Tunica Plication for Peyronie's Disease

Tunica plication is a shortening procedure that corrects penile curvature by placing sutures, imbrications, or wedge excisions on the convex (longer) side of the penis — opposite the plaque — effectively matching the convex side to the concave side. It is the most commonly performed surgery for Peyronie's disease, representing approximately half of all PD operations, with curvature improvement in ≥90% of appropriately selected patients.^[1][2]

Plication is the right operation when curvature is moderate, not complex, and the patient accepts some shortening in exchange for a straightforward, technically low-risk correction with the lowest rate of de novo erectile dysfunction among PD surgeries.

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Indications and Patient Selection

Ideal candidates

• Curvature ≤60° (some centers extend to ≥60° with modern variants)
• Adequate penile length — stretched length >13 cm is commonly cited
• Intact erectile function, or ED responsive to oral PDE5i, VED, or ICI
• No significant hourglass deformity or hinge effect
• Patient accepts expected shortening of up to ~20% of pre-op length^[3]

Relative contraindications

• Curvature >60–70° without mitigating factors (consider grafting)
• Complex deformity — hourglass, hinge, biplanar — where shortening alone will not correct
• Pre-existing short penis where additional shortening is unacceptable
• ED unresponsive to medical therapy (consider prosthesis pathway)

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Plication Techniques

The plication families all shorten the convex (long) side of the tunica albuginea opposite the plaque, but by different mechanics. Nesbit excises a wedge of tunica and closes the defect. 16-dot (Gholami-Lue) plication infolds the tunica with plicating sutures — no tissue is removed. Yachia makes a longitudinal incision closed transversely (Heineke-Mikulicz corporoplasty). For the strategy-level choice between shortening the convex side and lengthening the concave side with a graft, see the Peyronie's overview figure. (Original WARWIKI schematic)

Modified Nesbit procedure

Originally described by Reed Nesbit for correction of congenital chordee in children and later adapted by Goldstein 1984 for adult PD and congenital curvature.^[15][4][5] The fundamental principle — shorten the convex side to match the concave side — is the foundation of all tunical-shortening operations for curvature.

Technique:

1. Degloving or penoscrotal incision to expose the convex side of the tunica
2. Artificial erection induced intraoperatively to localize maximal curvature
3. Elliptical wedge of tunica albuginea excised on the convex side opposite the plaque, typically 5–10 mm wide
4. Defect closed horizontally with permanent braided suture (Ethibond 2-0 or 3-0) to match the concave-side length
5. Closure buried and confirmed by repeat artificial erection
6. Redraping of the penile skin

Sislow rule of thumb (1989): approximately 1 mm of tunical excision corrects ~10° of curvature; the number of 1-cm wedges needed equals the measured difference in centimeters between convex and concave surfaces.^[16]

Modern modifications:

• Tunical shaving (Rehman 1997) — partial-thickness shaving rather than full-thickness wedge excision; minimizes cavernous tissue damage and improves adhesion of plicated tunical layers^[4]
• Superficial shaving (Schneider 2003) — combines simple plication advantages with Nesbit-style superficial excision of the tunica albuginea outer layer; minimizes bleeding and avoids cavernous tissue damage^[17]
• Vertical incision / horizontal closure (Heineke-Mikulicz principle) — running locked permanent suture with knots buried beneath the tunica for watertight closure with no palpable knot material^[5]
• Geometrical modified Nesbit (Vicini 2016) — geometric principle for wedge sizing applied to all curvature types; n = 74, 100% correction, 92% satisfaction, no significant relapse; 74% reported some shortening^[19]

Outcomes:

Series	n	Follow-up	Straightening	Satisfaction	Shortening	De novo ED
Pooled (Rehman 1997)[4]	—	—	89.7%	—	—	—
Licht-Lewis comparative[5]	—	—	93% (modified) vs 79% (standard)	—	—	—
Savoca 2004 (largest long-term)[18]	218	median 89 mo	86.3% complete	83.5%	17.4% any; only 2.3% functionally significant	—
Vicini 2016 (geometrical modified)[19]	74	—	100%	92%	74%	minimal
Falcone 2020 (tertiary referral)[20]	—	long-term	—	—	—	up to 38.5% in PD long-term; 0–5% in CPC

Yafi 2018 multi-institutional head-to-head vs CCH and PEG: tunical plication achieved 72.0° mean curvature change (92.2% correction) vs 71.8° for PEG and 23.3° for CCH — surgery is substantially superior to intralesional therapy for absolute curvature reduction.^[21]

Population-specific outcomes

• Congenital penile curvature patients consistently have better outcomes than PD patients — less shortening, less de novo ED, lower recurrence.^[2][20]
• Age > 35 yr and PD etiology are independent risk factors for higher de novo ED rates.^[2][20]
• Mean length change in prospective Yafi 2018 plication arm: −1.0 cm.^[21]

16-dot technique (Gholami-Lue)

First described by Gholami and Lue 2002 in 132 consecutive patients (ages 16–79; curvatures 30–120°) as a simplified incisionless alternative to Nesbit and Yachia.^[30] The technique uses multiple parallel pairs of non-absorbable sutures placed under minimal tension on the convex tunica, distributing the corrective force across many small plications rather than concentrating it in one or two large excisions.

Technique:

1. Artificial erection (intracavernosal papaverine / trimix / saline) to localize maximal curvature
2. Penile exposure — original technique uses circumcising / subcoronal incision with degloving; modern penoscrotal-without-degloving (Adibi / Morey) is increasingly preferred^[10][35]
3. Two parallel rows of 8 dots on the convex tunica opposite maximal curvature; 5 mm spacing within row, 8–10 mm between rows
4. Permanent braided non-absorbable suture (2-0 or 3-0 polyester / Ethibond / Gore-Tex) passed through partial-thickness tunica at each dot pair, tied at minimal tension to create incremental plication folds — distributes shortening force across many sutures rather than relying on a few high-tension bites
5. Repeat artificial erection; additional sutures placed as needed (24-dot configuration with 3 rows of 8 for severe curvature)
6. Buck's fascia and skin closure

Outcomes:

Series	n	Etiology	Follow-up	Straightening	Recurrence	De novo ED	Suture issues
Gholami-Lue 2002 (original)[30]	132	116 PD, 16 CPC	mean 2.6 yr	93% straight / 7% acceptable	15%	3% worsened EF	Palpable bumps expected
Çayan 2019[2]	202	CPC + PD	long-term	87.6% complete	—	Significantly lower than Nesbit (p = 0.016)	Significantly higher than Nesbit (p = 0.001)
Cantoro 2014[32]	89	PD	mean 103 mo	91% complete	—	88.7% IIEF-5 > 21	8.9% glans-sensitivity loss
Salem 2018 (buried-knot)[31]	18	8 CPC, 7 PD	1–2 yr	100% at 6 mo	13% slight (20°)	13% worsened	0% knot complications

