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  • Review Article
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Current status of the surgical management of Peyronie's disease

Nature Reviews Urology volume 8, pages 95–106 (2011)Cite this article

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Abstract

Surgery is the standard treatment for patients in the chronic phase of Peyronie's disease. Reconstructive surgeries function by either shortening the convex side of the tunica albuginea (Nesbit procedure, Yachia technique and penile plication) or lengthening the concave side by incision of the plaque with subsequent grafting. Tunical shortening procedures are ideal for men with good erectile capacity, penile curvatures less than 60° and predicted postprocedural length loss of less than 20% of erect penis length. Tunical lengthening procedures with grafting are indicated in patients with severe penile length loss, curvatures greater than 60° and prominent hourglass deformities. Saphenous vein and tunica albuginea are the most commonly used autologous graft materials. Cadaveric or bovine pericardium and 4-layer small intestinal submucosa are promising nonautologous tissues. Penile implantation of a prosthesis is the standard procedure in men with erectile dysfunction who do not respond to conservative treatment. If residual penile curvature is less than 30° after implantation, no further treatment is required. However, residual curve of greater than 30° can be straightened with manual modeling. Additional procedures such as penile plication, the Nesbit procedure, or grafting can be performed if modeling fails to correct the residual deformity.

Key Points

  • Surgical correction is the gold standard treatment option for Peyronie's disease (PD), but should only be considered after stabilization of the disease

  • Tunical shortening procedures are ideal for men with good erectile function, penile curvatures less than 60° and predicted postprocedural length loss of <20% of erect penis length

  • Plication is currently the most utilized shortening procedure because extensive surgical experience is not required

  • Penile lengthening surgery is reserved for men with good erectile function but severe penile length loss, curvatures greater than 60° or prominent hourglass deformities

  • Massage and stretch therapy with bedtime use of PDE5 inhibitors are recommended for penile rehabilitation after lengthening procedures

  • Penile prosthesis implantation is the standard of care for patients with PD and concomitant erectile dysfunction nonresponsive to medical treatment

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Figure 1: The Nesbit procedure.
Figure 2: Medial dissection of the neurovascular bundle.
Figure 3: Penile plication.
Figure 4: Saphenous vein grafting.
Figure 5: Penile prosthesis implantation with rectus fascia grafting.
Figure 6: Surgical algorithm for patients in the chronic phase of Peyronie's disease.

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  1. Department of Urology, Section of Andrology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, 34390, Capa, Turkey

    Ates Kadioglu, Faruk Küçükdurmaz & Oner Sanli

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A. Kadioglu, F. Küçükdurmaz and O. Sanli contributed equally to the researching of data, discussion of content, writing and editing of this article.

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Kadioglu, A., Küçükdurmaz, F. & Sanli, O. Current status of the surgical management of Peyronie's disease. Nat Rev Urol 8, 95–106 (2011). https://doi.org/10.1038/nrurol.2010.233

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