ပိုင်ရိုနီရောဂါရှိ ပြင်းထန်သော လိင်အင်္ဂါကွေးညွတ်ခြင်း- ဆေးထည့်ခြင်း (အင်ပလန့်) လား၊ အဆင့်လိုက်ပြုလုပ်ခြင်းလား။

နောက်ဆုံး ပြင်ဆင်သည် ဩဂုတ် 21, 2026

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There is a point in Peyronie ၏ရောဂါ where the conversation changes. The bend is no longer a nuisance — it has made intercourse impossible. Tablets are not going to help. A course of injections alone may not be enough. The question is no longer whether to intervene, but how.

What surprises most men is how much of that decision comes down to a single question — one that has nothing to do with the curve itself.

Are your erections still working?

The four major urological societies — American, European, Canadian, and the International Society of Sexual Medicine — disagree about a great many things in Peyronie’s disease. They agree completely about this. Erectile function is the fork in the road, and everything downstream follows from which side of it you are standing on.

Disclosure: Boston Scientific, a manufacturer of penile implants, has provided travel and accommodation support for Dr. Soarawee’s prosthetic urology training workshops. No manufacturer has any role in the content of this article or in which device is recommended to any individual patient. Since one of the two pathways below is implant surgery, you are entitled to know that before reading further.

Why This One Question Decides Everything

The logic is simpler than it sounds.

Operations that straighten the penis — plication and grafting — do exactly that and nothing more. They correct the bend. They do not improve erections. If a man cannot achieve a usable erection before surgery, a perfectly straight penis afterwards has not solved his actual problem.

A penile implant, by contrast, restores rigidity and can be used to straighten the penis at the same time. It is the only option that addresses both problems in one operation.

So the pathway divides:

• Severe curve with erectile dysfunction that medication cannot fix → an inflatable penile implant, with straightening performed during the same procedure.
• Severe curve with erections still working → a staged approach: start with injections into the plaque, and add a straightening operation afterwards only if a bothersome bend remains.

One more rule applies to both routes: surgery is only for stable disease. Guidelines generally want at least twelve months of symptoms and a curve that has not changed for three to six months. Operating on a curve that is still evolving risks correcting a deformity that will simply reshape itself afterwards.

Before Anything: Getting the Assessment Right

A patient’s own description of his erections is a starting point, not an answer. Men routinely underestimate or overestimate their erectile function, and a bent penis can make an otherwise adequate erection feel inadequate.

This is why every major guideline recommends assessing the deformity with a medically induced erection in the clinic. It is the only way to measure the curve accurately, see the true direction and shape of the deformity, and — critically — judge how well the erectile tissue is actually filling. That examination frequently uncovers erectile dysfunction that the history alone did not reveal, and it can move a man from one pathway to the other before a single decision is made.

Skipping this step is the most common way a Peyronie’s operation ends in disappointment.

Pathway 1: The Penile Implant, When Erections Have Failed

An inflatable penile prosthesis is a device placed inside the erectile chambers, allowing a man to produce a firm erection whenever he chooses. In Peyronie’s disease it does double duty: the device restores rigidity, and the operation itself is used to straighten the penis.

How the straightening is achieved

Placing the implant alone is often not enough — in most Peyronie’s cases the surgeon adds a straightening manoeuvre during the same operation. The options escalate with severity:

• Manual modeling — with the device inflated, the surgeon firmly bends the penis against the curve to stretch and break up the scar. This is by far the most commonly used technique.
• The “scratch” technique — the scar is scored from the inside during the operation, making it easier to stretch straight.
• Plication — stitches placed on the opposite side to balance the two sides out.
• Grafting — the scar is cut and the gap patched with tissue. Reserved for the most severe curves, and it delivers the largest correction of all.

Some surgeons also add vacuum therapy after surgery to continue gently stretching the tissue during healing, which can bring residual curves down further over the following months.

What the outcomes look like

This is one of the most satisfying operations in men’s health. Across multiple large studies, the large majority of men are satisfied or very satisfied afterwards, most are still using the device years later, and most say they would choose the operation again. Surgical times and complication rates in Peyronie’s patients are broadly comparable to implant surgery in men without the condition.

One finding deserves particular attention. In a large multicentre registry study — co-authored by Professor Mohit Khera, under whom I worked as a Research Scholar and Clinical Observer at the Scott Department of Urology, Baylor College of Medicine — rates of self-reported depression among men who received an implant roughly halved within the first year after surgery. Registry studies of this kind describe what happened to men who chose the operation rather than proving the operation caused the change, but the size of the effect is striking either way.

That is worth pausing on. Peyronie’s disease carries a genuinely serious psychological burden — large national studies have found meaningfully elevated rates of anxiety and depression among affected men. An operation that measurably lifts that burden is doing considerably more than correcting a shape. It also cuts the other way: if low mood is a significant part of what you are living with, it deserves treatment in its own right alongside anything done for the curve, and it should not be left to wait for a surgical date. If you are struggling badly, please speak to a doctor about that part specifically rather than enduring it until the operation.

What men must understand before consenting

Two things, honestly stated:

It is irreversible. Placing an implant permanently alters the natural erectile tissue. There is no going back to natural erections afterwards, and tablets, injections and vacuum devices will no longer work — which is exactly why it is reserved for men whose natural erections have already failed.

