue (the vaginal membrane of the testicle, the wall of the vein, skin, other patient biomaterial) is implanted into the formed lumens. As a result, the penis straightens.
  3. Falloprosthesis straightening. Prosthetics are done for patients who have Peyronie's disease and persistent erectile dysfunction. Before prosthetics, the plaque is dissected (excised), removed, or left unchanged.

Likelihood of relapse

Relapses after surgery are rare, since healthy tissue forms at the site of excision of the protein membrane (incisions). In some patients, after surgical treatment, the curvature of the penis remains up to ten degrees, within six months the deviation increases by another ten degrees.

How long does rehabilitation take and what is needed for proper recovery?

The recovery period depends on the scale of the surgical intervention and surgical technique.. For a full recovery, the appearance of an erection is undesirable (within a month), to prevent it, the patient is prescribed amyl nitrite and diazepam.

During the recovery period, the attending physician prescribes:

  • electrophoresis with lidase and injections with polyoxidonium and the vitreous, trental,
  • for oral administration - vitamin E,
  • rectally prescribed diclofenac (suppository).

Surgical techniques provide reliable treatment for Peyronie's disease. After a period of rehabilitation, a man can lead a normal sex life, during intercourse, pain, discomfort disappear. Sometimes after surgery, there is a violation of the erection.

Possibility of surgery for Peyronie's disease

The first stage (duration of about 1 year) proceeds with an active inflammatory process. Surgical treatment of Peyronie's disease at this stage is contraindicated.

The second stage is characterized by stabilization of the angle of curvature and the absence of pain in the penis. If there is evidence, the operation can only be performed in the second stage of the disease.

Important! Only the presence of Peyronie's disease does not require surgery. Surgery is indicated only if Peyronie’s disease interferes with sexual intercourse.

Peyronie's disease + erectile dysfunction

  • Penile prosthetics is most indicated if Peyronie’s disease is combined with severe erectile dysfunction.

Recovery after surgery, in most cases, proceeds quite smoothly. The patient is discharged from the hospital 2-3 days after surgery. The onset of sexual activity is possible 2 months after surgery.

The information on this site is for reference only.

Protein Shell Plastics

Instruments. Basic kit, 19-gauge butterfly needle with pump, 1 L packets with saline for injection, skin hooks. Bishop-Harman tweezers and a drainage tube.


Prepare the operation area as described above. Through the glans penis, a saline solution is injected into the cavernous body with a butterfly needle in a volume sufficient for the onset of an erection. At a high rate of solution introduction, the application of a tourniquet on the base of the penis, as shown in the figure, is not necessary.

An alternative way. 1.5-2 ml of papaverine is injected into the cavernous body; with a flaccid erection, the legs of the penis are squeezed or saline is poured into the head (see above). Clarify the nature of the deformation.


An incision is made, as with circumcision, especially if the patient desires this. If circumcision has already been done to the patient, the incision is performed along the old scar, which can be located almost in the middle part of the trunk. In a dull way, the fleshy fascia of the penis is peeled off from the deep, the skin is pulled to the base.


Deep fascia is exfoliated starting from the lateral surfaces of the spongy body. On both sides of it, the scaffold is exposed with scissors. With congenital ventral deformities, the rear vessels and nerves are mobilized and removed to the sides.


On both sides of the scar, the retaining sutures are imposed on the protein membrane with a 3-0 non-absorbable thread. The borders of the scar are surrounded by a felt-tip pen. To find out how the scar deforms the penis, an erection is again caused.


Scalpel dissect the protein shell around the scar tissue to the entire depth. Raising the edge of the cicatricial tunic, separate it so as not to damage the underlying spongy tissue.


Plastic autovenous patch (Lue Lue method)

Autovenous plastic is more physiological than plastic with a dermal flap.
During an erection, the difference between the length of the penis from the side of the scar and the opposite side is determined. The obtained value also shows the length of the segment of vein required for plastic surgery. The technique of the initial stage of the operation is similar to that described in paragraphs 1-4. A segment of the deep dorsal vein of the penis or saphenous vein of the lower limb above the ankle is isolated and excised.


