Correction of acquired penile deviations due to induratio penis plastica (IPP)
The cause of induratio penis plastica (IPP) is a disorder of the connective tissue metabolism in which the elastic connective erectile tissue of the sheath becomes fibrous and brittle. This brittle connective tissue leads to shrinkage of the erectile tissue sheath and results in penile deformity, causing discomfort during sexual intercourse. This deformation can only be corrected by surgical straightening. Conventional procedures lead to a considerable shortening of the shaft of the penis. In 2002, Prof. Dr. med. Sven Lahme published a surgical method that corrects the curvature of the penis by stretching the shaft of the penis and covering the erectile tissue defect with collagen fleece. This method is particularly successful in case of pronounced penile deviations and is now established as the standard surgical technique for IPP.
Questions about the diagnosis and treatment of induratio penis plastica (IPP)
Induratio penis plastica (IPP), also known as Peyronie’s disease, is a disease affecting the connective tissue of the sheath, making it fibrous and brittle. The cause of the disease is still unknown. It is possible that a genetically determined change in the collagen mechanism which, together with injuries to the erectile tissue, triggers the development of plaques. IPP often occurs with Dupuytren’s disease, in which similar shrinking processes occur in the flexor tendons of the hands.
Typical symptoms of induratio penis plastica include hardening of the penis, curvature of the penis, penile shortening, constriction of the penis (also known as an “hourglass deformity”), erectile dysfunction, obstruction during sexual intercourse, and pain in the penis both when erect and not erect. It is important to distinguish IPP from congenital penile deviation. Penile deviations due to IPP do not occur until later in life, usually around 50 years old, whereas congenital penile deviations exist from infancy. Congenital penile curvatures are almost always directed downwards, whereas penile deviations caused by IPP are mostly directed upwards.
An operation for IPP is recommended if sexual intercourse is hindered or no longer possible due to the curvature of the penis. The operation is only a treatment for the curvature, but not for the underlying connective tissue disease. Despite successful stretching of the penis shaft through surgery, it is still possible for IPP to reoccur and lead to renewed curvature. In order to minimise this risk, the procedure should only be performed in what is known as the stable stage of IPP. Whether IPP is in the stable stage can usually only be determined by urological examination by an expert.
If the IPP is in the stable stage, surgery can be performed to stretch the shaft of the penis. Before the procedure, in addition to the general examination, it is necessary to conduct a urological examination with ultrasound and detection of the penile deviation using artificial erection.
In addition to the general risks of any surgical procedure, such as bleeding, inflammation, and disturbance of wound healing, there are risks specific to this type of surgery. Since the surgical intervention does not treat the underlying disease, there is a risk of renewed penile deviation. In rare cases, the release of the vessel/nerve bundle can lead to permanent impairment of sensation at the glans. Despite stretching the penis, penile shortening cannot always be avoided by the procedure. All possible risks of the surgical intervention are discussed in a detailed explanatory discussion prior to the procedure.
Short info on correction of induratio penis plastica (IPP)
|Indication||Penis deviation with functional complaints during sexual intercourse|
|Procedure||Stretching of the penile deviation by incision of the inner side of the curvature. Covering of the resulting defect with collagen fleece.|
|Surgery time||Approx. 1-2 hours|
|Clinic stay||3-4 days|
Questions about the correction of penile deviations in IPP
The skin of the shaft of the penis is detached through an incision, as in circumcision surgery. The vascular/nerve bundle is then carefully loosened. At the apex of the penile curvature, the erectile tissue sheath is incised transversely. This results in stretching of the penis shaft. The defect in the corpus cavernosum resulting from the stretching of the penile shaft is covered with collagen fleece. The vascular-nerve bundle is retracted. The procedure ends with adaptation of the penile shaft skin.
Admission for surgery takes place on the day of the procedure. After the operation, inpatient treatment is recommended for 3 days. Sexual intercourse is possible again about one month after discharge from the clinic. It is recommended not to work for 1-2 weeks after discharge and to avoid physical exertion.
During the procedure, artificial erection is used to check the success of the corrective surgery. The procedure is only finished when the straightening is complete. Since correction of penile deviation does not treat the underlying disease, there is a risk of recurrence of IPP with penile deviation in about 10-15% of patients, even after a successful procedure.
To stretch the shaft of the penis, it is necessary to release the vascular/nerve bundle in the midline of the shaft of the penis. These nerves are sensitive and difficult to see during the surgery. The detachment of the vascular/nerve bundle must therefore be done very carefully using a suitable technique. If the vascular/nerve bundle is detached improperly, it can lead to permanent disruption in the sensation of the glans. Therefore, experience in releasing the vascular/nerve bundle is essential for a successful procedure. Prof. Dr. med. Sven Lahme has performed this procedure about 1500 times over a period of more than 25 years.