Peyronie’s disease is an acquired condition where scar tissue (plaque) forms within the tunica albuginea, the firm layer that helps the penis become rigid during an erection. This can cause the penis to bend, narrow, or shorten during erections and may lead to pain, difficulty with penetrative sex, and distress or loss of confidence. When symptoms are significant and have stabilised, surgery can be an effective option to improve function and reduce curvature.

Understanding what surgery aims to achieve

Surgical treatment is designed to correct penile curvature that interferes with sexual activity or causes substantial bother. Depending on the type of operation, surgery may:

• Straighten the penis to make intercourse more comfortable or possible
• Improve deformities such as hinging or narrowing (in selected cases)
• Address erectile dysfunction at the same time, if present

Surgery does not remove the underlying tendency to form scar tissue, and it cannot guarantee a “perfectly straight” result. The goal is a functional, reliable improvement that supports a satisfying sex life.

When surgery may be the right option

Surgery is usually considered when Peyronie’s disease is in the stable (chronic) phase. This typically means:

• Curvature and deformity have been stable for several months
• Pain has settled or is minimal
• The condition has been present long enough to understand its pattern (often around 9 to 12 months or more)

It may be suitable if:

• Curvature prevents penetrative sex or causes repeated difficulty
• There is a significant bend, narrowing, or “hinge” effect
• Non-surgical treatments have not provided adequate improvement
• There is co-existing erectile dysfunction that does not respond well to tablets or other conservative measures

Surgery may be less suitable if the condition is still changing quickly, if pain is a dominant symptom in the early phase, or if there are medical issues that make anaesthesia or surgery higher risk. These factors are assessed carefully during consultation.

Assessment and planning before surgery

A thorough pre-operative assessment is essential because the best operation depends on the pattern of curvature, erectile function, and personal priorities.

At your appointment, our urology team will typically discuss:

• When symptoms started and whether they are stable
• The direction and degree of curvature and any narrowing or indentation
• Pain, sexual function, and any erectile difficulties
• Relevant medical history such as diabetes, cardiovascular disease, previous prostate or penile surgery, and medications

To plan surgery accurately, an assessment of the erect penis is often needed. This may be done using:

• Photographs taken at home (following clear guidance) and/or
• An in-clinic assessment where an erection is induced with medication

A penile ultrasound (often Doppler ultrasound) may be recommended to locate plaques, check blood flow, and help understand erectile function. This information helps match the surgical approach to your anatomy and goals.

Surgical options for Peyronie’s disease

There are three main surgical approaches. The most appropriate option depends on curvature severity, penile length, deformity type, and erectile function.

1) Penile plication (including Nesbit-type procedures)

Plication surgery straightens the penis by shortening the longer side opposite the plaque. Sutures are placed to “take up” tissue and counteract the bend. In some variations, a small piece of tissue may be removed (Nesbit-type technique), while in others the tunica is folded without tissue removal.

This option is often considered when:

• Erectile function is good
• Curvature is moderate and there is no major narrowing or complex deformity
• Penile length is adequate

Key consideration: because the longer side is shortened, some loss of erect length is expected. The amount varies and is discussed in advance.

2) Plaque incision or excision with grafting (lengthening procedures)

For more severe curvature, complex deformity, or significant narrowing, surgery may involve releasing the tight plaque area (by incising or removing part of it) and placing a graft to cover the defect. The aim is to restore a more even shape and preserve length as much as possible.

This option may be considered when:

• Curvature is more pronounced
• There is an hourglass deformity or hinge effect
• Preserving length is a priority and anatomy is suitable

Key consideration: grafting procedures can carry a higher risk of post-operative erectile dysfunction compared with plication, particularly in men who already have borderline erections. This is assessed carefully before recommending grafting.

3) Penile implant (prosthesis) with or without straightening manoeuvres

If Peyronie’s disease is accompanied by significant erectile dysfunction that does not respond to medication or other treatments, a penile implant may be the most reliable solution. The implant provides rigidity, and the curvature often improves once the implant is in place. Additional straightening steps may be performed during the same operation if needed.

This option may be considered when:

• Erectile dysfunction is a major issue
• Curvature and rigidity problems occur together
• A dependable erection is the main goal

Key consideration: an implant is a permanent device. The decision is made carefully with full discussion of benefits, limitations, and long-term considerations.

What to expect on the day of surgery

Surgery is carried out at our specialist urology clinic under anaesthesia, most commonly a general anaesthetic. The specific technique and incision location depend on the procedure chosen.

Typical timing and stay:

• Procedure time often ranges from around 30 to 120 minutes, depending on complexity
• Many patients go home the same day or after an overnight stay, based on the operation and individual recovery

Before discharge, you will receive clear instructions on wound care, pain relief, activity limits, and when to seek urgent advice.

Recovery and follow-up

Recovery varies by procedure, but most men can expect a gradual return to normal activities.

Early recovery (first 1 to 2 weeks)

• Swelling and bruising are common and usually settle
• Discomfort is expected and is managed with prescribed pain relief
• Keeping the wound clean and dry is important

A follow-up appointment is usually arranged around the first week to check healing and address any concerns.

Returning to daily activities

• Light activities can often be resumed within several days, depending on comfort
• Strenuous exercise and heavy lifting are usually avoided for a few weeks

Sexual activity

Penetrative sex and masturbation are typically avoided for about 6 weeks, though the exact timing depends on the procedure and healing. Your surgeon will confirm when it is safe to resume.

Longer-term expectations

Improvement in curvature is usually noticeable once healing is complete. Some men may still have a small residual curve that does not interfere with sex. If erectile function was already reduced before surgery, additional treatment may still be needed.

Risks, limitations, and important considerations

All surgery carries risks, and part of good care is making sure you understand them clearly.

General surgical risks include:

• Bleeding or haematoma
• Infection
• Wound healing problems
• Anaesthetic risks (assessed individually)

Procedure-specific considerations can include:

• Penile shortening (more common with plication techniques)
• Reduced sensation or numbness (usually temporary, occasionally persistent)
• Erectile dysfunction (risk varies, higher with grafting in some men)
• Residual or recurrent curvature over time
• Palpable sutures or firmness under the skin (particularly after plication)

It is also important to discuss expectations about length, straightness, and sexual function. A careful, realistic plan before surgery is one of the best ways to achieve a satisfying outcome.

How our team supports you throughout

Choosing surgery for Peyronie’s disease is a personal decision, and many men find it helpful to talk through both physical and emotional impacts.

From the first consultation onwards, our specialist urology team focuses on:

• A clear diagnosis and explanation of the condition
• A tailored surgical plan based on curvature pattern and erectile function
• Transparent discussion of likely benefits and trade-offs
• Structured follow-up to support healing and sexual recovery

If you have concerns about erections, confidence, or intimacy, these can be addressed as part of your overall care plan. The aim is not only to correct curvature, but also to help you return to a sex life that feels comfortable and dependable.

If you are considering surgery, an in-depth consultation is the best next step. It allows time to assess stability of the condition, measure curvature accurately, review erectile function, and decide together which option best fits your goals.