A. Without excising the scar, an H-shaped relaxing incision is made through it.You can “evaporate” the scar with a CO2 laser beam (power 5 W, pulse duration 0.5 s), but venous bleeding may develop due to excessive thinning of the protein coat.
B. Open a segment of a vein. If the defect is wider than the circumference of the vessel, the patch is formed by stitching 2 or even 3 fragments under the increase of magnifying glasses with a monofilament synthetic absorbable thread 4-0. Close the defect, as described above, laying the patch with the endothelium facing the wound surface.

If you had to make a lot of relaxing incisions, each of the defects is closed with a vein segment (according to Moriel). If possible, cover the patch with the deep fascia of the penis. They cause an erection and evaluate the results of the operation. If the penis is deflected in the opposite direction or lateral deformation is maintained, plication sutures are applied to the ventral surface without excision of the albumen (paragraph 9). The wound is sutured with 4-0 chrome catgut thread, a not too tight pressure dressing is applied. After 1 h, the condition of the glans penis is noted; if necessary, the bandage is loosened. After 24 hours, the dressing is changed, before discharge, the patient is warned about the need to change the dressing daily for 10 days. Sexual acts are allowed 6 weeks after the operation.

Ventral plication (Nesbit and Pryor-Fitzpatrick Nesbit, Pryor — Fitzpatrick methods)

An erection is caused by rapid infusion of physiological saline into the penis with an infusion pump or slow - with a syringe with a tourniquet applied. It must be remembered that the application of a tourniquet to the base of the penis distorts its anatomy. If local anesthesia has been selected, nerves are blocked on the basis of the penis with a 0.25% bupivacaine solution.


1 cm proximal to the coronary sulcus around the circumference of the penis, cut into the thickness of the skin and fleshy fascia and scalp the penis. For a while, the tourniquet is dissolved. Separate the spongy body from the cavernous and take it to the holder of a rubber strip. Opposite the site of greatest curvature, an ellipsoidal section of the deep fascia and the albumen is cut out. You can also excise 2 sites - to the left and to the right of the spongy body, without mobilizing it. When the penis is bent by 45 °, the width of the defect should be about 0.5 cm, it should cover 1/3 of the circumference of the trunk. When bent by 90 °, the defect is expanded to 0.8 cm. The edges of the defect are reduced and sutured by immersion seams with 3-0 non-absorbable synthetic thread. Instead of excising sections of fabric, you can simply pick it up with several seams with the same thread. The clamp is removed, they cause an erection and are convinced of the absence of bleeding and deformation.

With bleeding, additional sutures are applied, with permanent deformation, plication of new areas with excision of the tissue or without it is performed. Thin sutures hem the bulb, spongy body and urethra. These formations are sometimes difficult to put in the same box. Stretch the skin on the penis and suture, as with circumcision. If a catheter has been inserted into the bladder, it is attached to the drainage and removed when the bandage is removed.

Alternative plication methods

Simple plication. The internal seed fascia can not be excised if the white membrane is stitched with symmetrical sutures using a durable monofilament or wicker non-absorbable thread.


B. When bending to the back side, sutures are applied on the ventral surface of the penis lateral to the spongy body.

B. For reliable plication, 8-shaped seams are applied (Klevmark et al., 1994), as shown in Fig. A and B. Use a monofilament non-absorbable thread 2-0. Dotted lines indicate those parts of the sutures that are located under the tunica albuginea. So that the cavernous body does not decrease in size, the width of the stitch should not exceed 5 mm, the distance between the stitches is determined by the degree of deformation (1 cm corresponds to a 30 ° curvature correction).

The sutures are tied with 5-6 knots, which are located under the protein coat. To avoid local irritation during intercourse, the ends of the threads are cut as short as possible.

The Heinecke – Mikulich method (Sassine et al., 1994). On both sides of the protein coat, longitudinal sections of 1 cm are made and sutured in the transverse direction by interrupted sutures with a 3-0 synthetic absorbable thread.

PROSTHESIS IMPLANTATION

With a combination of Peyronie’s disease with impotence, you can not plicate the membranes, but implant a prosthesis and forcefully straighten the penis. The AMS 700CX model is the most rigid and therefore best suited in such cases, although the Alpha Mentor model generates the greatest tension sufficient to break the scar.

