German Center for Urology and Phalloplasty Surgery

Peyronie’s disease

Basic information on our work / results

Do you wish to have a high-quality microsurgical removal of your disease without a shortening of the penis and without having to accept further limitations due to acquired curvature of the penis? We will be glad to help you!

The distinguishing features of our work:

  • We are a competence and reference centre for reconstructive therapy for Peyronie’s disease (acquired curvature of the penis).
  • We are super-specialised in the reconstructive correction of Peyronie’s disease. Our surgeons have the greatest amount of experience in this field in all of Europe.
  • We have handled over 3,500 cases of Peyronie’s disease so far (in comparison: due to the high degree of specialisation required, a German university clinic only performs around 10 reconstructive surgeries of this type per year).
  • We effectively remove the seat of the disease and do not merely perform ‘patchwork’ (see the description of our surgical techniques)
  • We specialise in penis disassembly for the removal of distal plaques.
  • No shortening of the penis is caused by our technique.
  • Our success rate is over 90%.
  • We have specific experience with:
    • difficult cases (serious curvatures of the penis)
    • plaques under the glans penis and/or between the corpora cavernosa of the penis
    • corrections of failed previous operations using the Nesbit or Essed-Schröder techniques

The history of Peyronie’s disease

The disease Peyronie’s disease (IPP, Induratio Penis Plastica), which as a rule causes a curvature of the penis, has been known to the medical field for a long time already. There are references to it in specialist literature as early as 1561. The physicians Fallopius and Vesalius were among the pioneers who reported on the disease of curvature of the penis. However, curvature of the penis was first described in detail by the French physician Francois de la Peyronie, a surgeon at the court of King Louis XV, in 1743. This is why the disease is also commonly referred to as ‘Peyronie’s disease‘ in English.

Similarities in the way tissue is altered through Peyronie’s disease and Dupuytren’s contracture of the hand were later noted by Sir James Paget.

The first surgical operation to treat Peyronie’s disease was performed in 1882. The removal of the plaque resulting from IPP in its entirety and insertion of new tissue was first performed by O. S. Lowsley in 1943. In 1965, R. M. Nesbit introduced his simpler tucking technique that would indeed straighten the penis but unfortunately would also shorten it significantly.

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Prevalence of the disease

Peyronie’s disease is a benign disease that mostly occurs in middle-aged men (ages 40-60). However, it can also occur in younger men.

Peyronie’s disease is a disease that occurs in approximately 5% of all men.

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Changes caused by the disease in detail

First of all, there is a serious misconception must urgently be cleared up:

Peyronie’s disease is commonly called ‘abnormal curvature of the penis’. That is incorrect. This fact was not just discovered recently. As early as the 16th century, the physicians who first wrote of this disease consciously did not call it deviatio penis plastica (deviatio = curvature) rather induratio penis plastica (induratio = retraction). Curvature of the penis is one of several possible symptoms of this disease and not the only symptom or even the cause of the disease.

This conclusion is very important, as therapies that only deal with the actual curvature of the penis do not solve the actual problem but sometimes even worsen it. More information can be found in the ‘surgical treatment options for Peyronie’s disease section.

(In some places we also use the term ‘abnormal curvature of the penis’, but only so that patients can find us on the Internet.)

There are severe cases of Peyronie’s disease that do not exhibit any sort of curvature but rather significant hardening or shortening of the penis and serious erection problems. The necessary requirements for successful therapy of a disease are to understand it and to recognise the relationships involved.

It is true that curvature of the penis is a common symptom of the disease of Peyronie’s disease, but in addition severe shortening of the penis, significant erection problems, constrictions (the so-called hourglass phenomenon), lumps and other significant impairments of the penis.

Most patients suffer from a significant loss of self-confidence from the effects of the disease, which naturally has a serious effect on their sex lives. The Peyronie’s disease always leads to significant psychological strain. The topics of sexuality and coordination with one’s partner play a large role in the overall view of Peyronie’s disease.

How is Peyronie’s disease caused and what symptoms occur?

The exact cause of Peyronie’s disease is still unknown. Up to 47% of patients with Peyronie’s disease have similar concomitant diseases such as Dupuytren’s contracture or Ledderhose’s disease with hardening in the hands and feet. In some cases, Peyronie’s disease occurs after an operation in the pelvic region, mostly following radical prostatectomy.

Immunological factors also appear to play a major role, so genetic disposition is probable. However, recently there have been increasing indications that it may be caused by an infection (possibly HPV).

Either way, the exact cause is unfortunately still unknown.

What exactly happens to the penis?

The early stages of Peyronie’s disease are characterised by the occurrence of an inflammatory response between the tunica albuginea and the corpora cavernosa it sheaths, mostly on the back, or top, of the penis. This inflammation leads to the formation of collagen (hard fibre) deposits and can lead to lamellar fibrosis (accretion & hardening) that may or may not contain lime scale.

