An advanced surgical reconstruction reserved for severe, complex penile curvature where structural length must be optimized. The rigid, non-stretchy scar plaque is strategically incised to completely release anatomical tension, and a specialized flexible biological graft is meticulously sutured into the space.

Clinical Indication

This procedure is highly indicated for patients experiencing structural anomalies, severe localized scar tissue, or functional blockages that fail to resolve with initial conservative therapeutic adjustments.

Surgical Objective

The principal objective is the complete restoration of physiological form, functional urinary path independence, or mechanical integrity, maximizing long-term outcomes while minimizing systemic downtime.

Plaque Incision and Grafting (PIG) is an advanced reconstructive technique reserved for severe Peyronie’s disease deformities. When penile curvature exceeds 60 degrees, or is accompanied by severe ‘hourglass’ indentations or hinge instability, simple plication can result in noticeable penile shortening. By elevating the neurovascular bundle, making precise relaxing incisions in the contracted tunica albuginea plaque, and covering the defect with a collagen biomatrix graft, this procedure straightens the shaft while preserving maximum possible penile length.

Clinical Indications & Patient Selection

Indicated for men with severe Peyronie’s disease curvature who have strong, rigid baseline erections and prioritize penile length preservation.

Severe Curvature (>60°): Complex multiplanar or severe dorsal/lateral curves that would cause unacceptable length loss with plication.

Hourglass or Hinge Deformities: Focal structural narrowing of the shaft leading to buckling during attempted penetration.

Excellent Baseline Potency: Confirmed rigid erections on in-office pharmacologic penile Doppler ultrasound.

Surgical Technique & Procedural Nuance

A complex reconstructive procedure requiring microsurgical loupe magnification.

Neurovascular Bundle Mobilization: Careful dissection and lateral reflection of the dorsal sensory nerves and deep dorsal vein off the tunica albuginea.

Geometrical Plaque Incision (Egydio Method): H-shaped or double-Y relaxing incisions are placed through the fibrous plaque, restoring symmetrical corporal expansion without excising tissue.

Biomatrix Grafting: The tunical defect is sealed with a collagen biomatrix (Tutoplast® pericardium, porcine small intestinal submucosa, or Tachosil) sutured with running 4-0 absorbable micro-sutures.

Postoperative Pathway & Recovery Timeline

Performed as an outpatient day surgery or with an overnight hospital stay for wound observation.

Catheter & Dressing: Foley catheter removed at 24 hours; snug supportive dressing for 48 hours.

Postoperative Traction / Vacuum Protocol: Beginning at 4 weeks, patients use a vacuum erection device or penile traction therapy for 6 months to guide collagen fiber alignment and prevent contracture.

Sexual Abstinence: Strict abstinence from intercourse for 6 to 8 weeks while the graft integrates into the corporal wall.

Outcomes, Durability & Clinical Evidence

Plaque incision and grafting achieves the most dramatic straightening and length preservation in complex Peyronie’s cases.

Straightening: Most men achieve substantial straightening and can have intercourse again.

Length Preservation: Minimizes the 1–2 cm shortening characteristic of shortening plication techniques.

Plaque Incision and Grafting (PIG) is an advanced reconstructive technique reserved for severe Peyronie’s disease deformities. When penile curvature exceeds 60 degrees, or is accompanied by severe ‘hourglass’ indentations or hinge instability, simple plication can result in noticeable penile shortening. By elevating the neurovascular bundle, making precise relaxing incisions in the contracted tunica albuginea plaque, and covering the defect with a collagen biomatrix graft, this procedure straightens the shaft while preserving maximum possible penile length.

Clinical Indications & Patient Selection

Indicated for men with severe Peyronie’s disease curvature who have strong, rigid baseline erections and prioritize penile length preservation.

Severe Curvature (>60°): Complex multiplanar or severe dorsal/lateral curves that would cause unacceptable length loss with plication.

Hourglass or Hinge Deformities: Focal structural narrowing of the shaft leading to buckling during attempted penetration.

Excellent Baseline Potency: Confirmed rigid erections on in-office pharmacologic penile Doppler ultrasound.

Surgical Technique & Procedural Nuance

A complex reconstructive procedure requiring microsurgical loupe magnification.

Neurovascular Bundle Mobilization: Careful dissection and lateral reflection of the dorsal sensory nerves and deep dorsal vein off the tunica albuginea.

Geometrical Plaque Incision (Egydio Method): H-shaped or double-Y relaxing incisions are placed through the fibrous plaque, restoring symmetrical corporal expansion without excising tissue.

Biomatrix Grafting: The tunical defect is sealed with a collagen biomatrix (Tutoplast® pericardium, porcine small intestinal submucosa, or Tachosil) sutured with running 4-0 absorbable micro-sutures.

Postoperative Pathway & Recovery Timeline

Performed as an outpatient day surgery or with an overnight hospital stay for wound observation.

Catheter & Dressing: Foley catheter removed at 24 hours; snug supportive dressing for 48 hours.

Postoperative Traction / Vacuum Protocol: Beginning at 4 weeks, patients use a vacuum erection device or penile traction therapy for 6 months to guide collagen fiber alignment and prevent contracture.

Sexual Abstinence: Strict abstinence from intercourse for 6 to 8 weeks while the graft integrates into the corporal wall.

Outcomes, Durability & Clinical Evidence

Plaque incision and grafting achieves the most dramatic straightening and length preservation in complex Peyronie’s cases.

Straightening: Most men achieve substantial straightening and can have intercourse again.

Length Preservation: Minimizes the 1–2 cm shortening characteristic of shortening plication techniques.

Related Conditions & Patient Recovery Protocols

Clinical Subspecialty Hub: Genital Reconstruction & Peyronie’s Center →

Underlying Clinical Condition: Peyronie’s Disease →