After the introduction and partial filling of the cylinders, the nature of the deformation is determined and the penis is forcibly straightened, which is usually accompanied by a characteristic crack (Wilson and Delk, 1995). The manipulation is repeated until the prosthesis is seamlessly filled to its full capacity, and the penis is not straightened. Alternatively, laxative incisions can be made on the convex side of the curved penis. After straightening, it is checked whether sutures imposed on the cavernous bodies are cut. If the deformation persists, expose the plaque and cut it across so as not to damage the cylinders. When using the AMS 700CX, suturing a defect in the protein coat is not necessary.

POSTOPERATIVE COMPLICATIONS

Spontaneous erections in the postoperative period not only do not harm wound healing, but even contribute to the straightening of the penis. Nevertheless, any sexual activity is contraindicated for 1 month, and sexual intercourse for 2 months. After plastic surgery of a defect with a patch, the risk of eruption of sutures and tissue damage in the plastic region with subsequent relapse of deformation is higher than after plication. With unsatisfactory hemostasis or displacement of the dressing, hematomas may develop that need to be drained.

Wound infection leads to rejection of the patch, which requires repeated plastic surgery. In the event of the formation of a cavity under the patch, it is necessary to remove the patch and seams. After wound healing, patients very rarely complain of pain in the penis. Penile edema can be reduced by replacing the pressure dressing with napkins moistened with chilled saline. After traumatic manipulations on the neurovascular bundle, anesthesia of the glans penis may develop. If the bandage is too tight, skin necrosis is possible.

Impotence, not diagnosed before surgery for Peyronie's disease, is treated conservatively or by implantation of the prosthesis. Approximately 1 month after surgery, due to a reduction in the patch, a relapse of the deformity is possible, which usually resolves after 3-6 months. Cases of curvature of the penis in the opposite direction as a result of disease progression are described.

Commentary by J. Jordan

Peyronie's disease is associated with damage to the protein coat (especially at the site of attachment of the fibers of the median septum) during intercourse, when there is a sharp or repeated “breaking” of the penis. This is characteristic of a period of weakening erection against the background of intact sexual desire and sexual intercourse in certain poses. So, more than 70% of our patients had sexual intercourse in the pose of • a woman from above. ” On the back of the penis, the protein membrane consists of 2 layers of fibers: external longitudinal and internal circular.

The fibers of the median septum are woven into the inner layer of the protein coat. According to Devin's concept of "microvascular damage", forced flexion of the penis leads to the separation of the fibers of the median septum from their attachment sites, as well as to the stratification of the protein coat. On the ventral surface of the penis, the inner layer of circular fibers is not pronounced. When bending towards the ventral surface, a complete separation of most fibers of the median septum from this single layer of the protein membrane is observed, in this case, the disease is much less susceptible to surgical correction through plasty or plication.

After trauma to the protein coat in persons predisposed to the disease, it undergoes scarring. Double-blind studies necessary to prove the effectiveness of conservative treatment during scar formation have not been conducted. Apparently, such treatment is advisable, as it can provide psychological support to the patient. Surgical correction of penile curvature should be resorted to only after complete "maturing" of the scar.

In addition, it is not indicated in situations where sexual dysfunction is not associated with penile deformity, but with progressive erectile dysfunction. Regardless of whether the dysfunction is caused by Peyronie’s disease or vice versa, I believe it is the weakening of the erection that is guilty in most cases of acute or repeated “breaking” of the penis. Therefore, before the operation, it is necessary to evaluate the quality of the erection. If it was weak before the correction of the curvature, it will remain the same after the intervention, which will replenish the list of medical failures.

Many methods have been proposed for correcting penile curvature. A study of the results of operations in the United States and Great Britain showed the efficacy of plication with excision of the protein coat or without it. The plicated portions of the protein coat do not straighten out over time, which can be explained by the low intracavernous pressure at the height of the erection in most patients. Sometimes, using plication, it is possible to completely eliminate the deformation of the penis.

