Penile Plication for Treatment of Penis Curvature Caused by Peyronie’s Disease
Dr. Alex Shteynshlyuger is a board-certified urologist in NYC who specializes in treating men with Peyronie’s disease. He performs penile plication as well as other surgeries for treatment of Peyronie’s disease.
What is Penile Plication?
Penile plication is a surgical procedure used to correct penile curvature. Penile plication applies counter-tension with permanent sutures on the side opposite of where the curvature occurs to mechanically straighten the penis.
Penile plication can be used to correct both ventral curvature (penis points and curves down) and dorsal curvature of the penis (penis curves up).
Penile Plication for Treatment of Penile Curvature (Bent or Curved Penis)
Penile plication is a well-established surgical procedure for treatment of penile curvature. There are a number of different surgical approaches to penile plication with names such as “Nesbit plication” and “16-dot technique” among others. At New York Urology Specialists, we perform both Nesbit plication and 16-dot plication technique depending on patient’s situation.
What Type of Anesthesia is Used for Penile Plication?
Depending on the severity of the problem and patient characteristics, local or general anesthesia can be used for penile plication. We often are able to perform plication in the office under local anesthesia. The procedure usually takes 1 to 1.5 hours to perform.
How Effective is Penile Plication for Treatment of Curvature Associated with Peyronie’s Disease of the Penis?
Plication is a very effective treatment option for correcting curvature caused by Peyronie’s disease in particular for a penile curvature of fewer than 60 degrees. Some men with curvature greater than 60 degrees may also be candidates for penile plication. Penile plication results in the functionally straight penis (residual curvature of fewer than 20 degrees) in 80-90% of patients. Patient satisfaction ranges from 75-90%.
Many men with stable Peyronie’s disease who do not improve with injection therapy, are good candidates for penile plication.
Penile plication does not help men with pain or penile narrowing caused by Peyronie’s disease. Penile plication only treats curvature but not other symptoms of Peyronie’s disease.
Penile plication is not usually a good choice for a man with erectile dysfunction caused by Peyronie’s disease if medications such as Cialis, Viagra, and Stendra do not allow him to achieve an adequate erection.
When Is Penile Plication Performed?
Penile plication is a good surgical treatment option for many patients with a penile curvature of 30-70° who have good erections and do not have significant narrowing of the penis (“hourglass” appearance). Men with minor narrowing of the penis (minor ‘hourglass’ appearance) may still be candidates for penile plication. It is important for men to understand the risks and benefits of penile plication as well as other treatment options for penile curvature.
Who is NOT a Good Candidate for Penile Plication (Nesbit or 16-dot procedure)?
Men with erection problem for whom medications such as Viagra or Cialis do not work well and who are unwilling to use penile injections (Trimix) or if Trimix does not work either are not good candidates for penile plication.
While penile plication will fix the curvature, a straight penis without an erection is of limited use. In men with ED, penile implant surgery often in conjunction with penile plication or penile plaque excision and grafting is necessary to fix both CURVATURE and ERECTILE DYSFUNCTION.
Men with severe narrowing of the penis are also not good candidates for penile plication as it does not treat narrowing. Depending on the quality of erection, plaque incision/excision with grafting or penile prosthesis is advised.
What To Expect From Penile Plication
Penile plication procedure aims to straighten the penis to what we call a “functionally” straight penis. It is nearly impossible to make the penis completely straight as gravity can contribute to mild penile curvature and deviation. In addition, it is not always advantageous to try to make the penis perfectly straight as that may require additional surgical maneuvers that may not necessarily justify the risk of complications.
Typically, we consider a functionally straight penis and a good result if the curvature of less than 20% is achieved.
What are the Advantages of Penile Plication?
Penile plication is a minimally invasive surgical procedure with the least amount of complications among surgical treatment options for penile curvature including curvature caused by Peyronie’s disease and congenital penile curvature.
Penile plication is associated with the least risk of postoperative difficulty with erections and changes in sensation compared to penile plaque excision with grafting.
Penile plication can be performed in the office under local anesthesia. Most patients are able to go back to work within a few days.
Is it Possible for Curvature to Recur after Penile Plication?
While the intent of penile plication is to permanently fix and correct penile curvature, in about 10-15% of patients curvature may worsen over time after penile plication. Typically, recurrence results in partial worsening of curvature. In other words, if 60° curvature was corrected to 10°, over time the curvature may worsen in some men to 20-30°.
Other reasons why curvature may recur after correction of penile curvature with plication.
- Sometimes, the disease progress disease process progresses after surgery leading to worsening penile curvature.
- Loosening of the suture used for penile plication could also lead to partial worsening of penile curvature after plication over time.
- In rare circumstances, suture failure may occur which can lead to complete reversal of penile plication.