What is Peyronie's disease? Share your Peyronie's disease experience Andropeyronie penis extender Visit my Peyronie's shop

Plication Surgery
For Men With Peyronie's Disease

Plication surgery is relatively straightforward surgical procedure aimed to straighten penis curvature, one of the main symptoms of men with Peyronie's disease.

Penile plication is not suitable for all men with Peyronie's disease. The ideal candidate has good erectile function, adequate penile length and moderate penile curvature without any associated deformity.

What Is Penile Plication Surgery?

Penile plication is a group of surgical procedures aimed to straighten curved penis. One of them is the Nesbit procedure, the original tunical shortening procedure.

Surgeons at work

There have been several modifications on the Nesbit procedure over the years, aimed to limit the risk of post-operative erectile impairment. The so-called simple plication approach is now preferred over the Nesbit procedure to treat men with Peyronie's disease.

Penile plication is a tuck procedure on the side opposite to the plaque (scar) thus shortening the long side of the penis.

Trying to explain this simply - think of bent penis. The curvature is because one side of the penis is longer than the other side. The short side is inside the penis, i.e. where it bends. The long side is the outer side of the penis. By shortening the long side (by pinching together the tissues on the outer side of the penis bend), the penis is kind of “hauled” back up.

The outcome is straighter, but usually a shorter penis.

If you have already had, or are planning to have, plication surgery, then you should consider using traction device to prevent post-surgical penile shortening.

Who Is Ideal Candidate For Plication Surgery?

The ideal Peyronie's candidate can achieve erection, has adequate penile length and simple penile curvature, i.e. without any associated deformity like hour-glass effects, hinge or waisting.

Most Peyronie's specialists prefer the penis curvature to be less than 60 degrees to qualify for plication surgery (some even insist on less than 40 degrees). Grafting Surgery is more suitable for men with more severe penis curvature, as well as those that have narrowing penis deformity.

There is also substantial risk of penile shortening after plication operation. Men with stretched penile length under 10 cm. might therefore prefer to have grafting surgery.

Any penis surgery can result in penis shortening but the risk is less for those that undergo grafting surgery, i.e. lengthening the shorter side (grafting) vs. shortening of the longer side (plication).

Finally, to qualify for plication operation, the patient must also be able to achieve and maintain erection (even if assisted with Viagra or other virility medication). Men with Peyronie's disease that suffer from erectile dysfunction will have to have Penile Implants.

What Are The Benefits Of Peyronie's Plication Surgery?

Penile plication benefits include the simplicity of the procedure. Plication is usually performed on a patient under local anesthesia, which reduces the operation risk (less potential morbidity).

Plication also offers excellent results (straightening bent penis) and high patient satisfaction.

What Are The Downsides Of Plication Peyronie's Surgery?

Peyronie's surgical treatments are the most expensive treatment options available. However, in some cases they are the only option. Surgery is the most reliable way of correcting penis deformity but unfortunately, the side effects can be substantial and severe.

Men undergoing any penile surgery cannot resume sexual activity immediately after surgery. It varies how long it takes but usually up to 2-6 months to recover enough for full intercourse to take place.

However, the biggest downside of plication surgery for most men is the penile shortening. This is due to the nature of the process. Plication makes the long side of the penis shorter, resulting in shorter penis (0.5cm - 1.5 cm shorter).

What Are The Possible Side Effects?

There are number of side effects. The most serious one is the inability to achieve or maintain erection, i.e. the risk of becoming impotent. Penile shortening is though more common side effect, been reported in between 41 to 90% cases (various studies).

Other possible plication side effects include loss of penile elasticity / sensation and permanent palpable penis lumps.

Does Plication Operation Involve Any Health Risk?

All surgery is an invasive procedure and therefore involves some level of risk. This risk is somewhat reduced as plication can usually be performed under local anesthesia.

There are no major complications associated with the plication procedure as such but there is a real risk of erectile dysfunction or becoming impotent.

Results Of Using Plication For Peyronie's Disease

Penile plication surgery has shown reliable results in straightening curved penis and improving sexual function in appropriately selected Peyronie's patients. Many patients have achieved near complete correction of their penis curvature.

Furthermore, the long-term results have been promising, with low rate of penile curvature recurrence. Few Peyronie's patients have therefore needed second surgery.

There has also been high patient satisfaction with the cosmetic results achieved by the surgery.

Find out what Dr. Levine, one of the best known Peyronie's specialists in the world today, has to say about the benefits, side effects and results from the different Peyronie's surgeries.

Scientific Support
For Plication Surgery As Peyronie's Treatment

There are numbers of studies and reviews available that confirm that plication is a good option for appropriately selected Peyronie's patients. Like this ten years outcome analysis concludes:

Corporeal plication is an effective surgical option for the correction of penile deformity in patients with Peyronie's disease, with good cosmetic results and acceptable functional success rate in the long-term(Int Urol Nephrol. 2007 Opens in new window symbol)

Laurence A. Levine, MD, is one of the best-known Peyronie's experts in the world today. He views plication as the optimum surgical technique for a man with curvature less than 60 degrees and without narrowing resulting in hinge effect (Peyronie's Disease; Page 151 Opens in new window symbol).