In some patients, this operation is the best way to treat. Some patients with impressive penis sizes are not very worried about the prospect of shortening it, while others categorically refuse surgery, after which a weakening of the erection is possible. Many flatly refuse implantation of the prosthesis. In such cases, plication seems to be the best choice, since it less than other methods affects the initial quality of the erection.

But, if scarring caused a shortening of the penis, patients negatively relate to any interventions, as a result of which its further shortening can occur. Such patients prefer plication, which allows you to save the length of the penis. The replication is performed with excision of the altered portions of the protein membrane or without it, or by dissection of scar plaques with plastic of the resulting defect. In most cases, it is possible to eliminate the curvature. If the scars are calcified, they are completely excised.

In Peyronie's disease, only the tunica albuginea is affected. Scarring of the deeper layers is associated with rupture of the fibers of the septum of the penis. Excising these thickened fibers and especially the tissue of the cavernous bodies is not necessary and even harmful. Only the scar of the protein coat is removed, which is always easily separated from the tissue of the cavernous bodies.

It was proposed to close the defect formed after scar removal with various materials: a dermal flap, a flap from the internal seminal fascia, temporal fascia and an autovenous patch. Plastic membrane defect repair with a synthetic patch often leads to complications and is therefore not recommended.

For plastic surgery with a dermal flap, it should be cut so that it is 30% larger in size than the defect, but in shape to match it (to prevent wrinkles or relapse). Since the skin covering the crests of the ilium is hairless and different people have approximately the same thickness, it is more convenient to use it than skin from other areas. In our clinic, they prefer to close the defect of the protein membrane with a dermal flap.
In some cases of Peyronie's disease, there are indications for implantation of the prosthesis, but the widespread use of this method is flawed and can be regarded as a doctor's recognition of his impotence.

In order to correctly evaluate the results of treatment, it is necessary to develop evaluation criteria. In our center, an operation for Peyronie’s disease is considered successful if it was possible to permanently eliminate the curvature of the penis, which before the operation interfered with normal sexual intercourse. The second criterion for success is the onset of natural erections. Therefore, all cases when it is necessary to resort to intracavernous administration of vasodilators to perform sexual intercourse, and even more so when the prosthesis has to be implanted, are examples of ineffective treatment. I would like to repeat once again that this approach does not exclude prosthetics of the penis in individual patients.

With the above evaluation criteria, a favorable clinical result was observed in 70% of patients, although, of course, in the subgroup of patients with erectile dysfunction this indicator is lower. Conversely, with a high quality erection, according to the intracavernous administration of a radiopaque substance followed by erotic stimulation and cavernosomanometry, the results of the operation are much better. At the beginning of our activity, we came to the conclusion that this indicator completely determines the outcome of the operation, but later we had to deal with situations where the initially high quality of an erection worsened after the intervention.

Nevertheless, good results in patients with initially preserved ability to normal independent erection are observed in more than 90% of cases. With a satisfactory quality of erection, we achieve success in 75-80% of cases, and with severe erectile dysfunction with a decrease in intracavernous pressure at an erection height of up to 30 mm RT. Art. and below the operation will inevitably fail. It is better for these patients to perform implantation of a prosthesis with forced straightening of the penis.

One should not exaggerate the value of intracavernous administration of a radiopaque agent followed by erotic stimulation and duplex ultrasound. These studies imply an adequate response of the tissue of the cavernous bodies to the introduction of vasodilators. Of the latter, we usually use papaverine, regitin and prostaglandin E1, in most cases observing a normal erectile reaction. However, if the vascular test indicators do not contradict the anamnestic data, the results of a sexual partner survey, as well as documentary evidence (using photographs) of the erect penis, a morning erection test or a Rigi Scan system test should be prescribed.

It is believed that surgery for Peyronie's disease makes it difficult or even impossible for the subsequent implantation of a penile prosthesis. This is not always true. In our clinic, the frequency of complications associated with prosthetics in patients who underwent correction of curvature of the penis is the same as in patients who underwent prosthetics only.

Peyronie's disease causes significant inconvenience to most men suffering from it, but it does not mean the end of sexual activity. It is impossible to affect the natural course of this disease, and it is unacceptable to operate before the maturation of the scar. Patients and their sexual partners have a difficult time waiting for surgery and need psychological support.

