Can Curvature Correction and a Penile Implant Be Combined in Peyronie Disease?

In a proportion of men with Peyronie disease, the picture is also accompanied by erectile dysfunction. These patients are often caught between two decisions: should the curvature be corrected first, or should the erection problem be solved? The good news is that in properly selected cases both problems can be addressed in the same operation. This article explains the criteria on which that decision rests.

Why do the two problems occur together?

In Peyronie disease, the plaque that develops in the sheath of the penis (the tunica albuginea) impairs the elasticity of the tissue. The same process can also affect the mechanism that keeps blood inside the penis during an erection. In addition, a significant proportion of these patients are in an older age group, with conditions such as diabetes and vascular disease that affect erections. The result is that both a shape problem and a rigidity problem exist in the same patient.

The decisive question: what is the state of the erection?

One question determines the direction of the surgical plan: can the patient achieve rigidity sufficient for intercourse with medical support?

• If the erection is sufficient: correction directed at the curvature alone (plication or grafting) is planned. An implant does not come onto the agenda.
• If the erection is insufficient and does not respond to treatment: correcting the curvature alone is not enough — even with a straight axis, intercourse will not be possible. In these cases a penile implant is the main solution, and the curvature is addressed in the same session.

This distinction is the most critical step of the preoperative assessment, which is why erectile function is evaluated objectively with methods such as pharmacologically assisted colour Doppler ultrasound.

Does an implant on its own correct the curvature?

Partly. Because an inflatable implant stretches the tissue from within, it can spontaneously correct part of mild and moderate curvature. For this reason the surgeon inflates the penis after the implant is placed and assesses the residual curvature. If it has fallen within an acceptable range, no further step is needed.

Which additional techniques are used if curvature persists?

If curvature remains after the implant, there are stepwise techniques applied in the same session:

1. Manual modelling: with the implant inflated, controlled counter-bending is applied to the penis to loosen the plaque. In most cases no additional incision is required.
2. Plaque incision: if modelling is not enough, relaxing incisions are made over the plaque.
3. Grafting: if the opened area is wide, a graft may be used to support the tissue.

These steps are applied from top to bottom, only as far as necessary; the aim is to obtain an axis suitable for intercourse with the least possible intervention.

Why does combined surgery demand experience?

Two goals are pursued at once in these operations: correct sizing and positioning of the implant, and elimination of the curvature. Working in scarred tissue with plaque is harder than in healthy tissue; cylinder placement, preservation of tissue integrity and avoidance of infection all require technical precision. Assoc. Prof. Zülfü Sertkaya has high success in complex Peyronie surgery, including pronounced curvature, widespread plaque and combined cases — experience that matters particularly when curvature correction is planned together with an implant.

Timing: when is surgery performed?

Surgery in Peyronie disease is performed in the stable phase. Pain is expected to have resolved and the curvature not to have progressed in recent months. Surgery carried out in the active phase may give a result that changes as the process continues. Conversely, if erectile dysfunction is advanced and the patient gains no benefit from oral or injection treatments, the waiting period is reassessed together with the patient.

Loss of length and realistic expectations

This subject must be discussed honestly. Peyronie disease itself can lead to shortening; and when curvature-correction techniques rest on shortening the longer side, some loss of length is possible. In patients who receive an implant, perceptions of length often differ from their pre-operative erections. Measurements are therefore taken before surgery, expectations are discussed openly, and it is made clear that the goal is a straight or near-straight axis suitable for intercourse.

Recovery and afterwards

Recovery varies with the extent of the techniques used. Swelling and bruising are normal in the first days; sexual activity is paused for the period specified by the surgeon. Patients with an inflatable implant are taught how to use the device in detail once healing is complete. This group is among those reporting the highest satisfaction with penile implants — because both the shape and the function problem have been solved within a single plan.

Assoc. Prof. Zülfü Sertkaya, one of Europe's leading high-volume penile implant surgeons, holds Boston Scientific AMS 700™ and Coloplast Titan® centre of excellence credentials and performs surgery using the no-touch technique, in which the prosthesis is placed without contact with the skin. At his clinic in Istanbul all assessments are carried out with full confidentiality.

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