Grafts To Straighten Penis Curvature
As an alternative to plication, a technique to straighten penis curvature is to shorten the longer side. It is possible to fix a curved penis by adding tissue to the shorter side where the plaque is most prominent. This is appealing to patients with significant penile size loss. After careful dissection of the nerve and vascular structures (called neurovascular bundles), the scar can be incised/excised, and a graft (distant tissue) can then be placed to lengthen the short side. Many graft materials can be used. Our preference is to use dermis, material between the skin and the fat. This graft is harvested from the abdominal wall in the area known as the “love handle”. Grafts are often used to correct upward curvature by incising the scar along the top of the penis and adding graft tissue.
The following illustrations show correction of penile curvature with a dorsally placed graft. The skin is incised circumferentially (called a circumcising incision), and the penis is “de-gloved” to expose the underlying nerves and blood vessels that course along the top of the penis under the skin tp provide blood supply and sensation to the head of the penis (glans penis). There is a vein along the midline (dorsal vein) that can be excised without consequence to provide exposure to the plaque. Then, the neurovascular structures can be carefully moved toward the side to provide full exposure to the plaque along the tunica of the penis. We use optical magnification for this surgery.
We then incise the plaque using an incision that has the appearance of a modified letter “H”. As the plaque releases, a defect is created allowing the length to expand. However, the incision into the substance of the penis creates a hole in the penis that needs to be covered, and this is achieved with placement of the graft as shown below.
After the graft is sutured to the tunica of the penis, and correction of the curvature is confirmed, the neurovascular structures are repositioned in the midline, and the skin is closed.
It has been shown that the risk of erectile dysfunction when using a graft is significantly increased when there is underlying dysfunction pre-operatively. It is for this reason that we test the erectile function of our patients prior to surgery using penile duplex, an ultrasound test. Those who have any impairment are encouraged to have a plication despite the fact that post-operative penile length may be less than when a graft is used. Peyronie’s Disease surgery is best performed using an individualized approach.