Before accepting any surgery, it is important to understand how different materials may be used in surgical approaches and why there are safer alternatives.
When men with penile curvature gather the courage to research possible treatments, they may come across the risks of penile grafting and become even more distressed than before. However, they need to know that there is a graft-free Peyronie’s surgery described in the literature as a surgical alternative.
The complications of Peyronie’s disease surgery with grafting may make the decision to seek medical help more difficult. The fear of erectile dysfunction, infection, loss of sensitivity, contraction, and recurrent curvature affects many patients; therefore, the physician must explain these risks clearly to the patient.
In this article, it will be possible to understand why grafting is not always the best choice and why the Egydio Technique may be considered in certain cases, according to medical evaluation.
What is grafting in Peyronie’s surgery and why is it used?
A graft is a material used to cover the opening created in the tunica albuginea, with the aim of releasing the shortened side caused by the fibrotic plaque and allowing correction of the penile curvature.
How Peyronie’s disease creates the need for a graft
Peyronie’s disease leads to the formation of a rigid fibrotic plaque in the tunica albuginea, preventing the normal expansion of tissues during erection. This limitation is what causes penile curvature.
In surgeries that use grafting, the surgeon acts on the shortened side of the penis, creating space for the organ to become aligned again. However, if this tissue release creates a defect in the tunica albuginea, the surgeon needs to cover that area. A graft is then used to close the defect.
Types of grafts used in Peyronie’s surgery
Over the years, grafts have been derived from various materials. Today, the main guidelines highlight the following types of grafts for covering surgical defects in Peyronie’s surgery:
- Biological grafts of human or animal origin: these are the most common in this setting and include processed human tissues, bovine pericardium, and porcine intestinal submucosa;
- Autologous grafts: taken from the patient’s own body, such as vein, fascia, and oral mucosa;
- Synthetic materials: composed of medical-grade plastics and currently used less often because they present greater difficulty integrating into the body.
Why grafting is still adopted by many surgeons
The use of grafting has become established as one of the best-known approaches in Peyronie’s disease surgery. For decades, it was seen as the main alternative to shortening techniques, such as plication, especially in cases where the goal was to correct curvature without worsening penile length loss.
For this reason, incision or excision with grafting techniques remain part of international recommendations for severe curvatures, complex deformities, or hourglass narrowing.
It is important to emphasize, however, that grafting may not be the most appropriate option in all cases. The use of a graft must be evaluated carefully, always with a clear explanation of the risks, limitations, and functional impact.
The real risks of grafting: what happens after surgery
Grafting risks after surgery may affect the patient’s life in several ways, including healing, erectile function, sensitivity, and satisfaction with the final outcome.
Erectile dysfunction: the most feared risk
Erectile dysfunction is one of the complications that concerns men the most after Peyronie’s surgery with grafting.
This risk exists because the procedure requires opening the tunica albuginea and, in many cases, mobilizing delicate nerves and blood vessels in the region, which may affect erection rigidity.
A 2019 literature review published in the scientific journal Sexual Medicine showed that the rate of postoperative erectile dysfunction in surgeries with grafting may reach 65% in certain clinical series, and the need for additional treatment after surgery ranged from 4.6% to 67.4%.
In addition, when Peyronie’s disease is associated with erectile dysfunction, grafting alone does not solve the problem of penile rigidity. In these cases, the physician needs to implant a penile prosthesis so that the patient can adequately regain sexual function.
Infection and rejection: the graft has no blood supply of its own
Until the body incorporates the graft, the tissue does not have the same vascularization as intact native tissue. This makes it more vulnerable to contamination, inflammation, excessive scar response, and integration failure, especially in the case of synthetic materials.
In addition, patients with diabetes, immunosuppression, or changes in the healing process may present a higher risk of complications associated with graft use in penile curvature surgery.
Graft contraction and recurrence of curvature
During healing over the following months, the graft may contract. When this happens, the tissue loses elasticity, may begin to “pull” the penis again, and favor recurrence of curvature and length loss.
In a five-year follow-up, a 2011 study showed that recurrence of curvature and additional length loss were not rare in graft cases, contributing to high dissatisfaction.