There are 4 options for surgery.

Operation Nesbit - Lu

Price: 80 000 rubles

The basis of this method is the stitching of the protein coat on the side opposite to the curvature.

In this case, the cavernous bodies are not opened, which results in less trauma during the intervention.

The technique is ideal for treating minor penile deformities.

Nesbit surgery to dissect or remove plaque

Price: 100 000 rubles

Dissection or complete removal of the plaque occurs (depending on location and size).

The defect is covered with fascial tissues.

The size of the member during such an operation does not change. Of the minuses, a hematoma can form at the excision site.

Transplant grafting operation Tutoplast perecardum

Price: operation 150 000 + graft Tutoplast 130 000 r

Complete excision of fibrotic changes (plaques) in Peyronie's disease.

The excision site is replaced by a Tutoplast patch (allogeneic natural collagen biocompatible matrix, made in Germany).

This operation is considered the gold standard for Peyronie's disease.

Penile prosthesis implantation Coloplast Titan®

Cost: operation 175 000 r + prosthesis Coloplast Titan® 395 000 r (or 95 000 Coloplast GENESIS)

It is the only possible treatment for Peyronie's disease with impaired erectile function.

Elimination of deformation is carried out due to remodeling of the penis. Modern prostheses can completely restore an erection and even increase the size of the penis.

What determines the choice of operation?

The choice of the method of operation depends on the degree of curvature, the size of the plaque and its location, the state of blood flow, the size of the penis, and erection strength.

Sometimes the patient has a choice between operations, sometimes it all comes down to only one.

5 goals for the surgical treatment of Peyronie's disease:

  • Restore the shape and direction of the erection, minimize residual curvature,
  • Save, restore or increase the length and girth of the penis,
  • Maintain or restore a stable erection,
  • Get rid of the pain
  • Minimize the likelihood of any minor complications, such as bruising, decreased penile sensitivity, impotence, etc.

Indications for surgery for Peyronie's disease

Indications for surgery may include:

  • inability to have sexual intercourse (both due to curvature, and because of problems with erection)
  • ineffectiveness of conservative treatment

Menshchikov Konstantin Anatolyevich owns all the techniques for surgical treatment of Peyronie's disease. This allows him to choose the best treatment option for each patient.

Before starting a conversation about the types of operations with the patient, a complete diagnosis is made.

  • penis curvature,
  • plaque size
  • penis size
  • the nature of blood circulation in the cavernous (cavernous) bodies.

The operation is carried out only in the so-called stable phase. Those. when there is no active inflammatory process, constant pain or the dynamics of a change in the plaque last 3-4 months. In the acute phase, only conservative treatment is used.

It is important to understand the severity and complexity of the curvature, the location of Peyronie's plaques, whether the disease has led to severe shortening of the penis, and whether there is erectile dysfunction.

Read about the causes and symptoms on other pages of our site.

How is the operation with Peyronie

It all depends on the type of operation. When plication: stitching is performed on the opposite side of the plaque from the penis. When grafting: the plaque is removed and this place is replaced with a patch. During implantation: a prosthesis is installed. The principle, the technique of execution, and some details of each operation are described in more detail below.

Operation plication of Nesbit - Lou with Peyronie's disease

The operation was introduced into practice by Nesbit in 1965. Initially, these methods were used to treat congenital deformities of the penis, however, the general essence and sequence of actions were also suitable for curvatures as a result of Peyronie's disease. Then the Nesbit method received many modifications and changes thanks to the work of other authors. Menschikov's urogenital surgeon, uses a modification of Lou. Because she has established herself as the safest and most effective.

The logic of this procedure is quite simple: in most cases, the main reason for the curvature of the penis is that the plaque develops on one side of the cavernous bodies, which leads to a loss of elasticity. When the penis is straightened, the affected side stretches less than the healthy side (in fact, one side of the penis is longer than the other), and this imbalance leads to curvature of the penis.

