Correction of acquired penile curvature / penile deviation due to Peyronie's disease (IPP)

Penile curvature, also known as Peyronie's disease, is a connective tissue disease in which elastic connective tissue is transformed into fibrous, brittle connective tissue. The cause of the disease is still unknown. There may be a genetically determined change in collagen metabolism which, together with injuries to the erectile tissue, triggers the formation of plaques. Penile curvature often occurs together with Dupuytren's disease, in which similar shrinkage processes occur in the flexor tendons of the hands.

Typical symptoms of patients with induratio penis plastica are: hardening of the penis, curvature of the penis, shortening of the penis, constrictions of the penis (so-called "hourglass deformity"), erectile dysfunction, impairment during sexual intercourse, pain in the penis without erection, pain in the penis during erection. It is important to distinguish it from congenital penile deviation. Penile deviations due to IPP only occur later in life, usually in the 5th decade of life, whereas congenital penile curvatures exist from childhood. Congenital penile curvatures are almost always directed downwards, whereas penile deviations due to IPP are usually directed upwards.

Surgery for IPP makes sense when the curvature of the penis impairs sexual intercourse or makes it impossible. The operation only treats the penile curvature, but not the underlying connective tissue disease. Despite successful straightening of the penile shaft through surgery, a renewed penile curvature can therefore occur if IPP recurs. To minimise this risk, the operation should only be performed in the so-called stable stage of IPP. Whether IPP is in the stable phase can usually only be determined by an expert urological examination.

When IPP is in the so-called stable phase, an operation to straighten the penile shaft can be performed. Before the operation, in addition to the general examinations, a urological examination by a specialist with ultrasound and assessment of the penile deviation by means of an artificial erection are required.

In addition to the general risks of any operation, such as bleeding, inflammation and impaired wound healing, there are other special risks with penile curvature surgery. As the underlying disease is not cured by the operation, there is a risk of a new penile deviation due to a renewed flare-up of IPP. In rare cases, detaching the neurovascular bundle can lead to permanent impairment of sensation in the glans. Despite straightening of the penis, shortening of the penis as a result of the operation cannot be reliably avoided. All possible risks of the surgical procedure are discussed in a detailed consultation with a urology specialist before the operation.

The skin of the penile shaft is detached via an incision, as in a circumcision operation. The neurovascular bundle is then carefully detached. At the apex of the penile curvature, the tunica of the erectile bodies is then incised transversely. This results in a lengthening of the penile shaft. The defect in the tunica resulting from the lengthening of the penile shaft is covered with a collagen fleece. The neurovascular bundle is moved back. The procedure ends with the adaptation of the penile shaft skin.

Patients are admitted on the day of the operation. After the operation, inpatient treatment for 3 days is recommended. You can have sex again about one month after discharge from the clinic. It is advisable not to work for 1–2 weeks after discharge and to take it easy physically.

During the operation, the success of the corrective surgery is checked by means of an artificial erection. The operation is only completed when the straightening is complete. As correcting the penile deviation does not cure the underlying disease, there is a risk of approx. 10–15% of a recurrence of induratio penis plastica with penile deviation even after successful correction of the penile curvature.

To straighten the penile shaft, the neurovascular bundle in the midline of the penile shaft must be detached. These nerves are very sensitive and difficult to identify during the operation. The neurovascular bundle must therefore be detached very carefully and with a suitable technique. If the neurovascular bundle is detached improperly, this can lead to permanent sensory disturbances of the glans. Many years of experience in detaching the neurovascular bundle are therefore essential.

The costs of a medically necessary operation are determined during a detailed examination, taking into account the patient's individual circumstances. Before treatment, a cost estimate can be submitted to the health insurance company in order to clarify reimbursement.