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Oganes E. Dilanyan
Urologist, MD, PhD
+7(499)344-03-03

Penile Curvature

In this article

Causes and treatment of penile curvature and Peyronie’s disease.

Penile curvature is a condition seen in men who suffer from Peyronie’s disease. In this article I will describe the main causes of penile curvature and modern microsurgical ways of treatment for Peyronie’s disease, such as Nesbit procedure and corporoplasty.

Penile curvature

Characteristics: As most conditions relating to the reproductive system penile curvature is a very private problem and people tend to keep quiet about it. A man with penile curvature avoids sexual intercourse feeling inadequate in fear of misunderstanding or even mockery by their sexual partner.  As a result, they develop a deep fear of intercourse which leads to a condition known as psychological erectile dysfunction.  

Penile Curvature: Surgery

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  • The most effective form of treatment for penile curvature is corporoplasty microsurgery.
  • Unlike other types of penile curvature correction surgery this procedure does not shorten the penis.
  • The use of surgical microscope allows us to carry out the procedure with precision and rid the patient of all problems caused by Peyronie’s disease and penile curvature.

“I think there was a small fracture, my wife was on top and got carried away, and now my penis is bent”; “It has been like this for as long as I can remember, but it’s impossible for me to have sex”; “Every time a meet a new girl I can’t help but think she might laugh at me”; “It is simply technically impossible for me to do it. I get an erection but the penis is so bent it is impossible to insert”.

These are the common complaints of my patients suffering from penile curvature. Most of them can have intercourse but almost all of them worry about their partner’s perception of the abnormal shape of their penis.  As the condition progresses to Peyronie’s disease men develop pain during intercourse and start avoiding it all together.

"Don’t mind the pigeon chest, look how nicely curved the back is…”

Causes of penile curvature

Basically, the mechanism of penile curvature during erection is the shortening of tunica albuginea which is a fibrous envelope of tissue surrounding corpora cavernosa. When the latter is filled up with blood erection occurs.

The following can lead to tunica albuginea damage:

Penile Curvature mechanism.
  • Peyronie’s disease develops when thickened lesions form on the tunica albuginea which in turn shorten it and bend the penis.  
  • Penile “fracture” also known as tunica albuginea tear often happens in the “woman on top” position. Following the “fracture” tunica albuginea will scar which causes penile curvature.
  • Congenital penile curvature is a congenital abnormality when tunica albuginea is shorter on one side.  
     
One of many stories...

...- You must understand that I cannot even approach a nice girl with this. I don’t want to scare anyone, so I decided to pay for it. But when she saw it she gave me back my money and said “I might break it accidentally, I didn’t sign up for this” - The patient’s voice has no emotion. “I can’t even masturbate any more, I have no erection”. 
37 years old, not a single intercourse in over 5 years. Intercourse itself is not even entirely possible and his diagnosis is as follows: “Peyronie’s disease, severe penile curvature, fear of intercourse, severe psychological erectile dysfunction.”  

-Stone-like density is not good!
- What about when it’s in the penis?
-Stone-like density in the penis is Peyronie’s disease.
From the conversation of two urologists

Peyronie's disease: Symptoms and Treatment

There are a few different causes that can lead to lesions forming on the tunica albuginea. The lesion is basically scar tissue which thickens with time while absorbing and shortening tunica albuginea. Therefore, the curvature occurs towards the side of the lesion. Several lesions can lead to severe penile curvature and often to inability to have intercourse. 

One of many stories...

- I am afraid you have Peyronie’s disease. Four lesions on the tunica albuginea. Unfortunately, only surgery can help you. 
- Help me? – The patient looks interested for the first time in the last half an hour. “I’ve been told that only prosthetic penis would help as the operation shortens the penis by 10cm”.  
- Well, it’s not quite as bad. They possibly meant the Nesbit Procedure when plication is performed on the side opposite to the lesion. But it is not the only type of surgery available for penile curvature. We need to solve two problems, remove the penile curvature while ensuring normal function and aesthetically pleasing appearance and cure erectile dysfunction.   
- Can these problems really be solved?
-Yes of course. It is difficult but possible. 

…A dog’s penis has a bone in it. A human penis does not. But fractures still happen.

Penile Fracture

It is quite a rare occurrence that usually happens as a result of vigorous sexual activity, especially with “woman on top”. Penile fracture is the tear of tunica albuginea which after healing the wrong way leads to scarring and penile curvature, also known as Peyronie’s disease. Hour glass deformity can be one of the complications that can occur following the fracture.

Congenital penile curvature

Congenital penile curvature is caused by congenital deformity of tunica albuginea on one side. There are no lesions or scar tissue but the penis “faces” downwards or sideways when erect.

Penile curvature is always caused by some sort of damage to tunica albuginea.

Case from practice In 2008 I was at a surgical andrology congress and was presenting a clinical case of infertility affecting a young couple. The couple was thoroughly investigated and no problems were found. But the pregnancy still did not happen. It turned out the husband had congenital penile curvature which in turn led to the sperm collecting in the urethra but never caused any symptoms. The patient’s spouse fell pregnant 3 months after he underwent penile straightening surgery.