Operation principle:

The surgeon operates on the healthy side of the penis to correct the affected side and eliminate the curvature. Due to the loss of penis length associated with this, and also because this operation basically eliminates curvature, and not any other problems associated with Peyronie’s effects (for example, an hourglass or hinge effect, erectile dysfunction), ideal candidates for this surgery are patients with curvature having following characteristics:

  • the angle of curvature of the penis is not more than 45 about,
  • the absence of hourglass warps,
  • sufficient penis length,
  • normal level of erection (in response to pharmacotherapy).

The operation itself involves the excision of a small area of ​​tissue on the side opposite the deformation and subsequent suturing of this area with non-absorbable suture material. Thus, during the Nesbit operation, tension is created that prevents further curvature of the penis, which helps to restore its shape.

Loses member length during Nesbit operation?

Yes, the penis size after Nesbit surgery really decreases by 1-2 cm. The patient must be warned about this feature of surgical intervention. Moreover, one of the indications for Nesbit surgery is the sufficient size of the penis.

If necessary, we combine the operation Nesbit and the operation to lengthen the penis. But more often, the patient should simply consider other options for the operation - removal of the plaque with fascia closure or removal of the plaque with Tutoplast patch.

Can I wear an extender after Nesbit surgery?

Wearing the extender is allowed after the recovery period after surgery. For Nesbit operation, it is from one month or more.

Operation Modifications

The most common modification is the Nesbit-Lou operation, which involves not removing the portion of the protein coat, but creating its duplicate with subsequent immersion using a special unit.

The stages of the operation of plication of Nesbit - Lu

After examination and ultrasound, the location of the plaque, its shape and size are determined. On the opposite side, a place for plication is calculated.

The surgeon performs superficial and small excisions at the points of maximum curvature of the penis.

The surgeon makes suturing of tissues, this leads to tension and correction of curvature.

The cost of the operation plication Nesbit - Lou

Ligature plication of the protein coat -80 000 rubles

This price includes:

  • surgeon consultation
  • operation
  • anesthesia
  • 24 hours in the ward in a modern clinic
  • dressings and examination after surgery

Only analyzes are paid separately:

  • hospital complex
  • clinical blood and urine tests

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Recovery after surgery to correct penile curvature

The recovery period takes from one month or more. Postoperative therapy includes a number of tools aimed at reducing penile edema and preventing complications. For this purpose, it is permissible to use painkillers and anti-inflammatory drugs, as well as antibiotics. To prevent spontaneous erections after Nesbit surgery, patients are prescribed desipramine for 2 weeks.

Sexual contact is allowed no earlier than a month after the operation. Most reviews indicate that the quality of sexual intercourse after Nesbit surgery is significantly improved due to the restoration of the previous form of the penis.

Possible complications of plication

The Nesbit-Lu operation involves the following risks during the surgical intervention itself and after the operation, if it is performed by an inexperienced surgeon:

  • the development of bleeding during trauma of the protein membrane,
  • damage to the urethra and cavernous bodies during the operation, possible infection,
  • decreased sensitivity of the head of the penis.

If the operation is performed by Dr. Menschikov K.A. - In 99% of cases, there will be no complications.

Tutoplast® Pericardium Patch Transplant Methods

The plication method involves surgery on the healthy, longer side of the penis to make it shorter, while grafting methods (transplantation) based on a completely opposite principle, the surgeon operates on the affected side of the penis, on which the Peyronie plaque is located, to restore the lost elasticity (created by the plaque). During the operation, both sides will stretch to the same size, which eliminates distortion.

For this reason, grafting surgery restores the lost length of the penis caused by Peyronie’s disease, as well as correct any kind of deformation, such as hourglass effects or complex multi-plane bends.

Grafting is one of the most technically challenging penile operations. Only a few surgeons in Russia have experience in their implementation, and can perform the operation without complications. Dr. Menshchikov spent more than 500 complicated operations for his practice.

Who is suitable for transplantation:

  • No erectile dysfunction
  • Curvature over 60 degrees
  • Complex penile deformity
  • The average length of the penis

When this type of surgery was first introduced, the approach involved the complete removal of Peyronie's plaque - and subsequent transplantation of the closure flap to the site of removal. Practice has shown that complete removal of plaques could lead to the development of erectile dysfunction, because when removed, plaques could damage healthy tissues that are responsible for erection.

