Operation to correct a crooked penis: indications and correction techniques

Monday, December 3, 2018

Deformation of the male genital organ is a rare disease, but it brings physical and psychological discomfort to the patient. The pathology occurs in representatives of the reproductive age group of 30-60 years with a frequency of 3-8%. Persons with signs of severe deformation and erectile dysfunction consult a doctor.

The pathological condition in which there is a curvature of the penis is called Peyronie's disease. The first to describe the disease was the French surgeon Francois Peyronie. Fibroplastic induration of the penis develops as a result of the replacement of the structures of the tunica albuginea of ​​the penis with dense connective tissue, which leads to severe deformation of the organ, problems with painful erection and a man’s sexual life. Benign seals are located on the back of the organ, the urethra and on the sides of the penis.

Types of pathology

According to the development of the disease, they are distinguished.

1. Acute type of disease. There is an active blood supply to the penile plaques, which makes surgical treatment impossible.
2. Chronic appearance. Impaired blood supply and blood microcirculation in the plaque. The process leads to the formation of a dense scar.

There are three categories based on the degree of deformation:

• I change in curvature is less than 30 degrees;
• II curvature is 30-60 degrees;
• III violation of 60 degrees or more.

The appearance of severe pain during sexual intercourse, a change in the shape of the organ should alert the patient and force him to consult an andrologist or urologist. The degree of neglect of the process affects the choice of treatment tactics and management of the patient. The risk of developing the disease increases in young people who engage in active and extreme sports.

Is it possible to have sex after correction of the deformity?

In the postoperative period, to “consolidate” the result, I recommend that patients use a vacuum pump if necessary, and to improve blood flow in the penis, I prescribe special medications. Abstinence from sex is usually necessary for a month after surgery (and careful use of the organ in the future!) to avoid relapse.

Of course, I can correct deformities that arise again and again, but is this really necessary? Isn't it better to take care of something that has already been corrected once?

Of course, each procedure is prescribed individually, and first of all it is necessary to consult with a specialist.

THERE ARE CONTRAINDICATIONS. CONSULT WITH AN EXPERT

Causes

The pathogenesis of the disease is not fully understood. There are several theories that provoke penile curvature. It can be a consequence of two factors: congenital and acquired.

Congenital forms:

• heredity, the presence of gene abnormalities that are responsible for the synthesis of connective tissue protein collagen. Morphologically, the formation of connective tissue cords is noted in the cavernous bodies;
• abnormalities of organ development, short urethra, changes in the structure of the vascular network of the organ, hypoplasia of the tunica albuginea. The irregular shape of the penis is noticeable when it is filled with blood (erect state).

Purchased forms:

• injuries, bruises, organ fractures, which lead to the formation of hematomas and the development of inflammation. Without adequate therapeutic measures, the regeneration process leads to the formation of fibrous tissue of the cavernous bodies. Scar changes can thicken and cause deformation of the penis;
• autoimmune diseases. Cells of the immune system are able to attack their own tissues and cause damage, plaques and scars;
• drug therapy for diseases of the cardiovascular system, the use of beta blockers;
• drug treatment of impotence. Repeated administration of drugs injures the protein membrane of the organ and causes scarring;
• the use of various methods of stretching the penis, which provokes disruption of blood flow;
• vascular atherosclerosis, diabetes mellitus;
• connective tissue diseases: Dupuytren's contracture, Paget's disease, tympanosclerosis;
• hypo-, tocopherol vitamin deficiency, deficiency of microelements: calcium, magnesium;
• hypersecretion of the hormone serotonin;
• age-related changes in tissue elasticity.

How is penile curvature corrected?

Corporoplasty for Peyronie's disease is aimed at lengthening the tunica albuginea, which has shortened due to scarring. During surgery, the fibrous plaque is dissected, resulting in a defect in the tunica albuginea that must be replaced with some alternative tissue. A patch is actually applied to the resulting gap. This may be a venous wall, tissue from the inside of the cheek, cadaveric tissue, or artificial material used in surgery.

Corporoplasty is used in cases of severe curvature, when alternative techniques do not help, for example, corrugation of the tunica albuginea on the side not damaged by plaques and scars.

