Penile Curvature Surgery

Penile Curvature

Like a thin or short penis, penile curvature is included in the classification of penile shape deformities, and it can make sexual intercourse painful and even physically impossible, for the patient as well as for his partner.

Because many men with penile curvature are affected psychologically and sexually by this physical problem, treatment of penile curvature usually turns out to be a necessity rather than a choice.

When penile curvature is mentioned, the first thing that comes to mind is Peyronie's disease, which is seen at older ages, but penile curvature can also be congenital! Therefore, the treatment of penile curvature needs to be approached in two different ways: treatment of congenital penile curvature and treatment of Peyronie's disease. However, as always, I would first like to give a few explanations about the concept of penile curvature. I will share the answers to the most frequently asked questions, such as “What is penile curvature?”, “What causes penile curvature?” and “Does penile curvature go away on its own?”

What Is Penile Curvature?

Penile curvature is a physical condition, either present from birth or emerging with advancing age, characterized by the erect penis bending downward, to the right or to the left instead of extending straight. So what causes it?

Penile curvature can be present from birth or can also appear at later ages. The causes of the two conditions are different.

What Is Congenital Penile Curvature? What Causes Congenital Penile Curvature?

Congenital penile curvature is a condition boys are born with. This penile anomaly, which can be noticed in infancy when the penis is erect, can also cause the urine stream to go crooked when children urinate standing up. Raising parents' awareness of these specific signs is important so that they consult urology and andrology specialists for treatment of congenital penile curvature. Congenital penile curvature is often noticed when puberty begins. There are two main views on the causes of congenital penile curvature. One is that penile curvature results from disproportionate development, or a non-straight structure, of the tubular structures inside the penis that are responsible for erectile function. It is also accepted that hypospadias, a condition characterized by the urinary opening of the penis being located lower than it should be, may, due to the position of the opening, hinder the development of the spongy tissue inside the penis and lead to penile curvature after birth.

What Is Peyronie's Disease? What Causes Peyronie's Disease?

Unlike congenital penile curvature, Peyronie's disease appears at older ages. It is caused by the formation of scar tissue called “plaque” under the skin of the penis. Plaques form in the sheath called the tunica albuginea, which surrounds and protects the tubular structures inside the penis that produce erection. As these hard plaques, which can form in any part of the sheath, develop, they pull on the surrounding tissues and cause the penis to bend during erection. This bending can cause pain during erection, pain during sexual intercourse and, in advanced cases, penile fracture. The course of Peyronie's disease is examined in acute and chronic phases. The acute phase covers a period of approximately 18 months. In this phase, inflammation and plaque formation may be seen in the penis. Curvature of the penis may begin. The penis may hurt even without an erection. As plaque formation progresses, pain may be felt during erection. The chronic phase begins when plaque formation is complete. Approximately 12-18 months after the symptoms of Peyronie's disease appear, the plaques and the penile curvature that results from them become stable. Pain in the penis may decrease. Erectile dysfunction may develop, or existing erectile dysfunction may progress. Although the causes of Peyronie's disease are not known for certain, some risk factors can be mentioned. Factors that increase the risk of Peyronie's disease can be listed as follows: Trauma to the penis Sexual activity that causes micro-injuries to the penis Autoimmune disorders related to connective tissue Diabetes Advanced age Because there are so many risk factors, it is not really possible to give a single, definitive answer to the question “Who gets penile curvature?” What matters is being able to notice the signs of penile curvature early and to seek penile curvature treatment.

Why Is Early Diagnosis Important?

As with many diseases, early diagnosis is of decisive importance for penile curvature. Regardless of whether it is congenital or develops with advancing age, if left untreated or if treatment is delayed, penile curvature is a condition that can harm a man's psychological well-being, affect his sex life and result in erection problems.

It can cause pain and discomfort not only for the patient but also for his sexual partner. In advanced cases, sexual intercourse may become physically impossible because of penile curvature. This deformity, which also increases the risk of penile fracture, requires appropriate treatment options to be evaluated according to its cause and the patient's individual circumstances.

Does Penile Curvature Go Away on Its Own?

The answer to this question may vary depending on the cause of the penile curvature and/or the stage of the disease. Although drug treatment can be used in rare cases, in most cases surgery becomes the only solution.

When the curvature of the penis becomes pronounced, and when plaque formation is complete in curvature caused by Peyronie's disease, surgical treatment of penile curvature becomes the only option.

Waiting for penile curvature to go away on its own means lowering the quality of one's sex life and increasing the likelihood of encountering sexual problems. For this reason, the answers to the question “How is penile curvature treated?” become important.

How Is Penile Curvature Treated?

In the treatment of congenital penile curvature (penile curvature), the duration of the procedure is between 45 and 60 minutes, although it varies depending on the type of procedure, the experience of the surgeon performing it and the patient. The operation can be performed as same-day surgery (the patient arrives on the day of the operation and returns home the same day a certain time after the operation); depending on the type of surgery and anesthesia, the patient is generally discharged from the hospital within 1 day. The success of penile curvature repair has been reported at 85–100% with different techniques. In the surgical treatment of congenital penile curvature, the penile plication technique is a method that, in experienced hands, can be applied successfully with a high rate of patient satisfaction.

Penile curvature that begins in adulthood (Peyronie's disease) has 2 phases: the initial phase (acute phase) and the stable phase (chronic phase). Depending on the phase of the disease, treatment options include drug therapies, vacuum devices, ESWT (extracorporeal shock wave therapy) and surgical treatments.

Surgical treatment of Peyronie's disease is preferred in patients whose penile curvature is severe enough to prevent sexual intercourse, who are in the second phase of the disease (chronic phase) with no progression in the angle of curvature over the last six months, and whose pain has resolved or who have plaque calcification. The appropriate surgical method is determined by a specialist physician, taking into account penile length, degree of curvature, plaque location, whether erectile dysfunction is also present, and the patient's expectations.