Key advantages. Shortest operative time (mean 48 min vs 63 min for modified Nesbit, p = 0.001); lower de-novo-ED and sensory-loss rates than Nesbit; avoids NVB mobilization (sutures placed laterally / ventrally); intraoperatively adjustable; useful as salvage after failed Nesbit (12 of the original 132 patients).^[2][30]

Key disadvantages. Suture-related issues are the dominant drawback — 50–88% of patients can notice sutures; 10–33% report discomfort.^[2][30] Recurrence 15% at 2.6 yr in the original series.^[30]

Modifications addressing suture morbidity:

• Salem 2018 buried-knot modification (n = 18) — knots tucked into plicated tunical tissue; 0% palpable knots / granulomas / discomfort while maintaining 100% straightening at 6 mo.^[31]
• Papagiannopoulos / Levine 2017 hybrid — fewer permanent sutures supplemented by absorbable; bothersome nodularity reduced to 4.9% (vs historical 10–33%) at mean 56-mo follow-up; only 2.8% required reintervention.^[33]
• Suture-material optimization (van der Horst 2003) — PTFE / Gore-Tex significantly better tolerated than polypropylene (50% vs 88% noticed sutures; 10% vs 40% discomfort).^[34]

Iterative 8-dot technique (Demzik / Figler)

Demzik / Ehlers / Brems / Figler 2022 — minimally invasive variant developed to address the two main 16-dot limitations: permanent-suture morbidity, and the need for systematic incremental correction in complex deformities.^[6]

Key innovations:

• Absorbable sutures — rationale: by the time the suture dissolves, sufficient fibrosis has formed at the plication site to maintain correction
• Iterative stepwise placement — single 8-dot plication suture placed; repeat artificial erection; additional sutures added one at a time as needed (median 3 sutures, range 1–12) — allows precise incremental correction without overcorrection
• Minimally invasive ventral incision in 64% — avoids degloving

Technique:

1. Papaverine erection + curvature assessment
2. 2 cm ventral penoscrotal incision (or circumcising); distal mobilization without degloving
3. Single 8-dot plication suture on the convex side using absorbable suture (figure-of-eight or mattress configuration)
4. Repeat erection; assess correction
5. Additional 8-dot sutures placed iteratively until straight
6. Confirmatory final erection

Outcomes (n = 66; median age 58; curvature 20–90°):^[6]

• Intraoperative complete straightening: 97% — the 2 failures were due to inability to maintain intraoperative erection, not technique failure
• 91% straight erections at mean 4.5-mo follow-up
• 55% complex deformities (biplanar 38%; curvature > 60° in 50%; both 11%); 14% hinge effect — all complex cases successfully treated; no hinge patient had intraoperative failure or recurrence
• Minor complications 6% (superficial dehiscence, hematoma); no major complications
• No revision plications; no patients proceeded to penile implant
• Median 3 sutures (range 1–12)

Penoscrotal plication without degloving (Adibi-Morey lineage)

An evolution applicable to both 16-dot and 8-dot techniques and the Dugi-Morey 340-case series. Adibi 2012 validated the no-degloving approach for complex deformities; Hudak 2013 PROs (n = 154) reported 96% curvature improvement, 93% adequate-for-intercourse erections, 95% overall improvement, with stretched penile length unchanged in 84%.^[35][36] For complex deformities (≥ 60° or biplanar), correction averaged 5–6° per suture, with SPL unchanged in 69% and increased in 16%.^[35]

Suture debate — absorbable vs non-absorbable

This is one of the most debated issues in plication surgery:

Approach	Advantage	Disadvantage
Non-absorbable (Ethibond / Gore-Tex / Prolene)	Permanent mechanical support; lowest recurrence	50–88% notice sutures; 10–33% discomfort; Gore-Tex better tolerated than polypropylene[34]
Absorbable (Vicryl / PDS)	No long-term palpable knots; 0% granulomas at 41.5-mo median[13]	28% suture-failure rate at median 38.5 d in Hsieh; younger patients at higher failure risk[13]
Hybrid (Papagiannopoulos / Levine)	Bothersome nodularity reduced to 4.9%; durable correction	Requires meticulous technique[33]
Iterative 8-dot (Figler)	Fully absorbable + iterative placement; 91% straight at short-term FU	Long-term durability not yet established[6]

Plication approach comparison

Feature	16-dot (Gholami-Lue)	Iterative 8-dot (Figler)	Penoscrotal (Dugi-Morey)
Tunical excision/incision	None	None	None
Suture	Non-absorbable	Absorbable	Non-absorbable
Incision	Circumcising → modern penoscrotal	Ventral minimally invasive (64%)	Penoscrotal (no degloving)
Iterative assessment	After all sutures	After each suture	After all sutures
Complex deformities	Up to 120°	55% complex	Biplanar / ≥60°
Straightening rate	87–93%	91–97%	93–98% (340-case series)
Palpable knots	Common	Eliminated	Common
De novo ED	~3%	Not reported significant	Minimal
Recurrence	15% at 2.6 yr	9% at short FU	4–7%
SPL change	Shortening expected	Not specifically reported	Unchanged in 69%, increased in 16%

Yachia technique (Heineke-Mikulicz corporoplasty)

First described by Daniel Yachia in 1990 as a simpler alternative to the classic Nesbit. Applies the Heineke-Mikulicz pyloroplasty principle to the tunica — a longitudinal incision on the convex side is closed transversely, achieving the same shortening effect without removing any tunical tissue.^[22]

Advantages over classic Nesbit:

• No tunical tissue excision — preserves tunical integrity
• Reduced NVB / corpus spongiosum manipulation — the longitudinal incision is placed at a distance from these structures, which need not be mobilized
• Less risk of injury to underlying erectile tissue
• Adaptable — number and length of incisions can be tailored to curvature severity

Technique:

1. Artificial erection (saline + tourniquet or intracavernosal vasoactive)
2. Penile exposure — degloving or non-degloving (Dell'Atti 2019 comparison: WDG 48 min vs DG 66 min, p < 0.05; equivalent functional outcomes)^[27]
3. One or more longitudinal full-thickness incisions through the tunica on the convex side, opposite maximal curvature, at a safe distance from the NVB / spongiosum
4. Transverse (horizontal) closure of each incision with permanent or absorbable suture — Heineke-Mikulicz principle
5. Repeat artificial erection to confirm straightening; add incisions if residual curvature persists
6. Buck's fascia and skin closed in standard fashion