A benign tumour therefore results on the penis. Let us agree to henceforth refer to this benign tumour as a ‘plaque’ to make it completely clear that it does not involve cancer.

These changes can primarily have the following effects:

Possible symptoms

1. The erectile tissue in the area where this plaque is located can no longer expand fully during an erection. It is therefore shorter than the healthy side. This can lead to a curvature of the penis of up to 90° during an erection. The penis can therefore take a bad turn, to put it plainly. This is not at all a rare occurrence. At the start of the disease, when the erection is still very hard, the great strain on the tissue can lead to significant pain.

2. Depending on its size, the plaque squeezes the blood vessels that are required for an unproblematic erection. This leads to a disrupted valve mechanism and thereby to a decrease in erection hardness.

3. Due to the change, it is not uncommon for a pressure gradient to also occur during an erection which the body must now overcome in addition. A so-called hemodynamic problem results, which can lead to a reoccurrence or increase of the erectile dysfunction after a time.

4. Plaques that are not just located in one spot but rather go all around the penis lead to constrictions. The penis looks very thin and feels hard in this spot while the rest expands drastically. A kink can also occur in this spot.

5. If the plaque is large and exhibits multiple severe hardenings, the surface of the penis can look like a chain of beads. This condition often feels very uncomfortable for the patient as well.

6. Large plaques that affect a significant portion of the penis can sometimes lead to a significant shortening of the penis.

7. Depending on the location of the plaques, there can be a reduction of sensation on the glans penis.

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Course of the disease

There is a misunderstanding that has to be cleared up in this area as well: It is unclear to many urologists as well as many patients what the actual ‘active’ status of Peyronie’s disease is, while there may justifiably be hope for a spontaneous healing (approximately 20%).

The sad truth and difficulty with medication-based therapy is that you as the patient are not aware of the active status of your disease of Peyronie’s disease at all. The ‘active’ status is the inflammatory response that lapses before the plaque arises. According to our experience, as soon as a plaque has occurred the chance for spontaneous healing is therefore zero percent.

This plaque, which is nothing other than a simple scar, will change over time, however, as every scar does. Like any scar, the plaque will lose water, constrict and form mounds of fibre (which you can feel as bumps). This will not all occur at the same time but rather in different spots at different times.

This means that this plaque and the visual changes and symptoms caused by it will change over time. This is not because the disease is still ‘active’ but rather because the scar is going through its normal ageing process.

The growth of a plaque will not cease. The plaque will not continue to grow because the disease is still present but rather for purely mechanical reasons. Significant shear forces occur during every erection and all sexual intercourse in the transitional zone between solid plaque tissue and elastic erectile tissue. The results in small tears on the edge of the plaque or directly within it again and again, which then heal again as scars. The plaque therefore increases bit by bit over time like adding bricks to a wall. Depending on how things pass, these ageing processes can even cause the direction of the curvature of the penis to change.

As Peyronie’s disease is not a malicious disease that is terminal, it must be viewed purely from the perspective of medical science but does not necessarily require treatment.

If the patient decides not to be treated, that is his right. For the complete and conscientious provision of medical information, however, we will explain the consequences in detail to precisely these patients.

It would be a great fallacy to believe that the exhibited characteristics and symptoms of Peyronie’s disease will always remain the same as they were at the point in time when the patient decided against therapy. It would be an even bigger fallacy to believe that the prospects for successful therapy would be just as positive even if the patient waits longer before beginning therapy. Here are the facts on this:

1. Peyronie’s disease plaque continues to grow throughout the patient’s life through mechanical strain. Curvature and/or constriction and/or shortening will increase, it will become more difficult to get an erection, a venous leak will arise and at some point this will result in impotence.
2. Normally many years pass before such a dramatic development of the symptoms results, but unfortunately not always. Depending on the location and size of the original plaque, impotence can also result within a few months or even a few weeks. Unfortunately no physician is capable of foreseeing this.
3. The larger the plaque grows, the more and more structures it will influence and thereby the more difficult it will be to remove. This will increase the risk and costs of an operation.
4. The larger the plaque is, the more restrictions it will cause to the normal function of the penis. If the plaque exists for too long then it will no longer be possible to restore the function and length of the penis even through professional therapy.

The sad truth is that some patients who believe from insufficient or erroneous information that they could still wait before beginning therapy of their Peyronie’s disease are thereby squandering their chance for successful therapy.

The results of not treating Peyronie’s disease are normally significant and must not be left unstated, even if the statement seems drastic.

Approximately 90% of all sexual contact in Europe occurs within a relationship. This means that sexual intercourse plays an important role in a relationship. If the function of the penis is mostly or completely disrupted for months or years, this will normally place a significant strain even on relationships that started out well and have lasted for years. Then there is also the drastic impairment to the patient’s self-confidence after a time.

