54110 Excision of penile plaque (Peyronie disease)

Name of the Procedure:

Excision of penile plaque (Peyronie disease)

• Common names: Plaque removal surgery, Peyronie’s disease correction surgery
• Medical term: Penile plaque excision

Summary

This surgical procedure involves removing the plaques (scar tissue) from the penis that cause curvature, pain, and other symptoms associated with Peyronie's disease. The goal is to restore the normal shape of the penis and reduce discomfort.

Purpose

• Addresses: Peyronie’s disease, characterized by the formation of fibrous scar tissue inside the penis, leading to curved, painful erections.
• Goals: To remove the plaque, correct penile curvature, alleviate pain, and improve sexual function and quality of life.

Indications

• Men experiencing significant penile curvature (usually greater than 30 degrees) due to Peyronie’s disease.
• Presence of painful erections and/or difficulty with sexual intercourse.
• Failure to respond to non-surgical treatments.

Preparation

• Pre-procedure instructions: Fasting typically required from midnight prior to surgery.
• Medication adjustments: Blood thinners and certain other medications may need to be paused.
• Diagnostic tests: Ultrasound or other imaging tests to assess the plaque location and penile curvature.

Procedure Description

1. Patient is placed under local or general anesthesia.
2. An incision is made in the penis to access the plaque.
3. The surgeon excises (cuts out) the plaque.
4. In some cases, a graft may be used to replace the removed tissue and maintain penile shape and function.
5. The incision is closed with sutures.
   • Tools/technology: Scalpel, surgical scissors, sutures, graft material (if used).
   • Anesthesia: Local or general anesthesia depending on individual case and extent of surgery.

Duration

Typically takes 1 to 3 hours.

Setting

Performed in a hospital or an outpatient surgical center.

Personnel

• Surgeons specialized in urology.
• Anesthesiologists for anesthesia management.
• Surgical nurses and support staff.

Risks and Complications

• Common risks: Pain, swelling, infections, and bruising at the surgical site.
• Rare risks: Reduced sensation, erectile dysfunction, penile shortening, recurrence of curvature, or graft rejection (if a graft is used).

Benefits

• Expected benefits: Improved penile curvature, reduced pain, enhanced sexual function.
• Realization time: Many patients notice improvement within a few weeks, though complete healing may take several months.

Recovery

• Post-procedure care: Pain management, wound care, and avoiding sexual activity until cleared by the doctor.
• Recovery time: Generally, a few weeks to a few months, depending on individual healing.
• Restrictions: Avoid heavy lifting, strenuous activity, and follow specific instructions for sexual activity.
• Follow-up: Regular follow-up appointments to monitor healing and ensure satisfactory outcomes.

Alternatives

• Medical management: Oral medications, injections directly into the plaque, and penile traction therapy.
• Other surgical options: Penile plication and penile prosthesis implantation.
• Pros and cons: Non-surgical options may be less effective but have fewer risks; other surgeries might address different aspects of Peyronie’s disease or be appropriate for different stages of the disease.

Patient Experience

• During procedure: Under anesthesia, the patient should not feel pain.
• After procedure: Pain and discomfort managed with prescribed pain medications; expect some swelling and bruising.
• Pain management: Effective pain relief strategies, including medications and ice packs, are provided.