Loss of penile sensitivity
To adequately expose the plaque area and place the graft, it is necessary to mobilize the neurovascular bundle. Although the surgeon tries to preserve this structure as much as possible, decreased penile sensitivity may occur after surgery.
The change tends to be temporary, but it does not always disappear completely. A review published in Sexual Medicine in 2019 showed that sensitivity changes were reported in 2.0% to 22.5% of patients, with 80% to 100% of these cases being temporary.
Length loss: what no one tells you before surgery
During healing, the graft may contract and reduce part of the gain achieved by lengthening the short side of the penis during surgery.
In practice, this means that this technique does not guarantee preservation of penile length and does not recover what the disease has already taken away.
How the Egydio Technique may avoid these risks
By avoiding the use of a graft, the Egydio Technique may correct the deformity while also seeking to preserve penile anatomy and function.
The geometric principle that eliminates the need for a graft
The Egydio Technique is based on a geometric principle. By precisely identifying the point of maximum curvature and distributing smaller incisions along the area of penile fibrosis, it becomes possible to create smaller defects in the tunica albuginea.
This difference is decisive. When the defect is smaller, the need to cover it with additional material also decreases. A surgical review published in 2012 in the journal Asian Journal of Andrology indicated that defects in the tunica albuginea larger than 2 cm tend to require grafting.
An approach recognized in the international literature
The Egydio Technique appears consistently in the specialized literature as one of the most recognized approaches for treating complex penile deformities.
The method is described in multicenter studies, surgical reviews, and international reference publications on Peyronie’s disease. In addition, international recognition of the method continues to grow as guidelines from Europe, the United States, and Canada include it in their recommendations.
READ MORE | Penile prosthesis and severe erectile dysfunction: an option for complex Peyronie’s disease in Portugal
Results: aspects to consider in graft-free approaches
In some cases, graft-free approaches may be associated with different risk and recovery profiles, as well as functional outcome and patient satisfaction in the medium and long term.
- Lower risk of complications: by avoiding grafting, risks such as contraction, palpable irregularity, and integration difficulties may be reduced;
- More natural appearance: without additional material, the correction tends to provide a more homogeneous result;
- Better penile preservation: the technique seeks to better preserve length and girth;
- Less impact on erection: by allowing the creation of smaller defects in the tunica albuginea, the Egydio Technique favors reconstruction with less functional impact.
When might grafting still be necessary?
Although a specific technique may avoid grafting in many cases, not all deformities allow for this choice. In extremely complex situations or when there are large defects in the tunica albuginea, the surgeon may still consider grafting essential to reconstruct the penis.
Who may benefit from graft-free surgery
Certain patient profiles may have an indication for treating curvature with the Egydio Technique.
This decision is based on penile anatomy, the type of deformity, the presence or absence of erectile dysfunction, and the history of previous surgeries.
Patients with Peyronie’s disease in the stable phase
The patient must present stable curvature for 12 months before undergoing surgery, while preserving erectile function or experiencing only partial impairment.
Men who have already undergone previous operations without achieving the expected result
The surgeon may use the Egydio Technique as revision surgery, including in patients who have already undergone graft surgery and developed complications.
Recurrence of curvature, length loss, erectile dysfunction, or discomfort after previous graft surgery may justify a new surgical intervention.
Patients with congenital curvature and complex cases
The geometric principles of the Egydio Technique also apply to congenital penile deformities and complex cases of acquired curvature, including severe curvatures, hourglass deformity, or cases associated with erectile dysfunction.
The most important decision is not whether to operate, but how to operate
Grafting is not just a technical detail: it may bring real risks to a man’s sexual health and contribute to dissatisfaction with the surgical result.
Therefore, more important than deciding to undergo surgery is choosing an approach capable of correcting the deformity with the lowest possible functional impact. This is where the Egydio Technique represents one possible approach among the available surgical options.
If you have doubts about your clinical case, seek evaluation by a qualified urologist for individualized guidance. If you have made it this far, you have already taken the first step. The next is to speak with a specialist. You may request an initial clinical evaluation, which will be reviewed individually.