Centro de Curvatura Peniana

History of the Disease

Peyronie Disease, as it is known around the world, was described in 1743 by François Gigot de La Peyronie (1678 - 1747), King Louis XV of France’s doctor, who lived at the Palace of Versailles.

Peyronie Disease is characterized by penile curvature during erection that can reach up to 90 degrees in the upward, downward or lateral direction, and may or may not be associated with pain during erections. It can thus make the sexual act difficult or even impossible.

Origin and Cause

How the penis is formed and how the erection occurs

The penis is comprised of three cylindrical cavities. The two upper cavities are called cavernous bodies, and the lower one, a spongy body, which contains the urethra (the channel through which urine and sperm pass).

The two upper cavities are wrapped in an elastic membrane called an albugineous tunic that expands with the arrival of blood, which increases the size and girth of the penis. When both are full of blood, the erection is obtained. It must be sufficiently hard to permit penetration, so long as there is no curvature that impedes or makes penetration impossible, or if there is penetration, of having the penis easily slip out of the vagina.

Above the cavernous bodies, that is, over the albugineous tunic, there are superficial nerves and vessels that provide sensitivity to the penis' skin and the gland and which irrigate them.

Why does the penis curve?

In Peyronie Disease, the albugineous tunic’s normal elastic tissue is replaced by a scar (plaque or nodule).

Normally, with the erection, the elastic membrane (the tunic) expands and elongates symmetrically, resulting in a straight erection. In Peyronie Disease, due to the plaque or nodule (scar – palpable in 70% of the cases), the membrane begins to have less elasticity, resulting in curvature. However, the disease can also present itself as a constriction of the tunic, leading to a thinning of the penis.

OBS: If the man has this curvature from a young age, it may have been caused by a pulling back of one of its membranes (albugineous tunic and/or covering of the tunic). This is the so-called youth’s curved penis (congenital), which can easily bend or hit against the perineum upon exiting from the vagina during the sex act, resulting in trauma that may lead to Peyronie Disease. The surgical treatment for congenital curved penis is similar to that for Peyronie Disease.

Causes of the Disease

Studies show the problem comes from several cause, the most common being:

» Micro traumas and traumas during sexual relations, which in patients with hereditary predisposition facilitates the formation of scars, or plaque, which is responsible for penile curvature. This explains the incidence of the disease in more than one family member.

» Erection problems, which predispose the penis to bending during the sex act, increasing the chances for micro traumas that can lead to Peyronie Disease.

It is estimated that nearly 10% of all men develop the disease during their lifetime.

Evolution of the Disease

Patient complaints regarding Peyronie Disease can be grouped into two phases: inflammatory and fibrosis (scarring).

The inflammatory phase is characterized by progressive curvature, associated or not to pain during erections and with a palpable or not plaque or nodule (scar) under the skin. This phase is generally temporary and treated with anti-inflammatory medication and general instructions. In order for the clinical treatment to have good results, early diagnosis, still in this phase, is important.

In the second phase, when the scar is mature, penile deformity is already defined. Surgery can only be indicated after this phase, however not every patient needs it.

In most cases, the plaque is at the top of the penis, causing curvature in the upward or lateral direction.

Does Peyronie cause impotence?

Some men with Peyronie Disease (about 20%) lose capacity to keep blood in their penis (venoclusive disorder or venous escape), which impedes them from having erections. However, the loss of erection can also be associated with anxiety or stress and not necessarily to disease. Therefore, it is important for the erection problem, regardless of the cause, to be treated, thus avoiding the bending of the penis during the sex act, which consequently reduces the chances for micro traumas.

Relation to other diseases

Incidence of the disease is higher among diabetics, but it may also be associated with Dupuytren Disease, or thickening of the palm of the hand and the consequent curvature of the fingers.

Veja qual o seu caso

Click here to access a window with illustrations of the various possibilities of penile curvature.

Real cases of penile curvature

Attention: This topic was inserted in the site to illustrate real cases at the request of Internauts. The photos published herein are for illustrative purposes only. Penile curvature may very from one case to the other. Therefore, nothing can substitute an appointment with a specialist.
All of the images contained herein were previously authorized. Nevertheless, the identities of the people have been preserved, keeping the photos anonymous.

If you should feel uncomfortable seeing images (photos) of male sexual organs, do not access the link below.

Click here to access a window with real photos.