Symptoms

Congenital curvature of the penis is rarely diagnosed. The deformity develops as a result of genetic damage during pregnancy. Injuries to the penis in childhood affect the processes of its growth during the active synthesis of hormones. Healthy tissues continue their development, which provokes the development of downward curvature of the organ.

The main symptom of the disease is pain during sexual intercourse. Morphologically, this process is manifested by differences in the anatomical areas of the organ. During an erection, the area with lost elasticity and compaction is stretched with great tension, causing pain. Peyronie's pathology provokes the development of acquired curvature of the penis.

The disease is diagnosed in men starting at the age of 40; cases occur in young people after 30 as a result of an overly active sexual life.

In areas of the organ with impaired tissue nutrition, salt crystals are deposited, around which an inflammatory process develops and tissue tightening and scarring occurs. As a result, the functioning of the reproductive system is disrupted, ejaculate is retained, and erectile dysfunction develops. Treatment of penile curvature must begin in the early stages of the formation of the pathology.

If the disease does not cause sexual discomfort or pain during erection, surgery will not be necessary.

Situations in which you should contact an andrologist-urologist.

1. Injury to the organ causes contraction of the urethra and disruption of the outflow of urine. The patient feels severe discomfort, the frequency of the urge to go to the toilet increases, irritation of the bladder, and the development of inflammation are noted. Correction of this condition must take place urgently in order to preserve the functions of the urinary system.
2. Circulatory disorders. Insufficient oxygen saturation of tissues causes atrophic changes. Prolonged oxygen starvation will lead to organ necrosis.
3. Fibrous scars. Causes deformation of the penis with a deviation of 20 degrees. Tissue damage leads to malignant degeneration and therefore requires immediate treatment.
4. Erectile disfunction. Correction of the curvature of the penis is needed if the pathology disrupts a man’s sexual activity and interferes with ejaculation.

Therapeutic measures restore the biological functions of the organ and help prevent irreversible changes in the shape and size of the organ.

How does the anomaly develop?

The intrauterine development of girls and boys in the first seven weeks is identical. The difference in the formation of the genital organs begins only from the 8th week and occurs gradually:

• In boys, the edges of the folds of the urethra form a tube during the process of fusion;
• The urethra is closed - first in the area near the perineum, and then moving towards its center;
• Its most distant part is a separate structure; an opening is formed in it that connects the distal and central parts.

The frequency of occurrence of such an anomaly indicates that the formation of the genital organs is a rather vulnerable process, and there is a possibility that a negative impact will lead to its disruption.

Hypospadias is accompanied by defects of the genital organs. The most common ones are the following:

• Splitting of the foreskin;
• Fusion of the scrotum and penis;
• Narrowing of the urethra;
• Inguinal hernias;
• Cryptorchidism.

In severe forms of the disease, the modification can be so pronounced that determining the sex of a newborn child is difficult. The pathology is determined by a neonatologist during an examination in the maternity hospital.

Classification of the disease

Fibroplastic induration of the penis occurs in acute and chronic forms.

Inflammatory phase:

• period of plaque formation.

Acute (active) phase:

• develops from 6 to 18 months;
• there is pain during sexual intercourse, slight deformation of the penis, dense plaques begin to form;
• conservative treatment is prescribed;
• in the absence of a therapeutic effect, surgical intervention is used.

Chronic form:

• plaque growth stops;
• symptoms of erectile dysfunction worsen;
• The maximum permissible curvature is noted.

If the pathology does not complicate the patient’s life, therapy can be avoided. Connective tissue plaques do not degenerate into a malignant tumor.

Indications for surgery

As the pathology progresses, curvature from the central axis to the left or right, upward or downward is noted. The need for surgical treatment arises mainly in the later stages of Peyronie's disease.

The main indications for penile correction surgery are:

• discomfort and pain during erection, coitus, ejaculation;
• the occurrence of erectile dysfunction;
• severe forms of deformation in which sexual intercourse becomes impossible;
• personal dissatisfaction of the patient with the fact of curvature.

