Penile Reconstructive Surgery

Peyronie’s disease is a constellation of penile symptoms and signs such as penile pain, loss of penile length, abnormal penile curvature or deformity (indentation or hour-glass), presence of penile fibrous plaque and ultimately male erectile dysfunction.

 

Penile reconstructive surgery can be divided into penile plication, penile graft reconstruction (using biocompatible and inert materials) and penile prosthesis implantation. The choice of penile surgery depends on several factors and each reconstructive surgery has its own advantages and disadvantages.

Professor Chung has published extensively on penile reconstructive surgery (see below) and is considered the leading surgeon expert in Australia. He is the only surgeon in Australia invited to serve on Peyronie’s disease and penile reconstructive committee at the International Consultation on Sexual Medicine, the peak authority body for the International Society of Sexual Medicine. He is the lead author on several major Peyronie’s disease guidelines. He has mentored many surgeons over the years including invitation as surgeon expert at various hospitals and surgical workshops around the world. He is often asked to see complex and salvage cases by other surgeons to restore penile size and shape in difficult patients.

 

  1. Penile plication surgery

    a. Advantage- Low risk of erectile dysfunction
    b. Disadvantage- Penile shortening

     

     

  2. Penile graft reconstructive surgery

    a. Advantage- Penile length preservation
    b. Disadvantage- Higher risk of erectile dysfunction and sensory change

     

     

  3. Penile prosthesis (Please refer to the “Penile Prosthesis Implant” section)

    a. Advantage- Treat underlying erectile dysfunction and restore penile size
    b. Disadvantage- Risks associated with penile prosthesis

What preparation is required?

Since reconstructive penile surgery is performed under general anaesthesia, you should be fasted (nothing to eat or drink) for 6 hours prior to surgery. Regular medications can be taken with a sip of water with the exception of blood thinning agents (such as warfarin, clopidogrel) or non-steroidal anti-inflammatory drugs which need to be stopped for 7-10 days. A mid stream urine (MSU) test is required to ensure the urine is sterile before treatment is undertaken.

What happens in the operating room?

You will meet Professor Chung and your anaesthetist prior to surgery. Your procedure will be performed under general anaesthesia with appropriate anti-microbial cover. The genital area will be shaved in the theatre, and appropriate povidine surgical scrub will be performed to minimise microbial skin colonisation and infection risk.

What are the risks?

When performed by expert surgeon, penile reconstructive surgery is considered a safe procedure with minimal complications. Potential surgical complications are dependent on the complexities of your Peyronie’s plaque size and the type of penile reconstructive surgery.

Common complications involve:

  • Pain
  • Bruising, bleeding or hematoma
  • Dysuria from urinary catheterisation
  • Skin irritation or mild infection

Potential serious complication include

  • Temporary decrease sensation to the glans of penis
  • Potential penile shortening
  • Injury to the urethra
  • Development of erectile dysfunction
  • Recurrence of penile curvature (due to existing abnormal penile tissue)

What to expect afterwards?

You are usually discharged the same day and you can remove the surgical dressing after 36 hours. You will be discharged with appropriate oral antibiotics. At home you should rest and avoid strenuous physical exertion for 3-4 weeks. During this time, normal spontaneous penile erection is common but any forms of sexual activity is discouraged. In re-do (complex) surgery, Professor Chung may prescribe you with a medication to temporarily suppress your penile erection so that healing can occur more effectively and prevent potential complications.

Follow-up

You will have a follow-up appointment with Professor Chung scheduled at 4-6 weeks postoperatively.

Some of the key articles published by Professor Chung on Peyronie’s disease

  • Chung E, Gillman M, Tuckey J, La Bianca S, Love C. A clinical pathway for the management of Peyronie’s disease: integrating clinical guidelines from the International Society of Sexual Medicine, American Urological Association, and European Urological Association. BJU Int. 2020;126 (Suppl 1):12-17
  • Chung E. Penile prosthesis implant in the special populations: diabetics, neurogenic conditions, fibrotic cases, concurrent urinary incontinence, and salvage implants. Asian J Androl. 2020;22(1):39-44
  • Chung E, Gillman M, Rushton D, Love C, Katz D. Prevalence of penile curvature: a population-based cross-sectional study in metropolitan and rural cities in Australia. BJU Int. 2018;122(Suppl 5):42-49
  • Chung E, Wang R, Ralph D, Levine L, Brock G. A worldwide survey on Peyronie’s disease surgical practice patterns among surgeons. J Sex Med. 2018;15(4):568-75
  • Chung E. Penile reconstructive surgery in Peyronie’s disease: Challenges in restoring normal penis size, shape and function. World J Mens Health. 2018; 36:e10-17
  • Chung E, Ralph D, Kadioglu A, Garaffa G, Shamsodini A, Bivalacqua T, Glina S, Hakim L, Sadeghi-Nejad H and Broderick G. Evidence-based management guidelines on Peyronie’s Disease. J Sex Med. 2016;13(6):905-23
  • Chung E. Pro: does shockwave therapy have a place in the treatment of Peyronie’s disease? Transl Androl Urol. 2016;5(3):366-70
  • Chung E. Diagnosis and management of Peyronie’s disease: an evidence-based review. Trends in Urology Men’s Health. 2015;6(1):18-22
  • Chung E, De Young L, Solomon M and Brock GB. Peyronie’s disease and mechanotransduction: An in vitro analysis of the cellular changes to Peyronie’s disease in a cell-culture strain system. J Sex Med 2013;10(5):1259-67
  • Chung E, Solomon M, DeYoung L and Brock GB. Comparison between AMS 700 CX and Coloplast Titan penile prosthesis for Peyronie’s disease treatment and remodelling: Clinical outcomes and patient satisfaction. J Sex Med 2013;10(5):1259-67
  • Chung E and Brock GB. Penile traction therapy and Peyronie’s disease: A state of art review of the current literature. Ther Adv Urol. 2013;5(1):59-65
  • Chung E, Yan H, De Young L and Brock GB. Penile Doppler sonographic and clinical characteristics in Peyronie’s disease and/or erectile dysfunction: An analysis of 1500 men with male sexual dysfunction. BJU Int 2012;110(8):1201-5
  • Chung E and Brock GB. Duplex sonographic study of impotent men with Peyronie’s disease: is veno-occlusion the cause? J Sex Med 2011;8(12):3446-51
  • Chung E, Cledinning E, Lessard L and Brock GB. Five Year Follow-Up of Peyronie’s Graft Surgery: Outcomes and Patient Satisfaction. J Sex Med. 2011;8(2):594-600
  • Chung E, DeYoung and Brock GB. Rat as an animal model for Peyronie’s disease research: A review of current methods and the peer-reviewed literature. Int J Impot Res. 2011;23(6):235-41