| Treatment | Penile Reconstructive Surgery |
|---|---|
| Also known as | Penile grafting, plaque incision and grafting, tunical lengthening surgery |
| Used for | Severe penile curvature, significant penile shortening and complex deformities associated with Peyronie’s disease |
| How it works | The shortened side of the penis is released through an incision in the affected tunica albuginea, and the resulting defect is covered with graft material to help straighten the penis |
| Procedure type | Reconstructive penile surgery |
| Anaesthesia | Usually performed under general or regional anaesthesia |
| Treatment setting | Hospital or surgical facility |
| Recovery | Initial recovery usually takes several weeks; sexual activity is temporarily restricted while the tissues heal |
| Suitable for | Selected men with stable Peyronie’s disease, severe or complex deformity and sufficiently preserved erectile function |
What is Penile Reconstructive Surgery?
Penile reconstructive surgery using grafting is a surgical treatment for selected men with significant penile deformity, most commonly resulting from Peyronie’s disease (link to service page). In Peyronie’s disease, fibrous scar tissue known as plaque develops within the tunica albuginea, the strong tissue surrounding the erectile chambers of the penis. This can restrict expansion on one side during an erection, resulting in curvature, indentation, narrowing or an hourglass-type deformity.
During penile grafting, the surgeon makes an incision in the shortened or scarred side of the tunica albuginea to release the restriction and allow the penis to straighten. The opening created by the incision is then covered with graft material.
Unlike penile plication, which straightens the penis by shortening the longer side, grafting is a tunical lengthening procedure intended to correct the deformity while reducing the degree of additional shortening associated with plication. It does not, however, guarantee restoration of penile length lost because of Peyronie’s disease.
Watch Dr Joe Lee explain what Peyronie’s disease is and how it can affect the shape and curvature of the penis.
@drjollyurology Named after a French surgeon, but no romance here. 🇫🇷 Peyronie’s disease can cause pain, deformity, and performance problems. #urology #doctor #menshealth #fyp #PeyroniesDisease #menshealthawareness #doctorsoftiktok
♬ original sound - Dr Joe Lee | Urology - Dr Joe Lee | Urology
When is Penile Grafting Recommended?
Penile grafting is not required for every man with Peyronie’s disease. Surgery is generally considered when the disease has become stable and the penile deformity significantly interferes with sexual intercourse. Before recommending surgery, the degree and direction of curvature, penile length, erectile function, plaque characteristics and the presence of complex deformities are assessed.
Grafting may be considered when there is:
- Severe penile curvature that makes sexual intercourse difficult or impossible.
- Complex penile deformity, such as an hourglass deformity, indentation or hinge effect.
- Significant penile shortening, where further shortening from a plication procedure would be undesirable.
- Stable Peyronie’s disease, rather than curvature that is still actively changing.
- Adequate erectile function, either naturally or with appropriate erectile dysfunction medication.
The European Association of Urology recommends tunical lengthening procedures particularly for men with severe curvature, inadequate penile length or complex deformities who have normal erectile function. A curvature greater than approximately 60 degrees is often considered severe in surgical practice, although the guideline notes that this threshold has not been formally validated.
Watch Dr Joe Lee explain when surgery may be considered for Peyronie’s disease and the factors that help determine the appropriate timing.
@drjollyurology When is surgery for Peyronie’s worth it? 📏 If the bend makes s*x painful or impossible, it may be time to straighten things out. 🩺 #urology #doctor #menshealth #fyp #PeyroniesDisease #menshealthawareness #doctorsoftiktok
♬ original sound - Dr Joe Lee | Urology - Dr Joe Lee | Urology
How Does Penile Grafting Work?
The aim of penile grafting is to release the shortened side of the penis so that it can expand more evenly during an erection.
After exposing the affected area, the surgeon identifies the point of maximum curvature and makes one or more carefully planned incisions in the tunica albuginea at or around the plaque. This releases the contracted tissue and creates a defect that allows the shortened side to lengthen. A graft is then positioned over this opening to restore the continuity of the tunica and support the erectile tissue beneath it.
Complete removal of the Peyronie’s plaque is generally avoided because extensive plaque excision may increase the risk of postoperative erectile dysfunction. The exact reconstructive technique depends on the curvature, plaque characteristics and anatomy of the individual patient.
Watch Dr Joe Lee explain who may be suitable for grafting surgery and the factors considered when selecting this treatment for Peyronie’s disease.