We do not wish to pressure any patient into therapy, however it is our duty as physicians to point out that lack of treatment or treatment that is provided too late can lead to a grave defect of the primary sex organ (in this case the male penis) and normally to significant long-lasting consequences that the affected patient cannot begin to imagine in advance for the most part.

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Non-surgical treatment options for Peyronie’s disease

The fact is: Unfortunately medical science still offers no non-surgical therapy that would be capable of removing the plaque or even causing a notable change to the symptoms at least.

That will probably surprise you. You may be one of the many patients who continue to have medications such as Potaba, tamoxifen, colchicine, vitamin E or other wonder drugs prescribed by their urologists or physicians for the ‘treatment’ of Peyronie’s disease.

This is very unfortunate and shows the serious influence of the pharmaceutical industry.

We do not wish to bore you with our own opinion of the medications listed above at this point, but rather will quote from a certified continuing medical education that was already published by Springer in the medical journal Der Urologe (The Urologist) on 14 January 2006.

On the subject of the most commonly used non-surgical methods for treating Peyronie’s disease, it states:

1. Potassium para-aminobenzoic acid (Potaba): ‘showed no notable effect’

2. Vitamin E: ‘there is no scientific evidence that therapy for Peyronie’s disease using vitamin E is sensible’

3. Tamoxifen: ‘use for Peyronie’s disease is not sensible’

4. Colchicine: ‘the use of colchicine for Peyronie’s disease is not sensible’

5. Verapamil: ‘no effect on Peyronie’s disease could be proven’

On the subject of shockwave therapy it was also stated: ‘it cannot be recommended’

On the subject of radiation therapy: ‘this therapy does not appear to be sensible for Peyronie’s disease’

It is frightening that few urologists or physicians seem to care, despite these results and despite the fact that they were already published in 2006 – in a medical journal for urology, at that. Nearly all patients who contact us still report that they were prescribed either Potaba or vitamin E by their physician – without any noticeable effect. Some of them suffered from significant side effects during the use of these medications.

Please excuse our blunt language in this section.

Everyday urology is unfortunately very conservative when it comes to diseases to the penis itself. Many patients report that they had the impression that their urologist was uncomfortable discussing this disease, did not provide extensive answers to questions or did not even want to really listen. In fact this unfortunately still seems to be the case. Even the topics of visual changes to the penis and erectile disorders due to diseases of the penis continue to be taboo in Germany.

They are not discussed in social situations either, not even between close friends. This can be seen in the fact that Peyronie’s disease was forgotten to be listed at all in the medical accounting system at that time.

The German medical journal Deutsches Ärzteblatt consequently published an article entitled ‘Induratio Penis Plastica – eine verschwiegene Erkrankung’ (‘Induratio Penis Plastica – a Concealed Disease’) in February 2007. Accordingly, the therapy is mostly poor as well.

We are annoyed by the fact that patients are driven to take almost completely ineffective medication and to squander valuable time due to a lack of information or due to erroneous information. For more on this, see the previous section entitled ‘Course of the disease‘.

We are also annoyed by the fact that we often have to ‘apologise’ for the fact that standard urologists know so little about Peyronie’s disease, even though this has nothing to do with us.

Dear patient, please ask the urologist who is treating you about this. We have been specialised in the treatment of Peyronie’s disease for years and know precisely what it involves.

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Surgical treatment options for Peyronie’s disease and our technique

If you have not done so already, please first read the section entitled ‘Changes caused by the disease in detail‘, as otherwise you probably will not understand the following explanations. We apologise again for the blunt language and polemics used, but they are especially necessary at this point.

There are basically four different surgical techniques that currently exist for treating Peyronie’s disease. We refuse to perform three of them, as we are of the opinion that they are detrimental to patients. Despite this, you will also find them described below for the purpose of complete information.

It must first be stated, however, that the statement above adopted by us from urology and the claim that there are four surgical techniques for treating Peyronie’s disease is fundamentally incorrect: Techniques one to three do not address Peyronie’s disease plaque at all but rather merely deal with one single symptom, the curvature of the penis. The rest of the symptoms are completely left alone.

This particularly applies to the tucking technique of Nesbit or Essed-Schröder offered as the ‘standard therapy’ for Peyronie’s disease in many locations.

You will find the technique we perform described below as the 4th technique.

In detail:

1st technique: Tucking techniques according to Nesbit or Essed-Schröder

As you have learned in the section entitled ‘Changes caused by the disease in detail‘, curvature of the penis is only one of several symptoms of Peyronie’s disease.

It is probably because the more extensive therapy procedures existing at that time seemed too elaborate to him that the American physician R. M. Nesbit developed a tucking technique for correcting the curvature of the penis in the 1960s. Due to the simplicity of its execution at an extremely low expense, this technique enjoyed great popularity and is unfortunately still the standard therapy applied by nearly all surgeons.

