Surgical Methods Compared

What Moves Many Patients – and Why They Look for Alternatives

Many men who come to us have already had a conversation with a doctor. They were often recommended a Nesbit procedure or a similar shortening technique – as the standard treatment covered by health insurance.

And then comes the question that occupies many of them:

"Do I really have to lose even more length – for a condition that has already shortened me?"

That is not an unrealistic expectation. It is a legitimate question. And it leads directly to the crucial difference between the available surgical methods.

The Core Issue: Compensate or Treat?

All surgical methods for Peyronie's disease pursue the same goal: straightening the curved penis. But they take fundamentally different approaches to get there.

Shortening Procedures: Compensation

Methods such as Nesbit or Essed-Schröder leave the plaque – the actual disease process – untouched. They compensate for the curvature by shortening the healthy opposite side. The penis becomes straighter, but also shorter.

For patients whose Peyronie's disease has not caused significant shortening and whose starting length is sufficient, this can be a sensible solution. For patients who have already lost length due to the condition, this means a double loss.

Reconstructive Procedures: Treatment

Grafting techniques, and microsurgical reconstruction in particular, take the other approach: they treat the plaque directly. The altered tissue is removed, and the resulting defect is reconstructed. The healthy side remains untouched – no surgical loss of length.

The Methods in Detail

Nesbit and Essed-Schröder Techniques – The Classic Standard

The Nesbit operation and the similarly functioning Essed-Schröder technique are among the most widely used procedures for treating penile curvature. Their shared principle: the plaque remains entirely in the body. The healthy opposite side is shortened or plicated so that it matches the shortened, altered side.

• Technically simple and well established
• Often covered by statutory health insurance
• Measurable loss of length is unavoidable – up to 8 cm depending on the curvature
• The plaque remains and can continue to grow
• Common complication: pain during erection caused by the plication suture (up to 48% in studies)
• Repeated procedures of this kind can leave no functioning penis at all

We do not use these procedures, because they do not treat the underlying disease but instead damage healthy tissue. This is our clinical assessment – supported by scientific evidence.

Why This Method Is So Commonly Offered

Grafting technique is designated in the EAU guidelines as the preferred approach for pronounced curvatures – yet it is rarely offered at German statutory hospitals. The reason: the budget allocated for this condition is not sufficient for a complex reconstructive operation. Physicians trained within this system have therefore been unable to gain experience with this technique.

How often does it happen that we send a patient elsewhere because a colleague can do it better? Certainly rarely. Why? Because we would rather offer the other procedure ourselves – even if we can't do it as well.

We regret this situation and actively work to ensure that patients receive the treatment that is best for them – including support with reimbursement.

Grafting Techniques – Length Preservation Through Direct Treatment

The term grafting covers procedures in which the plaque is incised or removed and the resulting defect is covered with a graft. Various materials are possible – ranging from the patient's own tissue to biological materials and synthetic products. The goal is length preservation.

• Length preservation is possible
• Direct treatment of the plaque
• Technically more demanding – requires specialized experience
• Synthetic materials: long-term risks; EAU guidelines recommend caution

Penile Prosthesis – When ED Is the Primary Problem

A penile prosthesis does not primarily correct the curvature, but treats severe erectile dysfunction. It is considered when a pronounced case of erectile dysfunction exists alongside Peyronie's disease that cannot be adequately treated with other methods. Modern hydraulic implants can, at the same time, help reduce curvature.

Microsurgical Reconstruction with Biological Collagen Fleece – The UGRS Approach

Our method goes one step further than classic grafting techniques: the plaque is removed microsurgically, and the defect is reconstructed using the patient's own material – primarily inner oral mucosa (buccal mucosa), and in selected cases a biodegradable collagen fleece. No permanent artificial material.

• Direct treatment of the plaque through complete removal
• Length preservation as an explicit goal – no surgical loss of length
• The patient's own material – no foreign-body reaction
• Erectile function preserved as a treatment goal
• Preferred procedure in the EAU guidelines for pronounced curvatures
• Requires specialized experience in reconstructive genital surgery

What This Means for Your Decision

Nesbit and Essed-Schröder are the right choice for certain patients – technically well established and sufficient for many cases. But if you have already lost length due to the condition, if the curvature is pronounced, or if length preservation matters to you: then the standard insurance-covered treatment does not describe what you are looking for.

What this actually costs, and how out-of-pocket expenses and possible reimbursement break down, is explained on our costs page.

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Which method is right for you can only be determined in a personal conversation – based on your individual anatomy, symptoms, and expectations.

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