What is Penile Straightening, and why is it performed?

Penile straightening is a surgical procedure aimed at correcting an abnormal bend or curvature in the penis, which can make sexual intercourse difficult or painful, or cause significant distress. The most common cause is Peyronie's disease, where scar tissue (plaque) forms within the tunica albuginea (the fibrous sheath surrounding the erectile tissue), leading to a bend, indentation, or shortening of the penis during erection. Another reason for straightening is congenital penile curvature, a condition present from birth.

A functionally straight penis that enables pleasurable and pleasant sexual activity is the aim of the procedure.

What are the different types of penile straightening procedures?

There are generally two main surgical approaches, chosen based on the degree of curvature, presence of erectile dysfunction, and penile length:

1. Plication (Shortening Procedures):

How it works: This technique involves shortening the longer, unaffected side of the penis (opposite the curve) by placing sutures or excising small pieces of tissue. This "tucks" or "bunches up" the longer side to match the shorter, scarred side, thereby straightening the penis.
Best suited for: Curvatures typically less than 60 degrees, in men with good erectile function and adequate penile length.
Common techniques: Nesbit's procedure and various plication techniques.

Note: This method usually results in some degree of penile shortening (0.5-2 cm), as the longer side is brought to the length of the shorter side.

2. Plaque Incision/Excision and Grafting (Lengthening Procedures):

How it works: This involves cutting into or removing the scar tissue (plaque) on the curved side of the penis to release the constriction. A graft is then used to fill the resulting gap in the tunica albuginea, allowing the penis to straighten and, ideally, preserve or regain length.
Best suited for: More severe curvatures (often greater than 60 degrees), or when significant penile shortening or indentation is present. It may also be considered if the man has good erectile function.
Graft materials: Can include tissue from the patient's own body (e.g., saphenous vein, dermal graft) or pre-packaged synthetic or biological grafts.

Note: This technique has a higher risk of consequences, including possible deterioration of erectile function, even though it is intended to maintain or improve length.

3. Penile Implants (Prosthesis):

How it works: If a man with Peyronie's disease also experiences significant erectile dysfunction (ED) that doesn't respond to other treatments, a penile implant may be recommended. The implant itself can help straighten the penis, and additional maneuvers might be performed at the time of implantation to further correct curvature.
Best suited for: Men with both Peyronie's disease and significant ED.

What happens during the procedure?

Anesthesia: Penile straightening surgery is typically performed under general anesthesia or spinal anesthesia with sedation.
Artificial Erection Test: Before and during the surgery, an artificial erection is often induced (by injecting a saline solution or medication into the penis) to precisely assess the curvature and guide the correction.
Incision: A small incision is usually made just behind the head of the penis, and the skin is "de-gloved" (rolled back) to access the underlying erectile tissue.
Correction: The chosen surgical technique (plication or grafting) is then performed to correct the bend.
Closure: The skin is rolled back, and the wound is closed with dissolvable stitches. A firm dressing or bandage may be applied to limit bruising and swelling.
Catheter: A urinary catheter may be inserted temporarily (24-72 hours) to ensure proper drainage of urine and facilitate healing.
Circumcision: If not already circumcised, a circumcision may be performed at the same time, as it can aid in the surgical approach and cosmetic outcome.
Duration: Plication procedures typically take 1-2 hours, while grafting procedures may take up to 3 hours.

What are the benefits of penile straightening?

Improved Sexual Function: A straighter penis can greatly enhance the capacity for comfortable and fulfilling sexual activity, which is the primary advantage.
Decreased Pain: Men who suffer from pain during erections or sexual activity because of their curvature may find that surgery helps ease their discomfort.
Enhanced Confidence: Addressing a physical concern like penile curvature can boost self-confidence and improve body image.
Functional Straightening: The goal is to achieve a functionally straight penis (typically less than 15 degrees of residual curvature) that allows for penetration, even if a very slight bend remains.

What are the risks and potential side effects?