Treatment

Dr. Paulo Egydio’s Procedure - Click here

Surgery to elongate the short side of the penis

Penile curvature occurs because a membrane (tunic) with less elasticity than it should have causes it to draw back.

All of the surgical procedures used until then led to penis reduction because part of the membrane from the long side of the curved penis was removed until it became equal to the short side. Thus, one problem was solved, however the patient was never fully satisfied.

The surgical procedure developed by Dr. Paulo Egydio permits the elongation of the short side of the penis until it is as long as the long side. This technique permits achieving the maximum penile size possible in a reconstructive surgical procedure for penile curvature.

This technique consists of making an incision in the membrane, the form of which changes for each patient, in order to eliminate any pulling back of the penis. In these cases, the membrane (tunic) is smaller than it should be. When the penis is straightened, a part of the membrane is missing. This is corrected by placing a graft that covers the tunic and allows it to grow again. This graft is made with an already prepared membrane that is not rejected, and this avoids another surgery to get it.

This graft has been used for more than 20 years in cardiac surgery by the Heart Institute and in ophthalmological surgeries.

International publications:

Cardiology

Ophthalmology

The studies and cares for developing this technique have been so precise that specially designed instruments were made to carry out this surgery.

Especially designed material for preserving penile structures.

Transparent and absorbable stitches that forgo removal after surgery.

Dr. Paulo Egydio uses this surgical procedure, which is broadly recognized internationally, since 1988, with great success and patient satisfaction, permitting countless youths and adults to have normal sexual performances.

There are cases when the disease itself leads to a reduction in penis elasticity as a whole, one side more than the other. In these cases, with the use of the previous surgical procedures (reducing the long side until it was the same size as the short one) reduction was even greater. In other words, there was the reduction of the penis as a whole caused by the disease itself as well as the reduction caused by the use of the previous surgical procedures.

The surgical procedure developed by Dr. Paulo Egydio lengthens the short side of the penis, leaving it the size of the long side, recovering penis size lost to the deformity as much as possible by means of a reconstructive surgical procedure for penile curvature.

This same surgery treats penile curvature in youths (curved penises in youths).

The advantages of this surgery

» The procedure is simple with minimal discomfort.

» Recovery is quick. The patient is admitted in the morning, operated on that same day and released no later than the next day, and is able to travel that same day. He may also be operated on the weekend, returning to work and/or school on Monday, thus maintaining confidentiality at work and/or school.

» The technique developed by Dr. Paulo Egydio lengthens the short side of the penis, leaving it the size of the long side, recovering penis size lost to the deformity as much as possible by means of a reconstructive surgical procedure for penile curvature.

» Scarring is discrete and similar to phimosis scarring. Dr. Paulo Egydio use transparent and absorbable stitches to close the incision, similar to what is used in plastic surgery, making it unnecessary to remove them.

» When the patient has erectile dysfunction, it can be treated, and if it responds well to medication, only the surgery to correct penile curvature is needed.

» Dr. Paulo Egydio avoids penile prosthesis implants as much as possible. The penile prosthesis is indicated when the patient has erection problems associated with penile curvature that does not respond to conventional clinical treatment or when the pre-surgery exam proves severe vascular problems in the penis.

» In those cases in which prosthesis implants are indicated, Dr. Paulo Egydio has the great differential of correcting penile curvature and implanting the prosthesis during the same surgery. Through his surgical procedure, correction of the curvature will be done permitting the maximum possible recovery of penis size in a reconstructive procedure for curvature.

Then, during the same surgery, the prosthesis will be implanted with the largest possible prosthesis size for the case. Prosthesis implants without correction of the curvature with the elongation of the short side of the penis will not permit this gain. This is a great differential, when using the surgical procedure by Dr. Paulo Egydio, recovering penile size as much as possible before prosthesis implantation.

For more information on penile prostheses, please access:
www.protesepeniana.com.br

Sex life after surgery

Six weeks after surgery, the patient can go back to normal sexual relations.

The Anesthesia
Dr. Sidney Luiz Stabile Jr. - Anesthetist

The anesthesia begins with the pre-anesthetic preparation in which the surgeon or anesthetist conducts a study to learn of the patient’s health, associated illnesses and medical history, and whenever necessary requests complementary exams or appointment with other specialists to schedule and carry out the most appropriate anesthesia.

It is important to know that the more you know about the patient’s health, the better the surgery and anesthesia results will be. As in any medical specialty, anesthesia is also not exempt from possible complications. However, at present, with the development of new anesthetic techniques, safer drugs and more efficient monitors, anesthesia is safer and incidents involving complications very low. The patient can minimize possible complications by controlling pre-existing illnesses and having periodic check-ups.

