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Excision Peyronie's Placque
What is
Excision Peyronie's Placque?
Excision Peyronie's Plaque is a kind of surgical
treatment for the correction of Peyronie's
disease which involves elongating the concave
side of the tunica albuginea of the penis either
be incision or excision of the plaque and graft
placement.
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Effects
of Excision Peyronie's Placque
This
procedure is able to treat patients suffering
from Peyronie's disease. Peyronie's disease is a
condition which causes pain on the penis during
erection, erectile curvature, pain during
intercourse, erectile dysfunction, and a corpus
cavernosum indurated plaque.
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Candidates for Excision Peyronie's Placque
Ideal
candidates for this procedure include patients
whose erections are suitable for sexual activity
but have reduced function due to the presence of
Peyronie's disease or a curvature or hourglass
deformity. On the other hand, a penile
straightening procedure may be considered.
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Your Consultation
Before
undergoing the procedure, patients are injected
intracavemosally with 30 mg of papaverine in
order to stimulate an erection so that penile
curvature may be demonstrated before doing the
correction.
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The
Excision Peyronie's Placque Procedure
If
excision is selected, complete penile
straightening is ensured by doing relaxing
incisions at the four extremities of the excised
defect. The area of defect is cautiously
measured once the incision or excision has been
carried out, then the cadaveric pericardial
graft is customized. In order to reconstitute
its flexibility and compliance, the graft is
immersed in an antibiotic solution. For ample
penile straightening, the graft is measured
approximately 20% larger than the defect
measured. Once the graft is measured, tailored,
and placed over the defect, the graft is held in
place with running, locking suture of 4 or 5-0
PDS. At the end of the placement of the graft,
additional artificial erection is done with
securing of the graft in order to prevent
damage.
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Recovery
Postoperatively, the suction drain is detached
the morning after the procedure and application
of ice is sustained. In order to limit
postoperative nocturnal erections for 2-3 weeks,
medication is given for control of pain and to
improve possible surgical outcomes.
Approximately 3-4 weeks after the procedure, the
erection status of the patient is reviewed. If
there are consequent mild curvature or
noteworthy graft induration observed on
examination, consideration of application of a
series of vacuum erection device is done. This
device is used twice a day for about 10 minutes
without the use of a constriction ring. This
will lead to extension of the graft and
improvement of the mild curvature seen
postoperatively in some patients. Satisfactory
postoperative results may be expected.
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Risks
Complaints of reduced rigidity of erection, as
well as impotence after the surgery are usually
related to excision of the plaque. These
complaints have been related to erectile nerve
damage during penile surgery.
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Frequently Asked Questions
Q:
What is Peyronie's disease?
A:
Peyronie's disease or PD is a localized disorder
of the penis which is distinguished by collagen
composition changes of the tunica albuginea.
This results in a fibrotic plaque containing
excessive collagen. Men suffering from PD
complain of penile plaque, painful erection,
penile shortening, penile curvature, and
erectile dysfunction or ED. Peyronie's disease
is typically found in men between ages 40 and 70
years.
Q:
What are the causes of Peyronie's disease?
A:
In Peyronie's disease, penile curvature is
caused by an inelastic scar or plaque that
shortens the involved part of the tunica
albuginea of the corpora cavernosa when erection
happens. In about one third of patients,
scarring involves the dorsal and ventral aspects
of the shaft. The offsetting plaques may make
the penis straight but shortened or may have a
lateral bend.
Q:
Who are the candidates for this procedure?
A:
The perfect candidates for this procedure are
men with shorter penile length, regardless of
the degree or complexity of the curvature whose
erectile function is normal prior to the
procedure. Plaque incision and grafting is best
for men who have hourglass deformity or waisting.
Q:
What happens during the procedure?
A:
Excision of the plaque is done in this procedure
together with "patch grafting" of the defect due
to the excision. The material used in the graft
is usually taken from the scrotal tunica
vaginalis or from the skin of the forearm that
does not have hair. Gortex, which is an
artificial graft material may also be used
although there have been mixed results with its
use. This is generally less elastic and
therefore does not allow sufficient stretch of
the corpora during erections. Besides these
techniques, penile prosthesis and plication of
the tunica albuginea may be used.
Q:
What are the pros and cons of this procedure?
A:
The benefit of this procedure is that it is
usually not related with loss of penile length.
On the other hand, its drawback is that
postoperative erectile dysfunction may develop
in men who have poor erectile function prior to
the procedure. Also, in approximately 10% of
men, prolonged loss of sensation in the penis
may occur.
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The following list of Urology procedures are
performed at Beverly Hills Medical Group -
please click the links to find out more:
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