Giammusso modification for ventral curvature. Yachia plasty performed in the bed of the deep dorsal vein (ligated and resected) — the only corporoplasty for ventral deviation that avoids dorsal NVB mobilization while ensuring definitive tunical edge coalescence.^[25] Bagnara 2021 Giammusso-modification series (n = 206 congenital ventral curvature): 95% complete satisfaction, 2% recurrence, only 3% reported penile-shortening complaints.^[26]

Outcomes table:

Series	n	Etiology	Follow-up	Straightening	Satisfaction	Shortening	De novo ED
Yachia 1990[22]	10	PD + CPC	—	All successful	—	—	—
Sassine 1994[23]	55	32 CPC, 23 PD	up to 10 yr	95%	—	—	—
Daitch 1999[24]	28	19 PD, 9 CPC	mean 24 mo	89% excellent / 7% good	79%	58% noticed some	4% early detumescence
Giammusso 2004[25]	12	Ventral CPC + PD	—	100%	83%	67% (1–2.5 cm)	8%
Nyirády 2008 (HM cohort)[28]	62	CPC	mean 89 mo	93.1%	Significantly better than Nesbit / plication	17%	0%
Dell'Atti 2019[27]	64	CPC + PD	mean 20.8 mo	100% functional	100%	9–10%	—
Bagnara 2021[26]	206	CPC ventral	up to 24 mo+	95%	95%	3%	0.5%

Yachia vs Nesbit-Kelâmi (Popken 1999, n = 105 CPC):^[29]

Metric	Modified corporoplasty (Yachia)	Nesbit-Kelâmi
Postoperative hematoma	6%	18%
Late palpable indurations	16%	44%

Bottom line. In the 20-year Nyirády 2008 comparative study (n = 87 CPC), the Heineke-Mikulicz / Yachia technique was statistically superior to both classic Nesbit and simple plication for palpable nodules, recurrence, and overall satisfaction — establishing it as the dominant tunical-shortening technique for congenital curvature when length is acceptable.^[28]

Tunica albuginea plication (TAP — Levine algorithm)

TAP in the literature is used in two overlapping ways: as a generic term for any suture-based plication of the tunica albuginea without excision (encompassing Essed-Schröder, Lue 16-dot, and modifications), and as the specific technique refined by Laurence Levine beginning in 1997 — which forms the tunical-shortening arm of the Levine surgical algorithm alongside plaque excision/grafting (PEG) and IPP. Levine's TAP series carries the longest follow-up dataset in the PD plication literature (up to 147 months).^[37][38][39]

The Levine surgical algorithm (1997 → 2013 update):^[37][38]

Curvature / Status	Procedure
Curvature < 60°, no hourglass / hinge, adequate rigidity	TAP (preferred)
Curvature ≥ 60° or significant hourglass / hinge, adequate rigidity	PEG (plaque excision + grafting)
Inadequate rigidity unresponsive to pharmacotherapy	Penile prosthesis

The 2013 update extended the TAP threshold to < 60–70° in selected cases when length is acceptable.^[38]

Technique:

1. Preoperative duplex ultrasound + ICI (trimix); SPL measured pubis-to-corona
2. Intraoperative artificial erection to localize maximal curvature
3. Incision choice — historically circumcising / subcoronal with degloving; Seyer 2025 (n = 189) validated the ventral penile-raphe incision without degloving with comparable outcomes (wound complications 9.6% ventral vs 3.2% subcoronal, p = 0.081)^[40]
4. Identify the convex side opposite maximal curvature (ventral / ventrolateral for dorsal curve; dorsal for ventral curve, avoiding NVB)
5. Parallel rows of horizontal mattress plication sutures through partial-thickness tunica — mean 3 plications (range 1–6) per patient
6. Suture-material evolution (Levine 2007 → 2017 update): originally non-absorbable braided (Ethibond, Gore-Tex); Papagiannopoulos / Levine 2017 modification limits permanent sutures + adds absorbable, reducing bothersome nodularity from historical 50–88% to 19.8% palpable / only 4.9% bothersome with 2.8% reintervention at mean 56 mo^[33]
7. Repeat artificial erection; residual curvature ≤ 15° accepted

Long-term TAP-vs-PEG outcomes (Taylor & Levine 2008, n = 142; mean follow-up TAP 90 mo / PEG 31 mo):^[41]

Outcome	TAP (n = 61)	PEG (n = 81)
Curvature ≤ 30° at follow-up	93%	91%
Rigidity as good or better than preop	81%	68%
Rigidity adequate for coitus (± PDE5i)	90%	79%
Mean SPL change	+0.6 cm (range −3.5 to +3.5)	+0.2 cm (range −1.5 to +2.0)
Sensation as good or better than preop	69%	69%
Able to achieve orgasm	98%	90%
Very satisfied / satisfied	82%	75%

The objective +0.6 cm SPL gain is a TAP-defining finding — likely reflects correction of curvature-related foreshortening rather than true tunical lengthening, and resolves the historical subjective-vs-objective discrepancy (69% reported subjective shortening vs only 18% objective loss in the Taylor-Levine 2008 cohort).^[41]

Greenfield-Lucas-Levine 2006 length-loss predictors (n = 102; 68 PD / 34 CPC):^[42]

• Mean length loss: 0.36 ± 0.5 cm (only 2.4% of preop length)
• Significant predictors of greater shortening: ventral / ventrolateral curvature direction (p = 0.04), greater preoperative curvature, shorter preoperative SPL
• Not significant: age, number of plications, plaque size, hinge / narrowing
• Outcomes similar between PD and CPC; 99% achieved acceptable straightness (≤ 15° residual)

Algorithm validation (Papagiannopoulos & Levine 2015, n = 390; 114 TAP / 159 PEG / 114 IPP, mean FU 17 mo):^[43]

• No significant difference across the three groups in satisfaction with rigidity, bothersome residual curve, or ability to engage in intercourse
• 88.4% achieved penetrative intercourse; 84.9% satisfied with curvature correction
• Matching procedure complexity to disease severity yields equivalent satisfaction across pathways — the central validation of the Levine algorithm

TAP for CPC with worsening deformity (Ziegelmann / Farrell / Levine 2020, n = 32 CPC-WC):^[44]

• Median curvature 62° (SD 23); CPC-WC older (median 34 yr) than CPC-only (median 24 yr); more palpable tunical scarring and decreased elasticity
• Satisfactory straightening: 93% overall (90% CPC-only, 100% CPC-WC) — TAP is effective regardless of stability vs progression

TAP + PEG for compound curvature (Chow / Sidelsky / Levine 2018, n = 240; 79 PEG-alone / 161 PEG + supplemental TAP):^[45]

After PEG, men with compound curvature had average residual curvature of 30° (range 20–50°), requiring 1–6 supplemental TAPs for functional straightness. 89.6% had persistent correction at median 23.5 mo. Graft palpable in 74% flaccid but only 8.6% erect.

