Plaque incision and grafting

Making the short side longer ...

It is often preferable to correct a curved penis by adding tissue to the side that has been shortened by the plaque. 

This is particularly appealing in patients with >60 degree curvatures and in patients who have experienced a significant loss in penile length due to the deformity.

The surgery is technically more challenging as it requires very meticulous dissection: access to the plaque generally requires elevation of nerves and vascular structures (neuromuscular bundle) on the back of the penis.

An "H"-type incision into the plaque with subsequent stretching of the penis releases a rectangular defect in the bone-like plaque. This hole in the penis will need to be covered by graft material that can either be harvested from other parts of the patient's body (autologous graft), or by commercially available grafts such as porcine dermal collagen matrix or bovine pericard etc. (allografts). Small residual deformities can often be corrected using additional plication sutures.

The advantage of this approach is that it is usually not associated with any significant loss in penile length and that it allows correction of even complex deformities (such as wasting of penile shaft (hourglass deformity)). 

The main disadvantage is the longer operating and recovery time, as well as the possible (temporary) loss of sensation in the tip of the penis and exacerbation of pre-existing erectile problems.