Surgical procedures for Peyronie’s disease at a glance

The comparison table on this page sets out the three families of operation for Peyronie’s disease: plication, plaque incision and grafting, and penile implants. Read it as a trade-off between straightness, length and the risk to erections; below, we explain when surgery is considered, how the choice is made, and what each operation means for length, sensation and sex.

When is Peyronie’s surgery needed?

Surgery is needed when the bend or shape change makes sex difficult or impossible, and the condition has stopped changing. A mild curve that does not interfere with penetration needs no operation; the British Association of Urological Surgeons (BAUS) is clear that the aim is a functionally straight penis, not a return to how it was before. The American Urological Association (AUA) guideline notes there is no agreed minimum curvature: what matters is the effect on sex and the distress it causes, which is why our main Peyronie’s disease treatment page reserves surgery for men who cannot have sex because of the condition.

Timing matters as much as severity, because surgical results in active disease are not known. As our main page explains, the active stage commonly lasts around six to twelve months; BAUS adds that you are usually stable at least six months after the pain stops, and that around 2 in 10 men who reach that phase later have a flare that worsens the curve. Before surgery, the AUA guideline recommends confirming that symptoms have been unchanged for at least three months.

Can non-surgical treatment avoid the need for surgery?

Sometimes, if erections or pain, rather than the bend itself, are what make sex difficult. Traction devices and medical therapy are covered on our main Peyronie’s page; these points bear on the decision to operate:

• If erections are the main problem, BAUS notes that tablets such as sildenafil or tadalafil may be all the treatment that is required. See our erectile dysfunction treatment page.
• If pain is the main problem in the active phase, some tablets may help, although BAUS notes the evidence for all medical treatments is weak. The AUA guideline adds that pain often settles untreated, whereas the curve is much less likely to improve.
• Collagenase injections (Xiapex), common in American sources, are no longer available in the UK. Other injections into the plaque are sometimes used; your consultant can advise whether they suit you.
• Shockwave and stem cell therapy are not alternatives to surgery: there is no good evidence that either straightens the curve or shrinks the plaque (the AUA guideline advises against shockwave for this), and we do not currently recommend them outside clinical trials.

How do surgeons choose between plication, grafting and an implant?

BAUS lists four deciding factors: erection quality, the degree of curvature, other shape changes such as hourglass narrowing, and stretched penile length. Before any invasive treatment, the AUA guideline recommends an in-clinic injection test to produce an erection, with or without an ultrasound scan, and a baseline stretched-length measurement. Home photographs of the erect penis, as described on our main page, also help. Your consultant can advise what assessment you need.

Erection quality comes first

Straightening operations correct shape; they do not treat erectile dysfunction. If erections are not firm enough for sex even with tablets, the AUA guideline advises that plication or grafting will generally not restore function, and BAUS notes an implant may be the best surgical option, whatever the degree of curve.

Angle and direction of the bend

BAUS and the table both use about 60 degrees as the dividing line between plication and grafting in men with good erections. Direction matters too: to reach the plaque for a graft, the surgeon lifts the nerves on top of the penis for an upward bend, or the urethra for a downward bend.

Hourglass narrowing and hinge

Plication gathers the longer side opposite the plaque. That straightens a curve but does not address a segment the plaque has pinched in, or a hinge, where the shaft buckles at the plaque during penetration. Grafting works on the plaque itself, releasing it and filling the gap, which is why the table lists these shapes under grafting.

What is the Nesbit procedure?

Nesbit’s procedure (also written Nesbitt’s, as in the table) is a plication operation: stitches gather the longer side of the penis to match the shorter, plaque-affected side, and BAUS describes it as the most commonly used technique. The skin is usually rolled back through a cut just behind the head of the penis, and an artificial erection during the operation confirms the angle. Yachia, TAP and the Lue 16-dot procedure work on the same principle.

BAUS figures for plication: almost all men have some shortening and a residual bend of under 20 degrees, which should still leave the penis functionally straight. Around 1 in 20 develop erectile dysfunction, 1 in 20 have temporary or permanent numbness, and 1 in 4 need a circumcision during the operation; the curve recurs in 1 in 10 to 1 in 50. The stitches can often be felt under the skin.

