Surgical penile grafting for Peyronie’s disease may be less indicated in certain clinical contexts, particularly when medical assessment identifies reconstructive alternatives that are appropriate for the case.

Learn, in an informative way, about some differences between the techniques and the criteria that may guide the medical indication in each case.

What is a surgical penile graft?

A surgical penile graft is a tissue transplant used in surgery to cover areas with a defect.

It is one of the therapeutic alternatives in the treatment of Peyronie’s disease. In these cases, the tissue is grafted onto the area affected by the curvature, with the aim of contributing to alignment and preservation of penile length.

There are several main types of penile graft:

• Tissue taken from another part of the patient’s own body;
• Animal-derived tissues, such as porcine submucosa or bovine pericardium, frequently used in Peyronie’s cases;
• Synthetic tissues, based on polymers.

Is surgical penile graft surgery effective?

The effectiveness of surgical penile graft surgery may vary according to the clinical context, and its indication has become progressively more selective.

In certain contexts, it has represented a therapeutic option for the treatment of penile curvature, namely as a complementary stage in surgeries directed at the shorter side of the penis. With the development of surgical approaches, the need to use grafted tissue should be assessed on a case-by-case basis.

In some situations, when the defect area is reduced or when penile reconstructive surgery is performed, the use of a graft may not be necessary. The decision depends on the patient’s anatomical, functional and clinical characteristics, as well as intraoperative assessment.

In addition, when clinically indicated, a graft-free approach may reduce exposure to some risks associated with the use of grafted tissue.

Possible complications associated with the use of a penile graft described in the medical literature may include:

Long suture lines

The graft requires non-absorbable suture lines, which may remain palpable after healing.

Different sizes and thicknesses

The grafts used may present different sizes and thicknesses. This means that structural irregularities may occur, with palpable prominence related to variations in thickness.

These changes may be identified by palpation of the area.

Limited resistance

As with differences in dimension and thickness, the penile graft may also present variable resistance.

In cases where there is an indication for a penile implant, there may be a risk of structural changes or mechanical complications, depending on the characteristics of the tissue, the technique used and the clinical course.

Need to adapt to the defect

When a graft must be used to cover the affected area, it is not always possible to obtain an exact match with the original area. This may result in greater reconstructive complexity and possible dissatisfaction with the outcome.

Avascular tissue and healing limitations

Because it is tissue transferred from one site to another, the graft has limited vascularisation in the initial phase.

Another aspect to consider is that limited vascularisation in the initial phase may, in some cases, be associated with a higher risk of infection and changes in the healing process.

Expansion limited by the graft

Penile lengthening may also be conditioned by the use of the graft, since it may act as a limiting element for tissue expansion in certain cases.

This limitation may, in some cases, contribute to scar retraction, that is, reduction or shortening of the tissues during the healing process.

Given these limitations, it is important to understand graft-free reconstructive approaches, selected according to individual clinical assessment.

How graft-free penile surgery works

Penile reconstructive surgery may be considered an alternative to penile grafting in selected cases, aiming to contribute to penile alignment and, when indicated, to preparing the tissues for a penile implant.

This method is based on small, geometrically planned incisions, which may contribute to gains in length and girth within each patient’s anatomical limits, while seeking to preserve nerve structures whenever possible.

This approach seeks to preserve tissues with blood supply and may, in selected cases, be associated with lower exposure to some complications related to surgical penile grafts.

The presence of vascularised tissues may favour local defence and healing conditions, although the clinical course depends on individual factors and the clinical context.

Egydio Technique: how to reconstruct the penis without grafting

Penile reconstruction without grafting aims to contribute to alignment and possible gains in length and girth, always within each patient’s anatomical and functional limits.

This approach may use principles of tissue expansion, relying on the patient’s own penile tissues, according to the clinical indication and the anatomical limits identified.

Correction may be performed in the tunica albuginea, through multiple small incisions that are geometrically dimensioned and located according to surgical planning, with the aim of favouring a more balanced distribution of tissues according to the anatomical needs of each case.

The orientation of the incisions is defined according to surgical planning and the type of correction intended. When the aim is to address length, horizontal incisions may be performed; when the need is related to girth, vertical incisions may be used, always according to individual anatomical assessment.

The balance between penile length and girth is relevant for function and comfort during sexual activity, always within the patient’s anatomical and functional limits.

The Egydio Technique may also be associated with the No-Touch Technique to avoid direct contact between the surgeon’s hands and the skin of the penis and scrotum, which may reduce the risk of infection and postoperative complications.

Schedule an appointment with Dr Paulo Egydio

Surgical treatment for Peyronie’s disease should be assessed by a qualified physician, who may indicate, when appropriate, whether surgical penile grafting or graft-free penile reconstruction is suitable for the case, considering clinical, anatomical and functional criteria.

For an assessment of your clinical case, contact the clinic to schedule a specialist consultation.