As banal and hard to comprehend as it may sound, this is the sad reality: In order to straighten the penis, the Peyronie’s disease plaque is not removed and the penis is not then lengthened again in this technique but rather an additional artificial plaque, called a purse-string suture, is added to the healthy side in order to shorten both sides equally and thereby straighten the penis. The symptom of curvature of the penis is therefore replaced by the symptom of shortening of the penis with the interesting belief that this shortening would be more pleasing to the patient than the curvature. Depending on the severity of the original curvature, the result can be a shortening of the erect penis by up to 8 cm.
The patients contacting us, at least, have not been more pleased with the shortening than the previous curvature. They therefore wish to have their previous Nesbit operation corrected by us.

In most cases, the patient must remain in the hospital 5 to 7 days following this surgery so that the treating physicians can use medication to ensure as far as possible that the sutures do not tear during the first strong erections during this initial healing phase.

As the Peyronie’s disease plaque is not removed, it can continue to grow mechanically and lead to curvature again after some time.

It may also occur that the operating physician (an assistant physician can perform this type of surgery – a specialist is not required) makes the artificial plaque too large, thereby leading to a shortening or curvature on the other side. There may also be pain on the purse-string suture during erections, described in up to 48% of cases in the literature. Some patients contact us who have undergone the Nesbit surgery up to four times. These patients no longer have anything that could be called a penis.

We are bothered by this technique because, in addition to shortening the penis, it leaves the actual seat of the disease, the Peyronie’s disease plaque, completely unaddressed while damaging healthy tissue for the ‘therapy’. Advanced medicine should involve thinking and acting in precisely the opposite way.

At this point we could write entire books about our inability to comprehend the use of this surgical technique, but we do not wish to bore you and will simply make this short statement:

It is incomprehensible to us why patients still undergo this torture in this day and age.

We would be very happy if this technique would finally cease to be used.

2nd technique: Cross cuts/incisions into the plaque with subsequent covering of the deformity with a saphenous vein graft or with artificial graft material

This technique is significantly simpler than our removal of the seat of the disease (plaque) and can thereby be offered by more clinics.

The catch is that even though practitioners like to claim and seem to be claiming more and more often, most likely in order to not lose their patients, that this technique is better than the Nesbit tucking technique on the one hand and that this incision (merely cutting into it) is just as good as our excision (removal of it) on the other, this is clearly not the case!

Even though a graft is used in this technique and an incision is also made into the plaque, this technique is NOT identical to ours nor does it provide comparable results because our technique involves the removal of the seat of the disease and is not merely an incision into it as in this technique!

If the seat of the disease, or even part of it, is left in place (such as in the case of tucking techniques or even an incision) then it can continue to grow. The curvature is not the problem in this case (because it can nearly always be corrected) but rather the irreversible erectile disorder that is caused by the illness (the plaque).

The troublesome part of this illness is the fact that the erectile disorder does not become apparent for a long period of time, even though it exists in the background. This is due to the fact that the penis becomes smaller in volume due to the induratio (it becomes shorter, thinner and more curved). In plain language, a much smaller amount of blood is therefore required to make it stiff.
If it were normal size then it would continue to hang practically limp for a longer time.

As the renowned Rudolfstiftung in Vienna was able to prove, this incision technique’s chances for success that are purportedly so good are severely ‘sugar-coated’. If patients are observed not for too short of a time but rather long enough, meaning that an assessment is not made until the remaining plaque has been able to start growing again, then a completely different picture arises:

Instead of the purported rate of merely 3%, in reality erectile problems occur in 39.5 % of cases!

Instead of the purported rate of 0% penis shortening, in reality there is penis shrinkage among 65.8% of patients!

Instead of the rate of reduced sensation of just 3%, in reality 31.5% of patients experience this!

Feel free to read more on the homepage of the European Association of Urology EAU.

Why do patients continue to be offered this technique instead of being immediately sent to us? To answer this question, we would like to quote Professor Dr Böhm, MD, of the Vivantes clinic in Berlin who wrote this warning on the topic of quality assurance in the 4/2009 issue of the medical journal ‘Chirurgische Allgemeine’ (‘General Surgical Matters’) (directed at medical colleagues):

‘How often do we send patients somewhere else because a colleague can provide them with better care. Surely this is a rare occurrence. Why? Because we would rather offer the other procedure ourselves in order to retain the clients – even if we are not as capable of helping them.’

3rd technique: Insertion of a (generally hydraulically-driven) penile prosthesis

With this technique, a prosthesis is inserted into the penis to maximise the tissue’s potential expansion in order to reduce the effects of the induratio penis plastica plaque.

The results of this technique are final and irreversible, because the actual erectile tissue is effectively destroyed by the insertion of the prosthesis. The pump it uses then substitutes the normal erectile function.
From a professional perspective, a prosthesis should only ever be inserted as the absolute last resort in cases of a serious Peyronie’s disease affliction coupled with severe erectile disorders which no longer respond to medication.
A prosthesis should never be inserted to merely treat cases of Peyronie’s disease with no accompanying erectile dysfunction.

