Current status of the surgical management of Peyronie's disease.

Surgery is the standard treatment for patients in the chronic phase of Peyronie's disease. Reconstructive surgeries function by either shortening the convex side of the tunica albuginea (Nesbit procedure, Yachia technique and penile plication) or lengthening the concave side by incision of the plaque with subsequent grafting. Tunical shortening procedures are ideal for men with good erectile capacity, penile curvatures less than 60° and predicted postprocedural length loss of less than 20% of erect penis length. Tunical lengthening procedures with grafting are indicated in patients with severe penile length loss, curvatures greater than 60° and prominent hourglass deformities. Saphenous vein and tunica albuginea are the most commonly used autologous graft materials. Cadaveric or bovine pericardium and 4-layer small intestinal submucosa are promising nonautologous tissues. Penile implantation of a prosthesis is the standard procedure in men with erectile dysfunction who do not respond to conservative treatment. If residual penile curvature is less than 30° after implantation, no further treatment is required. However, residual curve of greater than 30° can be straightened with manual modeling. Additional procedures such as penile plication, the Nesbit procedure, or grafting can be performed if modeling fails to correct the residual deformity.