Straightening procedures for Peyronie's disease
Correcting curvature so that intercourse is comfortable and possible again. Which operation is right depends on your curve, your length and your erections.
When straightening surgery is appropriate
Surgery for Peyronie's disease is considered when the curvature prevents or seriously interferes with intercourse, when the deformity is causing significant distress, and when the disease has been stable for at least three to six months with no further change in the curve and no pain.
Operating on active disease is the commonest reason for a disappointing result, because the curve can continue to evolve afterwards. Establishing that you have reached the stable phase is one of the main purposes of the consultation.
Assessment before surgery
Three things determine which operation is right, and all three must be measured rather than estimated:
- The degree and direction of curvature, assessed objectively — usually from photographs of a natural erection taken at home, or by inducing an erection in clinic with an injection.
- Erectile function, because a man who cannot maintain a rigid erection will not be well served by straightening alone. Penile duplex ultrasound is used where this needs objective measurement.
- Penile length and the shape of the deformity — whether there is an hourglass narrowing, indentation or hinge effect as well as a simple bend.
The operations
Plication
The longer, convex side opposite the plaque is shortened with sutures so that the two sides match and the penis straightens. It is reliable, technically straightforward, does not disturb the erectile tissue and carries a low risk of erectile dysfunction or numbness. The trade-off is that it shortens the penis by design.
Best suited to men with good erections, a curve under roughly 60 degrees, and adequate length.
Plaque incision or excision with grafting
The scar plaque is cut or removed to release the tethering, and the resulting defect is patched with a graft. This preserves length far better and handles severe curves, hourglass deformity and complex multi-plane bends that plication cannot.
The trade-off is a meaningfully higher risk of post-operative erectile dysfunction and of altered sensation, because the surgery is performed directly over the erectile tissue and the nerves have to be lifted out of the way. It requires good pre-operative erections to be a sensible choice.
Straightening with a penile prosthesis
Where there is significant erectile dysfunction that has not responded to medication, placing an inflatable implant and straightening at the same operation treats both problems at once. The implant itself straightens many curves; where it does not, modelling, plication or grafting can be added during the same procedure.
For men with both problems this is usually the right answer, and it avoids a second operation later.
Length is the honest conversation
Every man asks about length, and every surgeon should answer it directly. Plication shortens deliberately. Grafting preserves length better but risks erections. And Peyronie's disease itself has usually already caused shortening, so the comparison is with your current state, not with how you were before the condition began. I will measure you and give you the realistic numbers rather than a reassurance.
Recovery
Straightening surgery is performed under general anaesthetic, usually as a day case or with one night in hospital. Expect swelling and bruising for two to four weeks, and a dressing for the first few days.
Most men return to desk work within one to two weeks and avoid heavy lifting and strenuous exercise for around four to six weeks. Sexual activity is normally resumed at around six weeks. Where a graft has been used, you may be advised to use a vacuum device or traction during recovery to maintain length and prevent contraction.
Risks
Risks include bleeding and haematoma, infection, recurrence or residual curvature, penile shortening, palpable suture knots, altered or reduced sensation, and erectile dysfunction — which is uncommon after plication and a genuine risk after grafting. All are discussed in detail against the specific operation being proposed.
My practice
Peyronie's surgery sits within the tertiary referral andrology practice I built at Guy's Hospital, for which I received a UK National Clinical Impact Award in 2022. I am a past National Chair of the BAUS Andrology & Genito-urethral Reconstruction section and Director of the Andrology Prosthesis Centre at Guy's, so I am able to offer the full range — plication, grafting and implant-based straightening — rather than the one technique a unit happens to perform.
Frequently asked
Will I be completely straight afterwards?
The aim is a functionally straight penis — straight enough for comfortable, effective intercourse. A residual bend of up to about 20 degrees is common, is not usually a problem in practice, and is not counted as a failure. Complete geometric straightness is not always achievable, particularly in complex or multi-plane curves.
Which operation will I need?
It depends on the size and shape of your curve, your penile length and above all the quality of your erections. Good erections with a moderate curve usually means plication; good erections with a severe curve or hourglass deformity usually means grafting; poor erections usually means an implant with straightening. That decision is made together after measurement.
Can Peyronie's come back after surgery?
Straightening surgery corrects the deformity but does not cure the underlying disease process. Recurrence of curvature is uncommon once the disease is stable at the time of operating, which is precisely why waiting for the stable phase matters so much.
How long should I wait before having surgery?
Until the disease has been stable for at least three to six months — no change in curvature and no pain. In practice this is usually at least twelve months from when symptoms started. Operating too early risks the curve continuing to change afterwards.
Is non-surgical treatment worth trying first?
In the active phase, yes — pain management, traction and in selected men intralesional injection therapy. Once disease is stable and the curve is significant enough to prevent intercourse, surgery is the only treatment that reliably corrects it, and delaying does not improve the outcome.
Speak to my team
Appointments at The Shard and Canary Wharf are arranged by my PA, Jeanette Bush. Tell us briefly what the problem is and we will find the right clinic slot for you.