4th technique: Peyronie’s disease plaque removal (excision) with subsequent reconstruction

This is the surgical technique we employ to effectively treat Peyronie’s disease.

Using this technique, the underside of the penis is opened (leaving almost no visible scar) and the skin is pushed back toward the stomach (the skin is not firmly attached to one position; otherwise sexual intercourse would not be possible).

The structures of the penis are exposed using microsurgery so that the corpora cavernosa are visible. We thereby get the opportunity to view the entire corpora cavernosa from the base to the tip and to detect all possible plaque structures. At the same time, the important structures are handled with the optimal gentleness.

The technique of disassembling the penis into its individual pieces for gentler surgery is the prerequisite for modern Peyronie’s disease therapy, particularly for the removal of plaques that reach as far as under the glans penis.
Disassembling was developed by Dr Konstantinos Konstantinidis as well as former UGRS member Professor Perovic, who has unfortunately passed in the meantime. Professor Perovic published multiple articles on this technique.

Using microsurgery, we remove the Peyronie’s disease plaque as well as the accompanying scar tissue to re-establish the original status quo before the onset of the disease.

We subsequently reconstruct the affected parts of the corpora cavernosa using non-artificial materials (usually high-quality collagen fleece). The material therefore disintegrates on its own.

Earlier, until into the 1990s, the body’s own materials such as vein walls or oral mucosa were used. However, these materials from the patient’s own body have several disadvantages:

First, they have to be removed from somewhere, meaning that a second location has to undergo surgery with the corresponding risks.

Second, the options are limited by this. In cases of large plaques, so much material is required that it can no longer be removed without great risk.Third, there is one general problem with the body’s own material: Differentiated tissue (tissue that is already fully mature) is added to another mature tissue, the penis. A docking scar then results all around. It is well-known that patients with Peyronie’s disease already have difficulties with scarring and, in this respect, the use of such a technique is a rather unsophisticated idea these days.

We have therefore been using collagen fleece for over 10 years. Collagen is one of the body’s basic fibres. The body uses it as a building material, similarly to bricks for building a house. The body completely transforms this collagen into the body’s own tissue without any transitional zone, therefore without any scars.

The tendency of the newly resulting tissue developing without enough elasticity in a patient with Peyronie’s disease is counteracted through physiotherapy to be applied for a few minutes a day for two months.

According to our experience, this procedure is the only sensible therapy option in the vast majority of cases.

It results in no visible scars on the penis. The scar is located in the same place as the circumcision scar so it is not noticeable on circumcised men.

In rare cases it may become necessary to perform a simultaneous circumcision when the foreskin has been adversely affected by the affliction or has become so narrow and restrictive that it could otherwise impair the results. We do not feel that generally performing circumcisions is sensible. An experienced surgeon can successfully retain the foreskin while avoiding the risk of infection or paraphimosis.

Due to the degree of difficulty involved, this technique can only be offered with satisfactory results in a few clinics in Europe that possess sufficient experience.

This technique was established over 20 years ago, so it is by no means new.

We are generally capable of satisfactorily treating cases that have even been pronounced irredeemable by other doctors.

We will be glad to provide you with information in a detailed and non-binding consultation on the options available for your specific case.

We are pleased that the majority of patients have grasped the benefits that our treatment offers. Our patients have tripled since 2006.

At this point we would like to first answer two questions frequently and justifiably asked by patients:Many patients ask us:

‘Why do patients continue to undergo a tucking technique (such as the one developed by Nesbit) if it always leads to a shortening of the penis?’

‘Why don’t more surgeons perform your surgical technique or refer their patients to you?’

Answer to question 1:

We will let an actual case answer this for us: One of our patients who previously underwent the Nesbit surgery in a well-known university clinic and then had to have this surgically corrected by us ended up suing his professor because the professor had not told him that the Nesbit surgery would shorten his penis by 5 cm. The case was heard in Heidelberg. The judge asked the assistant physician involved how the Peyronie’s disease patients had been informed about the loss of length at this university clinic. The assistant physician openly admitted that during the consultation they would tell patients that there would only be a shortening of 1.5 cm. She was then quoted as stating, ‘…if we would say anything more then no one would undergo the surgery anymore…’.

This statement is clear and alarming at the same time. Patients are deceived merely in order to allow doctors to operate on them and obtain money from them. In fact, it is very difficult for us to imagine that patients would actually voluntarily choose a technique involving a shortening of the penis by up to 8 cm. According to statements from our patients, they are very often not provided with the true information regarding tucking techniques.

