All men, when their penis is in a state of maximum erection, have some degree of penile tortuosity. Axis deviations of up to 20 degrees are considered physiological, which means they do not hinder penetration in any position.
Pathological penile curvature (deviation of the axis greater than 20 degrees) is an extremely prevalent disease, affecting one in ten men.
It can be congenital, where the individual is born with this deviation, or acquired, called Peyronie’s Disease, a condition that affects men over 40 years of age who previously had a penis without any tortuosity.
Peyronie’s disease is mainly caused by microtraumas that occur throughout a man’s sexual life and lead to injury and subsequent scarring of the corpora cavernosa (erectile tissue of the penis). The consequence of this is an asymmetrical shortening of these corpora cavernosa, causing the most varied types of curvature.
The most common curvature is dorsal (upwards), but the deviation and/or deformity can occur in any direction, including circumferentially, causing an hourglass penile deformation.
The most common congenital curvature is ventral (downward).
When evaluating a patient with Peyronie’s Disease, it is very important to identify the stage of the disease.
Acute phase: the earliest phase in which the curvature is still occurring and there is usually pain during erections. In this phase, treatment is based on oral and injectable drugs and traction therapy, with the use of penile extenders.
Chronic phase: final phase where the penis has reached the maximum degree of curvature. There may or may not be shortening, deformities or calcified plaques on the penile shaft. In this phase, treatment is usually surgical.
Surgical treatment of penile curvature
Corporoplasty with graft
Corrective surgery for curvature that involves lengthening the short side of the region of the corpora cavernosa affected by the disease. The procedure uses grafts that can be tissue from the body itself or synthetic. This procedure is recommended for complex curvatures or for cases where the patient wishes to restore the penile length that was prior to the onset of the disease.
Penile plications
The curvature is surgically corrected through stitches placed on the long side of the region of the corpora cavernosa affected by the disease. Indicated for milder curvatures, in patients with an above-average penis and who give little importance to the penile shortening caused by this technique.
Implantation of semi-rigid or inflatable penile prostheses
Procedure indicated for cases of penile curvature associated with erectile dysfunction or when there are severe deformities, such as hourglass deformation. The implantation of a semi-rigid and/or inflatable prosthesis restores the penile length prior to the onset of the disease and definitively treats erectile dysfunction.
Implantation of semi-rigid or inflatable penile prostheses associated with penile enlargement techniques
Prosthetic implants can be associated with penile lengthening procedures in selected cases:
- Major penile shortening caused by Peyronie’s disease.
- Small shortenings in a patient with a below average penis.
- Patient who has the desire for penile enlargement
The standard and best-known procedure for penile lengthening associated with prosthesis implantation is the Sliding Technique, first described in 2012. After dissection of the neurovascular bundle and the urethra, 4 incisions are made in the corpora cavernosa and then the prostheses are implanted. This technique provides penile lengthening of up to 3.5 cm.
After the description of this technique and the high level of patient satisfaction due to the penile enlargement caused by the procedure, several modifications were proposed, however, always with the same concept: lengthening the corpora cavernosa to the limit of the neurovascular bundle, causing a real penile enlargement, thus improving surgical results related to patient satisfaction. The important thing for the surgeon and the patient is to understand the concept of the technique. The excessive use of eponyms for small variations of the original technique only hinders general understanding, providing benefits only to the “creator” of the small modification.
Photos of curvature types:
Congenital Curvature
Congenital penile curvature is caused by congenital asymmetry of the corpora cavernosa, which are the tissues responsible for erection. The individual is born with this defect and, in general, has an above-average penis.
Treatments
There are two types of procedures for curvature correction:
Corporoplasty with graft
Corrective surgery for curvature that involves lengthening the short side of the region of the corpora cavernosa affected by the disease. The procedure uses grafts that can be tissue from the body itself or synthetic. This procedure is recommended for complex curvatures or for cases where the patient wishes to restore the penile length that was prior to the onset of the disease.
Penile plications
The curvature is surgically corrected through stitches placed on the long side of the region of the corpora cavernosa affected by the disease. Indicated for milder curvatures, in patients with an above-average penis and who give little importance to the penile shortening caused by this technique.
For more information about the treatments available at the office of Dr. Luiz Augusto Westin, a doctor specializing in reconstructive urology in Rio de Janeiro, please contact us by email or phone!
Peyronie’s disease
Peyronie’s disease is an acquired penile curvature. It is caused by microtraumas that have occurred throughout a man’s sexual life and that have led to injury and subsequent scarring of the corpora cavernosa (erectile tissue of the penis). The consequence of this is an asymmetrical shortening of these corpora cavernosa, causing penile curvature.
When evaluating a patient with Peyronie’s disease, it is very important to identify the stage of the disease. There is the acute phase, in which the curvature is still occurring and there is usually pain during erections. In this phase, treatment is based on oral medications and the use of penile extenders. In the chronic phase, when the penis has reached the maximum degree of curvature, with or without deformities or shortening, treatment is usually surgical.
Treatments for Peyronie’s Disease
Corporoplasty with graft
Corrective surgery for curvature that involves lengthening the short side of the region of the corpora cavernosa affected by the disease. The procedure uses grafts that can be tissue from the body itself or synthetic. This procedure is recommended for complex curvatures or for cases where the patient wishes to restore the penile length that was prior to the onset of the disease.
Penile plications
The curvature is surgically corrected through stitches placed on the long side of the region of the corpora cavernosa affected by the disease. Indicated for milder curvatures, in patients with an above-average penis and who attach less importance to the penile shortening caused by this technique.
Implantation of semi-rigid or inflatable penile prostheses
Procedure indicated for cases of penile curvature associated with erectile dysfunction or when there are severe deformities, such as hourglass deformation. The implantation of a semi-rigid and/or inflatable prosthesis restores the penile length prior to the onset of the disease and definitively treats erectile dysfunction.
Implantation of semi-rigid or inflatable penile prostheses associated with penile enlargement techniques
Prosthetic implants can be associated with penile lengthening procedures in selected cases:
- Major penile shortening caused by Peyronie’s disease.
- Small shortenings in a patient with a below average penis.
- Patient who has the desire for penile enlargement
The standard and best-known procedure for penile lengthening associated with prosthesis implantation is the Sliding Technique, first described in 2012. After dissection of the neurovascular bundle and the urethra, 4 incisions are made in the corpora cavernosa and then the prostheses are implanted. This technique provides penile lengthening of up to 3.5 cm.
After the description of this technique and the high degree of patient satisfaction due to the penile enlargement caused by the procedure, several modifications were proposed, however, always with the same concept: Lengthening the corpora cavernosa to the limit of the vascular-nervous bundle, causing a real penile enlargement, thus improving the surgical results related to patient satisfaction.
The important thing for the surgeon and the patient is to understand the concept of the technique. The excessive use of eponyms for small variations of the original technique only hinders general understanding, providing benefits only to the “creator” of the small modification.
It is worth mentioning that routine visits to the doctor are very important and help prevent more serious illnesses. Look for a specialist you trust, such as Dr. Luiz Augusto Westin, who specializes in reconstructive urology in Rio de Janeiro.