TAP for indentation deformity — Roadman / Levine 2024 extra-tunical grafting + TAP — 89.6% persistent correction at ~ 2 yr; less invasive option for corporal indentation without hinge.^[46]

TAP as IPP adjunct. Per AUA, TAP can be placed before or after prosthesis insertion. Pre-placement avoids damage to the prosthesis and allows tension adjustment after inflation; post-placement may negate the need for plication if modeling alone corrects the curvature. No correlation between surgical complexity and infection / revision rates.^[1]

Severe-curvature application (Li 2022, n = 72): TAP achieved 90.6% complete straightening in patients with curvature > 60° (vs 90.0% for ≤ 60°), though 100% of the severe group reported some shortening. No outcome difference between disease stable ≥ 3 mo vs < 3 mo — supporting earlier surgical intervention in selected cases.^[47]

TAP vs other plication techniques — distinguishing features:

Feature	TAP (Levine)	16-dot (Gholami-Lue)	Classic Nesbit	Yachia
Tunical excision	No	No	Yes (wedges)	No
Tunical incision	No	No	Yes	Yes (longitudinal)
Suture (modern)	Hybrid (Papagiannopoulos / Levine)	Non-absorbable	Non-absorbable	Non-absorbable
Mean plications	3 (1–6)	8 pairs (16 dots)	1–3 wedges	1–3 incisions
Mean SPL change	+0.6 cm (objective)	−1.0 cm	−0.36 to −1.5 cm	−1 to −2.5 cm
Straightening	93–99%	87–93%	86–100%	89–100%
Bothersome nodularity	4.9% (hybrid)	10–33%	Variable	14–16%
Long-term FU	Up to 147 mo	Up to 103 mo	Up to 89 mo	Up to 89 mo

Essed-Schröder technique

A classical plication variant using monofilament non-absorbable sutures (PTFE or polypropylene) on the convex tunica without excision.^[8]

Outcomes (50 patients):

• 24% improved erectile function; 24% persistent ED; no worsening of ED
• 90% able to resume intercourse; 78% patient satisfaction; 78% partner satisfaction
• 12% required reoperation for recurrent curvature
• Palpable suture knots: 50% (PTFE) to 88% (polypropylene) — the highest rates in the plication literature

Multiple Parallel Plication (MPP)

Non-incisional technique using multiple deep plication sutures at the point of maximal curvature, without any tunical incision or removal.^[9]

Leonardo comparison vs. Nesbit:

• Shortening: 73.5% (MPP) vs 100% (Nesbit), P=.19 (not statistically significant)
• Recurrence: 15.8% (MPP, absorbable suture) vs 0% (Nesbit); 0% (MPP, nonabsorbable)
• Palpable suture knots: 100% (both techniques)
• Patient satisfaction: 68.5% (MPP) vs 75% (Nesbit); none dissatisfied in either group

Morey penoscrotal plication (PSP) — UT Southwestern lineage

The Morey penoscrotal plication is a minimally invasive, suture-only tunical plication performed through a ~2 cm longitudinal penoscrotal incision without penile degloving — developed by Allen F. Morey and colleagues at UT Southwestern. It is the most validated single-incision approach for all curvature directions and severities, including complex biplanar and severe (≥ 60°) deformities, and seamlessly accommodates synchronous IPP placement.^[10][35][36]

Core philosophy:

1. Uniform ventral approach — single ventral incision corrects dorsal, ventral, lateral, and biplanar curvatures
2. No degloving — avoids circumferential dissection, reducing edema, sensory loss, wound complications, operative time
3. No tunical incision or excision — pure suture-based plication
4. Broad indications — challenges the traditional < 60° threshold; equivalent long-term outcomes for severe vs mild/moderate

Technique:

1. Intracavernosal alprostadil 20 mcg prior to drape — induces artificial erection; second 20 mcg dose if inadequate
2. 14F Foley catheter for dorsal deformities — aids urethral identification
3. 2–3 cm longitudinal incision along proximal / mid-shaft penoscrotal junction
4. Dissection through dartos and Buck's fascia with Senn retractors; no circumscribing incision or degloving
5. Tissue retracted distally / laterally as needed to access the convex tunica
6. For dorsal plication (ventral curvature): Buck's fascia retracted to access dorsal tunica with minimal NVB displacement — no formal mobilization required
7. Short plication sutures spanning 15–20 mm — each ~ 5–6° correction per suture
8. 2-0 Ethibond braided non-absorbable in inverted mattress pattern ("near to far, far to near"); 4 knots per suture
9. Reassess after each suture; add until straight (range 4–17 sutures)
10. Three-layer closure — Buck's fascia (3-0 Monocryl), dartos (3-0 Monocryl), skin (4-0 Monocryl subcuticular + Dermabond)

Cumulative Morey-group outcomes (327 patients across 5 publications):

Series	n	Key finding
Dugi & Morey 2010 (origin)[10]	48	Median correction 28°; median 6 sutures; SPL unchanged; 93% single-procedure success
Adibi-Hudak-Morey 2012 complex[35]	102 (43 complex)	Biplanar: primary 45° → 10°, secondary 35° → 5° (mean 7 sutures, ~5°/suture). Severe ≥ 60°: 70° → 15° (mean 11 sutures, ~6°/suture). SPL unchanged in 69%, increased mean 0.65 cm in 16%, decreased 0.5 cm in only 14%
Hudak-Morey 2013 PROs[36]	154	96% curvature improvement, 93% adequate-for-intercourse erections, 95% overall improvement; mean 7 sutures simple vs 10 complex (p < 0.005); 84% no measurable SPL decrease but 78% perceived shortening
Chung-Tausch-Morey 2014 dorsal-vs-ventral-vs-lateral[48]	215 (118 with complete data)	No difference between dorsal (n=17), ventral (n=65), lateral (n=36) plication arms in correction (p=0.33), satisfaction (p=0.64), or objective length loss 0.3–0.8 cm (p=0.24) — validates the no-degloving dorsal-plication approach
Reddy-McKibben 2018 long-term[11]	327 at median 59.5 mo	Severe (n=51) vs mild/moderate (n=51): 91% curvature correction in both arms; equivalent reported sexual function, IIEF-5, PD Questionnaire metrics. On multivariate analysis, worsening sexual function predicted only by age (OR 1.07) and higher preop IIEF (OR 1.14) — not curvature severity or suture count
Chung-Scott-Morey 2014 synchronous IPP + plication[49]	18	Curvature 39° (range 30–60°) → < 15°; same incision for both procedures
Ly 2023 functional penile length[50]	28	FPL 11.1 → 12.5 cm — average +12.8% increase despite convex-side shortening — quantifies the curvature-correction-restores-usable-length insight