@drjollyurology Big bend, big fix. Grafting surgery is for advanced Peyronie’s with severe curve or length loss. #urology #doctor #menshealth #fyp #PeyroniesDisease #menshealthawareness #doctorsoftiktok
♬ original sound - Dr Joe Lee | Urology - Dr Joe Lee | Urology
What Types of Grafts Can Be Used?
Different materials can be used to cover the tunical defect created during reconstructive surgery. These broadly include tissue taken from the patient, processed human donor tissue and animal-derived biological grafts.
The choice of graft depends on factors such as the size and location of the defect, surgical technique, availability of the material and the surgeon’s assessment. Current evidence has not established a single graft material as superior for all patients, and graft selection therefore needs to be individualised.
Synthetic grafts have also historically been used, but contemporary European guidance recommends avoiding materials such as Dacron and Gore-Tex because of concerns including infection, inflammation, fibrosis and graft contracture.
Penile Grafting vs Penile Plication
Both procedures are designed to straighten a penis affected by Peyronie’s disease, but they achieve this in different ways.
Penile plication places sutures on the longer, unaffected side of the penis, effectively shortening that side until it corresponds with the shorter side. It is generally more suitable for men with adequate penile length, good erectile function, less severe curvature and no major hourglass or hinge deformity.
Penile grafting, by comparison, operates on the shortened side. The restricted tunica is incised and reconstructed with a graft. It is therefore generally reserved for more severe curvature, significant shortening or complex deformities where a shortening procedure may be less suitable.
Neither operation is universally better. The choice depends on the anatomy of the deformity, penile length, erectile function and the patient’s priorities and expectations.
Watch Dr Joe Lee explain when plication surgery may be suitable for correcting penile curvature caused by Peyronie’s disease.
@drjollyurology Fix the curve, keep function. 💡 Plication for Peyronie’s is less invasive, with recovery in weeks. 🩺 #urology #doctor #menshealth #fyp #PeyroniesDisease #menshealthawareness #doctorsoftiktok
♬ original sound - Dr Joe Lee | Urology - Dr Joe Lee | Urology
What to Expect During Penile Reconstructive Surgery
Before Surgery
A detailed assessment is necessary to determine whether grafting is an appropriate reconstructive option.
- Assessment of the curvature — The degree, direction and location of the curvature are documented, usually during an erection or using appropriate photographs.
- Evaluation of the deformity — Hourglass narrowing, indentation, hinge deformity and other complex changes are assessed.
- Penile measurements — Penile length is documented to assist surgical planning and establish realistic expectations.
- Assessment of Peyronie’s plaque — The location and characteristics of the plaque are evaluated.
- Erectile function assessment — Your ability to achieve and maintain an erection is particularly important when deciding whether grafting is suitable.
- Additional investigations — Penile Doppler ultrasound may be recommended in selected patients to assess penile blood flow and erectile function before grafting.
- Discussion of expectations — The intended degree of straightening, possible changes in length, erectile function and sensation, and the possibility of residual or recurrent curvature are discussed before surgery.
During Surgery
Penile grafting is performed under anaesthesia, with the surgical approach tailored to the location and complexity of the deformity.
- Accessing the affected area — The surgeon carefully exposes the tunica albuginea and identifies the area responsible for the curvature or deformity.
- Assessment of the curvature — The penis may be temporarily made erect during surgery to confirm the degree and location of the deformity and guide correction.
- Releasing the shortened side — One or more incisions are made in the affected tunica to release the contracted area and allow the shortened side to expand.
- Placement of the graft — Graft material is positioned over the resulting tunical defect and secured to reconstruct the tissue.
- Checking the correction — The penis is reassessed for straightness, and further correction may be performed if significant residual curvature remains.
- Completing the procedure — The surgical area is closed and dressed once satisfactory correction has been achieved.
After Surgery
Recovery focuses on allowing the reconstructed tissues to heal while monitoring erectile function and the correction achieved.
- Early recovery — Swelling, bruising and discomfort are expected during the initial healing period and generally improve gradually.
- Wound care — Instructions are provided for keeping the surgical area clean, caring for the dressing and recognising signs that require medical attention.
- Pain management — Prescribed medication may be used to manage postoperative discomfort during the early recovery period.
- Activity restrictions — Strenuous physical activity should be limited according to the surgeon’s instructions while the surgical site heals.
- Temporary sexual restriction — Sexual intercourse and masturbation are avoided during initial healing, with the timing of resumption determined by the surgeon based on recovery.
- Penile rehabilitation — Penile traction, a vacuum erection device or medication to support erectile function may be recommended for selected patients as part of postoperative rehabilitation.
