Peyronie’s surgery

Surgery for Peyronie’s disease is serious business

As the author of this website I am not against Peyronie’s disease surgery;  I am against the abuse of surgical treatment of Peyronie’s disease.   Commonly I encounter men who report that at the office visit when their newly developed and manageable case of Peyronie’s disease was first examined and diagnosed, the doctor proposed that same day that Peyronie’s surgery should be scheduled soon.   This is not consistent with medical standards, but is apparently done with some frequency based on my communications.

Typically, a good surgeon will demand that a man with Peyronie’s disease will fulfill these basic requirements before even bringing up the topic of penis surgery:

  1. Severity – This is the most important factor.  The deformity must be severe enough to seriously interfere with or stop satisfactory sexual intercourse.
  2. Adequate time for healing and spontaneous recovery has passed – Usually agreed to be from 12-18 months from the time of onset of Peyronies.
  3. Non-responsive to a fair trial of medical therapy –  In practice, many doctors attempt only one form of drug treatment.  When that fails the patient is told surgery is the only other option.  It appears that doctors acknowledge the poor results achieved by medication for Peyronie’s disease, that they are quick to brush aside drugs and proceed to the operating room.  
  4. Painless, stable and unchanging condition of scar –  Since it is difficult to judge stability of the Peyronies plaque on the basis of two or three office visits that are a few months apart, and that many doctors ever locate the PD scar, it is doubtful this criteria is seriously considered.

The p0ateint’s decision to agree to surgery is often based only on the doctors recommendation.  The patient with Peyronie’s disease is so lambasted by shock and confusion that this kind of health problem even exists that he accepts the first suggestion given to him, and does not appraise his condition in relation to the likely outcome of surgery.  From my experience since 2002 counseling men who have had failed Peyronie’s surgery outcomes, this is where the real problem of Peyronie’s surgery begins.  I have worked in the office of surgeons so I have direct experience in how they think about their own work , how they explain procedures to nervous and worried patients, and how they tend to appraise surgical outcomes.

As an example, taken from the Mayo Clinic website:  “Mayo Clinic urologists have achieved a high rate of success using surgery to restore the normal shape and function of the penis in men with Peyronie’s disease.”

When a doctor says that “a high rate of success” is achieved from surgery to restore penis shape and function, there are two different possible interpretations what that means.   The first is what the doctors means and the second is what the patient thinks a high rate of success means; I will bet you they are two different things.    This same difference of interpretation takes place when a doctor says she gets “very good” results from a surgery and what the patient thinks “very good” means in relation to surgical outcome.

Surgical success in Peyronie’s disease is usually about improvement of the curved penis, and how that relates to improved ability to penetrate for intercourse.    In the surgeons mind it is possible that success means taking a 90 degree curve to something around 20-30 degrees, period.   So long as the surgery has made a large improvement in the penile distortion, the surgery will be called a success even if pain, numbness or softening of the erection are direct side effects of surgery.  In the patient’s mind he thinks he has traded one problem for another, and he is not sure if he was better off before the surgery.

The surgeon thinks:   “The penis was badly curved, and now it is much closer to being straight.  I had to do three hours of difficult cutting and reconstruction.  Of course there will be some residual nerve damage and soft tissue problems with all the tissue that had to be removed.  Any side effects he is having is within the accepted limits of a standard and customary outcome.   On top of all that the insurance company cut my bill in half.  What does this guy expect from me?  Miracles?”

Surgical success in the patient’s mind is basically about getting back to normal.   That is success.   If the doctor said he has a high degree of success or high rate of success, then the patient expects that most people are back to normal after surgery.   This likely includes no penile curvature and erections of a teenager.   In the patient’s mind he thinks he has traded one problem for another, and he is not sure if he was better off before the surgery.

The patient thinks:  “Sure, my penis is less curved, but now it is smaller.  I can have sex, but now I don’t want to anymore because of the pain I have.  At least before the surgery I did not have pain.   Sure I am straighter, but what difference does that make if it hurts so much?  On top of that I now lose my erections after a few minutes because of the pain.  I am having new kinds of trouble and my surgeon got almost $20 thousand dollars for a few hours work.  It is just now fair.”

A patient should ask the doctor specific questions about the outcomes of the proposed surgery, but seldom does for many reasons, the first being simply a feeling overwhelmed.  Ask the doctor what she means when she says that she gets real good results with her Nesbit technique or whatever kind of surgery will be done.   Get a crystal clear image of what you can expect to happen and how you will feel after the 1st day, the 1st week, the 1st month, and the 1st year.   If the doctor will not talk to you before the surgery, you will get less time and attention after the surgery.

Risks of Peyronie’s disease surgery

Risks of surgery for Peyronie’s disease include problems that are essentially permanent:

  • Pain, constant or occasional
  • Lost or diminished penile sensation
  • Reduced penis size, length and girth, sometimes as much as two inches
  • Impaired ability to achieve an erection, minor to total impotency
  • Return or worsening of the curvature

 

How to select a Peyronie’s surgeon

There are those times when Peyronie’s penis surgery must be done.

