Penile shortening may be one of the consequences of Peyronie’s Disease, with a significant impact on the sexual and emotional lives of some patients. In this article, we explain how certain surgical approaches, including the Egydio Technique, are described in the medical literature for treating deformities associated with this condition and for assessing whether it may be possible to recover penile size in selected cases.

In Peyronie’s Disease, men may face not only penile curvature, but also the perception that the organ is shorter than before. This finding can affect identity, intimacy and confidence.

When seeking medical help, the patient may receive different recommendations, since loss of length may be part of the condition’s progression and should be assessed on an individual basis.

In selected cases of severe curvature associated with Peyronie’s Disease, surgical treatment may be considered when there is relevant functional impact. In this article, we explain what the medical literature describes about the possibilities and limits of correcting these changes and attempting to recover penile size.

Why Peyronie’s Disease causes penile shortening and loss of size

Peyronie’s Disease causes penile shortening because the fibrotic plaque that forms in the tunica albuginea reduces tissue elasticity, preventing normal expansion during erection. This shortening may be progressive and may affect not only length, but also penile girth and shape.

The mechanism of fibrosis and loss of elasticity

In Peyronie’s Disease, part of the tunica albuginea, the structure that surrounds the corpora cavernosa, is affected by fibrosis, leading to the formation of a hard and rigid scar area.

Under normal conditions, the tunica albuginea has enough elasticity to follow the expansion of the corpora cavernosa during erection. When a fibrotic plaque forms, that area loses flexibility and begins to limit tissue expansion, causing the affected side not to stretch evenly.

The greater the extent of the plaque and the more rigid it is, the greater the tendency for limitation of penile expansion and, consequently, loss of functional length.

The psychological impact: what the data show

Penile shortening caused by the plaque is associated with emotional distress, as penile size remains socially linked to virility, masculinity and sexual self-confidence.

A review published in Translational Andrology and Urology reports that men with a subjective loss of length greater than 2.5 cm are significantly more likely to report lower satisfaction with their ability to have sexual intercourse.

Shortening without curvature: a possible presentation

Although penile curvature is one of the best-known manifestations of Peyronie’s Disease, not all patients have an evident penile deviation.

In some cases, there is a more symmetrical loss of elasticity in the tunica albuginea. As a result, curvature may not be evident, despite the presence of penile shortening.

This presentation may delay recognition of the problem because the patient does not always associate loss of length with Peyronie’s Disease. In these cases, medical assessment may be postponed, which can make proper monitoring of clinical progression more difficult.

What the most commonly used techniques do for penile length and size

Some surgical approaches used in the treatment of Peyronie’s Disease have correction of curvature as their main objective. Depending on the technique, anatomical characteristics and the patient’s clinical condition, there may be an impact on penile length or functional risks that should be discussed with the physician in advance.

Nesbit plication and the issue of shortening

Plication techniques, including Nesbit surgery and its variations, work by placing sutures on the side opposite the deformity, with the aim of correcting penile curvature. In selected patients, they may provide good results in curvature correction, although they may be associated with reduced penile length in some cases.

Incision with grafting: possible benefits and functional risks

Tunica albuginea incision techniques may be considered in the treatment of some complex curvatures and, in certain cases, may contribute to better preservation of penile length compared with plication techniques. They usually involve placing a graft in the area opened after incision of the fibrosis.

However, the use of a graft is not free from complications, including difficulty integrating into the tissue, inadequate healing, irregular appearance of the treated area, changes in sensitivity, recurrence or persistence of curvature, and less predictable results in terms of erectile rigidity.

In addition, in some cases, this approach may be associated with changes in the veno-occlusive mechanism, with a possible impact on erectile function.

What the literature says about long-term postoperative satisfaction

Some studies report that, after certain surgical techniques for Peyronie’s Disease, dissatisfaction may persist in some patients, even when curvature correction is considered satisfactory.

