Plaque incision and grafting as a salvage after a failed Nesbit procedure for Peyronie's disease

To analyse the outcome of plaque incision and grafting in patients who have a residual penile deformity after a Nesbit procedure for Peyronie's disease, as a further Nesbit procedure may present difficulties in dissection at the previous operative site, and may result in further penile shortening.

Over a 5-year period, 15 patients (mean age 58 years, range 34-66) presented with a residual penile deformity after a Nesbit procedure. All the patients had painless and stable Peyronie's disease. All patients had the Peyronie's plaque incised and grafted with either saphenous vein (12) or modified human fascia lata (three). The outcome was assessed using criteria which recorded the degree of penile shortening, quality of erections and penile angulation.

Before surgery the mean (range) angle of deformity was 56 (40-90) degrees ; at a mean follow-up of 10 (3-16) months 11 patients had a straight penis, three a residual angle of 10-30 degrees and one had no change in angle. Two patients reported penile shortening and one a new onset of erectile dysfunction. Overall, 14 patients reported either an excellent or satisfactory result.

These results indicate that plaque incision and grafting is an effective salvage operation to correct a residual penile deformity after a failed Nesbit procedure in patients with Peyronie's disease.