The following slideshow contains surgery photos of actual Peyronie’s surgery performed by Dr. Gelman at the Center for Reconstructive Urology at the University of California, Irvine Medical Center in Orange County, California. These pictures demonstrate the technique of correcting penile curvature with plication.
Surgery to correct straighten a bent penis in a man with Peyronie’s Disease begins with a skin incision. In this picture of Peyronie’s Disease surgery, the skin is marked circumferentially approximately 1 cm proximal to the area where the head of the penis (glans penis) meets the shaft, called the coronal sulcus.
In this Peyronies Disease surgery picture, the skin is incised. This is called a circumcising incision, even though in this case, an actual circumcision (removal of foreskin) is not performed. Our surgery to correct penile curvature is performed under general anesthesia.
After the skin is incised, the penile skin is “degloved” and brought down to the base of the penis. The penis plaque is deep to the skin and other tissues. In this picture of surgery to correct upward penile curvature, after the skin is degloved, the urethra (surrounded by a structure called corpus spongiosum) and the erectile bodies called the corpora cavernosa can be seen.
In this photograph of surgery to straighten penile curvature, saline is rapidly infused into the penis as the base of the penis is compressed to create an "artificial erection". The abnormal area where the penis is crooked can be seen. Plications are then performed on the opposite side. When there is upward penile curvature, the plications are performed on the undersurface of the penis.
After the penile skin is degloved and the area of penile curvature is identified, the neurovascular structures (that contain nerves to the glans penis) must be moved to the side, exposing the tissue to be plicated to straighten the bent penis. This tissue is called the tunica albuginea. This dissection is performed under optical magnification, and expertise is required to safely expose this tunica without damaging the sensitive nerves.
A pen was used to mark the exposed tunica albuginea to be plicated. The removal of the tissue between the yellow lines will shorten the penis in that area by an amount corresponding to the distance between the lines. When there is penile curvature, the long side is shortened to tilt the bent penis straight.
In this Peyronie's Disease surgery photograph, the neurovascular bundles have been mobilized on the right side of the undersurfase of the penis (ventral-lateral) which is on the left side of the picture, and the area to be plicated is marked. This picture demonstrates the comparison of the appearance before and after the mobilization.
When upward penile curvature is corrected, we plicate along the undersurface of the penis on both sides of the urethra. In this photo, the neurovascular bundles have been lifted off the tunica albuginea. The urethra is in between the areas to be plicated. Curvature could also be corrected by mobilizing the urethra and performing a midline plication. However, it is our preference to not disturb the urethra to best protect the urethra from possible injury.
Before actually making a permanent change to the penis, we first perform a temporary plication using suture to pinch the area to be plicated. In this photograph of penile plication surgery for Peyronie’s Disease, the suture has been placed but has not yet been tied.
After the temporary plication suture is placed, the suture is tied. An artificial erection is then performed to confirm that the plication of this area will help straighten the bent penis. We will then remove the temporary suture and perform a permanent plication to correct the penile curvature by performing an oval shaped excision of tissue and a 2 layer closure.
In this photograph of Peyronie’s Disease plication surgery for upward penile curvature, plications have been performed with one plication on each side of the urethra along the undersurface of the penis. Our preference is to use absorbable suture that will eventually dissolve so that the patient does not feel the knots of permanent sutures.
When there is severe penile curvature, multiple plications are needed to fix a curved penis. In this patient where the penis is abnormally bent upwards, there was only partial correction of the curvature after a single plication on each side of the urethra. We then performed additional plications, and this straightened the penis, which was confirmed with an artificial erection.
In addition to Peyronie’s Disease, another cause of an abnormal penis is Congenital Penile Curvature. Men who report life long curvature, especially to the side, are born with unequal development of the tunica albuginea of the penis. During an erection, one side is abnormally longer than the opposite side, and this causes a bent penis. In this photograph, plication is performed to fix the penile curvature.
When there is downward penile curvature, which is less common than an upward bent penis, the plications are performed along the top of the penis to tilt the penis back upward. In this patient, 3 plications were required. Prior to surgery, he had disabling 90 degree downward penile curvature. After surgery, his penis was straight and he was able to resume sexual intercourse.
After the plications are all performed and the penis is straight, the neurovascular bundles are then replaced to again cover the tunica albuginea. In this Peyronie’s Disease surgery picture, on one side, the neurovascular tissue is being repositioned to cover the exposed tunica albuginea as it did before the surgery.
Before the skin is closed following penile plications to correct curvature, a final artificial erection is performed to confirm that the bent penis was straightened. In this photograph, the artificial erection revealed that the penis is now completely straight.
In this picture of Peyronie’s Disease surgery, the skin incision has been closed with absorbable suture. These sutures do not have to be removed as eventually, they dissolve. We leave a small tube under the skin for less than 24 hours to drain any blood. However, bleeding after surgery is rare and to date, we have never had the complication of significant bleeding after penile curvature correction surgery.