For this reason, instead of complete excision, it is preferable to perform a relaxing incision on the plaque and remove only the areas of greatest tension, then cover the area with a Tutoplast® Pericardium patch. This approach does not lead to any damage to erectile tissue and at the same time completely corrects the curvature of the penis, restoring the penis to its original length.

Various modifications to this technique have been proposed, including the Lue and Egydio techniques. The Egydio technique, the approach our surgeon uses, is more advanced in that it uses precise geometric principles to determine the cut points on the penis, as well as accurately determine the size of the graft, which is used to close the plaque dissection site.

The advantages of the geometric principles approach are as follows:

  1. No penis contraction - A significant length of the penis and restoration of girth can be achieved (average 3 cm)
  2. Any type of curvature can be fixed using this technique.
  3. Due to the exact nature of the surgical technique, the risk of recurrence of curvature is extremely low - more than 95% success after the first operation
  4. Plaque closure is performed in a very accurate surgical manner, minimizing the likelihood of postoperative erectile dysfunction

Tutoplast® Pericardium Implant

Innovative implants from canned human donor tissue.

Coloplast offers Pericardium tissue, a canned human donor tissue that has been sterilized during the sterilization of Tutoplast tissue.

Transplantation cost (graft) Tutoplast perecardum

Transaction price 150,000 rubles + Tutoplast patch 130,000 (price depends on the Central Bank rate)

This price includes:

  • surgeon consultation
  • operation
  • German patch Tutoplast® Pericardium
  • anesthesia
  • 24 hours in the ward in a modern clinic
  • dressings and examination after surgery

Only analyzes are paid separately:

  • hospital complex
  • clinical blood and urine tests

Request a call back

Transplant Recovery

The recovery period takes from one month or more. Postoperative therapy includes a number of tools aimed at reducing penile edema and preventing complications. For this purpose, it is permissible to use painkillers and anti-inflammatory drugs, as well as antibiotics.

Why install a prosthesis?

About 30% of patients with Peyronie's disease also suffer from severe erectile dysfunction.

It is the only possible treatment for Peyronie's disease with impaired erectile function, which is not amenable to treatment with drugs stimulating erection. It is also used for common lesions of the penis, when the use of other surgical techniques is not possible.

We use only 3-component denture options from Coloplast. Now these are the most reliable and high-quality prostheses on the market. In this case, deformation is eliminated through remodeling of the penis. Modern prostheses can completely restore an erection and even increase the size of the penis.

Before treatment with Peyronie, a detailed assessment of the patient’s erectile function is required.

For patients suffering from severe erectile dysfunction, which does not respond to non-surgical treatment options, simply straightening the curvature of the penis will not restore the erection, insufficient rigidity will remain which will prevent sexual intercourse. It is best for these patients to have penile implantation.

Penile prosthetics surgery involves installing a device that allows the patient to cause an erection on demand.

Penile implants have been in clinical use for over 40 years, during which time more than 700,000 operations have been performed in the world.

Studies show that 93.8% of men are satisfied with the treatment of erectile dysfunction with penile prostheses. Percentage of satisfaction with drug stimulation of an erection (51.6%) or injection therapy (40.9%).

Denture Coloplast Titan

Coloplast offers Titan Inflatable Dentures (IPP) for those who need surgery for Peyronie's disease and erectile dysfunction. The Titan product line is a hydraulic system designed for surgical implantation in the penis. These cylinders are available in various sizes from 11 cm to 28 cm, with two different pump options.

The implant consists of two Bioflex® cylinders implanted in the cavernous membrane of the penis. Cylinders are attached to the pump. The pump is connected to a reservoir that is filled with sterile saline and is implanted in the scrotum or under the abdominal muscles.

Coloplast provides a lifetime warranty on the Titan dentures.

Why choose three component prostheses?

The prosthesis of the penis is invisible, it does not matter - in an erect state or in a calm. Your partner will not be able to say that you have an implant unless you tell him.

With an implant, you will always have a strong and permanent erection on demand during intercourse. You are in full control over long proximity.