Non-surgical treatments of penile curvature

There are ways to treat Peyronie’s disease without surgery. This includes various medications that soften the lesion and injections straight into the lesion with the same aim. But these methods are not proven to be effective for severe curvature.  Moreover, this sort of treatment can turn a so called simple curvature which only causes aesthetic inconvenience into a more serious problem which sometimes can be difficult to solve surgically. 

«it’s easy to cut it off. But no one has managed to grow it back on just yet”
Professor of surgery and anatomy I. Buyalski,1834

Peyronie’s disease – Surgery

Nesbit Plication

There are several surgical ways to correct downwards, upwards or sideways penile curvature. The most common one is Nesbit procedure when tunica albuginea on the side opposite to the curvature is shortened using non-dissolving sutures. This surgery in the presence of Peyronie’s disease can be suitable for treatment of small lesions or congenital penile curvature.  During Nesbit procedure penis shortening of 0.5-1 cm is a possible side effect. I personally rarely use this procedure and only use it when the degree of curvature is less than 60 degrees, the lesion is small or absent (in congenital cases) and I can be sure that the shortening of the penis is not going affect the patient’s quality of life. 

Corporoplasty with tunica albuginea. Grafting

Penile curvature correction surgery

Corporoplasty surgery with lesion removal is more complex. The aim of this operation is to get rid of the lesion and restore tunica albuginea using own cheek mucosa. This guarantees no rejection which can occur when using synthetic material. The advantages of this type of operation is that the patient gets rid of the lesion and in the cases of congenital curvature this surgery helps to avoid penis shortening. 

What you need to know about tunica albuginea corporoplasty

Result

First and foremost, elongation or grafting allows us to achieve both functional and aesthetic results. 

Relapse

As the damaged part of tunica albuginea is replaced with a different type of tissue relapses after this type of surgery occur very rarely. 

Trauma

Use of surgical microscope allows us to perform the surgery with precision avoiding the risk of damaging corpus cavernosum and interrupting erectile function.

Shortening

Replacing the damage part of tunica albuginea with a different tissue allows us to avoid penis shortening and ensures aesthetic straightening.

Inflammation

Risk of pain and inflammation is minimised by applying microsurgical technology and through pre-operative assessment of the patient.

Innervation

The use of surgical microscope allows us to avoid nerve stems and safeguard the patient from sensitivity loss and erectile disfunction.

Penile prosthesis

Penile prosthesis

The third option is used in extremely complex situations of penile curvature when it is not possible to restore tunica albuginea or in the presence of incurable erectile disfunction. This option is penile prosthesis. The aim of this operation is to implant special silicon cylinders filled with water into the penis. This prosthesis allows the patients to have intercourse while experiencing ejaculation and orgasm. Patients’ testimonials show us that the only difference when compared with a natural erection is the need to “pump” the cylinders.   

One of many stories...

...- Scalpel, small swab, scissors. Dry. Here is the lesion. Pass the microscope. I micro-surgically remove the first lesion and carefully measure the length of the required graft.
...- Finishing up. Let’s check the result again. The penis is straight after stimulated erection and the complex curvature has been corrected without shortening the penis. Thank you everyone, we are finished for today.
Three months after the surgery:
- Good afternoon, doctor, may I come in?
- Hello, yes please come in.
- I am just popping in for a minute, everything is fine and I am getting married!
-  Don’t you dare blame me! – I look “scared”.
- Here, I have a gift for you!
...What I really struggle to understand is why patients having had penis related operations bring me alcoholic drinks in penis shaped bottles as a gift. Where do they get them from? I now have quite a collection.

The earlier the patient sees a doctor abut penile curvature the more effective the operation will be. But in modern andrology practice even the most complex cases of penile curvature such as “hourglass” curvature is also surgically treatable. 

Our Advantages

Professional Approach:  Up to date diagnostics methods of penile curvature causes. 

Our team: Specialised science based surgical andrology team.

Board of doctors for your safety, consisting of a urologist, micro-surgeon and anaesthetist.

Equipment: Specialized microsurgical Karl Storz unit.

Comfort: no queueing or waiting for a consultation and premium inpatient facility.

Safety: we only use methods recommended by professional associations such as EAU and AAU.

Result: Removal of curvature and return to normal sex life. 

We are also GCP certified, which confirms we provide the highest standards of diagnosis and treatment. 

Certificates

Участник мастер-класса по андрохирургии

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Our Guarantees

- We guarantee your safety by using modern and highest quality anaesthesia manufactured in Austria or France. 
- We DO NOT USE low quality equivalents of any drug which significantly lowers the risk of any complications.
- Use of Karl Storz microsurgery microscope guarantees the integrity of the testicular artery for all my patients. 
- Andrology surgical work placements in Austria and Italy together with extensive experience in andrology surgery ensure absence of complications. 
- We DO NOT REFER our patients to unknown clinics for follow up and further treatment and provide outpatient follow up as well as inpatient treatment. 

Every patient is provided with a discharge summary with detailed recommendations and an official sick leave certificate
Information for foreign patients:

If you require treatment for penile curvature in Moscow please contact us. We will arrange admission to hospital on the day of your arrival and carry out all necessary investigations and tests and carry out the penile curvature surgery on the following day.  You will be able to return home the day following the operation. 

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