Diagnostics

To determine the exact cause of the curvature of the penis, the patient goes to a specialized clinic. The doctor conducts a visual examination, which allows you to determine the presence of plaques, their location and size, and an assessment of erectile function. To confirm the diagnosis, methods are used:

1. Ultrasound diagnostics. The vessels of the genital organ, patency, and the presence of foci of thrombosis are examined. The size of the urethral canal is assessed.
2. Radiography. A mandatory study that helps determine the presence of plaques containing calcium salts. In the absence of calcifications, the method may be uninformative.
3. CT scan. Identifying problems with venous blood flow that may occur with penile deformation.
4. Laboratory research.
5. An advisory opinion from an andrologist based on the collected history and condition of the patient, who will decide how to correct and cure the curvature of the penis.

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Reviews

I sincerely express my gratitude to the pediatric surgeon, urologist, andrologist, head of the International Children's Andrology Center Asaad Akhmadovich Matar for his warmth, professionalism, conscientious performance of his official duties and friendly attitude towards his patients.

• city ​​of Uralsk Hypospadias of scrotal form

Dear Asaad Akhmadovich, I want to express my gratitude to you for the operation performed on my child. Thank you for your accuracy and great professionalism. The operation was repeated, the unsuccessfully performed hypospadias was redone. We are glad that we found you and had a repeat procedure at your clinic.

• Julia Hypospadia

Seryozha’s dream came true... A miracle happened in his life, close only to his heart. Children's happiness cannot be confused with anything; every child is sincere in their feelings. And the greatest gratitude, memorable for a lifetime - in his words, in his happy eyes, in his strong hugs. And for a second we felt like good wizards. And this is worth living for!

• Toroptsevs Ksenia and Seryozha Scrotal hypospadias

Many thanks and low bow to all the employees of this clinic. Doctors from God work here. The professionalism of this clinic is at the highest level. I would like to express my special gratitude to the surgeon Dr. Matar for his golden hands, for his complete confidence in his actions, for operations that are always done perfectly. After all, it is in these hands that we entrust the most valuable thing, the life and health of our children.

• Didenko

Twins, Maxim and Vadim, our miracle, our joy! We were born, diagnosed with coronal hypospadias - Vadim, hypospadias of the chord type, curvature of the penis - Maxim. Vadim’s first operation took place on March 2, 2018 at the Filatov Hospital. Just a terrible rehabilitation period, tied to a bed for 10 days, the result is that after a year smegmal stones have formed, a second operation is needed! The decision was made unequivocally - only the best surgeon, the best specialist in this field! 10/03/2019 The operation was performed on both of them! The result is excellent! 6 days and we are home! The children feel great both physically and psychologically! Thank you very much from our entire family to Asaad Akhmadovich! For his golden hands! For his kindness! For his patience! Thanks to Nadezhda Alexandrovna! Thanks to the entire clinic team for the warmth and attention to patients and their parents! Thank you for the health of our boys!

• Ksenia Hypospadia, curvature of the penis

I would like to share my words of gratitude to Matar Asaad Akhmadovich for performing a complex operation on my child in 2009, when he was 3 years old. The diagnosis is very serious. Distal form of hypospadias.

• Olga, Dmitrov Distal form of hypospadias

I want to thank Allah for sending us a very responsible and professional doctor in his field, who on my son’s birthday gave him “a new man’s life!”

• Aigul Boltaeva Hypospadias

Many thanks to Matar Asaad Akhmadovich. My name is Nikolai. I am the father of the boy Alexander. Who is 2 years and 10 months old. We are from Ukraine. The story began after the birth of our baby, who was diagnosed with hypospadias and curvature of the penis, after which we could not find a place for ourselves and peace of mind. And we began the search for a qualified clinic and a professional doctor for our child.

• Belovol Nikolai Hypospadia

Hello! I want to tell our story. Our baby was born beautiful and strong on time, with good weight, natural birth.

• Olga from Donetsk Hypospadia

Hello! We are from Moldova and were diagnosed with hypospadias at birth. Our doctors said that everything was fine and that our child did not need surgery!

• Apukhtina Tatyana Hypospadia

Hello! Our son underwent surgery two weeks ago and the results were visible almost immediately. Why practically? It’s just that the first days there was a bandage and it was impossible to see)

• Podolsky family Hypospadias

Our story is very similar to all others; we were diagnosed with hypospadias in the maternity hospital. From the first days of life, there were many visits to urologists and surgeons, who advised either to wait until 3 years, or not to have surgery at all, and diagnosed either the stem or scrotal-trunk form of hypospadias.

