The penile curvature typical of Peyronie’s disease or congenital recurvatum can negatively impact the patient’s quality of life, making penetrative sexual intercourse difficult or, at times, impossible.
Although conservative therapies can alleviate painful symptoms in some cases, only a small percentage of patients report an actual improvement in their condition; in these cases, surgical intervention may be necessary to correct the curvature and restore normal sexual function. Surgery is indicated for all patients who present with significant and stable deformity for at least six months.
Before considering reconstructive surgery, it is essential to discuss potential complications with the patient (such as penile shortening and the risk of erectile dysfunction) in a comprehensive manner so that they can make an informed decision. The primary goal of surgery is to achieve a penis that is “functionally straight,” and this concept must be clearly understood to reach the best postoperative satisfaction outcomes.
The surgical treatment of penile curvatures employs numerous techniques, which can be classified into three categories:

• Shortening procedures
• Lengthening procedures
• Penile prosthesis implantation

The choice of the most suitable procedure is based on the evaluation of several factors, such as penile length, severity of curvature, and erectile function status.

• Shortening Procedures

This approach is most appropriate for patients with good penile length, effective erectile function, and no complex deformities. It corrects the curvature by shortening the convex side (the longer side) at the point of maximum curvature. Shortening procedures include excision, incision, and plication techniques.

• Nesbit corporoplasty is based on elliptical excision of the tunica albuginea at the point of maximum curvature.
• Yachia corporoplasty takes advantage of the Heinke-Mikowitz principle, where a longitudinal incision closed transversely allows shortening of the convex side
• Plication techniques are the simplest. They involve one or more simple plications without incising the albuginea, thereby limiting the risk of damage to the veno-occlusive mechanism.

Generally, these techniques ensure good correction of penile curvature while minimizing the risk of postoperative erectile dysfunction.

• Lengthening Procedures

This approach is preferred for patients with good erection, excessive penile shortening, and complex deformities. Here, the correction of curvature occurs by acting on the concave side, which is the shorter side, at the point of maximum curvature. These techniques involve partial or total incision or excision of the plaque, followed by coverage of the defect with a graft. Various types of grafts can be used. However today the only possible solutions are:

• Autografts, such as buccal mucosa, dermis, or saphenous vein.
• Xenografts, such as bovine pericardium.

These procedures carry a higher risk of postoperative erectile dysfunction.

• Penile Prostheses

Penile prosthesis implantation is reserved for the most severe cases of penile curvature associated with concomitant erectile dysfunction. Hydraulic prostheses are considered more effective, although some studies report a good level of satisfaction following the implantation of malleable prostheses as well. The surgeon should always recommend the type of prosthesis most suitable for the patient; however, the final decision regarding the prosthesis to be implanted rests with the patient.

In conclusion, surgery for the correction of penile curvatures encompasses a significant number of surgical techniques, each with its own indications, advantages, and disadvantages. This wide variety can often leave the patient feeling confused, raising doubts and uncertainties about the procedure to follow. Therefore, it is crucial to consult an experienced specialist in the field who can guide the patient through their therapeutic journey. The specialist will not only provide detailed information on the various available options but will also be able to illustrate which solution is most appropriate for the patient’s specific case.
It is important to emphasize that for the surgical intervention to be satisfactory, it must be “tailored” to the individual needs of each patient. Only through a thorough evaluation of the specific conditions and expectations can the doctor direct the patient toward the most suitable treatment, thereby ensuring a path toward improved quality of life and personal satisfaction.

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