Dugi-Morey 2010 + 340-case follow-up failure-mode analysis:^[10]

• Success rate: 98% (7 failures); median time to revision 6 mo (range 3–24)
• All failures had preop curvature > 35° with complex/multiplanar (71%) or severe ≥ 60° (43%) deformity
• 71% of failures had poor intraoperative artificial erection — the dominant preventable failure mode
• Mean sutures at revision 9 (range 4–11) vs 6 (range 1–8) at initial operation

The perceived-vs-objective length discrepancy. The Morey-group dataset is the strongest evidence base for the perceived-vs-objective shortening gap: 84% have no measurable SPL decrease yet 78% report perceived shortening.^[36] The Ly 2023 functional-penile-length measurement (pubis-to-glans-tip in a straight line, disregarding curvature) reframes this — FPL increases an average of 12.8% ± 6.6% after plication because curvature correction restores usable straight-line length.^[50] This is invaluable for preoperative counseling.

Dorsal plication for ventral curvature. Chung 2014 established that the same ventral penoscrotal incision can access the dorsal tunica with minimal NVB displacement — no formal NVB mobilization required. Outcomes equivalent across dorsal / ventral / lateral plication arms.^[48]

Synchronous IPP + plication. Both procedures share the same penoscrotal incision; Chung-Scott-Morey 2014 reported 18 patients with mean preop curvature 39° corrected to < 15° with high satisfaction; in the larger Hudak series, 11 of 154 patients (7%) underwent IPP + plication with outcomes equivalent to plication alone.^[36][49]

Expanded indications challenging the traditional < 60° threshold:

• Severe curvature ≥ 60° — equivalent long-term outcomes to mild/moderate (Reddy 2018)^[11]
• Biplanar curvature — both planes corrected at ~ 5° per suture^[35]
• All curvature directions — same ventral approach^[48]
• Combined with IPP — same incision^[49]
• Hinge effect — iterative 8-dot variant adopting the penoscrotal approach showed no failures in hinge patients^[6]

Traditional contraindications still apply: inadequate penile length to tolerate shortening; predicted shortening > 20% of erect length.

Key principle. Distributing tension across a greater number of shorter sutures leads to more durable correction with less postoperative pain and less penile shortening than a smaller number of wider plications.

Kiel Knots plication (Osmonov)

A modern modification of the 16-dot technique using inverted knot burial and 5-mm dot spacing (vs. the traditional 15 mm) with the goal of eliminating palpable suture material.^[11]

Technique:

1. Circumcision, degloving, tourniquet at penile base, 60 mL saline intracorporal injection for simulated erection
2. Dorsal curvature: Buck's fascia dissected bilaterally parallel to the urethra. 8 bilateral dots (16 total) marked 5 mm apart from sulcus coronarius to base
3. Transverse 5-mm incisions made without cutting into the corpus cavernosum
4. 4-0 Gore-Tex double-armed suture passed through adjacent incisions
5. Knots tied inside the incisions (inverted burial)
6. All sutures placed before final knot tightening (allows tension adjustment)
7. Ventral curvature: Buck's fascia dissected longitudinally above the NVB; complete NVB mobilization emphasized

Outcomes (20 patients, 26-month follow-up):^[11]

• Mean operative time: 64 minutes
• No recurrence at 8 months; 10% mild recurrence at 24 months
• Moderate ED at 1 year: 15%
• Cosmetic satisfaction: 90%
• Shortening: 35% at 6 months → 30% at 26 months (0.5–1 cm range)
• No bothersome sensations from suture knots — the primary technical claim validated

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Technical Pearls

Incision choice — four options

The incision selection has meaningful implications for morbidity, recovery, and prepuce preservation.^[3][7]

Approach	Best for	Key consideration
Circumcision + degloving	Classical exposure; complex or multiplanar deformity	Requires circumcision; longest recovery; widest exposure
Ventral raphe incision	Lateral or ventral curvature	Avoids circumferential skin disruption; corpus spongiosum visible during dissection
Dorsal base incision + penile inversion	Long gradual curvature requiring many dots; prepuce preservation	Inverts the penis to access the convex tunica without circumcising — important for uncircumcised patients who decline circumcision
Penoscrotal (Dugi-Morey)	Minimally invasive approach; experienced hands	2–3 cm incision; no degloving; 98% success in 340 cases[10]

The dorsal penile inversion via dorsal base incision is particularly important: it allows correction of long gradual curvatures requiring up to 24 dots while sparing the prepuce — the alternative to circumcision + degloving for uncircumcised patients.^[7]

Suture choice

Nonabsorbable suture is the traditional choice — durability matters because recurrence is a consequence of suture failure. Specific materials:

Material	Type	Palpable-knot rate	Notes
Ethibond 2-0 / 3-0	Braided polyester, nonabsorbable	Moderate	Workhorse; standard for Dugi-Morey technique
Ticron	Braided polyester, nonabsorbable	Moderate	Alternative to Ethibond
4-0 Gore-Tex (PTFE) double-armed	Monofilament, nonabsorbable	Moderate (50% with inverted burial[11])	Used in Kiel Knots technique
Prolene / polypropylene	Monofilament, nonabsorbable	High (88% in Essed-Schröder)[8]	Lower knot security; smooth monofilament increases palpability
Vicryl / PDS (absorbable)	Braided or monofilament absorbable	Low (6% vs 39% for nylon, Basiri RCT)[12]	Used in iterative 8-dot; 28% acoustic suture-failure rate but only half of those develop recurrence (Hsieh)[13]

The absorbable-vs-nonabsorbable debate:

• Basiri RCT: equal correction (88% both groups); absorbable had significantly lower palpable-knot rate (6% vs 39%)^[12]
• Hsieh 114-patient series with absorbable suture: 86% complete correction at 6 months; 28% of patients "heard a snap or felt the penis pop" (acoustic suture failure); notably, only half of those developed recurrent curvature — the plication scar holds even when the suture fails^[13]
• Leonardo MPP comparison: 15.8% recurrence with absorbable; 0% with nonabsorbable^[9]

Bottom line: nonabsorbable is the default, particularly for severe curvature or complex deformity. Absorbable is a legitimate option in low-risk cases where palpable-knot avoidance is a priority.