• Arthur Khusnullin Hypospadias

Dear parents, you and I have a wonderful surgeon, whose hands work miracles, a doctor and a man with a capital M. This is Matar Asaad Akhmadovich.

• Zlotnikova Hypospadias

Good afternoon, Asaad Akhmadovich! My son was operated on in April 2015 for hypospadias. Everything is great with us.

• Svetlana Zlotnikova Hypospadias

Hello dear doctor Asaad Akhmadovich, I am Adil’s mother, Anara. From Ust-Kamenogorsk, Kazakhstan. I want to express my deep gratitude to you.

• Anar Hypospadias scrotal form

Dear Asaad Akhmadovich, we sincerely express our deep gratitude to you for your sensitive attitude and golden hands, for your professionalism.

• Panarina Irina Viktorovna Hypospadia

Asaad Akhmadovich, our whole family is grateful to you for your work, for your golden hands, for your professionalism!!! We were not immediately diagnosed with hypospadias of the chord type.

• Ekaterina Kienya Chord type hypospadias

Dear Doctor Matar Asaad Akhmadovich! We sincerely express our deep gratitude to you for your professionalism, sensitive attitude and golden hands!

• Maria Karetnikova Hypospadia

Dear doctor Matar Asaad Akhmadovich, Yura Trofimenko’s mother writes to you from Kharkov. I want to say “thank you” a thousand times for what you have done for us, for your kind and sympathetic heart, for your golden hands, for your patience and understanding.

• Irina Trofimenk Hypospadias

Dear parents of boys who have been diagnosed with hypospadias, I want to tell my story.

• Natalya 2015 Hypospadias

Today exactly a year has passed since you operated on hypospadias.

• Ilgiza Blinova Hypospadias

EVERYONE, stop being afraid of these terrible diagnoses!! Dear mothers, don’t tear your hair out and don’t cry! Your problem will be solved very quickly, and in a month you will completely forget that you had it.

• Elena Vagner Hypospadias

Hello Asaad Akhmadovich! THANK YOU VERY MUCH ! I want to start from the very beginning.

• Veronica Hypospadia

Good day seven! To begin with, I would like to say a huge thank you to Asaad Akhmadovich for his attention, responsiveness, dedication to his work and for the result that I can already see!

• Natalia Hypospadia

To everyone who reads, have a good day and good health! For those who read to the end, be patient and calm. After all, it is so important to remain calm and cool minded when faced with the problem of your child’s health.

• Margaret Hypospadias capitate

Dear mothers, we went through surgery for the stem form of hypospadias with curvature - the diagnosis was made to us from birth.

• Elena Smorodina Stem hypospadias with curvature

In 2001, I gave birth to twins, one of the boys was born weak, and “scrotal hypospadias” was added to the huge number of diagnoses.

• Natalya Nikolaevna scrotal hypospadias

We would like to express our deep gratitude to the wonderful doctor Matar Asaad Akhmadovich.

• Andrey Lopatin Stem hypospadias

Dear mothers and fathers of boys with hypospadias. Perhaps my review will be too long. Take the time to read it.

• lady-ams Hypospadias

Dear Asaad Akhmadovich, on behalf of our entire family we want to say a HUGE THANK YOU!!!

• Svetlana Stvolovaya hypospadias

I want to express my deep gratitude to Doctor with a capital D Asaad Akhmadovich!!! 2 months have passed since the operation.

• Zhanna Stem hypospadias

We would like to appeal to parents who have children with penile pathology (hypospadias). Do not despair. There is a doctor who can help you. His name is Asaad Akhmadovich Matar.

• Valery Hypospadia

A year ago, our son was 13 years old when Matar Asaad Akhmadovich operated on him for the first time.

• Parents Truncal hypospadias

My son is 2 years old. Diagnosed from birth: “Hypospadias.”

• Lena Dalyuk Hypospadias

With a diagnosis of coronary hypospadias, we went for surgery to Israel with Dr. Y. Ben Haim. At the time of the operation, the child was one year and a month old; on October 23, 2012, the operation was performed and after 2 hours we were sent home.

