Recurrence of curvature after surgery for Peyronie’s disease is uncommon when the intervention is performed at the appropriate time. Learn about the factors that can influence this risk and when a penile prosthesis may be part of the treatment.

If the curvature was corrected, could it reappear later? Recurrence of Peyronie’s disease is possible, and precisely for that reason it can leave men worried, with low expectations about treatment and apprehensive after surgery. However, this does not mean the deformity will necessarily return.

Accurate assessment of the phase of Peyronie’s disease, selection of the surgical technique and performing the procedure at the appropriate time are important factors to reduce that risk.

Therefore, understanding the condition’s evolution and planning each case individually is essential to pursue more predictable and longer-lasting results.

Why Can Penile Curvature Return After Surgery?

The possibility of recurrence of Peyronie’s disease is mainly related to the stability of the condition at the time of intervention.

During the active phase, fibrosis may continue to progress, with changes in curvature or other penile deformities. For that reason, the recommendations of the European Association of Urology (EAU) advise that surgery be performed after clinical stability has been confirmed – that is, during the chronic phase of Peyronie’s disease.

Performing a surgical treatment while the fibrosis is still in the inflammatory phase may cause the anatomy to continue to change after surgery, even if the existing deformity was correctly reconstructed during the procedure.

Even when surgery is performed in the stable phase of Peyronie’s disease, there is a chance that the curvature may reappear later, due to the development of a new fibrotic process, especially when the patient has a predisposition.

When Is a Penile Prosthesis Considered?

The penile prosthesis should not be used as a strategy to prevent recurrence of Peyronie’s disease. Its main indication in this context is the presence of erectile dysfunction significant enough that it does not respond adequately to medical treatment.

This means that having a marked curvature or a severe form of the disease does not, by itself, determine the need to implant a prosthesis. A man may have a complex deformity and maintain sufficient erectile function. In that situation, other reconstructive techniques may be considered.

When Peyronie’s disease is associated with clinically relevant erectile dysfunction, a penile prosthesis may be part of the surgical strategy to restore the rigidity necessary for sexual activity.

If a curvature persists after cylinder placement, penile reconstructive surgery can be performed during the same procedure, using techniques appropriate to the case.

Therefore, the indication for a penile prosthesis results from the assessment of erectile function and not with the goal of preventing fibrosis from redeveloping.

Peyronie’s Disease Recurrence After Surgery: Factors That May Reduce the Risk

Some clinical and follow-up aspects can be considered when addressing the risk of recurrence of penile curvature:

• Confirm clinical stability of the disease before surgery: the decision on the timing of intervention should result from individualized clinical assessment. Stability of the curvature is one of the elements commonly considered, since evolving disease may be associated with subsequent changes.
• Choose the surgical technique: penile deformities are not all addressed in the same way. The type of curvature, the presence of areas of thinning, penile length and erectile function are elements that may contribute to the discussion of the surgical approach in each patient.
• Carry out individualized surgical planning: the assessment may include analysis of penile anatomy, fibrotic plaques, areas of deformity and erectile function, according to the characteristics and clinical needs of each case.
• Consider the complexity of the case: the deformities associated with Peyronie’s disease may require different penile reconstruction strategies. The therapeutic decision should result from individualized assessment, appropriate competence of the clinical team and an informed discussion of the alternatives, expected benefits and risks.
• Maintain follow-up after surgery: the postoperative follow-up allows monitoring of healing, the evolution of erectile function, symptoms and the stability of the reconstruction. If new changes arise, these can be assessed in a timely manner in the appropriate clinical context.

In Peyronie’s disease, reducing the risk of recurrence of curvature depends mainly on correct assessment of the disease phase, choice of the most appropriate surgical technique and the timing of surgery. When there is significant erectile dysfunction, a penile prosthesis may be part of the therapeutic plan, but its indication results from the patient’s functional assessment and not from prevention of recurrence.

Peyronie’s Disease Recurrence: Surgical Planning and Follow-Up

In Peyronie’s disease, discussion of the risk of deformity recurrence should be part of the preoperative information and subsequent follow-up. New fibroses may appear, so no surgery completely eliminates the possibility of future changes.

Individualized assessment before intervention and subsequent follow-up are relevant components of decision-making. Indication for a penile prosthesis may be considered when there is clinically relevant erectile dysfunction, after discussion of the case characteristics, alternatives, expected benefits and risks; it is not intended to prevent recurrence of curvature.

Because each case may evolve differently, an individualized clinical assessment may help to appraise disease stability, identify potentially relevant factors and discuss follow-up or treatment options appropriate to each patient’s context.

When there is erectile dysfunction, the indication for a penile prosthesis may also be evaluated, according to the characteristics and needs of each patient.