Embarrassing Illnesses

Voiceover:
For the last year, Keith has been living with a curvature of his penis that occurs whenever he gets an erection.

Keith:
Can’t have sex now. It makes me a bit…inadequate.

Voiceover:
He’s come to Russells Hall Hospital to meet consultant urological surgeon Mr Paul Anderson. Because Keith’s condition only presents itself when the penis is erect, he’s given an injection to induce an erection, so that the extent of the curvature can be fully assessed.

Mr Anderson:
I’m looking at how curved it is, and I’m looking at how long it is, and I’m looking to see if the foreskin’s going to cause any problems…and you really have got an S-shaped curvature.

Voiceover:
Keith has two options for surgery…

Mr Anderson:
There is the shortening option. What we would do is we would make two incisions and remove some tissue from here, close that area up, so you are going to lose length with this operation, but there’s a very low risk of erectile dysfunction with this. An alternative would be to think about a grafting procedure, but rather than operating on the good side, we’d concentrate our efforts on the bad side, and I would open it up, and there would be a defect just there. And into that defect, I would place a graft. And this is often a graft taken from a vein from the top of your legs. It is a good option, but the problem is it does carry a much higher rate of impotence, problems with erections, afterwards.

Voiceover:
Keith’s got a tough decision to make: risk impotence or lose length.

Keith:
I’ve, uh, took the option of shortening, cutting the penis on one side to pull it over to the right. It might shorten it two or three centimetres, but that would be okay.

Voiceover:
It’s the day of Keith’s operation. He’s undergoing the Nesbitt’s procedure, where he will lose some length, but the risk of impotence is low.

Mr Anderson:
Now, he’s got a fairly healthy-looking foreskin, and we spoke about whether we should get rid of the foreskin or not, and he decided he wants to keep it. About one in ten men need a circumcision later. The first thing I need to do, really, is just get all the skin off here, and start to have a look at the problem underneath the skin.

Voiceover:
Mr Anderson makes a small incision just under the head of the penis, and then pulls back the skin.

Mr Anderson:
Right, this is the bit where we skin the penis. It comes off quite nicely, typically. And all these structures that you can see here, these are the nerves and arteries and some of the veins that we’ll be so careful to avoid during the operation. So the curvature will be all around the plaque there, so the correction that we want to do will be all along the opposite side of the penis.

Voiceover:
A tourniquet is placed around the base of the penis, so that an erection can be induced with saline solution.

Mr Anderson:
Okay, so now we’re going to induce an artificial erection. And we shall see how bad this curvature is. Now you can see here how curved he is, you can see that he’s straight to about that point there, so nothing needs to be done between there and there. So all the work is going to be done between here and here.

Voiceover:
It’s a delicate procedure as all of the nerve structures on the side of the penis need to be moved out of the way.

Mr Anderson:
All this tissue here contains all his nerves that supply sensation to his glans there, and I need to continue working in this plane here to get it out of the way, so I can operate on the white area.

Voiceover:
Mr Anderson uses clamps on the good side of the penis to work out where the incisions need to be made to correct the curvature.

Mr Anderson:
You can see that now I’ve got three corrections down the right side, to uh, to straighten his penis. But if you now come and have a look around at this side here, I’ve had to fully mobilise his new vascular bundle past the midline at the back, to put in a further correction. So now he’s got a slight…no, now this is straight, but there’s a slight curve upwards, but some men…and women…would regard that as an advantageous thing. So a slight degree of dorsal curvature is a good thing to have in a penis. Right, so the next step of the operation is for me to remove small defects within this corporal tissue and sew him up again.

Voiceover:
Two hours later, and Keith’s wonky willy is no longer.

Mr Anderson:
I think you’ll agree that he’s a lot, lot, lot straighter now. That won’t cause any problems whatsoever with uh, vaginal intercourse. Put the skin back up there again.

Voiceover:
Mr Anderson stitches and bandages Keith back up, and a catheter is put in place overnight.

Voiceover:
A few weeks after the surgery, and Keith is back to update Dr Christian on his progress.

Dr Christian:
So how long has it been since the operation?

Keith:
It’s been six weeks tomorrow.

Dr Christian:
Okay, and how are you feeling?

Keith:
Oh, I’m feeling all right, back more or less to normal now, and it’s uh, it’s straight.

Dr Christian:
Have you used it yet?

Keith:
No, I haven’t.

Dr Christian:
You haven’t, you’re too scared.

Keith:
It’s still a virgin.

Dr Christian:
And are you peeing okay?

Keith:
Oh yeah, but instead of going straight into the pot, it comes out three different places, because there’s too much skin.

Dr Christian:
Because you’ve lost the length…

Keith:
Because I’ve lost an inch, I’ve got a lot of skin now.

Dr Christian:
I’d like to have a quick look, check that it has healed properly, and also maybe have a look at this foreskin issue, see what we can do about that if we need to, yeah? Come over to the couch with me.

Dr Christian:
Proud owner of a new willy.

Keith:
Yup, a new willy, no?

Dr Christian:
That’s a little bit of bumpiness in the middle, isn’t there?

Keith:
Yeah.

Dr Christian:
That’s going to settle. You are new…is it very sore or not too bad?

Keith:
No, no, not at all, it’s not sore now at all. It’s just it won’t come out there, that’s as far as it comes out, a bit tight, yeah?

Dr Christian:
Yeah. Well, because you’ve got all this tethering, all the skin is still a little bit stuck to the shaft. You need to leave this well alone for a little while, let it all heal. Eventually when the scarring settles down, things will loosen up a bit as well. The more you get erections, the more that’ll just help the skin to loosen up and shift around a bit. And only a good three, four months down the line do you then start to think ‘do I have too much foreskin, will I need a circumcision as well, because it’s affecting the way I pee’. But otherwise, are you pleased?

Keith:
Oh yeah, happy as a lark.

Dr Christian:
I think it’s a great result, so I’m pleased.

Keith:
I am too.

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