Surgical Treatment for Peyronie’s Disease: Penile Grafting vs. Penile Plication

A significant number of men are facing issues like Peyronie’s disease in the United States. According to the National Library of Medicine, Peyronie’s disease (PD) prevalence in the US is estimated at around 0.3% and 20.3% with the specific figures varying depending on the study methods and age groups.

Peyronie’s disease is a condition that leads to the development of fibrous scar tissue in the penis that causes curvature, pain, and, in some cases, erectile dysfunction. In many cases, men may have symptoms that are distressing and interfere with their sexual function and quality of life.

For the treatment of the condition, different procedures are performed, including conservative and non-conservative. When the conservative or non-surgical treatments fail to offer significant relief, surgery is the only effective option. For Peyronie’s disease treatment, the two most common surgical options are penile plication and penile grafting.

It is important to understand the difference between the two, which one offers the best results, and the risks of each can help patients make informed decisions for the treatment. In this guide, we will explore “Surgical Treatment for Peyronie’s Disease: Penile Grafting vs. Penile Plication”.

Let’s begin with what Peyronie’s disease is and what it causes.

What Is Peyronie’s Disease?

When the hardened scar tissue starts developing inside the tunica albuginea (fibrous sheath surrounding the penile erectile tissue), this condition is Peyronie’s disease. This development of scar tissue inside the penis can lead to:

• Penile curvature, especially during erections
• Shortening of the penis
• Painful erections
• Difficulty with penetration
• In some cases, erectile dysfunction (ED)

The exact cause of this condition is not known, but it is believed that this condition can be a result of trauma or repeated micro-injuries during sexual activities.

Who can Consider Surgery?

Surgery is recommended for Peyronie’s disease for those men who have:

• Have stable curvature for at least 6–12 months
• Experience sexual dysfunction or distress
• Do not respond to oral medications, injections, or traction therapy
• Have no active pain or progression of the disease

The choice of surgical procedure may vary depending on the severity of curvature, penile length, and erectile function.

Surgical Treatment for Peyronie’s Disease: Penile Grafting vs. Penile Plication

Let’s understand the difference, benefits, and risk factors for both the condition, penile grafting, and penile plication.

Penile Plication is the procedure that results in shortening the longer side of the penis to straighten it. This procedure does not remove the plaque completely, but it can be a less invasive option.

What is the Working of Penile Plication?

In penile plication, sutures are placed on the opposite side of the curvature. These sutures can straighten the penis by pulling the longer side inward.

This procedure is considered best for:

• Men with a curvature of less than 60 degrees.
• Good erectile function
• Minimal penile shortening concerns.

Advantages of Penile Plication Procedure may include:

• Shorter surgery and faster recovery time
• Fewer chances of complications
• Results in preserved erectile function.

Disadvantages of Penile Plication Procedure:

• May cause penile shortening (usually 1–2 cm)
• Not suitable for severe or complex curvatures
• Doesn’t address plaque directly.

Penile Grafting

In comparison to penile plication, penile grafting is an advanced procedure in which the plaque is removed with incisions, and the defect is covered with a graft to restore penile length and straightness.

Procedure:

For penile grafting, the surgeon cuts into or removes the fibrous plaque. Further, a graft material is placed to fill the gap. The main focus is to lengthen the shorter side of the penis rather than shortening the other side.

This procedure is considered Best For:

• Men with curvatures greater than 60 degrees
• Hourglass deformity or significant indentation
• Shortened penis or complex curvature

Advantages of Penile Grafting:

• Can restore lost penile length
• Suitable for severe deformities
• Corrects indentation and hourglass deformities

Disadvantages:

• Longer surgery and recovery
• Higher risk of erectile dysfunction
• More complex postoperative care
• Not ideal for men with existing ED

Understanding The Difference: Penile Grafting vs. Penile Plication

Comparing Penile Plication and Grafting in brief, in the form of a table:

Recovery and Postoperative Expectations: Difference between these Procedures

Penile Plication:

Penile Plication is an outpatient procedure that involves minor discomfort and swelling. After the procedure is performed, you can resume sexual activity in 4-6 weeks. In this procedure, minimal restrictions are involved.

Penile Grafting:

Penile Grafting requires an overnight stay and includes more swelling and discomfort. After the procedure is performed, the sexual activity may be postponed for 6-8 weeks. There may be possible temporary changes in the sensation.
In both procedures, Penile Grafting and penile plication, patients are encouraged to follow up regularly and may benefit from penile rehabilitation, such as:

• PDE5 inhibitors (if erectile function declines)
• Vacuum erection devices
• Manual stretching or traction therapy

Are there any Risks and Complications of Surgery?

Yes, like other surgeries, the surgical treatment for Peyronie’s disease also has risks and complications. This procedure has risks and complications, which may include:

• Bleeding or infection
• Penile numbness
• Recurrence of curvature
• Penile shortening (more common in plication)
• Erectile dysfunction (more common in grafting)

Final Thoughts

Peyronie’s disease is responsible for impacting the physical and emotional well-being of men. Fortunately, effective surgical treatments are available for Peyronie’s disease. Penile plication is an ideal choice for those men with mild to moderate curvature and good erectile function. Penile Grafting is a more advanced procedure for those with severe curvature or shortened penile length.

For the effective results in the treatment of Peyronie’s disease, choosing the right surgical option is essential. Weighing risks, benefits, and suitable procedures is crucial when selecting the ideal surgical option. It is suggested to select an experienced robotic urologic surgeon, like Dr. Shirin Razdan, who is a Peyronie’s disease specialist based in Miami, as this key to reduced risks and achieving the favorable outcomes.

FAQs Regarding Surgical Treatment for Peyronie’s Disease

Question 1. Is surgery the only option for the treatment of Peyronie’s disease?

Answer. No, surgery doesn’t have to be the only option when it comes to the treatment of Peyronie’s disease. In many cases, men have responded to the non-surgical treatments like injections or traction. Surgery is the option when the conservative methods have not offered the desired results and when the curvature is stable with significantly impaired functionality.

Question 2. Can surgery make my penis longer?

Answer. Surgical procedures, penile grafting, and plication can be used to restore the length or reduce penile length for improved functionality of the penis. These procedures cannot increase the actual length of the penis.

Question 3. How long does it take to recover from penile surgery?

Answer. Recovery from the surgical procedures can vary depending on different factors. For recovery after penile plication, it may take 4-6 weeks, and for grafting, it may take 6-8 weeks. In many cases, men resume their normal activities and sexual intercourse when it heals after the surgery.

Question 4. What factors can influence the choice of the right penile surgery?

Answer. Factors that influence the choice between plication and grafting include:

• Degree and type of curvature
• Penile length and rigidity
• Sexual function before surgery
• Personal preferences and expectations

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