Penile Plication Procedure
Warning: Actual procedure images below are graphic
This patient had already undergone the Xiaflex protocol without acceptable benefit. His sideways curvature is less common than an upwards/dorsal curvature. This curvature made intercourse painful for his wife and thus prompted the desire for surgery. This 45 degree angulation leads to a relatively mild shortening of the penis that he found acceptable. He was fully potent prior to the procedure.
Figure A: This image demonstrates his sideways curvature prior to plication A papaverine injection is used in the operating room to create an erection. A catheter is placed into the penis which allows easy identification of the urethra.
Figure B: An incision is made ventrally, or underneath the penis, to expose the corporal bodies. In this case, only the right corporal body is exposed to straighten a leftward curvature. Dr. Engel utilizes the dot technique with absorbable sutures typically. Here, 32 dots are used which produce four sutures. The distal rows are place more dorsally to address a slight downward bend also present.
Figure C: Shown here are all sutures prior to tying. However, after each row is placed they are tightened and clamped to guide additional suture placement until straightening is achieved.
Figure D: After tying all sutures but before closing the incision with absorbable sutures, an artificial erection is given with saline to ensure that the penis is now straight. The incision usually heals in a very inconspicuous way.
The catheter is then removed, and the penis is wrapped with a mild pressure dressing. This is changed daily for a few days. Intercourse is to be avoided for 4-6 weeks to allow for healing. Soreness at the suture sites is typical for some weeks after surgery with erection, but patients are usually able to return to work within a day or two. Regardless of suture type, there is an approximately 15% chance that a suture will break or pull through which may result in some degree of recurrence of angulation.