54112 Excision of penile plaque (Peyronie disease); with graft greater than 5 cm in length

Name of the Procedure:

Excision of Penile Plaque (Peyronie Disease) with Graft Greater than 5 cm in Length

Summary

Excision of penile plaque with grafting is a surgical procedure to remove scar tissue (plaque) from the penis and replace it with a graft. This helps to correct penile curvature and improve function for men affected by Peyronie's disease.

Purpose

The procedure addresses Peyronie's disease, a condition characterized by the formation of fibrous scar tissue inside the penis, leading to curved, painful erections. The goal is to straighten the penis, relieve pain, and improve sexual function.

Indications

• Severe penile curvature or angulation interfering with sexual intercourse
• Erectile dysfunction linked to Peyronie's disease
• Persistent pain during erections
• Failure of non-surgical treatments

Preparation

• Preoperative fasting for at least 8 hours
• Discontinuation or adjustment of certain medications as advised
• Preoperative physical examination and medical history evaluation
• Diagnostic imaging, like penile ultrasound, may be performed

Procedure Description

1. General anesthesia or regional anesthesia is administered to the patient.
2. An incision is made along the shaft of the penis to expose the plaque.
3. The plaque is carefully excised (removed).
4. A graft material (e.g., tissue from another part of the body or synthetic material) is used to cover the excised area, measuring more than 5 cm in length.
5. The graft is meticulously sutured in place to maintain the shape and function of the penis.
6. The incision is closed, and the area is bandaged.

Duration

The procedure typically takes 2-3 hours.

Setting

The procedure is usually performed in a hospital operating room or an outpatient surgical center.

Personnel

• Urologist or specialized surgeon
• Anesthesiologist
• Surgical nurses
• Operating room technicians

Risks and Complications

• Infection at the surgical site
• Bleeding or hematoma formation
• Graft rejection or failure
• Erectile dysfunction
• Sensation changes or numbness in the penile area
• Recurrence of penile curvature

Benefits

• Correction of penile curvature and improvement in the appearance
• Relief from pain during erections
• Enhanced sexual function and ability to engage in sexual activity

Recovery

• Hospital stay of 1-2 days for monitoring
• Pain management with prescribed medications
• Instructions for wound care and hygiene
• Avoidance of sexual activity and strenuous exercise for about 6-8 weeks
• Follow-up appointments for progress assessment and stitch removal

Alternatives

• Oral or injectable medications (e.g., collagenase injections)
• Non-surgical therapies like shock wave therapy
• Penile traction devices
• Expectant management (watchful waiting), especially if symptoms are mild

Patient Experience

During the procedure, the patient will be under anesthesia and will not feel pain. Post-operatively, some discomfort and swelling are expected, which can be managed with medications. Gradual improvement in symptoms is expected, though patience is required for complete healing.