Name of the Procedure:

Excision of Penile Plaque (Peyronie Disease); with Graft to 5 cm in Length
Common Name: Peyronie's Disease Plaque Removal with Grafting
Medical Term: Penile Plaque Removal with Tunical Insertion Graft

Summary

This procedure involves surgically removing fibrous plaque from the penile tissue, which is causing curvature and pain. The removed area is then repaired using a graft to restore normal function and appearance.

Purpose

Addresses the condition known as Peyronie's disease, characterized by the development of fibrous scar tissue inside the penis, leading to curved and painful erections.
Goals: To remove the plaque, correct penile curvature, and relieve pain, thereby improving erectile function and sexual performance.

Indications

• Significant penile curvature causing difficulty with sexual intercourse.
• Painful erections.
• Psychological distress due to deformity.
• Length of penile curvature causing functional issues, typically warranting surgical intervention when over 30 degrees.

Preparation

• Patients may be instructed to fast for 8 hours before surgery.
• Medication review to stop blood thinners or other pertinent drugs.
• Pre-operative assessment including lab tests, penile ultrasound, and erectile function evaluation.

Procedure Description

1. Anesthesia is administered (general or spinal).
2. An incision is made to expose the affected penile tissue.
3. The fibrous plaque is carefully excised.
4. A graft, typically sourced from the patient’s own tissue (autograft) or synthetic material, is applied to the excised area.
5. The incision is closed, and the area is dressed.

Tools: Scalpel, surgical scissors, tweezers, graft material. Anesthesia: General or spinal anesthesia.

Duration

The procedure typically takes 2 to 3 hours.

Setting

Performed in a hospital or specialized surgical center.

Personnel

• Urologist/Surgeon
• Surgical nurses
• Anesthesiologist
• Operating room staff

Risks and Complications

• Infection
• Bleeding or hematoma formation
• Erectile dysfunction or changes in erectile sensation
• Graft rejection or complications
• Recurrence of plaque formation

Benefits

• Straightening of the penis
• Improved sexual function and less pain during erections
• Psychological benefits from improved penile appearance
• Benefits usually realized within a few weeks post-surgery

Recovery

• Post-operative monitoring for a few hours to a day in the hospital.
• Instructions to avoid sexual activity for approximately 6-8 weeks.
• Pain management with prescribed medications.
• Follow-up appointments to monitor healing and graft success.
• Return to normal activities gradually over several weeks.

Alternatives

• Medical therapy with oral medications or injections (less effective for severe cases).
• Non-surgical therapies like shockwave lithotripsy.
• Risks and benefits vary; surgery generally offers the most definitive correction for significant Peyronie's disease.

Patient Experience

Patients may experience discomfort and swelling immediately post-surgery, managed with pain medication. Initial restricted activities and gradual resumption of normal functions are to be expected, with full recovery and benefits often seen in 6-8 weeks.