Will you lose length after Peyronie’s surgery?

With plication, usually some, compared with the longer side before surgery; grafting and implants can restore some of the length lost to the disease. Peyronie’s disease itself can shorten the penis, so some length may already have been lost before any operation.

Plication. Plication shortens the longer side, so the straightened penis will be shorter than its longer side was, roughly matching the scarred side; BAUS links the amount to how much gathering is needed. A 2024 single-centre study looking back at 91 men after Nesbit’s procedure found stretched length was no shorter after surgery than before, suggesting most of the loss comes from the disease and can be predicted; later shortening from scarring still needs study. Earlier series reviewed by the AUA did record shortening: in two, most men lost under 1.5 cm, and one reported an average loss of 2.6 cm.

Grafting. BAUS puts the risk of shortening at around 1 in 5. In the grafting studies reviewed by the AUA that measured stretched length, some men gained length while others lost some: shortening was reported in anywhere from none to 63% of men, with average losses of 0.2 to 1.0 cm where these were given.

Implant. As the table notes, an implant can restore lost length: six AUA-reviewed studies combining it with grafting or cuts to relax the outer layer measured gains of 1.3 to 3.6 cm. On its own, BAUS notes, an implant does not lengthen or widen the penis as a natural erection does.

Perception and measurement often differ: in two plication studies in the AUA review, 69% and 78% of men felt their penis was shorter afterwards, yet only 18% had a measurable loss in one and 84% had none in the other.

What happens to erections and sensation after each operation?

The risk rises with how much the operation disturbs the erectile tissue and nearby nerves. Plication stitches the outer layer without cutting the plaque, and BAUS puts the risk of erectile dysfunction and of numbness at around 1 in 20 each. Grafting lifts nerves or the urethra and cuts into scar tissue, and both figures rise to around 1 in 4.

BAUS states an implant itself does not affect desire, penile sensation or orgasm, although across the implant studies in the AUA review, many with extra straightening procedures, persistent changes in sensation were reported in 0% to 50% of men. The trade is permanence: the spongy tissue inside the erectile chambers is broken down to fit the cylinders, so natural erections will not return if the implant is removed. BAUS reports an infection risk of around 1 to 2 in 100 after a first implant, rising to between 1 in 10 and 1 in 16 for a revision or a complex operation.

The table lists malleable and inflatable implants. The AUA panel advises inflatable devices in Peyronie’s disease (expert opinion), partly because modelling the penis straight is harder with semi-rigid rods; BAUS notes malleable rods rarely go wrong mechanically and suit men with poor hand function, so both are worth discussing. See also erectile dysfunction treatments compared.

How long is recovery, and when can you have sex again?

BAUS advises no sexual activity, including masturbation, for six weeks after plication or grafting, and for at least four weeks after an implant unless your surgeon advises otherwise. BAUS describes the typical course:

• Plication or grafting: one to two hours for plication, around three for grafting, normally under general anaesthetic. Most men go home 24 to 48 hours later, sometimes with a catheter, and swelling and bruising last several days.
• Penile implant: most men go home the same day or the next, with swelling and discomfort for a couple of weeks; an outpatient appointment two to three weeks later teaches you to inflate or bend the device.

If you develop a high temperature, bleeding that will not stop, redness or discharge from the wound, rapidly increasing pain or swelling, or cannot pass urine, contact your surgical team straight away; you will be told how before you go home. Out of hours, call NHS 111, or go to your nearest emergency department if you feel very unwell; in an emergency, call 999.

What should you ask before agreeing to surgery?

Ask enough to understand why one row of the table fits you, for example:

• Is my condition stable, and how do we know?
• Why this operation for my bend, and not the others?
• What is my stretched length now, and what should I expect afterwards?
• What are your personal results with this procedure? BAUS suggests asking.

Our consultants practise at Guy’s & St Thomas’, named by Newsweek in 2025 as the number one urology service in Europe. Read about our consultants and a first urology appointment, check fees and insurance, or contact us on +44 7889 318584 (8am to 4pm, Monday to Friday).

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References and further reading