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The Nesbit Procedure

The Nesbit Procedure is a procedure usually adopted to as part of Peyronie’s disease surgery.

If your penis is curved to the extent that it causes difficulties during sexual intercourse, of the curvature bothers you, then this is the most common procedure performed to fix a bent penis.

It is the procedure with least risk and is the easiest operation for Urologists to perform. The success rate is high but it can leave the penis shorter afterwards, how shorter depends on the extent of the curve.

You will have noticed that when you get an erection one side of your penis is longer than the other.

With the Nesbit procedure the surgery is performed on the long side of the penis to make the penis straight, but this leads to some shortening. Whereas in the plaque incision and grafting procedure the surgery is performed on the short side to lengthen it.

Our Urologists will assess your curvature at the consultation to ascertain which procedure would be most suited to your Peyronie’s disease.

If your penile curvature is mild, then the Nesbit the most appropriate choice. Mild curvatures are very suitable for the Nesbit procedure and patients report a very high satisfaction rate.

The aim of the procedure is to make the penis functionally straight so that the patient can enjoy sexual intercourse without pain for him or his partner.

If your curvature is severe then the plaque incision and grafting procedure maybe more appropriate because the Nesbit will lead to a dramatic loss of length.

The Nesbit Procedure Operation

As this is a surgical procedure that will take around one hour to perform, you will be given a general anaesthetic. In most cases, you can home on the same day as the surgery.

On the operating table an artificial erection is induced by injection of a medication so that the Urologist can see the curvature and work with it.

With the Nesbit technique, a wedge incision is made on the longer side of the penis following a roll back of the skin of the penis to access the corpora cavanosa of the penis. Stitches are then placed which bunch up the tissues on the long side of your penis ( the opposite side to the bend )

You may be advised to have a circumcision or partial circumcision with this procedure, so that the foreskin matches the penis shaft. You will be advised by the Urologist if a circumcision is recommended in your case.

You will be discharged on the same day as the procedure , providing someone comes to the hospital to collect you.

The Nesbit Procedure Recovery

After the Nesbit procedure, you should arrange to take some time off work. You will have swelling and bruising to the penis and you will need to avoid sexual activity for around six weeks. Similarly, you should avoid strenuous exercise for six weeks.

At first your penis will be swollen and bruised. This completely normal. You will be discharged from hospital with antibiotics and pain relief medication for the first week. You may need to wear a dressing on the penis for at least one week , or until the Urologist advises you it is advisable to remove it. You will be able to urinate as normal and you will get nocturnal and morning erections. It is quite okay to have erections in the first weeks after surgery. These encourage blood supply to the penis and promote healing. You may find that they are a bit uncomfortable at first but this will improve over time.

You will be asked to avoid baths at first and use showers and replace the dressing.

All stitches placed are dissolvable. You should not be tempted to pull them out but let them fall out on their own. You may feel them underneath the skin.

Follow up appointments will be made for you with the Urologist to track your progress after surgery and provide ongoing support and advice.

The Nesbit Procedure Risks

Most men who undergo a Nesbit procedure to fix their Peyronie’s disease are incredibly happy with the outcome of the operation. Being able to enjoy a healthy active sex life again is welcome in all patients , not to mention the improvement in mental health from the freedom of worry and embarrassment of the disease.

All surgery carries risks and The Nesbit Procedure is no different. Although most patients do not experience any complications it is important that you are aware of them.

Infection

Infections are possible after any surgery. If you experience a post-operative infection this will be need to be treated.

Loss of penile length

Some loss of length is to be expected with the Nesbit procedure. In mild cases of Peyronie’s disease this is not too much, between 1 and 3 cm. Your Urologist will be able to give you some indication as to the likely loss of length at your consultation. If your curvature is severe, then a different , length sparing, procedure may be advised.

Erectile dysfunction

Many patients who present with Peyronie’s disease also have an element of erectile dysfunction, but not always. It is thought that erectile dysfunction maybe a pre cursor to Peyronie’s disease because the penis is not fully hard during penetration and therefore more likely to suddenly kink in shape causing damage to the tissues. In some cases the ED can worsen after surgery and medication may be required afterwards to treat any residual Erectile dysfunction

Stitches you can feel.

