Rigi10™ Malleable Penile Prosthesis
Also Known As
Peyronie's disease treatment, Chordee correction (for congenital curvature), Penile straightening, Correction of penile angulation.
Definition
Penile curvature correction refers to a range of medical and surgical interventions designed to address abnormal bending or curving of the penis, most commonly when erect. This condition can be congenital (present from birth) or acquired, with Peyronie’s disease being a primary cause of acquired penile curvature.¹ Peyronie’s disease is characterized by the formation of fibrous scar tissue (plaques) within the tunica albuginea, the sheath surrounding the erectile tissue of the penis. This inelastic scar tissue can cause the penis to bend, shorten, or develop an hourglass deformity during erection, often accompanied by pain and erectile dysfunction.¹
The purpose of penile curvature correction is to straighten the penis, alleviate pain, improve sexual function, and reduce psychological distress associated with the deformity. Treatment approaches vary depending on the cause, severity of the curvature, presence of pain, erectile function status, and patient goals. Options range from oral medications and intralesional injections in the acute phase of Peyronie’s disease to various surgical procedures for stable, chronic conditions.¹ Surgical correction aims to restore a functionally straight penis, allowing for satisfactory sexual intercourse.¹
Clinical Context
Penile curvature correction is clinically indicated when the curvature is significant enough to cause pain, difficulty with sexual intercourse, emotional distress, or erectile dysfunction.¹
For Acquired Curvature (e.g., Peyronie’s Disease): Acute Phase: Characterized by pain, ongoing plaque formation, and changing deformity. Treatment in this phase is often conservative, aiming to manage pain and potentially limit disease progression. Options include oral medications (e.g., NSAIDs for pain, pentoxifylline, vitamin E, colchicine – though evidence for efficacy varies), intralesional injections (e.g., collagenase clostridium histolyticum (CCH), verapamil, interferon), and mechanical traction therapy.¹
Chronic Phase: Occurs when the pain has resolved, and the penile deformity has been stable for at least 3-6 months. Surgical intervention is typically considered in this phase if the curvature is severe, impairs sexual function, and conservative measures have failed.¹
Patient Selection Criteria for Surgery: Stable disease (curvature and pain stable for 3-6+ months).¹ Penile curvature significant enough to interfere with sexual function or cause distress.¹
Adequate erectile function, either naturally or with medical assistance (e.g., PDE5 inhibitors). If severe erectile dysfunction coexists, a penile prosthesis implantation with or without concurrent straightening maneuvers may be recommended.¹
Surgical Procedures: Tunical Plication/Shortening Procedures (e.g., Nesbit procedure and its modifications): Involve shortening the convex side of the penis (opposite the plaque) to straighten it. Suitable for less severe curvatures (typically <60 degrees) and adequate penile length. May result in some penile shortening.¹
Plaque Incision/Excision and Grafting Procedures: Involve incising or excising the plaque on the concave side and placing a graft (e.g., autologous vein, dermis, cadaveric pericardium, synthetic materials) to lengthen the shorter side. Suitable for more severe curvatures (>60 degrees), hourglass deformities, or when penile length preservation is critical. Higher risk of postoperative erectile dysfunction compared to plication.¹
Penile Prosthesis Implantation: Recommended for men with penile curvature and significant erectile dysfunction unresponsive to medical therapy. The prosthesis itself can often correct some degree of curvature, or adjunctive straightening maneuvers (e.g., modeling, plication, incision/grafting) can be performed at the time of implantation.¹
Expected Outcomes: The primary goal is a penis that is functionally straight for intercourse. Success rates vary by procedure and patient factors but are generally high for achieving functional straightness.¹ Potential complications include penile shortening, recurrent curvature, altered sensation, palpable sutures or grafts, and erectile dysfunction (especially with grafting procedures).¹ Recovery involves a period of abstinence from sexual activity, typically 4-8 weeks, depending on the procedure.¹
For Congenital Penile Curvature (Chordee): Usually identified in adolescence or young adulthood. Surgical correction (often plication procedures) is the mainstay of treatment if the curvature is significant enough to interfere with function or cause concern. Outcomes are generally excellent.¹