Devices are mechanical, and mechanical things eventually fail. Modern implants are durable and last many years, but a proportion of men will need revision surgery at some point in their lives. That is a known part of the deal, not a complication that was hidden from you. Infection is the other risk that matters: uncommon with modern coated devices and careful technique, but when it happens the device usually has to be removed, and the risk is higher in men with diabetes, in revision surgery, and after radiotherapy.

There is also a length conversation to have. Men who start with the most severe deformity and need grafting during the implant procedure are noticeably more likely to be unhappy with penile length afterwards. It is far better to discuss that honestly beforehand than to discover it at the follow-up visit.

After surgery, contact your surgical team the same day for fever or shaking chills, spreading redness, pain that increases rather than settles after the first few days, discharge from the wound, difficulty passing urine, or any part of the device becoming visible through the skin. Do not inflate or cycle the device until you are shown how at a follow-up visit. In Thailand the emergency number is 1669.

See how penile prosthesis surgery is structured in practice.

Pathway 2: The Staged Approach, When Erections Still Work

If erections are intact, the priority shifts. Now the goal is to fix the bend without creating the erectile dysfunction the man does not yet have. That argues for starting small and escalating only if necessary.

Stage one: injections into the plaque

Collagenase injections are given directly into the scar, where the enzyme breaks down the collagen holding the curve in place. A full course runs to four treatment cycles paired with in-clinic stretching, and it is intended for men with a plaque the doctor can feel and a curve of at least thirty degrees.

The typical man ends up with roughly a third of his curve corrected. Completing the full course matters: men who finish all four cycles do measurably better than those who stop early. The treatment also carries a real risk of corporal rupture, which is why abstaining from sexual activity for at least two weeks after each modeling session is not optional. I have written in detail about how this injection treatment works, who qualifies, and what the risks are.

If Xiaflex is something you are interested in, please email the Urology department at bhquro@bdms.co.th to enquire first.

For some men, that is the end of the story — the curve becomes workable and no operation is ever needed. For others, a bothersome bend remains, and that is where stage two comes in.

Stage two: plication for what is left

Plication straightens the penis by placing stitches along the longer, outer side of the curve, shortening it until both sides match. It is technically straightforward, quick, and carries a low risk of causing erectile dysfunction — which is precisely why it suits this group of patients.

The trade-off is inherent to the technique: because it works by shortening the longer side, plication makes the penis somewhat shorter. That is not a complication. It is how the operation functions, and every man considering it should hear it plainly. Palpable knots at the suture sites and some change in sensation are also common and worth expecting.

Two practical points about doing plication after injections:

• It works, and it works well. Published series of men who had plication after a course of collagenase report excellent straightening, with most ending up with little or no residual curve and no complications attributable to the earlier injections.
• Timing matters. Surgeons have reported more scarring and technically harder operations in men taken to theatre less than six months after their final injection. Waiting at least six months is the sensible rule.

Injections Versus Surgery: An Honest Comparison

A study that compared all three options in the same institutions gives the clearest picture, and the message is refreshingly blunt. One caveat first: men were not randomly allocated to these treatments, so the groups differed to begin with, and the comparison shows what happened in each group rather than what would happen to the same man under each option.

Surgery straightens far better than injections. Plication and grafting corrected the great majority of the curve; injections corrected roughly a third. If maximum straightening is the only thing that matters to you, surgery wins and it is not close.

But injections cost you almost nothing in length. Men treated with injections alone had essentially no change in penile length. Plication shortened the penis; grafting, interestingly, tended to add a little.

Erectile function held up in all three groups. None of the approaches damaged erections in that study — though grafting in particular carries a recognised risk of new erectile dysfunction in wider practice, which is why it is used selectively.

And a detail that validates the whole staged strategy: the men in that study who still had a troublesome curve after injections went on to have plication without difficulty. Starting with injections did not close any doors.

That is the real argument for the staged approach. It is not that injections are better than surgery — they are not. It is that starting with the less invasive option costs you very little, may spare you an operation entirely, and leaves the surgical option fully available if you need it.

အနှစ်ချုပ်

Severe Peyronie’s disease is treatable, and treated well it changes lives — not only physically. But there is no single best operation. There is only the right pathway for the individual man.

If erections have failed despite medication, an inflatable implant with straightening performed at the same time is a definitive, single-stage answer with consistently high satisfaction — provided you accept that it is irreversible and mechanical.

If erections still work, there is rarely a reason to rush to theatre. Start with injections, see how much curve they take away, and reserve plication for what remains — accepting some shortening as the price of a straight result.

What determines which of these you should be offered is not how bad the bend looks. It is a proper assessment — a measured curve, an examined erection, a stable disease course, and an honest conversation about what matters most to you. See how Peyronie’s disease treatment is structured in practice, and how erectile ကမောက်ကမဖြစ်မှု is assessed alongside it.

If your curve has stopped changing and is preventing intercourse, it is time for a proper assessment rather than more waiting. Dr. Soarawee Weerasopone offers specialist consultations in men’s health, Peyronie’s disease, and penile prosthesis surgery at ဘန်ကောက်ဆေးရုံ