Peyronie implantation cost

Operation 175 000 r +Coloplast Titan® prosthesis 395,000

Operation 175 000 r +Coloplast Genesis® prosthesis 90,000

This price includes:

  • surgeon consultation
  • operation
  • Coloplast Titan® 3-component penile prosthesis or Coloplast Genesis One-component prosthesis
  • anesthesia
  • 24 hours in the ward in a modern clinic
  • dressings and examination after surgery

Only analyzes are paid separately:

  • hospital complex
  • clinical blood and urine tests

Request a call back

The cost of the operation excision of the plaque

Excision or removal of plaque and fascia closure -100 000 rubles

This price includes:

  • surgeon consultation
  • operation
  • anesthesia
  • 24 hours in the ward in a modern clinic
  • dressings and examination after surgery

Only analyzes are paid separately:

  • hospital complex
  • clinical blood and urine tests

Request a call back

Questions from patients

What is the best surgical technique for treating Peyronie?

There is no such thing as the best technique or operation. It is important who does the operation. It all depends on the specific case and on the professionalism of the surgeon. This is not a simple operation that can be done in any clinic. All methods that we use have been significantly improved and improved by Menshchikov Konstantin Anatolyevich. In 99% of cases, patients are satisfied with the result and recovery takes place without complications. All surgical methods have their advantages and disadvantages. The most important thing is to choose the option for the patient that will accurately solve the problem.

Am I right for surgery?

Surgery remains the gold standard for most patients with Peyronie. However, as we explain in the Conservative Treatment section, we assume that less invasive treatments are considered first before moving on to the surgical method. Only at face-to-face admission decides on treatment. If the curvature of the penis exceeds 30 degrees - most likely, you need surgery.

How long does the operation take?

The operation takes from 1 to 2 hours. We leave all patients in the clinic for 24 hours.

Do I need general anesthesia?

Yes. You fall asleep just before the operation starts and wake up right after the surgeon finishes - so that in total you will be under anesthesia for about 2 hours.

How long do I need to stay in the hospital after Peyronie’s surgery?

After surgery, you will need to be in the hospital 24 hours. During this time, our nurse will visit you, who will be provided with food, your surgeon will check your condition, and then you will be ready to return home. You can walk and function normally without much pain or discomfort.

I plan to come from another city - how long do I need to stay after the operation in Moscow?

The day after the operation with the surgeon, you will have a second consultation to make sure that everything is in order. After this, most patients can travel, although we recommend that you stay for another 1-2 days so that you can consult your surgeon over the next few days if necessary. Depending on the operation, ligation, or the prosthesis, may be necessary, then you need to stay in Moscow for 7 days. You can learn more detailed information by phone +7 (495) 175-7943

What do I need to do to prepare for the operation?

Almost nothing. We recommend that you follow a light diet and lead a more active lifestyle for 2 weeks before surgery. This will help recovery. From the surgeon you will receive detailed instructions on fasting before surgery. You will need to pass a standard hospital complex of tests, a clinical blood test, a clinical urine test. If you have any health problems before surgery, be sure to tell your doctor.

What is the cost of the operation?

From 80,000 rubles to 525,000 rubles (prosthetics). You can look at all prices on this page.

How much experience does the surgeon have?

Menshchikov Konstantin Anatolyevich performed more than 500 operations related to Peyronie’s disease and penile implantation. In addition to these operations, he performed over 200 penis enlargement surgeries using the PLGA biomatrix. He performs the most complicated operations for urethral stricture. In addition to this, she makes dozens of simpler operations per month, such as circumcision and varicocele. He is one of the 3 genital surgeons in Russia who performed several neofallos phalloprosthetics.

How do you rate the success of the operation?

  • No serious complications
  • Lack of curvature and pain
  • Patient's apparent satisfaction

Based on these three criteria, our success rate for Peyronie’s surgical correction is over 99%, which is significantly higher. We believe that a very important element that leads to such high success rates, in addition to the surgeon’s surgical skills, is the correct selection of the treatment method for each patient.

What do I need to do after surgery?

The doctor will schedule a consultation after surgery. At this consultation, an evaluation of the result and dressing will be carried out. Then you need to follow the doctor’s recommendations, all recommendations are individual, for each type of operation.

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