Выраженное искривление полового члена при болезни Пейрони: имплантат или поэтапный подход?

Последнее обновление: Август 21, 2026

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There is a point in Болезнь Пейрони 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.

Итог

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 Лечение болезни Пейрони is structured in practice, and how эректильная дисфункция 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 Головной офис Бангкокской больницы and at Samitivej Sriracha Hospital, Chonburi — 088-022-1445.

Bangkok Hospital Telemedicine is available for patients who cannot attend in person, including international patients — arrange it in advance by email to the Urology department at bhquro@bdms.co.th. Samitivej Sriracha is in-person only. Bear in mind that a curve cannot be measured remotely: telemedicine is best used as a first conversation before travelling, with the examination done in person. For any enquiry about the cost of consultation, the device or the operation, please contact the hospital directly at the same address, or Samitivej Sriracha on 088-022-1445.

Frequently Asked Questions About Surgery for Severe Penile Curvature

How do doctors decide between a penile implant and straightening surgery?

The deciding factor is erectile function, and all major urological guidelines agree on this. Straightening operations such as plication and grafting correct the curve but do nothing to improve erections. A penile implant restores rigidity and can straighten the penis during the same procedure. So men with severe curvature and erectile dysfunction that medication cannot fix are directed toward an implant, while men whose erections still work are offered curvature correction that preserves their natural erections.

What is the staged approach for Peyronie’s disease?

The staged approach applies to men with severe curvature whose erections are intact. It begins with a course of collagenase injections into the plaque, which typically corrects around a third of the curve. If a bothersome bend remains afterwards, a plication operation is performed to straighten what is left. The advantage is that some men are corrected sufficiently by injections alone and avoid surgery entirely, while those who still need an operation lose nothing by having tried the less invasive step first.

Is a penile implant reversible?

No. Placing an implant permanently alters the erectile tissue, so natural erections do not return afterwards and tablets, injections and vacuum devices will no longer work. That is precisely why it is offered to men whose natural erections have already failed, and why the decision deserves unhurried discussion. The main risks are infection, which usually means the device has to be removed, and mechanical failure, which a proportion of men will face eventually and which is addressed with revision surgery.

Does penile plication make the penis shorter?

Yes, to some degree, and this is inherent to how the operation works rather than a complication. Plication straightens the penis by placing stitches along the longer outer side of the curve to shorten it until both sides are equal. Comparative studies confirm measurable shortening with plication, while collagenase injections cause essentially no length change and grafting procedures may add a small amount. Palpable knots at the suture sites and some change in sensation are also common. Every man considering plication should have these trade-offs explained clearly before consenting.

How long should you wait after collagenase injections before having surgery?

At least six months after the final injection. Surgeons have reported increased scarring and technically more difficult operations in men who underwent surgical correction less than six months after their last collagenase treatment. When an appropriate interval is observed, plication after prior injection therapy is safe and effective, with published series showing excellent straightening and no complications attributable to the earlier injections.

When is a man ready for Peyronie’s surgery?

Surgery is reserved for stable disease. Guidelines generally require at least twelve months of symptoms with the curvature unchanged for a minimum of three to six months, and erection pain typically resolved. Operating while the disease is still active risks correcting a deformity that continues to change afterwards. Assessment should include measuring the curve during a medically induced erection in the clinic, which also reveals erectile dysfunction that the patient’s history alone may not have shown.

What symptoms after implant surgery need urgent attention?

Fever or shaking chills, spreading redness, discharge from the wound, pain that increases rather than settles after the first few days, difficulty passing urine, or any part of the device becoming visible through the skin. Contact your surgical team the same day rather than waiting for a scheduled appointment, since early recognition often determines whether an infected device can be salvaged. In Thailand the emergency number is 1669.

How do I enquire about Xiaflex injections?

If Xiaflex is something you are interested in, please email the Urology department at bhquro@bdms.co.th to enquire first. Whether injection treatment is suitable for you at all is a separate question, answered by the assessment described above: a stable curve, a plaque that can be felt, a measured curvature of at least thirty degrees, and erectile function that still works. Men whose erections have already failed are generally better served by considering an implant instead.

Can I discuss this by telemedicine before travelling to Bangkok?

Yes, for the initial conversation. Bangkok Hospital Telemedicine is available for patients who cannot attend in person, including international patients, and is arranged in advance by email to the Urology department at bhquro@bdms.co.th. It is a sensible first step for reviewing your history, previous treatments and expectations. However, a curve cannot be measured remotely: the deformity must be assessed during a medically induced erection in the clinic before any decision between an implant and a staged approach can be made. Samitivej Sriracha is in-person only.

Ссылки

1. Chierigo F, Fallara G, Tozzi M, et al. Guideline of guidelines: Peyronie’s disease. BJU Int. 2026;137(5):770–782. PubMed
2. Manka MG, White LA, Yafi FA, et al. Comparing and contrasting Peyronie’s disease guidelines: points of consensus and deviation. J Sex Med. 2021;18(2):363–375. PubMed
3. Khera M, Bella A, Karpman E, et al. Penile prosthesis implantation in patients with Peyronie’s disease: results of the PROPPER study demonstrates a decrease in patient-reported depression. J Sex Med. 2018;15(5):786–788. PubMed
4. Moncada I, Krishnappa P, Zaccaro C, et al. Penile prosthesis implantation is safe and effective in Peyronie’s disease patients with and without erectile dysfunction. Международный журнал импотенции исследований. 2025;37(1):61–65. PubMed
5. Hammad MAM, Barham DW, Simhan J, et al. A multicenter evaluation of penile curvature correction in men with Peyronie’s disease undergoing inflatable penile prosthesis placement. J Sex Med. 2025;22(2):349–355. PubMed
6. Yafi FA, Diao L, DeLay KJ, et al. Multi-institutional prospective analysis of intralesional injection of collagenase clostridium histolyticum, tunical plication, and partial plaque excision and grafting for the management of Peyronie’s disease. Urology. 2018;120:138–142. PubMed
7. DeLay K, Diao L, Nguyen HMT, et al. Successful treatment of residual curvature in Peyronie disease in men previously treated with intralesional collagenase clostridium histolyticum. Urology. 2017;110:110–113. PubMed
8. Levine LA, Larsen SM. Surgical correction of persistent Peyronie’s disease following collagenase clostridium histolyticum treatment. J Sex Med. 2015;12(1):259–264. PubMed
9. Kuja-Halkola R, Henningsohn L, D’Onofrio BM, et al. Mental disorders in Peyronie’s disease: a Swedish cohort study of 3.5 million men. J Urol. 2021;205(3):864–870. PubMed
10. Ziegelmann MJ, Bajic P, Levine LA. Peyronie’s disease: contemporary evaluation and management. Int J Urol. 2020;27(6):504–516. PubMed

Отказ от ответственности: This content is written and reviewed by Dr. Soarawee Weerasopone, a board-certified urologist at Bangkok Hospital Headquarters. It is intended for educational purposes only and does not constitute medical advice. No diagnosis, prescriptions or medical advice are given through personal messaging channels or social media. Always consult a qualified healthcare professional before starting, stopping or changing any medical treatment. Industry disclosure: Boston Scientific 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. In an emergency, attend the nearest emergency department — in Thailand the emergency number is 1669.