- Follow-up assessment — Follow-up appointments allow the surgeon to monitor wound healing, penile straightness, sensation and erectile function and address any postoperative concerns.
Why is Erectile Function Important Before Penile Grafting?
Penile grafting is generally intended for men whose erectile function is sufficiently preserved. Opening and reconstructing the tunica albuginea can affect the mechanisms involved in maintaining an erection, meaning postoperative erectile dysfunction is an important consideration.
For men who already have significant erectile dysfunction that does not respond adequately to medication, grafting alone may therefore not be the most appropriate surgical option. In men with both Peyronie’s disease and medication-resistant erectile dysfunction, penile prosthesis implantation, with additional straightening procedures where required, is generally the recommended surgical approach.
Watch Dr Joe Lee explain how Peyronie’s disease can contribute to erectile dysfunction and why erectile function is an important consideration when planning treatment.
@drjollyurology Yes, Peyronie’s Disease can contribute to ED, but how? Find out more. #urology #doctor #menshealth #fyp #PeyroniesDisease #erectiledysfunctionisreal #menshealthawareness #doctorsoftiktok
♬ original sound - Dr Joe Lee | Urology - Dr Joe Lee | Urology
Benefits of Penile Reconstructive Surgery
For appropriately selected patients, penile grafting can provide several potential benefits:
- Correction of severe curvature to achieve a straighter, more functional erection.
- Treatment of complex deformities, including hourglass narrowing and indentation.
- Reduced additional penile shortening compared with procedures that straighten the penis by shortening the opposite side.
- Improved ability to have penetrative sexual intercourse when curvature previously made intercourse difficult.
- Reconstruction tailored to the deformity, allowing the surgeon to address more complex patterns of Peyronie’s disease.
The primary surgical goal is a functionally straight penis, instead of achieving a perfectly straight penis or restoring the penis to its exact appearance and dimensions before Peyronie’s disease developed.
Risks and Limitations of Penile Grafting
Penile grafting is a more complex reconstructive procedure than plication and requires careful patient selection. Potential risks and limitations include:
- Erectile dysfunction — This is one of the most important risks. The EAU guideline advises that men without erectile dysfunction before surgery should still be counselled about a significant postoperative ED risk, reported as high as 50% in some evidence.
- Residual curvature — Some degree of curvature may remain after surgery.
- Recurrent curvature — Curvature can occasionally recur as tissues heal and remodel.
- Changes in penile sensation — Temporary or persistent numbness or altered sensation can occur.
- Changes in orgasm — Delayed orgasm has been reported following reconstructive surgery.
- Penile shortening — Grafting is intended to minimise additional shortening compared with plication in selected patients, but it does not guarantee preservation or restoration of penile length.
- Graft-related complications — These can include contraction, fibrosis or other problems related to healing.
- Bleeding, infection or wound complications — These are general risks associated with surgery.
- Need for additional treatment — Persistent erectile dysfunction, recurrent deformity or other postoperative problems may require further management.
Published surgical evidence is largely derived from retrospective and non-randomised studies, so outcome estimates vary between techniques, graft materials and patient populations.
Results of Penile Grafting
The principal aim of penile grafting is to produce a penis that is sufficiently straight for satisfactory sexual function while addressing deformities that may not be well suited to a shortening procedure.
Results vary according to the original severity and type of deformity, preoperative erectile function, grafting technique, healing and individual patient factors. Some residual curvature may remain, and the operation cannot guarantee restoration of penile length lost before surgery.
Erectile function is particularly important to long-term outcomes. For this reason, careful assessment and counselling before surgery are essential so that the expected improvement in penile shape is balanced against the potential effect of reconstructive surgery on erectile function.
Summary
Penile reconstructive surgery with grafting is a surgical option for selected men with stable Peyronie’s disease and severe or complex penile deformity, particularly when significant curvature, shortening, indentation or hourglass deformity makes sexual intercourse difficult.
The procedure releases the shortened side of the tunica albuginea and uses a graft to reconstruct the resulting defect. Unlike plication, it avoids relying solely on shortening the opposite side of the penis, making it particularly useful in selected men where preservation of available penile length is an important consideration.
Because grafting carries a risk of postoperative erectile dysfunction and other complications, careful assessment of penile anatomy, erectile function and treatment goals is important when determining whether it is an appropriate surgical option.
If penile curvature or deformity is affecting your sexual function, consider scheduling a consultation with Dr Joe Lee to discuss whether penile grafting or another treatment approach may be suitable for you.