Various studies have as well confirmed the side effects and risk previously described. Various studies report penile shortening in between 41 to 90% of cases.

While sexual dysfunction after plication has been reported in between 7 to 40% of the time. The main reasons for functional failure have to do with penis pain, erectile dysfunction and / or persisting penis deformity.

Other reported plication side effects include loss of penile sensation (3-48% of patients) and permanent palpable knots reported as “bothersome” (12-18% of patients). (Adv Urol. 2008 Opens in new window symbol)

My Personal Experience
And Opinion Of Plication Surgery

I have no personal experience of penile plication operation. Surgery is always the last Peyronie's treatment option in my mind.

Surgery is never performed until your Peyronie's disease has reached the stable stage, so you should use the time during the acute stage to try other Peyronie's treatments available to you. And hopefully like me, you will not need Peyronie's surgery.

However, if you need Peyronie's surgery, which surgery to go for depends more on your Peyronie's condition than your preference. Plication is the right option for men with mild or moderate penis curvature that can achieve erection and have adequate stretched penile length and no narrowing deformity.

If you do not fulfill those criteria, then plication is not the right surgery for you. But if you do, and you have tried other things without satisfying result, than plication surgery might be what you are looking for.

 

Have you undergone penile plication operation?

If so, please use the form below and leave your Comments, or relevant practical advice to other Peyronie's sufferers.

Comments on this article

Andy January 28th, 2014

I had the nesbit operation Jan 2014. The operation lasted one and a half hours. I have had virtually no pain at all and was released from hospital the following day.

I have had some semi painful erections during the night but on the whole it's not been to bad. Time will tell how much I have lost off my penis but at the moment I am very pleased.

  • Birgir January 28th, 2014

    Dear Andy,

    Thank you so much for sharing your experience of the Nesbit procedure with My Peyronie's readers. It is great to hear you had such a positive experience.

    Regarding penile shortening. Using traction device is now considered effective and safe way to minimize loss of penile length in patients operated for Peyronie's disease. You may want to discuss this with your doctor?

    http://www.mypeyronies.com/penile-shortening.html

    Wish you best of luck with in the future. It would be great if you would let us follow your progress.

    Best regards,

    Birgir

Ianjd June 16th, 2015

I've had the Nesbit procedure 8th May 2015, it was done under general anesthetic and I was kept in over night with a catheter inserted, I have to say it was the worst decision of my life.

The operational pain has gone and the scar has healed well, but I've been left in continuous pain since, the head of my penis is ultra sensitive to anything touching it, even the wind blowing on it hurts, the stitches (plication) are painful, I've lost almost 4cm's off the length, I cannot get an erection without pain, I've had nothing but sleepless nights.

I've been back to the doctor to be told my pain threshold is low, (it's not) I've seen my gp 3 times, I've been on 3 types of antibiotics and continuous pain killers, my advise DO NOT HAVE THE OPERATION AT ALL.

Before surgery I was pain free with no sex life, post op and I'm in constant pain and still no sex life so I was better off pre op.

  • Birgir June 16th, 2015

    Dear Ianjd,

    I'm really sorry to hear about your condition and kind of lost for words. I find your doctors comment about low pain threshold quite offensive. It does not matter if you have low pain threshold or not. If you are in pain then that needs to be addressed. I hope you can find another doctor that will work with you in trying to find some resolution for you.

    Have you looked into traction therapy in order to gain back lost length? There is no question that traction does lengthen the penis if used for prolonged period of time, that's just how traction works. That though of little use if you cannot get an erection without pain so you need to address that as well / first.

    I wish you all the best and thank you very much for sharing your experience with My Peyronie's readers. Fortunately, many men have had successful surgery but your experience highlights why surgery should always be the last option, the risk is just too high.

    Kind regards,

    Birgir

Robert September 24th, 2015

I saw my urologist yesterday and was told I was a good candidate for the surgery. I had good length and the curve was about 45* downward. I wanted the xiaflex but the curve is to close to the P tube.

After reading Ianjd's comments now I'm scared to go forward. Nobody has said in inches how much loss I would have after the op. Still have to discuss it with my SO and decide to live with the curve and no pain or go through the op.

Thank you Birgir for this forum

  • BirgirSeptember 24th, 2015

    Dear Robert,

    I'm really sorry to hear about your condition. I personally think surgery is the last treatment option BUT it can be the right treatment option in some cases. You should not base your decision on one man's experience, whether it is negative (Ianjd) or positive (Andy). Their experience is very but what works, or does not work, for one man does not automatically mean it does not work, or does work, for another.

    So don't lets others experience decide what is right for you. Do your homework, ask your doctor all the questions you want to have answered before taking this big step. Because surgery is a big irreversible thing and men need to be comfortable with every aspect before going down that route.