• Elena Dolganova Coronal hypospadias

We live in Sakha-Yakutia. While still in the maternity hospital, I noticed that something was wrong with my son’s pisyun.. Since there is no urologist in our city, we were sent for examination to Yakutsk a year ago.

• Anna Hypospadias chord type

Hello dear Asaad Akhmadovich! What might the mother of a child feel, whom you, Doctor, freed from monstrous captivity - whose name is Hypospadias.

• Olga Vladimirovna Hypospadia

I would like to express my deep gratitude to Matar Asaad Akhmadovich for his attentive attitude, kindness and of course professionalism.

• Proshin family Coronal hypospadias

We were diagnosed with hypospadias at the maternity hospital and were told to see a urologist in a month, which we did. Our local specialist silently confirmed the diagnosis at the medical center. map.

• Ekaterina Stem hypospadias

a short story of my son (1y.3m). At the maternity hospital, a diagnosis of truncal hypospadias was made.

• Marina Stem hypospadias

We were diagnosed with the distal form of hypospadias, after 3 months of debt, suffering from a lack of information and fear of the hospital.

• Anastasia Hypospadia

I'll tell you my story. We were diagnosed with the stem form of hypospadias while still in the maternity hospital. I thought about it for a very long time and was worried.

• Elena Stvolovaya hypospadias

We operated on the distal form of hypospadias on A. A. Matar at the Moscow Research Institute of Pediatrics and Children's Surgeries (2 Taldomskaya St.).

• Pukhova Sveta Distal form of hypospadias

Our advantages

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Without pain and fear

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Treatment

In modern practice, urologists use several treatment regimens for penile curvature.

Conservative treatment:

• hormonal drugs: cortisone, hydrocortisone. Their action is aimed at inhibiting collagen synthesis and resorption of fibrous plaques;
• enzymatic preparations. Enzymes reduce the concentration of connective tissue protein and the formation gradually resolves, the deformation is removed;
• using an extender to correct and change the shape of the penis. Used in the early stages of the disease;
• physiotherapeutic methods, ultrasound therapy, laser treatment. Used to treat Peyronie's pathology in children. Under the influence of ultrasound, stimulation occurs, then resorption of the seals occurs;
• administration of anti-inflammatory drugs;
• taking vitamins A and E.

Drug therapy is suitable in the initial stages of the disease and is effective in the classic form of Peyronie's disease.

Surgical method.

The operation is often used in case of a pronounced defect to correct the curvature of the penis. After the intervention, organ functions are restored within several months.

Types of surgical interventions:

• excision or removal of fibrous plaques;
• increase in the size of the protein shell;
• penile prosthesis is used for severe erectile dysfunction.

The quality of treatment will depend on the stage and severity of the pathological process. Surgical intervention is carried out within a year from the appearance of the first signs and during the active stage of the process.

Postoperative period

After discharge, it is necessary to limit physical activity for 1 week, and also apply dressings for some time.

During the entire recovery period after surgery (about one month), it is necessary to refrain from sexual activity in any form, including masturbation. At the end of the recovery period, the man can return to intimate life in full. Around this time, the seam, made using a special cosmetic technique, becomes almost invisible.

Possible complications and contraindications will be discussed with you individually by your attending physician.

conclusions

Fibroplastic induration or Peyronie's pathology is a pathological process in which foci of tissue fibrosis form in certain areas of the organ. The deformity causes pain during sexual intercourse, causes erectile dysfunction, difficulty in ejaculation, and psychological problems due to disruption of the quality of a man’s sexual life. Modern medicine has described congenital and acquired forms of pathology. The main cause of the acquired disease is frequent injuries to the penis and impaired blood supply.

Modern clinics use conservative, microinvasive and surgical treatment methods. The pathology of penile curvature can be successfully treated in the initial stages of development. An individual approach and selection of the optimal treatment method are applied to each patient.

What examination can be offered to me?

The examination will consist of a detailed consultation with a doctor, a thorough examination and a possible ultrasound examination of the penis against the background of an erection. Sometimes the doctor may ask you to provide a photograph of the penis during an erection to better understand the extent of its curvature. Only after a detailed conversation with the patient, a thorough examination and examination, the doctor can decide on the choice of surgical technique that will be optimal for this particular case.