Penile curvature may occur from birth or may occur after a certain age. Penile curvatures that have been present since birth are called "Congenital Penile Curvature". The reason is an embryological development defect. In this type of penile curvature, the curvature may be slight or at a level that prevents sexual intercourse (more than 25 - 30 degrees). In general, it is not necessary for the penis to be straight like a tower. In mild curvatures, there is no need for any intervention as there will be no problem during sexual intercourse. However, in case of curvatures greater than 25 degrees, the partner may experience pain due to strain in the vagina, while the man may also experience a fracture of the penis due to strain (penile fracture). For this reason, curvatures over 25 degrees need to be corrected by surgery.
Penis curvature can be detected in childhood, but it is appropriate to perform surgical intervention in young adulthood. Patients generally consult a doctor if they have difficulty in sexual intercourse or because they think that it may cause problems during sexual intercourse because they work a lot with their penis in adolescence.
In congenital penile curvatures, it is not possible to correct the curvature with medication or the use of tools other than surgery. The curvature can be corrected with surgery, and it is necessary to stay in the hospital for 1 day after the surgery. It is recommended not to have sexual intercourse for 1 month after the surgery. The bandage applied to the penis is applied for 15 days. There will be no obvious incision scar after the surgery, because during the surgery, the penis skin is incised from the area where the foreskin stitches were placed and moved to the penis root. The surgery is performed on the corpus cavernosum wall.
The later form of penis curvature is called "Peyronie's Disease":
Peyronie's disease occurs later and is the presence of a hard tissue in the penis. It is a disease characterized by The most important cause of Peyronie's disease is penile trauma. It may occur due to situations such as bending, bending or straining on the penis due to rough sexual intercourse. Peyronie's disease can be encountered in later years, especially in patients with a history of penile fracture. A. In addition, Peyronie's disease may occur due to injection applications into the penis used in the treatment of erectile dysfunction.
Although it is usually seen between the ages of 40-60, it can also be seen in the 20s, although rarely. When it occurs in the twenties or below, when the patient's history is examined, it is noticed that there are bending and twisting movements of the penis during erection. It may also occur due to masturbation by rubbing the penis on a flat hard surface, which can be seen in some boys.
Peyronie's disease is a disease that manifests itself with deformity and pain in the penis due to the thickening caused by calcification in the tunica albuginea layer, one of the layers under the skin of the penis. . Peyronie's disease may occur due to a fracture of the penis (penile fracture) due to rough sexual intercourse or trauma while the penis is erect. The severity of the trauma and the continuity of small traumas (microtraumas) facilitate the formation of Peyronie's disease.
When we examine the causes of Peyronie's disease;
-Penile trauma,
-Continuous forceful movements (against the penis).
-Injection treatments into the penis used for erection treatment,
-Use of vacuum device,
-Presence of connective tissue diseases.
The diagnosis of Peyronie's disease can be made by examination. The location of Peyronie plaques can be determined with films. With penile Doppler ultrasonography, plaques can be evaluated and information about the erection status of patients scheduled for surgery can be obtained.
Surgical treatment is not recommended in the first 6-8 months of the onset of the disease in the treatment of Peyronie's disease. Surgery can be planned after the progression of the disease has stopped. Firstly, drug treatment, intralesional drug application, shock treatment to Peyronie plaque (ESWT) are among the options. If there is a curvature that prevents sexual intercourse despite these treatments, surgery is planned to correct the curvature.
When is the Surgical Treatment of Penile Curvature Performed?
Surgical intervention is preferable for patients with congenital penile curvature in their 20s. It should be done at different ages. The first reason patients come to the doctor may be because their partner feels pain during sexual intercourse, or because they feel pain in their penis. It may also occur due to discomfort during erection.
Sometimes, patients come to the hospital saying that they feel that their penis is straining and will break during sexual intercourse. While they may have difficulty in some positions, they may not have any difficulty in others. In general, in most congenital curvatures, the curvature is downward, and the penis is likened to a banana. However, it can be seen in slight curvatures to the right, left and upwards.
The decision for surgery, the patient's complaint, the discomfort of the partner and the risk of penis fracture in some positions help to make the decision for surgery. Practically, surgery is recommended as problems may occur in curvatures over 25-30 degrees.
Penis curvature can be evaluated by taking a photo of the curvature during erection. In some patients, the degree of curvature can be determined by injecting the penis to create an artificial erection. In Peyronie's disease, surgery can be performed as early as 6 months after the onset of the disease, but it is preferably done by waiting 1 year. During this period, the active period of the disease passes and surgery can be performed easily as the curvature stops getting worse.
How is Penile Curvature Treated?
Surgery is the only option in the treatment of congenital penile curvature. The curvature must be corrected surgically. It is not possible to correct the curvature with various device applications and medication use. It is necessary to stay in the hospital for 1 day after the surgery. The ban on sexual intercourse is stated as 30 days. It is taught to wrap the penis with a bandage for 15 days to prevent night erections.
Congenital penile curvature can cause a deficiency psychology in some people, apart from distress in sexual intercourse.
In the treatment of Peyronie's disease, at least 6 months from the beginning of the disease. – Drug treatment is applied for 1 year. A different form of treatment can also be applied in which various substances are applied to the Peyronie plaque. Peyronie's disease is also being treated with shock wave therapy. Shock treatment aims to eliminate pain and correct the curvature.
In Peyronie's disease, no results can be achieved with medication and shock treatment, and the curvature depends on gender. If the curvature is at a level that prevents intercourse, it is preferred to correct the curvature with surgery. Plication stitches can be used for curvature, as well as patching (graft application) to the curvature area.
If the person with Peyronie's disease also has erectile dysfunction, a penis prosthesis can be attached to the patient and the curvatures can be corrected with inflatable prostheses without using plication and graft.
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