Burying the knot (and why the Kiel Knots matter)

The single most consistent patient complaint with plication is palpable suture material. Reported palpable-knot rates are remarkably high: 50–100% across most series, depending on suture material and burial technique.^[8][9][12] The disconnect:

• Palpable rate: 50–100%
• Bothersome rate: 0–40% — most palpable knots do not actually bother patients
• Interference with intercourse: 0–10%^[14]

The Kiel Knots inverted-burial technique specifically addresses this by tying the knots inside small tunical troughs and using 4-0 Gore-Tex — reporting no bothersome knot sensations in 20 consecutive patients.^[11] Running-locked or buried-interrupted closures with any modern suture achieve partial benefit.

Intraoperative pharmacologic erection is essential

The single strongest predictor of failure in the Dugi-Morey 340-case series was inadequate intraoperative artificial erection — 71% of failures had this feature.^[10]

Protocol:

• 20 mcg intracavernosal alprostadil (PGE1) prior to drape
• Second 20 mcg dose if erection inadequate after 10 minutes
• 60 mL saline injection + tourniquet (Kiel protocol) as an alternative when pharmacologic erection is insufficient

The artificial erection is used for (1) intraoperative curvature measurement, (2) precise dot marking, and (3) final confirmation of straightening before closure.

Differential suture tension for multiplanar curvature

For biplanar or compound deformities, plication sutures in both planes can be placed and tied with differential tension — correcting the primary curvature more aggressively and the secondary curvature to a lesser degree. The shodded-clamp technique holds individual knots at partial tension until the final pattern is confirmed, then all knots are tightened simultaneously.^[7]

Plaque thinning / incision adjunct

In selected severe cases approaching the 60° threshold, thinning or incising the plaque itself on the concave side allows modest lengthening that reduces the amount of convex-side shortening required. This extends plication into territory previously reserved for grafting.

Intraoperative goniometric measurement

A goniometer is used to objectively document pre- and post-plication curvature. The target is complete straightness (0°); <15° residual is generally acceptable. Notably, only ~20% of patients can accurately estimate their own curvature within 5° of objective measurement — objective documentation matters both for operative planning and for postoperative counseling.^[7]

Subjective vs. objective length loss — the Taylor-Levine lesson

The defining counseling insight of modern plication practice: patients substantially overestimate their postoperative shortening compared with objective measurement.^[7]

Measurement	Rate
Objective length loss (any)	18–41%
Subjective length loss reported by patients	50–75%
Length loss sufficient to affect intercourse	5–11.9%

Protective maneuvers: measure stretched penile length in clinic preoperatively; demonstrate it to the patient; document it. Patients with a reference anchor report less postoperative length-loss distress than those without.

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Complications

Complication	Rate	Notes
Objective length loss	18–41%	Measured shortening; Taylor-Levine TAP series averaged 0.36 cm[7]
Subjective length loss	50–75%	Patients overestimate vs. objective; anchor with preoperative measurement
Length loss affecting intercourse	5–12%	The clinically meaningful subset
Palpable suture knots	50–100%	Universal; bothersome in only 0–40%; interferes with intercourse in 0–10%[14]
Suture granulomas	<5%	Foreign body reaction to permanent suture
Sensory change	6–75%	6% with 16-dot; 21–75% with Nesbit[2][14] — wide range reflects technique-dependence
De novo / worsened ED	0–6%	16-dot: 3% at 6 mo, 6% at 6 yr[5]; Essed-Schröder 24% persistent but no worsening[8]
Recurrent curvature	0–20%	Suture-dependent: 0% nonabsorbable MPP, 15.8% absorbable MPP[9]
Hematoma	2–5%	Usually self-limited
Infection	<1%	Rare

Recurrence timing pattern

When recurrence does occur, the timing distribution reveals mechanism:^[13]

• Immediate recurrence: 9.6% — typically suture failure (acoustic "snap" / "pop")
• Early recurrence (mean 2.5 months): 25.8% — under-correction or inadequate initial straightening
• Late recurrence (mean 11 months): 64.5% — progressive Peyronie's disease, not surgical failure

The late-recurrence pattern is important for counseling: most late recurrences represent ongoing disease activity rather than technical failure and may require medical therapy or secondary intervention regardless of the initial surgery's quality.

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Postoperative Management

Modern plication protocols include adjunctive postoperative therapies aimed at preserving length, maintaining erectile function, and reducing recurrence:^[10][11]

Intervention	Protocol	Rationale
Low-dose PDE5 inhibitor	Sildenafil 25 mg daily, start 4 weeks postop, continue 3 months	Preserves erectile tissue oxygenation during healing
Vacuum erection device	3–5 min daily × 12 weeks	Gentle traction prevents cicatrix contracture; maintains length
Foley catheter	Removed postoperative day 1	Short-term drainage
Abstinence from intercourse	4–6 weeks	Allow plication scar to consolidate
Return to sexual activity	6–8 weeks	After clinical examination confirms healing

Home modeling is not typically prescribed after isolated plication (unlike after IPP-with-plication, where home modeling is protocol) — the plication itself has straightened the penis; the goal of postoperative therapy is length preservation and tissue oxygenation rather than further curvature correction.

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Counseling

• Expect shortening. 1–2 cm is typical; occasionally more. The patient must be prepared for this.
• Return of straight erections is the primary outcome; 90%+ achieve this.
• De novo ED risk is real but lower than with grafting.
• Palpable suture knots are an inconvenience; they do not typically require reintervention.
• Recurrence is uncommon but possible — usually modest and managed conservatively.

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When to Choose Plication vs. Grafting vs. Prosthesis

Scenario	Preferred operation
Curvature 30–60°, intact EF, adequate length	Plication (first choice)
Curvature 60–90°, intact EF, length acceptable	Plication (aggressive variant) or grafting
Curvature >60° with short penis or complex deformity	Grafting (preserves length)
Hourglass, hinge, biplanar curvature	Grafting
PD + ED refractory to medical therapy	Prosthesis with adjuncts
Primary concern is length preservation	Grafting
Primary concern is speed / low complexity / low ED risk	Plication

See plaque incision / grafting and prosthesis with adjunctive straightening for those pathways.

