The three main surgical strategies for Peyronie’s disease are tunical shortening (plication), tunical lengthening with plaque incision and grafting, and penile prosthesis surgery for men who also have significant erectile dysfunction. There is no single best operation. Plication is simpler and has a lower risk of new ED but can shorten the longer side. Grafting is used for selected severe or complex deformities when erections are good, but it carries a greater risk of postoperative ED. A penile implant is preferred when rigidity itself is unreliable despite appropriate treatment.

Peyronie’s disease surgery options: quick comparison

1. Plication or tunical shortening surgery

The surgeon shortens the longer, convex side of the penis so it matches the scarred side. Techniques include excisional/incisional procedures such as the classic Nesbit concept and multiple suture-based plication methods. The plaque itself usually does not need to be removed. Plication is generally the most straightforward option when erections are strong and the penis has enough length.

2. Plaque incision and grafting

The scarred side is released with one or more incisions, and the resulting tunical defect is covered with a graft. The aim is to straighten by lengthening the shorter side rather than shortening the longer side. It is useful for selected men with severe curvature, significant shortening or complex narrowing, but the dissection is more extensive and can affect erectile function.

3. Penile implant surgery

When Peyronie’s disease is accompanied by ED that does not respond adequately to medical therapy, straightening the penis without restoring rigidity is unlikely to solve the functional problem. A penile prosthesis provides the erection. Cylinder placement alone can improve some curvature; if a meaningful bend remains, the surgeon may add modelling, plication or plaque incision/grafting.

What does “modelling” mean?

During prosthesis surgery, modelling refers to controlled bending of the inflated implanted penis in the direction opposite the curvature. It is performed by the surgeon under anaesthesia. It is not the same as a patient forcefully bending the penis at home.

How does a urologist choose among these options?

• Quality of erections without and with ED medicines.
• Degree and direction of curvature.
• Stretched penile length and how much shortening already exists.
• Presence of hourglass, indentation or hinge instability.
• Plaque position and previous surgery.
• Patient priorities: straightness, length preservation, erectile reliability and willingness to accept different risks.

Important risks to discuss before any Peyronie’s operation

• Residual or recurrent curvature.
• Penile shortening or a different perceived shape.
• Altered penile sensation or numbness.
• New or worsened erectile dysfunction, particularly after grafting.
• Palpable sutures or scar tissue after plication.
• Haematoma, infection, wound problems and need for further surgery.
• Implant-specific infection or mechanical problems when a prosthesis is used.

Curvature angle is only one part of the operation choice

Plication, incision/grafting and penile prosthesis surgery solve different problems. Plication is generally favoured when erections are good, length is adequate and deformity is less complex. Lengthening procedures are considered when erections are preserved but the curve is severe or there is a hinge/hourglass problem and shortening is a major concern; they carry a higher risk to erectile function. If ED is already refractory to medication, an implant often becomes the foundation of treatment because straightening a poorly rigid penis does not restore sexual function.

Why grafting is not automatically the ‘length-preserving’ choice

Lengthening surgery is sometimes interpreted as a way to avoid any loss of length, but that is too simplistic. Grafting aims to reduce the shortening caused by operating on the longer side, yet it does not reliably restore length already lost from Peyronie’s disease. It also involves opening the tunica on the concave side and may disturb the veno-occlusive mechanism. Current EAU guidance therefore reserves it for selected men with good erections, severe/complex deformity or inadequate length rather than using it routinely.

Why a perfect zero-degree result is not the only goal

Surgery aims for a functionally straight penis that allows comfortable penetration. Residual minor curvature may be acceptable if correcting the final few degrees would require disproportionate shortening, grafting or additional dissection. Pre-operative counselling should therefore define success in functional terms—usable rigidity, acceptable straightness, preserved sensation and an understood length trade-off—not only as a photographically straight penis.

How complex deformity changes planning

An hourglass narrowing or hinge deformity is different from a simple smooth bend. Even a moderate angle can be functionally severe if the shaft buckles during penetration. These cases may require a lengthening or extra-tunical strategy rather than simple plication, provided erections are strong. The surgeon should therefore assess the full erect shape—direction, angle, indentation, hinge effect and usable length—rather than plan surgery from a single curvature number.

When penile Doppler adds useful information

Penile Doppler is not mandatory before every Peyronie’s operation. It becomes useful when erection quality is uncertain, when the patient reports ED despite apparently good rigidity in photographs, or when the result would change the choice between straightening surgery and prosthesis. The test is most informative when performed with a pharmacologically induced erection, because the deformity and vascular response can be assessed together.

What your surgeon needs to plan the operation

• Erection photographs documenting angle, direction, hourglass narrowing and hinge instability.
• An objective assessment of erection quality, including response to tablets or injections when ED is present.
• Stretched penile length and your concern about further shortening.
• Details of previous Peyronie’s treatment or penile surgery.
• Your preference after counselling about the different trade-offs of plication, grafting and prosthesis surgery.

FAQs

Related reading

• When Does Peyronie’s Disease Need Surgery?
• Penile Straightening Surgery for Peyronie’s Disease
• Will Peyronie’s Surgery Shorten the Penis?
• Penile Implant for Peyronie’s Disease
• Urologist in Latur

References

• European Association of Urology. EAU Guidelines on Sexual and Reproductive Health: Penile Curvature. 2026 https://uroweb.org/guidelines/sexual-and-reproductive-health/chapter/penile-curvature
• Nehra A, Alterowitz R, Culkin DJ, et al. Peyronie’s Disease: AUA Guideline. J Urol. 2015;194(3):745-753. doi:10.1016/j.juro.2015.05.098.
• Chierigo F, Fallara G, Tozzi M, et al. Guideline of guidelines: Peyronie’s disease. BJU Int. 2026;137(5):770-782. doi:10.1111/bju.70201.
• Tozzi M, Gobbo A, Fallara G, et al. Erectile dysfunction in patients with Peyronie’s disease treated with different grafts: a systematic review. Sex Med Rev. 2026;14(1):qeaf053. doi:10.1093/sxmrev/qeaf053.