You may be able to feel the stitches underneath the skin after surgery. Most patients can feel the sutures and most find that the sutures are not bothersome. It is very rare that the sutures cause any discomfort for the patient or his partner during sexual intercourse.

Changes in sensation

Loss of some sensation in the glans (the head of the penis) has been reported by patients. In most cases this does not interfere with satisfaction during sexual intercourse. It is not clear why some patients experience changes in sensation after the procedure.

Recurrence of the penile curvature

It is important to ensure that the Nesbit procedure is performed when the disease has entered the stable phase. This usually takes six to twelve months. Your Urologist will know when your disease has entered the stable phase around this time when you have not noticed any change in your curvature for the last three months. When the Nesbit procedure is performed in the stable phase there is a much lower risk of recurrence of the disease. If the surgery is performed too early, then the risk of recurrence is higher.

An element of remaining curvature

Your penis may not be as straight as a poker , after the surgery. Remember that the goal is to give you a functionally straight penis that enables you to have sexual intercourse with no pain or discomfort for you and your partner. It may not be possible to make the penis perfectly straight. In truth, most men have a penis that bends slightly to the left naturally.

Want to learn more?

If you are interested in finding out more, make an appointment for an initial consultation today. We can go through some facts and figures with you and explain all the different options that we offer.

Frequently Asked Questions

Is the Nesbit procedure better than plaque incision and grafting?

One procedure cannot be said to be better than the other. Much depends on the penile curvature that you present with. If you have a mild penile curvature then the Nesbit procedure could be the right option. If you have a significant curvature with loss of length, or an hourglass deformity, then plaque incision and grafting may be the best option. Loss of penile length is usually a determining factor. The more the curvature the more the shortening with the Nesbit procedure. When we have assessed your curvature either by photos or injection of a medication to induce an erection.

Is a general anaesthetic required for the Nesbit procedure?

Yes. The procedure is performed under general anaesthetic, and you will be asleep throughout the procedure. The operation itself will take around one hour. You will be able to go home in the same day provided someone takes you home.

Will I lose penis length after the Nesbit procedure?

There will be some loss of penile length after this procedure. The good news is that most patients have less than 1.5 cm loss. Your assessment with the Urologist will help determine the likely loss of length. There are alternative procedures which may be more appropriate of the loss of length is potentially significant with the Nesbit procedure.

When can I have sex again after the Nesbit procedure?

You should avoid all sexual activity including masturbation for six weeks.

Is the Nesbit procedure worth it?

If your Peyronie’s disease is having a negative impact on your sex life, then the Nesbit procedure can be a good option. If you have a penile curvature which cannot be improved with more conservative means, then surgery may be the best option. The Nesbit procedure is best suited to mild to moderate penile curvature.

Who performs the Nesbit procedure?

The Nesbit procedure is performed by one of our GMC Specialist registered Urologists.

What is the cost of the Nesbit procedure?

The cost of the Nesbit procedure is £5495. This includes standard pre op tests, all surgery fees and aftercare.

Can I finance the Nesbit procedure?

Finance is available subject to status. No deposit options and flexible terms are available. Interest-free finance is also available up to £3500 over one year. We also accept all major debit and credit cards.

How long does recovery take after the Nesbit procedure?

Most patients will take around one week off work. You cannot have any sexual activity for six weeks. You should avoid gym and sporting activities for up to six weeks. Avoid driving until you feel comfortable to do so.

How do I know I am ready for the Nesbit procedure?

Your Peyronie’s disease must be in the stable phase before we can consider this surgery. This means that you will not have seen any changes in the curvature for at least three months. For most patients the disease moves from the acute phase to the stable phase between six and twelve months. It can be a good idea to take photos very four weeks to monitor the progress of your curvature. These can often be helpful for the Urologist too.

Can I feel the scar tissue?

You may be able to feel the scar tissue through your penile skin. This scar tissue is called Plaque, and it is the cause of the bending in your erect penis.