On the day of the surgery, the patient receives a doctor visit before going to the surgical center to explain any possible doubts and to receive pre-anesthetic medication, which is comprised of tranquilizers to comfort him and reduce any anxiety. A few minutes after taking the pre-anesthetic medication, he sleeps and is then taken to the surgical center. He will not even remember the preparations that precede the beginning of surgery.

Penile surgery can normally be performed with sedation and local anesthesia. After the patient is adequately sedated and sleeping, local anesthesia is administered where the surgery will be performed. With the continuous administration of anesthetics and sedatives, he remains sleeping and without pain throughout the surgery, regardless of its duration.
In isolated cases, general anesthesia can also be used, keeping him sedated and in deeper sleep.

Regardless of the anesthetic technique, at the end of the surgery, the patient wakes up and is forwarded to the post-anesthetic recovery room where he will be monitored for a period of time, normally about 30 minutes, and then sent to his bed.

Penile surgeries are not very painful during the post-surgical phase and common analgesics, like: Novalgina, Lisador or Tylenol, are sufficient to control pain, always remembering that if other, more potent analgesics are necessary, they may be used.

When he gets back to his hospital bed, the patient can eat and ingest liquids according to his wishes, as well as sit on the bed, read or watch television.

Psychological Aspects

Throughout history, the penis has not only represented the male sexual organ, but it is also the symbol of power, virility and pleasure. In many cultures, such as ancient Greece, for example, it was venerated, playing a core role in initiation ceremonies for adult life or a new life.

Therefore, it is not surprising that deformities or malformations should also profoundly alter basic emotional experiences in man, such as his sensuality and the sexual act itself.

Shame of one’s body and the impossibility to normally experience these feelings and sensations can lead the individual to chronic anxiety, generating great stress, extending to areas that are not directly connected to sexuality, disturbing the individual at work, in social relationships and even in overcoming small everyday problems.

Without the appropriate treatment, greater irritability, negative feelings, low self-esteem, compromising of the quality of life and social isolation can also appear and worsen over time.

Surgical and psychological interventions are very important in order to recover self-esteem and the necessary energy to experience relationships in the healthiest and most pleasure-filled manner, with quality of life, with oneself and with others.

With Dr. Paulo Egydio’s team, the patient is treated as a whole until his recovery and reintegration. For such, it counts on excellent professionals in Psychology, if necessary.

Confidentiality

Dr. Paulo Egydio takes special care in maintaining confidentiality, the reason for which he makes a point of consulting with and operating on each patient.

He takes the same care in choosing his highly qualified team, which is also geared towards confidentiality.

It is possible to make the correction using local anesthesia and sedation (to sleep during the procedure), with the possibility of being released from the hospital on the same day. The return to normal activities (work and/or study), except physical activities, in most cases has been possible in 1 to 2 days. It is not necessary for anyone at work, school or college to know about anything.

Discretion and privacy are fundamental at this moment.

Genital Reoperations / Reconstructions

With his broad experience, Dr. Paulo Egydio has been a reference in complicated cases, and together with his team, he has achieved excellent results in penile reconstruction surgeries.

Using principles of plastic surgery and microsurgery, tissues can be transferred for genital reconstruction. Testicle prosthesis and removal of excess fat that surrounds the penis can also be used concomitantly.

Examples of reoperations:

» Penile prosthesis

» Penile deformities

» Ugly phimosis scars

» Urethral deformities

» Removal of nodules from the penis or scrotum

» Reconstruction of the penis junction with the pubis and/or the penis with the scrotum

» Removal of the scrotum’s high fold in the penis, giving the appearance of a larger penis (the patient may have undergone phimosis surgery where too much skin was removed, causing the pulling back of the scrotum fold, which results in what is called “turkey neck” or he may have been born with this deformity).

Examples of reconstructions:

» Vasectomy reversal

» Embedded penis

» Micro penis

» Absent scrotum

» Scrotum reduction

» Loss of scrotum by accident

» Implant of testicle prosthesis

» Excess hair on the penis

» Excess skin on the tip of the penis

» Phimosis

» Correction of the scrotum surrounding the penis (scrotalization)

Types of prostheses used when necessary:


Flexible penile prosthesis	Inflatable penile prosthesis	Testicle prosthesis