Answer to question 2:

We will let an actual case answer this question for us as well: Professor Dr Böhm, MD, of the Vivantes clinic in Berlin wrote about this topic in the 4/2009 issue (directed at medical colleagues) of the medical journal ‘Chirurgische Allgemeine’ (‘General Surgical Matters’):

‘How often do we send patients somewhere else because a colleague can provide them with better care? Surely this is a rare occurrence. Why? Because we would rather offer the other procedure ourselves in order to retain the clients – even if we are not as capable of helping them.’

We would like to thank him for these honest words. Nothing more needs to be added.

It is completely true that it is simply impossible for a normal urology department to offer our reconstructive technique. There are so few cases of induratio penis plastica there that it would make little economic sense, if any at all, to specifically hire a highly experienced specialist for this.

In the quote above, Professor Dr Böhm has clearly explained why doctors unfortunately “tinker around” themselves instead of immediately referring their patients to experienced specialists. It is sad but unfortunately true.

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Why should you have your operation performed by us?

So that your penis does NOT look like this after the operation:

Complications after surgery on the penis

A chief surgeon in a university hospital personally operated on this patient. The penis had to be nearly completely amputated afterwards due to complications.

After long and careful consideration we have decided to only show this SINGLE photo. There are many patients like this who have turned to us seeking help.

Unfortunately the most common thing patients say to us is, ‘If only I had come to you first!’

This is true in two respects: Firstly we would like to prevent such procedures to the greatest extent possible and secondly it is not possible for us to operate on patients after they have already undergone poorly performed prior surgery and to achieve results that are as good as if the operation had been performed by us from the start.
Once the penis has had to be partially amputated then it is gone forever.

3 other facts about us:

  1. Scientific reasons why you should have your operation performed by us
  2. Common sense reasons why you should have your operation performed by us
  3. Other benefits we offer

1. Scientific reasons why you should have your operation performed by us:

  • We have the most extensive surgical experience in Europe.
  • Our procedure is described as the ‘preferred’ method in the European guidelines (see the guidelines under ‘Surgical Treatment Options’).
  • The highest social court has now finally defined 50 operations per year as the MINIMUM quality requirement for highly specialised surgeries (Docket number: B 3 KR 10/12 R). If this number were also legally required in order to perform surgeries treating curvature of the penis, which it unfortunately is not (yet), then 95% of all hospitals would no longer be allowed to operate on patients with curvature of the penis at all!

As you can clearly tell from this decision, there is definitely a reason why we keep mentioning our experience and repeatedly warn against undergoing surgery performed by unpractised hands. According to internal surveys of one transplant manufacturer there is virtually NO university hospital that performs more than 10 surgeries of this type per year and no city hospital or similar facility at all performs that many.
A doctor’s title (e.g. Professor) or position (e.g. Head of Urology) does not say anything at all about that doctor’s qualification to perform a specific surgery. The doctor can hold this title without even having performed the respective surgery a single time!
It is very unfortunate that there is so often still dishonesty regarding a doctor’s purported skills and number of cases handled.

If you follow the Internet and publications for a while you will find that there are ‘suddenly’ more and more homepages, doctors’ associations, purportedly neutral sources of information, pseudoscientific articles, etc. including the topic of induratio penis plastica. Some doctors’ and clinics’ homepages are ‘suddenly’ describing our surgical technique, even though it is not even performed there at all.

2. Common sense reasons why you should have your operation performed by us:

For patients it is repeatedly one of the most difficult tasks to seek out the right doctor and correct therapy. If you visit four doctors you will normally get four different opinions that are all explained in such a way that they sound completely logical in their own right because each doctor is trying to sell the method that they personally use.
This usually means that the patient has not become any more knowledgeable from such consultations.

Luckily there are illnesses whose structure is so easy to understand that no medical degree is required to understand them and common sense is perfectly sufficient and constructive: Such is the case with induratio penis plastica (IPP):

In this illness the seat of the disease is a plaque in the penis that is responsible for the widest variety of symptoms (curvature, retraction, shortening, erectile dysfunction, etc.). Certainly logic and common sense dictate that the only sensible therapy for this illness lies in removing the seat of the disease, not in leaving it in place and doctoring around with another area of the penis in the hope that this will somehow generate an improvement such as with tucking techniques (Nesbit) or incisions.
This would be as if a person came limping in on his right leg and instead of treating the right leg they just kicked him in the left leg so that he would at least limp evenly.

Hospitals, speciality departments and doctors that are angry about the fact that we perform better work all too often tell their patients that we perform this technique in order to earn more money. The truth is exactly the opposite.
We are a centre specialised in surgical therapy. Naturally we could also perform the much simpler techniques involving tucking or incisions. These are so much simpler that they would also be much less expensive to perform because they would take much less time, far fewer staff members and much less specialisation of the staff. We could also perform these simple techniques in the more modest operating rooms of a public hospital and would not have to bother with a private clinic.
We would therefore earn much more if we were to perform these simpler techniques. Patients would still come to us despite this simply due to our extremely extensive experience.

