In selected cases, Peyronie’s disease and erectile dysfunction can be addressed in the same procedure, with placement of a penile prosthesis and correction of penile curvature.
Living with penile deformities and difficulties in sexual life can be hard. When these problems occur together, a combined surgical approach may be considered in selected cases, after anatomy, erectile function, therapeutic alternatives and the patient’s expectations have been evaluated.
Before determining whether this is an option, it is essential to evaluate the characteristics of each case and take into account the needs of each patient.
Is it possible to perform Peyronie’s surgery with penile implant at the same time?
Yes. In selected cases, the prosthesis can be placed in the same procedure as techniques aimed at correcting the deformity.
In these cases, the penile prosthesis can provide mechanical support to the erection when there is erectile dysfunction. Sexual function and the possibility of sexual activity after the procedure depend on anatomy, sensitivity, adaptation to the device and other individual clinical factors.
The recommendations of the European Association of Urology address the possibility of considering a penile prosthesis in certain patients with Peyronie’s disease and erectile dysfunction who do not have an adequate response to pharmacological treatment. The applicability of these recommendations depends on individual clinical assessment and the exact content of the guideline consulted.
Indication should be made after specialized evaluation, considering erection quality, type of curvature, presence of complex deformities and the functional goals of each patient.
Why can Peyronie’s disease and erectile dysfunction occur together?
Peyronie’s disease does not necessarily cause erectile dysfunction, but the presence of penile curvature can make penetration difficult.
Attempting to maintain sexual intercourse despite pain or a significant curvature can promote repeated trauma and, in some situations, worsen symptoms or interfere with sexual function. In the presence of pain or difficulty with penetration, it is advisable to seek medical evaluation.
The relationship can also occur in the opposite direction: some men already have erectile dysfunction before the disease appears.
Reduced penile rigidity can change how the penis behaves during sexual activity and, in some patients, be associated with trauma or other changes. The relationship between trauma, curvature and fibrosis formation is complex and should be evaluated in the individual clinical context.
When can a penile prosthesis be considered in Peyronie’s disease and when is Peyronie’s surgery with penile implant indicated?
Peyronie surgery with penile implant can be considered when there is:
- Significant erectile dysfunction;
- Insufficient response to medications, injections and adjunctive approaches;
- Deformity that hinders or prevents penetration and movement during sexual activity.
Surgical indication depends on an individualized assessment. In many cases, the evolution and stability of the curvature are considered before deciding, but the appropriate timing for surgery depends on symptoms, anatomy, erectile function, disease evolution and the urologist’s guidance.
Does the penile prosthesis correct the curvature?
In Peyronie’s disease, the penile prosthesis is mainly intended to provide mechanical support to the erection when erectile dysfunction is present. The prosthesis, by itself, does not necessarily correct the curvature or other deformities caused by the fibrotic plaque, and reconstructive techniques may be considered when clinically indicated.
When curvature or other penile deformities persist, a reconstructive technique may be considered in the same surgical act or in another stage, depending on the anatomy, severity of the deformity and the urologist’s assessment.
Can surgery treat the curvature and erectile dysfunction in the same procedure, such as Peyronie’s surgery with penile implant?
When there is an indication for a penile prosthesis, reconstruction of the deformity and placement of the implant can, in certain cases, be performed in the same surgical act.
The technique utilizada deve ser escolhida pelo urologista de acordo com a anatomia, a deformidade e a experiência clínica, sem que a menção a uma técnica específica implique superioridade ou resultado garantido.
The first step is treat the deformity. For this, geometric incisions are made in the tunica albuginea.
These incisions can be used to treat tissue retraction and correct part of the misalignment, depending on each patient’s anatomy and tissues. Any change in length or girth is variable and cannot be guaranteed before the procedure.
After expansion and alignment, it is possible to place a malleable or inflatable penile prosthesis, chosen beforehand.
How is the surgical strategy decided for Peyronie’s surgery with penile implant?
The surgical strategy is defined from a detailed assessment.
In addition to taking the patient’s clinical history and understanding how the deformity interferes with sexual activity, the urologist examines the penis.
The penile ultrasound with Doppler is useful to assess the morphological and vascular characteristics of the penis and to provide information that helps plan the surgical procedure.
For decision-making, factors considered include:
- phase and degree of curvature,
- presence of complex deformities,
- characteristics of the fibrotic plaque,
- quality of erection,
- anatomy of the corpora cavernosa.
Surgeries and treatments previously performed are also taken into account, as well as the patient’s expectations.
From this set of information, the surgeon can assess whether there is an indication for surgery, which technical options to consider, whether placing a penile prosthesis as part of Peyronie’s surgery with penile implant is appropriate, and whether the procedures can be performed in the same surgical session.
The decision should result from an individualized clinical discussion with the patient.
Is it necessary to wait for Peyronie’s disease to be stable?
The evolution and stability of the fibrosis and curvature should be evaluated before surgery. In some patients, intervention is considered after a period of stability, but the appropriate timing depends on the clinical picture, symptoms, anatomy and the urologist’s assessment.
In the acute phase, penile fibrosis and the deformities may still be evolving, with the possibility of worsening or changes in curvature over time.
If surgery is performed in that phase, penile anatomy may continue to change after the procedure.
What is the recovery like after Peyronie’s surgery with penile implant?
In the first days of the postoperative period, there may be pain, swelling and discomfort. The patient goes home with a surgical dressing, which should be cared for according to the instructions received from the medical team.
The patient should maintain medical follow-up so that healing, adaptation to the implant and the possible need for rehabilitation can be assessed.
The resumption of activities and sexual life is gradual and should follow the guidance of the medical team. The timing for returning to the usual routine varies according to healing, the type of procedure, clinical course and individual response, so a single timeframe should not be presented as an expectation of recovery.
What results can be expected? (Peyronie’s surgery with penile implant)
Results vary according to the clinical picture, anatomy, technique used and the course of each patient. Depending on the indication and the procedure performed (for example, Peyronie’s surgery with penile implant), objectives such as reduction of curvature, support of erection or functional improvement can be discussed.
It is not possible to guarantee alignment, increase in size, penetrative ability, resumption of sexual activity or improvement in sexual quality of life in all cases.
Satisfaction after surgery varies among patients and should be interpreted in light of expectations, functional goals, clinical course and the possible risks and limitations of the procedure. Results from studies or patient groups cannot predict the satisfaction of any particular person.
When indicated, a combined surgery can treat the deformity and erectile dysfunction in the same procedure (for example, Peyronie’s surgery with penile implant). The eventual impact on sexual activity varies among patients, and the combination is not suitable or necessary for everyone.
If you have Peyronie’s disease associated with erectile difficulty or a deformity that interferes with sexual activity, a specialized evaluation can help determine whether surgery and placement of a penile prosthesis (Peyronie’s surgery with penile implant) may be considered in your case.