If you sincerely feel you have faithfully and honestly used all possible drug and non-drug options to avoid Peyronie’s surgery, and they have all been unsuccessful, and now you cannot continue with the pain or your reduced sexual function that is due to a curved penis caused by Peyronie’s disease, then you should most carefully consider penis surgery and the person who will do it.

This is reasonable advice to help you select a Peyronie’s surgeon, or any surgeon, because it all comes down to the same basic traits and characteristics that make someone a good surgeon:

1.     Do your research.  While any physicians can claim to be a Peyronie’s specialist, you should only consider using a doctor who is a  Board Certified Urologist with a sub-specialty in genitourinary surgery, or a Board Certified Urologist with a sub-specialty in surgery that does exclusively genitourinary surgeries.  For example, a surgeon might be a board certified urologist with a subspecialty in genitourinary surgery, but might also further specialize in operating only on male patients.  Whether this surgeon might do male urogenital surgery on the elderly (geriatrics) or male children (pediatrics) only makes his experience more valuable.  You definitely do not want to have surgery performed by someone who comes to you randomly, without experience in working with Peyronie’s disease.

2.    Get comfortable with the idea you might have to travel to a distant city to find what you are looking for.   The best doctor you can find will probably not be located near you.   The need to have experience and site-specific and disease-specific training cannot be emphasized too much.  After all, it is your penis that is going to be cut on, and you want the best you can find holding the knife above you.

3.    Do not allow yourself to be pressured into a decision; there is no need to rush.  Plan on spending at least six months doing your research.   The more time you spend the fewer mistakes you will likely make when you must decide.  If it takes you a full year to collect information, all the better you will feel and all the better your results will be.

4.    Generally, having a plastic surgeon do the Peyronie’s operation is not a good idea.  While a plastic surgeon might be skillful in facial work, with a good technique and a good hand for doing fine details around the face, those skills do not necessarily carry over into removal of the PD scar material.  If your primary Peyronie’s or genitourinary surgeon wants to use a plastic surgeon for one particular phase of your PD surgery, and that primary surgeon will stay at the operating table the entire time, that is fine.  It all comes down to training and experience in the area of the penis, especially removal and reconstruction of penis tissue.

5.    Your surgeon should have broad and deep experience with Peyronie’s disease.  The larger this number, compared to others, the more likely you should consider a doctor.  Your surgeon should have performed at least 25 prior surgeries of the specific type you are going to have; this is especially true concerning Nesbit plication.   Someone who has done 10 Nesbit surgeries does not know as much as someone who has done over 100. You want a doctor who has seen and done it all, cannot be rattled, knows how to handle every circumstance,  and will not be surprised while you are under the knife – or later.

6.    This might seem to be a small and slightly odd consideration, but it is a good idea to look for a suggest who has a spotless and well organized office, and a very clear and neat desk –you should look for indicators you have a surgeon who is meticulous and highly motivated for fine detail work.    You want a neat-freak to be doing your Peyronie’s surgery.

7.    Your surgeon should make good eye contact and have a warm personality.  Not only will this be what this surgeon is like when you are under his/her knife, but this is how you will be treated in discussions before and after surgical care – not ignored or forgotten.   Look for someone who is open and friendly and a good communicator before surgery, because these will be the skills of a great doctor when you need it the most.

8.    If you know someone who is a nurse where your surgeon practices, ask her to ask her nurse-friends about the surgeon you are thinking about using.   I worked with an orthopedic surgeon who was the extremely popular at the hospital where he worked; all the nurses who worked in that hospital thought highly of him and brought their kids to him for broken bones and for their husband’s bad backs.  Nurses know and talk about all  the bad stuff and all the good stuff going on in their hospital.   Take advantage of this information.  A good nurse will not give you bad information.

9.    Google the doctor you are considering to use to look for strong indicators about the skill and ability he/she possesses.   Get the surgeon’s  professional work history, as well as reports from the state board of medical review for any disciplinary actions that might have been taken against this doctor.  If one doctor has been sued three times for malpractice and there are three doctors who have never been sued, your decision becomes much easier to make.

Start with conservative Peyronie’s treatment, then consider penis surgery if necessary

Bad outcomes will not happen to all men who have Peyronie’s surgery.  Even if the possibility is remote you do not want to expose yourself to the chance of a surgical problem if you can avoid it.   Surgical bad reactions can and do happen, so the possibility should be clearly kept in mind before rushing into surgery.   Weekly I hear from men who tell me their doctor on the first visit suggested penis surgery to “correct” their Peyronie’s disease, and then they describe all the things that went wrong with the surgery.

It is safer and wiser to take a more conservative route of care using the Alternative Medicine form of natural Peyronie’s treatment options before considering surgery.