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See Also

• Peyronie's disease — overview
• Plaque incision / excision with grafting
• Prosthesis with adjunctive straightening

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Videos

16-Dot Technique for Penile Curvature Correction

Dr. Zin Abouelfadel (2022)

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References

1. Nehra A, Alterowitz R, Culkin DJ, et al. Peyronie's disease: AUA guideline. J Urol. 2015;194(3):745–753. doi:10.1016/j.juro.2015.05.098

2. Çayan S, Aşcı R, Efesoy O, et al. Comparison of patient's satisfaction and long-term results of 2 penile plication techniques: lessons learned from 387 patients with penile curvature. Urology. 2019;129:106–112. doi:10.1016/j.urology.2019.02.039

3. García-Gómez B, González-Padilla DA, Alonso-Isa M, Medina-Polo J, Romero-Otero J. Plication techniques in Peyronie's disease: new developments. Int J Impot Res. 2020;32(1):30–36. doi:10.1038/s41443-019-0204-1

4. Rehman J, Benet A, Minsky LS, Melman A. Results of surgical treatment for abnormal penile curvature: Peyronie's disease and congenital deviation by modified Nesbit plication (tunical shaving and plication). J Urol. 1997;157(4):1288–91. doi:10.1016/s0022-5347(01)64953-x

5. Licht MR, Lewis RW. Modified Nesbit procedure for the treatment of Peyronie's disease: a comparative outcome analysis. J Urol. 1997;158(2):460–463.

6. Demzik A, Ehlers M, Brems J, Figler BD. Penile plication for Peyronie's disease: the iterative 8-dot technique. Urology. 2022;164:e307. doi:10.1016/j.urology.2022.03.005

7. Taylor FL, Abern MR, Levine LA. Predicting erectile dysfunction following surgical correction of Peyronie's disease without inflatable penile prosthesis placement: vascular assessment and preoperative risk factors. J Sex Med. 2012;9(1):296–301. doi:10.1111/j.1743-6109.2011.02460.x

8. Savoca G, Trombetta C, Ciampalini S, De Stefani S, Buttazzi L, Belgrano E. Long-term results with Nesbit's procedure as treatment of Peyronie's disease. Int J Impot Res. 2000;12(5):289–93. doi:10.1038/sj.ijir.3900590

9. Leonardo C, De Nunzio C, Michetti P, et al. Plication corporoplasty versus Nesbit operation for the correction of congenital penile curvature: a long-term follow-up. Int J Urol. 2012;19(2):168–72. doi:10.1111/j.1442-2042.2011.02904.x

10. Dugi DD 3rd, Morey AF. Penoscrotal plication as a uniform approach to reconstruction of penile curvature. BJU Int. 2010;105(10):1440–4. doi:10.1111/j.1464-410X.2009.08957.x

11. Osmonov DK, Ragheb AM, Zastrow S, et al. Clinical evaluation of a novel minimally invasive surgical technique in the correction of Peyronie's disease: preliminary data. Urol Int. 2013;90(3):323–9. doi:10.1159/000345713

12. Basiri A, Sarhangnejad R, Ghahestani SM, Hosseini Sharifi SH, Ganjehei L, Radfar MH. Comparing absorbable and nonabsorbable sutures in corporeal plication for treatment of congenital penile curvature. Urol J. 2011;8(4):302–6.

13. Hsieh JT, Liu SP, Chen Y, Chang HC, Yu HJ, Chen CH. Correction of congenital penile curvature using modified tunical plication with absorbable sutures: the long-term outcome and patient satisfaction. Eur Urol. 2007;52(1):261–7. doi:10.1016/j.eururo.2006.12.039

14. Syed AH, Abbasi Z, Hargreave TB. Nesbit procedure for disabling Peyronie's curvature: a median follow-up of 84 months. Urology. 2003;61(5):999–1003. doi:10.1016/s0090-4295(02)02549-0

15. Goldstein M, Laungani G, Abrahams J, Waterhouse K. Correction of adult penile curvature with a Nesbit operation. J Urol. 1984;131(1):56–58. doi:10.1016/s0022-5347(17)50199-8

16. Sislow JG, Ireton RC, Ansell JS. Treatment of congenital penile curvature due to disparate corpora cavernosa by the Nesbit technique: a rule of thumb for the number of wedges of tunica required to achieve correction. J Urol. 1989;141(1):92–93. doi:10.1016/s0022-5347(17)40601-x

17. Schneider T, Sperling H, Schenck M, Schneider U, Rübben H. Treatment of penile curvature — how to combine the advantages of simple plication and the Nesbit-procedure by superficial excision of the tunica albuginea. World J Urol. 2003;20(6):350–355. doi:10.1007/s00345-002-0307-y

18. Savoca G, Scieri F, Pietropaolo F, Garaffa G, Belgrano E. Straightening corporoplasty for Peyronie's disease: a review of 218 patients with median follow-up of 89 months. Eur Urol. 2004;46(5):610–614. doi:10.1016/j.eururo.2004.04.027

19. Vicini P, Di Nicola S, Antonini G, et al. Geometrical modified Nesbit corporoplasty to correct different types of penile curvature: description of the surgical procedure based on geometrical principles and long-term results. Int J Impot Res. 2016;28(6):209–215. doi:10.1038/ijir.2016.28

20. Falcone M, Ceruti C, Preto M, et al. Long-term surgical, functional, and patient reported outcomes of a modified corporoplasty: a tertiary referral center experience. J Sex Med. 2020;17(9):1779–1786. doi:10.1016/j.jsxm.2020.06.002

21. Yafi FA, Diao L, DeLay KJ, et al. Multi-institutional prospective analysis of intralesional injection of collagenase clostridium histolyticum, tunical plication, and partial plaque excision and grafting for the management of Peyronie's disease. Urology. 2018;120:138–142. doi:10.1016/j.urology.2018.06.049

22. Yachia D. Modified corporoplasty for the treatment of penile curvature. J Urol. 1990;143(1):80–82. doi:10.1016/s0022-5347(17)39871-3

23. Sassine AM, Wespes E, Schulman CC. Modified corporoplasty for penile curvature: 10 years' experience. Urology. 1994;44(3):419–421. doi:10.1016/s0090-4295(94)80106-1