Like any surgery, penile straightening carries potential risks:

Common Risks:

Penile Shortening: This is a very common side effect with plication procedures (0.5-2 cm) and can occur to some degree with grafting or implant procedures.
Mild Residual Curvature: It's common to have a slight bend remaining (less than 15 degrees), as the aim is functional straightness, not always perfect straightness.
Swelling and Bruising: Expected for several days to weeks after surgery.
Altered/Reduced Sensation: Temporary or permanent numbness or changes in sensation in the penis are possible (20-30% with plication, higher with grafting).
Palpable Sutures/Bumps: With plication, you may be able to feel the stitches under the skin.
Minor Wound Ooze/Infection: Treatable with antibiotics.
Pain with Erections: Erection pain may start out painful and go away with time.

Less Common/More Serious Risks:

Curvature Recurrence: Over time, the bend might reappear.
Serious Bleeding or Infection: Additional care would be necessary.
Worsening Erectile Dysfunction (ED): Because grafting techniques require cutting the erectile tissue, there is a greater chance of this happening.
Nerve Injury: Permanent numbness may result from nerve damage.
Urinary Issues: Rarely, urethral injury or momentary difficulties urinating.
Dissatisfaction with Cosmetic or Functional Result: Despite successful surgery, some patients may not be fully satisfied.

What does recovery typically involve?

Immediately After Surgery: You might feel sensitive, swollen, and uncomfortable. Pain medication will be prescribed. There will be a dressing applied, which usually lasts for two to five days. There may be a catheter for one to two days.
First Few Weeks:
- Make sure that the surgical area is dry and clean. Do not soak the dressing until directed to do so.
- Apply cold packs as directed to reduce swelling.
- Swelling and bruising can be significant and last for several weeks.
- Usually, dissolveable stitches go away in two to four weeks.
- After five to seven days, light activities can typically be resumed.
Activity Restrictions:
- Sexual Activity: Refrain from all sexual activity (intercourse, masturbation, oral sex) for a minimum of 6-8 weeks to allow for complete healing. Your surgeon will advise on the specific timeframe.
- Strenuous Activity/Heavy Lifting/Driving: Avoid for at least 4 weeks, or until you are completely pain-free and cleared by your doctor.
- Bathing/Swimming: Avoid baths, hot tubs, and swimming for 2 weeks to prevent infection. Showers are usually permitted after 5 days.
Follow-up: You will have a follow-up appointment with your urologist typically 6-8 weeks after surgery to assess healing and outcome.

What is the long-term outlook after penile straightening?

The outlook is generally good for improving functional straightness and allowing for satisfactory sexual intercourse. Most patients experience significant improvement in their penile curvature. However, it's important to have realistic expectations regarding perfect straightness or regaining lost length. While pain often resolves, some degree of penile shortening and altered sensation can be permanent. Good patient satisfaction rates have been found in long-term follow-up studies; however, because Peyronie's disease can occasionally develop or recur, continuous monitoring may be required.

When should I call the doctor after penile straightening surgery?

If you notice any of the following symptoms, it's important to get in touch with your urologist or seek emergency medical assistance:

Uncontrolled Pain: If your pain is severe and not adequately managed by prescribed medication.
Inability to Urinate: If you cannot urinate for more than 8 hours after catheter removal, or if you experience significant difficulty or pain during urination.
Signs of Infection:
- Fever or chills.
- Increased redness, warmth, or throbbing at the surgical site.
- Pus or foul-smelling drainage from the incision.
Excessive Bleeding: Bleeding that doesn't stop with gentle pressure, or significant blood clots.
New or Worsening Curvature: If you notice a sudden or significant return of the penile curvature after the initial healing period.
Changes in Penis Appearance: Any unusual or alarming changes in the shape, color, or swelling of the penis that are not expected during recovery.
Numbness or Tingling: If you experience severe or spreading numbness or tingling, especially if it's accompanied by weakness or other neurological symptoms.

Always follow your surgeon's specific post-operative instructions and do not hesitate to contact them with any concerns.

Why choose Tender Palm Super Speciality Hospital for Penile Straightening Surgery in Lucknow, India?

Tender Palm Super-Speciality Hospital is one of the best hospitals for Penile Straightening Surgery in Lucknow, India. Our experienced Urologists uses advanced technology, and provides patient-focused care, the hospital ensures safer procedures, quicker recovery, and improved long-term outcomes.