Surgical procedures should only be used in cases of severe functional impairment i.e. severe penile curvature with significant problems with cohabitation (intercourse). Before surgical intervention, it must be ensured that there is a disease arrest of about 6-12 months.
1st order (for induratio penis plastica).
- Surgery according to Nesbit (shirring technique): on the longer, convex (“curved outward”) side of the penile curvature at the punctum maximum of the curvature, the tunica albuginea (connective tissue covering around the corpora cavernosa) is removed in an elliptical shape and the defect is closed with shirring sutures. This adjusts the longer side of the penis to the shorter (concave) side and thus straightens the penis.
- The surgical procedure does not affect the distal constriction of the corpora cavernosa (so-called hourglass-shaped retraction in the middle of the penis), ie does not correct this.
- Operation according to Ebbehoj or Essed/Schröder (shirring technique): in contrast to the first described surgical procedure, here skin wedges are not taken from the corpus cavernosum, but the corpus cavernosum skin is merely gathered by shirring sutures.
- Elimination of penile curvature by plaque excision with plastic coverage of the defect (grafting technique): in this surgical technique, the incision is made through the plaques on the concave i.e. on the shorter side of the penile curvature. In this way, the penis can be straightened and the shorter concave side is thus adapted to the long convex side. The material used for grafting is used to cover defects created during excision (surgical removal) of plaques (nodes). In grafting comes to use endogenous material (eg, great saphenous vein (the largest superficial vein of the lower limb), oral mucosa or a dorsal vein of the penis).
- Implantation of a hydraulic penile prosthesis (hydraulic erectile tissue implant): in this case, the pump is implanted (implanted) in the scrotum and is connected to a water balloon placed in the abdomen and the erectile tissue implant in the penis.
- Indication: simultaneous presence of induratio penis plastica, penile deviation and erectile dysfunction / erectile dysfunction (which does not respond or responds poorly to phosphodiesterase inhibitors (PDE inhibitors)).
Further notes
- After removal of penile bending by plaque excision with plastic coverage of the defect (grafting technique), treatment with vacuum erection systems should be performed from the second postoperative week to counteract shrinkage of the graft material.