24. Daitch JA, Angermeier KW, Montague DK. Modified corporoplasty for penile curvature: long-term results and patient satisfaction. J Urol. 1999;162(6):2006–2009. doi:10.1016/S0022-5347(05)68088-3

25. Giammusso B, Burrello M, Branchina A, Nicolosi F, Motta M. Modified corporoplasty for ventral penile curvature: description of the technique and initial results. J Urol. 2004;171(3):1209–1211. doi:10.1097/01.ju.0000110297.98725.25

26. Bagnara V, Arena S, Castagnetti M, et al. Giammusso corporoplasty for the treatment of isolated congenital ventral penile curvature: results and long-term follow-up. Andrologia. 2021;53(2):e13934. doi:10.1111/and.13934

27. Dell'Atti L, Polito M, Galosi AB. Is degloving the best method to approach the penile corporoplasty with Yachia's technique? Urology. 2019;126:204–208. doi:10.1016/j.urology.2018.12.040

28. Nyirády P, Kelemen Z, Bánfi G, et al. Management of congenital penile curvature. J Urol. 2008;179(4):1495–1498. doi:10.1016/j.juro.2007.11.059

29. Popken G, Wetterauer U, Schultze-Seemann W, Deckart AB, Sommerkamp H. A modified corporoplasty for treating congenital penile curvature and reducing the incidence of palpable indurations. BJU Int. 1999;83(1):71–75. doi:10.1046/j.1464-410x.1999.00887.x

30. Gholami SS, Lue TF. Correction of penile curvature using the 16-dot plication technique: a review of 132 patients. J Urol. 2002;167(5):2066–2069.

31. Salem EA. Modified 16-dot plication technique for correction of penile curvature: prevention of knot-related complications. Int J Impot Res. 2018;30(3):117–121. doi:10.1038/s41443-018-0018-6

32. Cantoro U, Polito M, Catanzariti F, et al. Penile plication for Peyronie's disease: our results with mean follow-up of 103 months on 89 patients. Int J Impot Res. 2014;26(4):156–159. doi:10.1038/ijir.2014.6

33. Papagiannopoulos D, Phelps J, Yura E, Levine LA. Surgical outcomes from limiting the use of nonabsorbable suture in tunica albuginea plication for Peyronie's disease. Int J Impot Res. 2017;29(6):258–261. doi:10.1038/ijir.2017.34

34. van der Horst C, Martínez Portillo FJ, Melchior D, et al. Polytetrafluoroethylene versus polypropylene sutures for Essed-Schroeder tunical plication. J Urol. 2003;170(2 Pt 1):472–475. doi:10.1097/01.ju.0000076370.30521.a6

35. Adibi M, Hudak SJ, Morey AF. Penile plication without degloving enables effective correction of complex Peyronie's deformities. Urology. 2012;79(4):831–835. doi:10.1016/j.urology.2011.12.036

36. Hudak SJ, Morey AF, Adibi M, Bagrodia A. Favorable patient reported outcomes after penile plication for wide array of Peyronie disease abnormalities. J Urol. 2013;189(3):1019–1024. doi:10.1016/j.juro.2012.09.085

37. Levine LA, Lenting EL. A surgical algorithm for the treatment of Peyronie's disease. J Urol. 1997;158(6):2149–2152. doi:10.1016/s0022-5347(01)68184-9

38. Levine LA, Larsen SM. Surgery for Peyronie's disease. Asian J Androl. 2013;15(1):27–34. doi:10.1038/aja.2012.92

39. García-Gómez B, González-Padilla DA, Alonso-Isa M, Medina-Polo J, Romero-Otero J. Plication techniques in Peyronie's disease: new developments. Int J Impot Res. 2020;32(1):30–36. doi:10.1038/s41443-019-0204-1

40. Seyer A, Piraino J, Lozoya AG, Ziegelmann M. What is the right approach for Peyronie's disease surgery? Comparing postoperative wound complications between ventral and subcoronal incisions with penile straightening surgery. J Sex Med. 2025:qdaf189. doi:10.1093/jsxmed/qdaf189

41. Taylor FL, Levine LA. Surgical correction of Peyronie's disease via tunica albuginea plication or partial plaque excision with pericardial graft: long-term follow-up. J Sex Med. 2008;5(9):2221–2228. doi:10.1111/j.1743-6109.2008.00941.x

42. Greenfield JM, Lucas S, Levine LA. Factors affecting the loss of length associated with tunica albuginea plication for correction of penile curvature. J Urol. 2006;175(1):238–241. doi:10.1016/S0022-5347(05)00063-7

43. Papagiannopoulos D, Yura E, Levine L. Examining postoperative outcomes after employing a surgical algorithm for management of Peyronie's disease: a single-institution retrospective review. J Sex Med. 2015;12(6):1474–1480. doi:10.1111/jsm.12910

44. Ziegelmann MJ, Farrell MR, Levine LA. Clinical characteristics and surgical outcomes in men undergoing tunica albuginea plication for congenital penile curvature who present with worsening penile deformity. World J Urol. 2020;38(2):305–314. doi:10.1007/s00345-019-02787-7

45. Chow AK, Sidelsky SA, Levine LA. Surgical outcomes of plaque excision and grafting and supplemental tunica albuginea plication for treatment of Peyronie's disease with severe compound curvature. J Sex Med. 2018;15(7):1021–1029. doi:10.1016/j.jsxm.2018.04.642

46. Roadman D, Quesada-Olarte J, Langbo W, Mossack S, Levine L. Experience with extra-tunical grafting and tunica albuginea plication for correction of indentation deformity in men with Peyronie's disease. Urology. 2024;186:17–22. doi:10.1016/j.urology.2023.11.040

47. Li WJ, Bao JW, Guo JH, et al. Effects of plication procedures in special cases of Peyronie's disease: a single-center retrospective study of 72 patients. Asian J Androl. 2022;24(3):294–298. doi:10.4103/aja202219

48. Chung PH, Tausch TJ, Simhan J, Scott JF, Morey AF. Dorsal plication without degloving is safe and effective for correcting ventral penile deformities. Urology. 2014;84(5):1228–1233. doi:10.1016/j.urology.2014.05.064

49. Chung PH, Scott JF, Morey AF. High patient satisfaction of inflatable penile prosthesis insertion with synchronous penile plication for erectile dysfunction and Peyronie's disease. J Sex Med. 2014;11(6):1593–1598. doi:10.1111/jsm.12530

50. Ly L, Christianson SS, Taylor LC, et al. Functional penile length after penile plication: "empha-sizing" what matters. Urology. 2023;172:210–212. doi:10.1016/j.urology.2022.11.035