Our Surgical Method – Microsurgical Reconstruction

Our Treatment Goal

Our surgical treatment of Peyronie's disease aims at more than just straightening the penis. Our goal is the most comprehensive treatment possible of all the changes caused by the condition:

• Correcting the curvature
• Preserving penile length – no surgical loss of length through shortening the opposite side
• Restoring the natural elasticity of the erectile tissue sheath
• Preserving erectile function
• A natural appearance

Which changes can be treated in an individual case, and to what extent, depends on the individual starting situation. There are no guarantees – but there is a clear treatment concept.

The Role of the Plaque – Why We Remove It

At the center of Peyronie's disease is the plaque: scar tissue within the tunica albuginea that has lost its elasticity and forces the penis into a particular shape during erection.

With shortening procedures such as the Nesbit technique, the plaque remains untouched. The curvature is compensated for by shortening the healthy opposite side. For certain patients, this is the right choice.

In our approach, we treat the plaque directly: we remove the altered tissue microsurgically and then reconstruct the resulting gap in the erectile tissue sheath. This is technically more demanding – but in suitable cases it enables better results, particularly with regard to length preservation.

Microsurgical Plaque Removal

The term microsurgery describes a surgical technique in which very fine instruments are used under optical magnification. This allows for precise treatment of small structures – in this case, the erectile tissue sheath.

The goal of plaque removal is to remove the diseased tissue as completely as possible without damaging surrounding structures – particularly the nerves and blood vessels that are essential for erectile function.

After the plaque is removed, a defect remains in the tunica albuginea. This defect must be reconstructed – that is the second, decisive part of the procedure.

Biological Reconstruction with Oral Mucosa or Collagen Fleece

What Is Collagen Fleece?

To cover the defect, we do not use permanent artificial material, but rather oral mucosa or a biological collagen fleece. This is a collagen-based medical material that serves the body as a scaffold for tissue healing.

The collagen fleece is biological and is converted by the body into the patient's own tissue during healing: over the course of healing, it is gradually replaced by the patient's own tissue. What remains is newly formed, natural tissue.

What the Reconstruction Must Achieve

The tunica albuginea is a functionally highly demanding structure. The reconstruction must:

• Be sufficiently stable to withstand the pressure during erection
• Remain elastic enough to allow normal expansion
• Integrate well with the existing tissue in the long term
• Not impair the function of the surrounding structures

What Happens When Erectile Dysfunction Is Also Present

Not every patient with Peyronie's disease suffers from erectile dysfunction. In advanced disease, however, erectile function can be significantly impaired – independent of the curvature.

In these cases, the surgical plan must be expanded. Straightening alone does not automatically improve erectile function. That is why, before every operation, we carefully assess whether relevant erectile dysfunction is present – and which therapy would be appropriate.

In severe cases, implantation of a hydraulic penile prosthesis can be part of the treatment concept. This involves a so-called plaque incision for straightening, combined with implantation of the prosthesis to restore function. This is discussed and planned on an individual basis.

Achievable Results

What can patients realistically expect?

• Significant reduction or complete correction of curvature in many cases
• Preservation of penile length – without surgical loss of length through shortening the opposite side
• Preservation of erectile function with careful technique
• A natural appearance once healing is complete

There are no guarantees in medicine. The degree of improvement depends on the individual starting situation, the extent of the plaque, and erectile function prior to the procedure. The surgeon's experience plays a decisive role in the reliability of the outcome.

Peyronie's disease procedures at UGRS are performed, on the one hand, by Prof. Agustín Fraile Poblador, who has many years of specialized experience in reconstructive genital surgery and is a sought-after EAU lecturer on the implantation of hydraulic penile prostheses.

For corrections using oral mucosa, the surgeon is Dr. Alessandro Perotti, who specializes in this procedure and enjoys a high international reputation for this complex technique.

Schedule a Consultation

Whether microsurgical reconstruction is the right choice for your situation is something we clarify in a personal conversation.

The first step isn't surgery – it's clarity.