Peyronie’s disease surgery can be performed by shortening the longer side or lengthening the shorter side of the penis, depending on the degree and type of curvature.

Peyronie’s disease surgery is indicated when the curvature interferes with penile function. At this stage, the anatomical change may cause pain during erection, as well as make sexual intercourse difficult or compromised, and increase the risk of erectile dysfunction.

The surgical procedure can be performed by shortening the longer side or, alternatively, by lengthening the shorter side. These are techniques currently used in surgical correction, and the indication depends on each patient’s clinical characteristics.

Below, learn about the main techniques used in Peyronie’s disease surgery.

What is penile curvature?

Penile curvature occurs when the penis has a deviation that exceeds what is considered acceptable in the angulation of the male organ.

This anatomical change may have two main causes: Peyronie’s disease or congenital penile curvature.

In Peyronie’s disease, curvature develops after microtrauma to the penis, usually during sexual intercourse, sports activities, or falls over time. These traumas can lead to the formation of fibrous plaques (internal scarring) in the tunica albuginea (the membrane that surrounds and protects the corpora cavernosa).

With the formation of these plaques, the tunica albuginea loses elasticity, which prevents uniform expansion of the penis during erection. As a result, curvature may appear upward, downward, or sideways.

In congenital penile curvature, the cause is related to the development of the organ during pregnancy. In this case, the deformity becomes more evident during puberty, when boys begin to have more frequent erections.

When is Peyronie’s disease surgery recommended?

There are two main criteria for indicating surgical treatment for penile curvature.

• When the patient does not have satisfactory results with medical treatment, such as oral medication and injections applied directly to the penis, or with complementary approaches, such as shockwave therapy or penile traction;
• When penile fibrosis makes penetrative intercourse difficult or impossible, either due to the deviation itself or associated erectile dysfunction.

Types of Peyronie’s disease surgery

In general, surgeries to correct penile curvature are divided into two large groups: techniques that shorten the longer side and techniques that lengthen the shorter side.

Techniques that shorten the longer side

1. Nesbit technique: It consists of removing a portion of the longer side of the penis, followed by a plication, which allows both sides to be equalized and thus corrects the curvature.
2. Kelami–Nesbit technique: It is a variation of the previous technique, in which the surgeon uses specific instruments to determine, more precisely, the location and the amount of tissue to remove and plicate.
3. Lue 16-dot technique: It is based on performing parallel plications (folds) in penile tissue to adjust and balance the length of both sides. In this approach, 16 suture points are placed for resection and plication.
4. Modified Yachia corporoplasty: It involves a longitudinal incision with transverse closure, allowing side equalization and curvature correction.
5. Essed–Schroeder plication technique: Mainly indicated for ventral curvatures (downward), this technique aims to reduce the risk of additional lateral deviation. In it, the surgeon performs four plications on the side opposite the point of greatest curvature to align the penis.
6. Egydio STAGE technique: This is an evolution of the method described by Nesbit in 1965. The technique is based on applying geometric principles to precisely determine the exact points for incision or tissue resection, enabling a more personalized correction of curvature.

Techniques that lengthen the shorter side

1. Devine–Horton technique: It consists of removing the fibrotic area (plaque), followed by placement of a dermal graft to reconstruct the affected region and promote lengthening of the shortened side.
2. Parallel I incision (Sampaio): It is based on a longitudinal incision (I-shaped) to expand and lengthen tissue without needing tissue removal or grafts.
3. Gelbard relaxation incisions: It involves multiple relaxation incisions in the tunica albuginea, allowing tissue expansion and, in selected cases, penile prosthesis placement in more complex situations.
4. Lue H incision technique: It promotes expansion of penile tissue through an H-shaped incision, allowing greater elasticity and curvature correction.
5. Egydio Geometric Principles: The surgeon performs the incision based on rigorous geometric calculations to allow symmetrical, controlled tissue expansion.
6. Sansalone–Egydio technique: Also based on geometric principles, it uses precise incisions to optimize curvature correction.
7. Miranda geometric model: It applies the geometric principles described by Dr. Paulo Egydio, combined with computerized planning, to increase surgical precision.
8. Gaffney lengthening strategy: It brings together different types of incisions designed to lengthen penile tissue while aiming to preserve key structures such as nerves and the urethra.
9. Egydio graft-free geometric method: A technique that expands fibrotic tissues and restores flexibility, which may enable penile prosthesis placement in cases of Peyronie’s disease associated with erectile dysfunction.

How much does Peyronie’s disease surgery cost?

It is not possible to anticipate the cost of Peyronie’s disease surgery. This is because medical fees are defined after an individual clinical evaluation, in accordance with the Medical Association’s deontological code. After all, the total cost depends on the complexity of the case, the technique used, and any need for complementary procedures.

It is also important to consider that this surgical treatment may involve placement of a penile prosthesis, whose price may range between €1,200 and €9,000 (approximate values and subject to change). In addition, hospital and admission costs apply, among other expenses associated with the operating room and anesthesia.