This means that we actually perform a highly complex technique yet earn much less in the end than we would have from the simpler techniques. The only reason why we do this is that the removal of the seat of the illness performed by us is much more sensible, delivers much better results for patients and actually treats the illness itself.

We became doctors to treat ill patients, not simply to tinker around with them.

3. Other benefits we offer

  1. It is not just any chief surgeon but rather one of the top specialists who (always personally) performs this therapy for us in Europe. This is a basis for a perfect result!
    Even poorly trained and unspecialised medical assistants operate in public hospitals. Even private patients often do not have their operations performed personally by the chief surgeon at all!
  2. Our operations are performed by out highly trained team of top specialists.
  3. Excellently trained anaesthesiologists handle our anaesthetisations. They are especially gently and comfortable for the patient.
  4. Only the best and most advanced materials are used.
  5. We select implants and substitute materials solely on the basis of their benefit for the patient and are not subject to any limitation imposed by the hospital administration or insurance company.
  6. We operate exclusively in high-quality fully private clinics and this has very decisive benefits for patients:
  • Specially furnished operating rooms with excellent hygiene. A highly dangerous bacterial infection has NEVER occurred in our operations. Such infections are a part of the daily routine in public hospitals. According to official statistics around 30,000 patients die each year in such hospitals and there is also a high estimated figure of such deaths that are unreported.
  • There is an entire armada of staff in the operating room for both the surgical procedure as well as for hygiene.
  • A massive array of caregivers and nurses are at the station so that our patients always receive the best care.
  • Things are never hectic and there are no time restrictions of any sort.
    In public hospitals there is sometimes such detrimental hecticness that cancer patients sometimes even have the healthy lung removed instead of the cancerous one and die from this, for example. There are unbearable conditions even in some University hospitals.
    We spare our patients those types of things.
  • And much more.

We thereby offer optimal medical care targeted exclusively at the benefit of the patient.

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Patient testimonials

We generally feel that listing patient testimonials on homepages or forums is problematic, as it is not possible for you as a patient to check to make sure that they are the true opinions of the patients. That is why we have not published anything on this for many years.

Since 2010, however, readers’ requests for patient testimonials have increased so much that we are now presenting three excerpts from letters from our patients with their consent below:

Patient 1

‘For as long as I can remember I have not had a straight penis so I have always had problems with sexual intercourse, which has sometimes led to great strain in my relationships. Not all of the common sexual positions were possible. There was simply no way to have a satisfying sex life. The urologists I asked could not or did not want to help me. “You’ll just have to live with it” I have often been told…too often. While researching on the Internet I came upon you and made an appointment to be examined. You diagnosed my congenital curvature of the penis and Peyronie’s disease resulting from the years of strain. As you know, I then underwent surgery from you on (omitted for reasons of privacy) and now have a straight penis. I would once again like to thank you deeply for this.’

Patient 2

‘Overnight the plaque was suddenly there. It was unbelievable how quickly it developed. I was in quite a panic and immediately made an appointment with a urologist in Ulm. I was horribly afraid of being diagnosed with cancer. He diagnosed me with Peyronie’s disease and prescribed vitamin E and Potaba. I carried on like that off and on for a year but the curvature was not affected. As a final option, my urologist proposed a surgery involving penis tucking. As I recall, it was the Nesbit technique. He also said that this would shorten my penis. I am very thankful for his honesty, because I did not want to undergo that technique and eventually found your institute while researching on the Internet. He was thereby indirectly the reason why I came to you. I was excited about your surgical technique from the beginning because it is logical. Today I am very pleased with the results and I would like to thank you very much. You kept your word and straightened my penis without making it shorter.’

Patient 3

‘Before I acquired the disease, I had never in my life heard anything about abnormal curvature of the penis. I would have thought it was a joke until I personally had a 90° kink upward in my penis. Even during the very first examination my urologist indicated that I would not be able to hope for improvement without surgery and felt that I should contact the UGRS immediately. As far as he knew, your technique is the only one that does not involve shortening the penis. When talking to you I then also learned that the tucking techniques not only shorten the penis but also completely ignore the seat of the disease. I do not understand why doctors then still perform these techniques. At any rate, I underwent surgery from Dr Konstantinos Konstantinidis and am very satisfied. The surgery was already over a year ago and the results are simply correct.’

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Costs and reimbursement

At our centre in Germany

Included in the price (NO further cost items will be added!):

Surgical team:– Surgery performed 100% by the chief surgeon
– Chief medical assistants
– Highly specialised staff
– Specially disinfected operating room
– Materials + medication
– Clinic services
Anaesthesia team:– Head anaesthesiologist
– Gentle intubation anaesthesia
– Anaesthesia nurses
– Materials + medication
– Clinic services
Nursing care:– Nurses in 2 stages (in the surgical department and in the ward)
– Double staffing
– Specialised UGRS staff
– Clinic services
Other + service:– Materials + medication for the follow-up treatment
– Patient education on post-op care
– Other services

Total costs: approx. EUR 13,400 to approx. EUR 22,500, depending on the severity of the case

(Payment also accepted in cash)

At our centre in Palma de Mallorca, Spain

Starting from around EUR 11.900,- total.