In a retrospective study published in Progrès en Urologie, involving plication surgery in patients with Peyronie’s Disease and congenital curvature, 72.5% of patients reported a noticeable loss of length and 47.5% stated that this shortening bothered them in their sexual life. In that study, 35% considered their postoperative sexual life to be as good as or better than before surgery.

Regarding incision and grafting techniques, in a series with a minimum follow-up of 5 years after venous grafting, postoperative erectile dysfunction was reported in 22.5% of patients and loss of length in 35%, according to a review commentary published in the Asian Journal of Andrology.

Have you been told that your surgical options may involve loss of length or a risk of erectile dysfunction? An individual medical assessment can help clarify the alternatives available. Dr. Paulo Egydio offers an online, free and confidential Case Pre-Analysis.

The Egydio Technique strategy to recover penile size lost to Peyronie’s Disease

The Egydio TEP Strategy (Tunica Expansion Procedure ) is a surgical approach described for selected cases of penile deformity, with the objective of promoting alignment and favoring tissue expansion of the tunica albuginea. The technique is based on multiple staggered incisions planned according to anatomical criteria, seeking to respect the limit of the neurovascular bundle and, when possible, avoid the need for grafting.

The principle of expansion instead of replacement

The neurovascular bundle limit and the possible extent of correction

The gain obtained is related to the anatomical limit allowed by dissection of the neurovascular bundle. This bundle determines how far the tissue can be safely released without compromising the vascular and nervous integrity of the penis.

For this reason, the extent of length and girth correction may vary according to the technique used, each patient’s anatomical characteristics and the intraoperative assessment.

This surgical step requires planning, anatomical knowledge and control of expansion, and should be performed by professionals with appropriate training and experience in this type of surgery.

In a series published in the Journal of Sexual Medicine, involving 416 patients submitted to the Egydio TEP Strategy, an average intraoperative penile increase of 3.3 cm was observed, with a range between 2 and 6 cm. These data should be interpreted in the context of the study design, the characteristics of the patients assessed and the fact that lengthening potential depends on the limit of the dissected neurovascular bundle.

TEP combined with penile prosthesis in selected cases

When penile curvature is associated with loss of length and relevant erectile dysfunction, combining a reconstructive technique with penile prosthesis placement during the same surgical procedure may be considered in selected cases, according to individual medical assessment.

This approach may aim to treat, in the same procedure, some manifestations of Peyronie’s Disease and improve penile rigidity when there is an indication for a prosthesis, always considering the risks, limitations and realistic expectations of each case.

Who may benefit from surgery to recover penile size

Surgery to recover length may be indicated in men with Peyronie’s Disease when there is a confirmed penile deformity, such as curvature, loss of size, narrowing, functional difficulty or impact on sexual life.

The most frequent indications are for men who present with:

• Penile curvature;
• Complex deformities, such as narrowing, hourglass deformity or axial instability;
• Loss of penile length due to curvature;
• Relevant erectile dysfunction associated with Peyronie’s Disease;
• Dissatisfaction with results after surgery with other techniques.

However, it is important to frame this indication correctly: the main objective of surgery should not be penile enlargement for aesthetic reasons, but rather improvement of penile functionality in selected patients, seeking to create more favorable conditions for sexual activity within the clinical limits of each case.

Therefore, recovery of length should be understood as part of penile reconstruction in selected patients, and not as surgery solely to recover penile size.

Can the size lost to Peyronie’s Disease be recovered with the right approach?

Changes such as penile shortening in Peyronie’s Disease should be assessed on an individual basis. There are surgical approaches that seek to improve anatomical and functional characteristics of the penis and, in selected cases, may contribute to some degree of recovery of penile length.

When there is a surgical indication for Peyronie’s Disease, it is advisable to discuss the available alternatives, potential benefits, risks and limitations of each approach with the physician. Assessment by a professional with appropriate training in penile reconstructive surgery can help determine whether functional and anatomical correction is possible, without creating guaranteed expectations of results.

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