Perception and Reality of Postoperative Penile Length in Men Undergoing Plaque Excision and Grafting for Peyronie's...

Partial plaque excision and grafting (PEG) is the gold standard treatment for patients with severe Peyronie's Disease (PD) with preserved erectile function and deformity refractory to conservative management. Post-PEG satisfaction rates are highly variable, with many patients attributing dissatisfaction to penile shortening. We aim to explore patient-reported penile shortening in the pre- and postoperative period. A retrospective chart review and telephone survey was conducted for 137 patients who underwent PEG at a single institution from February 2007 - November 2022. Overall, 75.2% of patients had measured increased or stable stretched penile length (SPL) following PEG, with a mean gain of 1.5 ± 0.9 cm in those who objectively gained length. 75.9% of patients reported preoperative perceived shortening; 46.0% reported postoperative perceived shortening. Perceived preoperative shortening was associated with perceived postoperative shortening (84.1% vs 68.9%, p = 0.03). There was no significant association between perceived postoperative shortening and objective change in SPL (p = 0.38). Subjective postoperative shortening was associated with lower satisfaction rates (38.1% vs 58.1%, p = 0.002) and shorter median follow-up (21 vs 53 months, p = 0.007). Although PEG generally results in SPL gain, managing expectations is critical, with emphasis that the goal of PEG is to achieve functional straightness and rigidity, not necessarily restore penile length lost to PD.