    As you point out, one of the biggest downside of plication surgery for most men is the penile shortening. This is due to the nature of the process. Plication makes the long side of the penis shorter, resulting in shorter penis (0.5cm - 1.5 cm shorter). This may be underestimated as some studies claim that most penis surgeries result in penis shortening of up to 3 cm.

    You say you have a good length so maybe this does not have to be the deal breaker in your case. And there are ways to work on penile shortening.

    Saying all this, I still feel surgery should be the latest option. You don't say how long you have had Peyronie's (assuming you are in the stable phase now) nor if you have tried something else to try to reduce your curvature.

    This article compares the most common Peyronie's treatments today and links to each article so you can find out more about each option. Maybe it can help you to identify some treatment options that you can discuss with your doctor, i.e. prior to taking the drastic decision of going under the knife, or deciding to do nothing.

    But as you say, having no treatment is also an option. If your condition is stable and you and your wife can live with it, then it is without a doubt the least stressful, least risky and cheapest option.

    Good sex is about so much more than the penis appearance. As long as you can have erection and pain free sexual intercourse… well, then the rest is just "cosmetic" if you think logically about it.

    I hope this is of some help and wish you all the best whatever you decide. Just make sure you take an informed decision, based on your own research and discussions with your doctor. You are in no hurry to decide on surgery. You can try other things first and if they don't work out go for surgery later. Or you can decide to do nothing for now and if you at some point change your mind, the surgery option is still there.

    I hope you keep us posted about your decision / progress.

    Kind regards,

    Birgir

Joe K November 21st, 2016

Good day,

I have had the Nesbit procedure done on 27/10/2016. My Urologist told me after 3 weeks that everything was healing perfectly and that I could have a "test drive" whenever. I did not experience any significant pain at the time, but got frequent but marginally painful erections. Well, I did not follow his advise but rather waited another three weeks. Sex was great for both of us but everything changed after that. The next time we tried, the head of the penis was stone dead (like belonging to someone else) and I have been on pain killers since (in the shaft). Will it improve?

Please can you give me advise on penile traction devices. I lost plus minus 2,5 cm.

Regards
JoeK

  • BirgirNovember 21st, 2016

    Dear Joe K,

    I'm sorry to hear about your experience. Unfortunately, penis numbness is not uncommon after penis surgery like the one you had. You should see your doctor about this and find out what he recommends.

    Penile shortening is however the most common complaint after Nesbit procedure surgery. This is due to the nature of the process. Nesbit procedure makes the long side of the penis shorter, resulting in shorter penis.

    Traction devices are commonly recommended post surgery to help men gain back lost length (however, I still recommend you liaise with your doctor prior to starting traction therapy).

    There is no question that traction does lengthen the penis if used for prolonged period of time. That's just how traction works (think of long neck Kayan women in Burma). It however does require commitment, you need to wear the device for up to 8 hours per day for few months for best results.

    You can realistically expect between 0.5 – 1 cm in penile length per month of use. So to increase your penile length by 1 - 2 inches (2.5 – 5 cm) you are likely to have to use the penis traction device for 6 - 10 hours daily for 3 - 6 months.

    This article contains links to my most popular traction devices articles. Many of the them concentrate on penile curvature but you may still find them helpful, especially the reviews of different devices, discussing the pros and cons of different devices, plus practical tips for using them.

    I hope this is of some help but feel free to contact me again if any further questions about traction therapy. But first, contact your doctor about your penis pain and numbness.

    All the best,

    Birgir

Kevin November 25th, 2016

Hey everyone!

I had my surgery on march/2016. I didn't had peyronie disease, but the congenital curvature. I born with this curvature, but I thought it was normal, so never talk to my parents, then when I enter to sexual life noticed that I had a problem. The intercourse it was almost impossible because I had the downward curve. So I went do the urologist, and did the surgery by the Nesbitt procedure.

Well, I must say that he did some magic downstairs. It's almost straight now. BUT, just like this guy "Ianjd", I have this pain in all my erections, and I never feel pain before.

I lost about 3cm too, but that is ok... well not really, but still have some 15cm left, so its ok.

I tried to search for someone who had this surgery experience here in my country (Brazil) but never found no one.

  • BirgirNovember 25th, 2016

    Dear Kevin

    I'm very pleased that your Nesbit surgery was success for your congenital curvature. Really great news. Though I would ask the doctor about this pain you are experiencing.

    Penile shortening is common side effect of penis surgery. It is great that you are not concerned about that and can just move on with your life. However, for those that are, then traction therapy is commonly used to help men gain back lost length.

    Thank you very much for sharing your experience and I wish you all the best in the future.

    Kind regards,

    Birgir

Please note that all fields followed by an asterisk (*) must be filled in.

Note that only the Display name will be shown with your comment.



Please enter the word that you see below.

Captcha submission challenge   


All comments are moderated and must comply with my Commenting Rules. I will send you an email notification when your comment has been published, so please ensure your email address is valid and correct.

Shopping cart trolley Cart: item(s) | View Cart

Hello, I'm Birgir

This website is based on my experience of Peyronie's disease