The difference in price results from the different cost structures in Spain. The quality of the medical service is identical.

Cost structure and reimbursement

The medical treatments are performed as private medical services.

Whether or not your insurance provider will cover any of the costs depends on the type of health insurance you have as well as your tariff.

In any case the entire procedure must initially be paid for by you, the patient.

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Additional information

Preparation for an operation

Around 3 weeks prior to your appointment you will receive an unmarked envelope by post containing your confirmation documents.

  • Once you have confirmed your appointment with us, please refrain from smoking and drinking alcohol for 14 days prior to the operation. This is not a general statement but rather has a decisive effect on your results. Smoking significantly worsens the healing process for wounds by constricting the blood-vessel walls, while alcohol has a negative effect on the body’s metabolism.
  • 10 days before the operation you must cease taking any aspirin, ASS or other blood-thinning medications. These medications increase the risk of bruising (haematomas) and unpleasant swelling occurring.
  • You will have a detailed consultation with one of our doctors, during which there will be ample time for all of your questions to be answered. However, you should also definitely read our description of the operation beforehand in preparation.
  • You must refrain from drinking or eating anything for 6 hours before your surgery on the day of your appointment. This also applies for procedures using local anaesthesia.
  • You will then be prepared for the operation, which includes receiving an mild tranquillizer and painkiller in advance.
  • The operation itself is performed in a relaxed environment. There is no need to feel anxious, as you will not feel any pain, while the carefully selected medication you are given will ensure you will rapidly recover after the operation with no lingering unpleasant memories of it.
  • Normally you may return home after around 1-2 hours (following ambulatory surgeries). However, because you are not permitted to drive a car for the next several hours due to the medication you have received and because many of our patients arrive from quite a distance, we would advise you to spend the night in a nearby hotel (which would be cheaper than staying in the clinic)..
  • You absolutely must bring another person with you for ambulatory surgeries.

Treatment guarantee

For your own security and in full confidence of the outstanding results and quality we provide, as of 1 July 2008 all of our patients are protected by our treatment guarantee.

Any unplanned treatments and surgeries that may prove necessary will be performed by us at our location free of charge. This guarantee is valid for a period of one year after the final operation we performed.

(There is a restriction on this in Germany: As it is illegal in Germany to perform medical services at absolutely no cost, we are legally required to still charge you a minimal fee. It will approximately correspond to the actual costs for materials and medications.)

Additional benefits generally available to our patients:

  • Our surgeries are performed exclusively by highly qualified specialist surgeons with many years experience, all of whom had their qualifications scrutinised in detail before being appointed/selected.
  • A detailed consultation on the options, limitations and risks involved will take place in the pre-operative discussion.
  • The treatments are naturally carried out using the most technically advanced equipment.
  • The members of the medical staff in the operating theatre and for post-op care are highly qualified.
  • We use modern, gentle anaesthesia procedures.
  • The materials and medications used are of the highest quality.

All patients who have their initial surgery performed by us are welcome to obtain post-op examinations and advice from us at any one of our centres free of charge. This offer is valid for a period of one year after the final operation we performed.

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Procedure & contact

You can relax knowing you have placed your query in the hands of our experienced secretarial staff. Their extensive training enables them to offer you optimal care and to coordinate all other details. Contacting us is the only thing you need to do yourself and the staff will take care of everything else for you.

Our staff will be happy to arrange an appointment for a private meeting including an examination for you. These pre-operative discussions are without obligation and are always conducted by our in-house specialist for your particular query. We offer you highly qualified medical consultation and treatment right from the start.

Your consultant

Image of Axel Birnbacher

Mr Axel Birnbacher will be glad to handle your query:

You can reach us
Monday - Friday
9:30 am - 12:30 pm
1:30 pm - 5 pm

+49 6151 606 10 34

Contact us

Contact us

You are also welcome to send us your query using our online form. However, please note that we are unable to provide advice by e-mail. Please only use this method of contact for asking general questions or requesting a return call. Thank you.

Please understand that we receive a high number of queries due to the quality of our work so that long wait times for appointments unfortunately cannot be avoided.

By submitting your request, you agree that we store and process your data for the purpose of processing your request. The legal basis for the storage is § 26 Abs. 1 BSDG-new and Art. 6 Abs. 1 f) DSGVO. Further information can be found in our privacy policy.

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Get in touch
Axel Birnbacher

(english speaking)
Plastic surgery office

+49 6151 606 10 34

+49 6151 606 10 34

Monday - Friday
9:30 am - 12:30 pm
1:30 pm - 5 pm

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