Plication surgery for Peyronie’s disease is a technique that corrects the bend of the penis by plicating (gathering or pinching) or removing a piece of the tunica albuginea from the side of the penis on the opposite side from the plaque (also known as the Nesbit procedure). This counteracts the shortage of the tunica albuginea and thus helps straighten the penis.
Plication surgery for Peyronie’s disease should be considered only for men who meet the following criteria: (1) the penis is bent to a degree that makes normal sexual intercourse impossible and/or it hurts the man’s partner; (2) other medical therapies have already been attempted; (3) time has been allowed for spontaneous resolution (at least 12 months from time symptoms first appeared); and (4) the condition should be stable.
Although plication surgery for Peyronie’s disease may also slightly reduce the length of the penis, it is less likely to cause erectile dysfunction than another surgical procedure, tissue grafting. In fact, plication is recommended by some experts for men who have Peyronie’s disease and erectile dysfunction.
Among the surgical choices for Peyronie’s disease, plication surgery is the first choice for men who have a moderate bend to the penis. Plication surgery is also the best choice for men who have a large penis, as men may lose up to 1 centimeter in length. Overall, however, plication is a relatively easy procedure and it has a good success rate.
Studies of plication surgery for Peyronie’s disease treatment
Two authors reviewed the results of 132 cases of penile curvature that were corrected using this technique. Men in the study had a bent penis that ranged from 30 to 120 degrees, and 116 of the study participants had Peyronie’s disease, including 8 in whom a previous Nesbit procedure had failed. Six months after plication surgery, 93% of the patients reported having straight erections and 7% had acceptable erections. Penile curvature returned in 15% of patients at an average of 2.6 years of follow-up, and 40% of men said their penis was shorter than before surgery. (Gholami 2002)
In a subsequent study, investigators questioned 102 men who had undergone plication surgery for Peyronie’s disease during a follow-up period that averaged 29 months. Nearly every patient (99%) said they had a straight penis after surgery. The average loss of length of the penis was 0.36 cm, ranging from no loss to 2.5 cm. According to the authors, three factors associated with a greater risk of losing some length of the penis after surgery were larger preoperative penile length, greater preoperative bend to the penis, and curvature that affected the front of the penis. (Greenfield 2006)
A 2007 study reported on how 57 men who had undergone plication surgery for Peyronie’s disease felt over a 10-year period. With an average follow-up of 51 months, 90 percent said the appearance of the penis was satisfactory, but only 71 percent said they were satisfied with function, which was defined as “straight or almost straight penis on erection with pain-free penetration and normal sexual intercourse.” (Fazili 2007)
Side effects of plication surgery for Peyronie’s disease treatment
As already noted, one of the side effects of plication surgery can be a shortening of the penis, which has been reported from 41% to 90% of cases. Men also may experience loss of elasticity, loss of penile sensation (3-48% of cases), permanent knots in the penis from the nondissolvable sutures (12-18% of cases) and erectile dysfunction (if this was not a problem before having the surgery), which has been reported anywhere from 7% to 40% of cases. (Tran 2008)
Fazili T et al. Ten years outcome analysis of corporeal plication for Peyronie’s disease. Int Urol Nephrol 2007; 39(1): 111-14
Gholami SS, Lue TF. Correction of penile curvature using the 16-dot plication technique: a review of 132 patients. J Urol May 2002; 167(5):2066-69.
Greenfield JM et al. Factors affecting the loss of length associated with tunica albuginea plication for correction of penile curvature. J Urol Jan 2006; 175(1):238-41
Tran VQ et al. Review of the surgical approaches for Peyronie’s disease: corporeal plication and plaque incision with grafting. Adv Urol 2008; 2008:263450