There are two principal ways of correcting penile deformity. The first one is plication technique, a procedure that shortens the longer side of the penis that has normal length by means of tucks in the walls done by cutting out healthy tissue opposite the plaque — straighter but shorter. This is frequently referred to as the the Nesbit procedure.
In cases such as dorsal curvature, when viewed from the side, the penis will normally have a concave dorsal side with an inward curve and a convex ventral side. Plication technique simply shortens normal penile length 2-3 cm (1 inch) or more to equalize it with the already deformed dorsal side.
Dr Perovic has done this procedure only a few times in recent years on patients with a very mild degree of curvature so there was insignificant loss of length. Otherwise, he almost never performs it because how many man choose to have a drastically shorter penis? Professor Perovic has also noticed that after plication, recurrence of Peyronies disease is much more common after plication than after using his grafting procedure, the second principal way of correcting bent penis disease.
Dr Perovic's standard technique is a radical and exact grafting procedure which restores shape and length of the tunica albuginea that existed before onset of Peyronies disease. It is done by geometrical calculation of the defect in a very logical and simple mathematical way.
The Perovic Procedure is complex and difficult but removes the plaque causing your bent penis and replaces it with a healthy tissue graft — the exact opposite of plication which cuts out healthy tissue and leaves all the diseased tissue.
About 85-90% of Dr Perovic's Peyronies disease patients do not develop erectile dysfunction after surgery. When ED occurs a penile prosthesis implant will be needed to achieve or keep an erection.
Correction procedures have two basically different results: Nesbit and plication give you a shorter penis; grafting gives you a longer, larger penis.
Perovic Peyronie's Treatment differs from almost all other bent penis correction surgery techniques in the world in that very exact measurements of the penile defects are taken and appropriate grafting done to restore its original shape prior to Peyronie's disease. Few surgeons in the world are able to perform the Perovic Peyronie's Procedure and most of them learned it directly from Professor Perovic.
In the majority of other surgical centers, they do only empirical grafting and their penis surgery does not re-establish penile shape exactly. In the majority of cases, there remains residual penile curvature after bent penis correction.
Starting in 2006, Dr Perovic also started restoring penile girth in Peyronie's Disease patients. In addition to transversal grafting of the penis, the Perovic Team also began doing longitudinal grafting to widen it. Penile girth enhancement is also based on geometrical calculation of the defect and of the graft that should be inserted.
During the same period, the Sava Perovic Team also introduced the regular use of InteXen® LP™ (lyophilized [freeze-dried] porcine), the acellular collagen dermal matrix graft material of American Medical Systems (AMS) Holdings Inc of Minnesota, USA. This soft, pliable biomaterial (harvested from animals) is the best grafting material the surgical team has found so far in his more than 36 years of practice. This proprietary biomaterial facilitates tissue integration and cellular remodeling, conforms to patient anatomy, has good hardness, promotes early vascularization, improves early cellular infiltration, promotes collagen rebuilding, maintains graft integrity and has many other good characteristics and gets excellent results. It is very similar to tunica albuginea and semi-resorbable which means that after several months the surrounding tissue grows into it.
The United Statest Department of Agriculture (USDA) regulates the facilities where the grafts are made according to Food and Drug Administration (a federal agency of the USA Department of Health and Human Services) and ISO 9001 standards.
Surgery normally takes 2½-3 hours and sometimes up to four hours if the grafts are big.
In patients who require a penile implant, very exact grafting is performed first, as with other Peyronie's patients, completely re-establishing penile structure and shape, then penile implant surgery is done with either a semi-rigid or inflatable prosthesis.
In a small percentage of patients (10-15%) there is post-operative progression of the disease. Nobody in the world can predict or estimate who will experience progression of the disease or who will not. The great thing about penile implant surgery for Peyronie's disease patients is that it ALWAYS stops the disease. The disease is completely beaten. When post-operative progression of Peyronie's occurs, the only proper solution is immediate penile prosthesis implantation in a second surgery.
For patients who have erectile dysfunction, we immediately implant a penile prosthesis and there is no re-occurence of disease in these patients. Both semi-rigid and inflatable prostheses can be implanted during surgery. We have no special preference and none of them have any special advantage.
This procedure is very radical but safe and effective. It is always done simultaneously with mobilization, complete penile disassembly — disassembly of the penis into it's basic parts — mobilization of the neurovascular bundle. Depending on whether the curvature is ventral or lateral, we also mobilize the urethra. After grafting, all penile parts are re-assembled again.
The procedure is not popularly performed in many surgical centers because penile disassembly is a little bit risky and results in complications if the surgeons are not experienced. However, Dr Perovic and the other surgeons comprisng his Team have performed this procedure for a very long time, even in small babies, without ANY complications to date (30 April 2009).
The Professor usually implants drainage tubes which are removed for about two days after surgery.