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Anesthesia Incisions Excision of Tissue Plication (Folding) of Penis Suturing Closure Benefits of the Nesbit Procedure Risks and Considerations Erectile Dysfunction Penile shortening Pain Management Follow-Up Visits
The Nesbit Procedure, also known as the Nesbit plication or Nesbit operation, is a surgical technique used to correct penile curvature, often associated with Peyronie's Disease. This condition is characterized by the development of fibrous scar tissue inside the penis, causing it to bend abnormally during erections. At its worst, it can be very difficult or even impossible to have penetrative sex.
How the Nesbit Procedure Works:
Identification of the Curvature: Before the procedure, our Urologist will assess the extent and location of the penile curvature. This helps determine the specific areas of the penis that need correction.
Anesthesia : The Nesbit Procedure is typically performed under general anesthesia . This means the patient is unconscious and feels no pain during the surgery.
Incisions: The surgeon makes small incisions on the side of the penis opposite to the curvature. These incisions provide access to the fibrous tissue causing the bend. The incisions are essentially on the longer side of the penis as seen when the penis is in full erection.
Excision of Tissue: The next step involves removing or excising the excess fibrous tissue that is causing the penis to bend. This tissue is often the result of scar formation due to Peyronie's Disease.
Plication (Folding) of Penis: Once the excess tissue is removed, the surgeon then "plicates" or folds the tunica albuginea, which is the thick membrane surrounding the erectile tissue of the penis. In is this plane of the penis where the plaque ( scar tissue ) of the penis is located. This folding is done on the side opposite the curvature, effectively straightening the penis.
Suturing: The surgeon carefully sutures the tunica albuginea into its corrected position. These sutures hold the penis in its straightened form.
Closure: After the correction is complete, the incisions are closed with sutures, and a dressing may be applied to the surgical site.
Benefits of the Nesbit Procedure:
Corrects Penile Curvature: The primary goal of the Nesbit Procedure is to straighten the penis, allowing for improved sexual function.
Improves Sexual Function: For men with Peyronie's Disease, penile curvature can make sexual intercourse challenging or uncomfortable. By straightening the penis, the Nesbit Procedure aims to restore normal sexual function. It should be understood that this proceure may not correct erectile dysfunction itself. If the patient has erectile dysfunction then some form of treatment to hekp with this may still be needed after The Nesbit Procedure.
Restores lost Confidence: Dealing with penile curvature due to Peyronie's Disease can impact a man's self-esteem and confidence. Correcting the curvature through surgery can lead to improved quality of life.
Risks and Considerations:
Infection: As with any surgical procedure, there is a risk of infection at the incision sites.
Bleeding: Some bleeding is common after surgery, but excessive bleeding may require medical attention.
Changes in Sensation: There is a possibility of changes in penile sensation following the Nesbit Procedure, though this is usually temporary.
Recurrence of Curvature: In some cases, the curvature may recur after the surgery, especially if the scar tissue reforms. It is important to only perform this surgery when the disease has reached the stable phase. This is usually around one year from the onset of the disease.
Erectile Dysfunction: While rare, there is a small risk of developing erectile dysfunction following the Nesbit Procedure. In any event if there is an element of erectile dysfunction already present, this will need to be treated alongside any treatment of the peyronies disease.
Penile shortening :
Because the plication is performed on the longer side of the penis, the penis is shorter after the surgery. The worse the curvature the more the shortening. Patients should discuss this with the Urologist to understand the expected level of shortening after the surgery. Alternatives to The Nesbit procedure include plaque incision and grafting surgery and the Stage Procedure. These differ as they aim to make the penis straight again whilst protecting the penis length. Some Urologists recommend the Nesbit procedure in cases of mild penile curvature.
Recovery:
Rest and Healing: Patients are advised to rest and avoid strenuous activities for six weeks following the procedure. Time will be needed off work depending on the type of work undertaken. Most patients take around one week off work. No gym , sport or sexual intercourse should be undertaken for a period of six weeks.
Pain Management: Pain medication will be give upon discharged from hospital to manage any discomfort during the recovery period. A course of antibiotics will also be given
Follow-Up Visits: Regular follow-up appointments with the Urologist will be arranged for the patient to monitor healing progress and address any concerns.
The Nesbit Procedure is a well-established surgical option for men with Peyronie's Disease who experience penile curvature due to peyronies disease . It aims to improve both the physical and emotional aspects of this condition, restoring confidence and quality of life for many patients.