Penile Curvature: When Is Surgery Necessary?

Surgery is not always necessary for penile curvature; the degree of curvature, the presence of pain, and its effect on sexual function determine the need for treatment. While follow-up and medical approaches may be sufficient in mild cases, surgical options come to the agenda in advanced deformities.

Penile curvature treatment methods are planned according to the stage of the disease, and especially in Peyronie’s disease, medication therapy, injections, or vacuum devices are preferred in the first stage. Surgery is generally not recommended in cases that have not reached the stable phase, and regular follow-up is important.

Symptoms of advanced penile curvature include painful erection, inability to have sexual intercourse, and significant deformity; when these conditions reduce quality of life, surgical intervention may become necessary. With surgery, functional improvement is achieved by correcting the curvature.

The answer to the question of when surgery is required in Peyronie’s disease is related to the curvature becoming stable and no response being obtained from conservative treatments. Surgical techniques include plaque excision, grafting, or shortening methods, and patient-based evaluation is performed.

Are Non-Surgical Solutions Possible in Mild Penile Curvatures?

Mild penile curvature often does not require treatment, and men can maintain their sexual life in a healthy way. However, if the curvature creates aesthetic concern or shows a tendency to progress, some methods that can be applied without the need for surgery come to the agenda. The aim here is not to completely eliminate the curvature, but to reduce complaints and slow its progression.

First of all, one of the most commonly used methods in mild curvatures is medication therapy. Some oral medications used under doctor supervision may reduce plaque formation and preserve the elasticity of tissues. In addition, some special medications such as collagenase injected into the penis may help reduce the angle by breaking down the fibrous tissue that causes the curvature.

Another option is mechanical treatment methods. Penile traction devices provide stretching by pulling the penis in a controlled and regular manner. With regular use for weeks or even months, a few degrees of improvement in curvature may be observed in some patients. These devices also help preserve penile length.

In addition, shock wave therapy (ESWT) is a modern option that can be tried in mild cases. Low-intensity sound waves provide tissue regeneration and increased blood flow. Although this method does not directly correct the curvature, it may reduce pain and prevent plaques from hardening.

In cases where psychological impact is intense, therapy and counseling support are important. Because mild curvature often does not create a functional problem, but it may lead to sexual self-confidence issues in men.

How Is Shock Wave Therapy (ESWT) Used in Penile Curvature?

Shock wave therapy (ESWT) is a modern method that has been used in medicine for many years in areas such as kidney stone fragmentation, musculoskeletal system diseases, and circulatory disorders. In recent years, it has also come to the agenda in the field of men’s health and has started to be researched especially in conditions such as erectile dysfunction and penile curvature. The purpose of using ESWT in penile curvature is to increase the elasticity of the hard plaque tissue causing the curvature and regulate blood supply in the tissue.

In curvatures developing due to Peyronie’s disease, plaque tissue causes hardening on one side of the penis. During ESWT, low-intensity sound waves are directed to these plaques. With the mechanical effect of sound waves, plaque tissue is partially broken down, softened, and blood circulation around it increases. Thus, the aim is to reduce the severity of the curvature over time. In addition, the healing process of microtraumas occurring during treatment may stimulate new vessel formation and increase tissue elasticity.

The effects of ESWT on penile curvature are still in the research phase. Some studies have reported that it reduces pain complaints and slows the progression of curvature, especially in early-stage Peyronie’s patients. However, it is seen that it is not sufficient on its own to completely eliminate advanced curvatures. Therefore, it is generally recommended to be combined with medication therapy, injections, or mechanical devices.

Treatment is generally applied once a week or in several sessions, and each session lasts an average of 15-20 minutes. No anesthesia is needed during the procedure, and the patient can immediately return to daily life. The most important advantages of ESWT are that it is non-invasive compared to surgery, does not require a recovery period, and has very few side effects.

Is Medication Therapy Effective in Penile Curvature?

Penile curvature, especially when it develops due to Peyronie’s disease, is one of the most frequently wondered treatment options. The aim with medications is to prevent the hardening of the fibrous tissue, namely plaques, that cause curvature, relieve pain, and preserve flexibility in the penis. However, medication therapy is generally effective in mild and moderate curvatures; it is not sufficient on its own in advanced curvatures.

Oral treatments are among the medications used in the first stage. Medications such as vitamin E, pentoxifylline, and Potaba may slow plaque progression by regulating vascular circulation or reducing hardening in the tissue. However, the effectiveness of these medications is limited; they are not expected to completely eliminate the curvature on their own.

Injection treatments come to the agenda as a stronger method. In this method, medication is injected directly into the plaque. For example, collagenase injections facilitate stretching of the penis by breaking down the hard tissue forming the plaques. Clinical studies have shown that collagenase significantly reduces the curvature angle in some patients. In addition, medications such as verapamil and interferon may also be applied for a similar purpose.

Another important contribution of medication therapy is the reduction of pain. Pain felt especially during erection in the curvature process can be greatly relieved with medications. Thus, both sexual intercourse becomes more comfortable and psychological burden decreases.

However, medication therapy also has limitations. In developed and advanced curvatures, the effect of medications remains insufficient. In addition, the treatment process takes a long time and requires patience.

Exercise and Mechanical Correction Methods in Penile Curvature

Exercises and mechanical correction applications have an important place among non-surgical methods in penile curvature. The main purpose of these methods is to stretch penile tissues, prevent plaques from hardening, and stop the progression of curvature. These methods may be beneficial especially in mild and moderate curvatures.

One of the most commonly used methods is penile traction therapy. In this method, continuous and controlled stretching force is applied to the penis with the help of special devices. When traction devices are used regularly for several hours daily, a decrease in the penile curvature angle and preservation of length can be achieved. Clinical studies have reported that curvature may improve by 10–15 degrees in some patients. In addition, since this method prevents shortening in penile length, it also offers an aesthetic advantage.

In addition, manual stretching exercises can also be applied. Controlled pulling and stretching are performed on the penis with specific movements recommended by the doctor. However, if these exercises are applied incorrectly, microtraumas may develop in the penis. Therefore, exercises must be learned under specialist supervision and performed carefully.

Another mechanical method is vacuum devices. Vacuum pumps facilitate erection by increasing blood flow in the penis. With regular use, they may increase tissue elasticity and contribute to a certain degree of reduction in curvature. However, a strong corrective effect should not be expected on their own.

Mechanical methods usually provide more effective results when combined with medication therapy or injection treatments rather than used alone. Especially the use of a traction device after collagenase injection may increase the improvement rate of curvature.

Who Is Penile Curvature Surgery Recommended For?

Surgical treatment may not be required in every patient with penile curvature. The decision for surgery is made according to the degree of curvature, its effect on the patient’s quality of life, and disorders in sexual function. According to the accepted criteria in urology, surgery is generally recommended in moderate and advanced curvatures or in cases that make sexual intercourse impossible.

One of the most important criteria requiring surgery is the curvature angle. If the curvature exceeds 30–40 degrees and makes sexual intercourse difficult, surgery is the most effective solution. In lower-degree curvatures, methods such as medication, injection, traction, or shock wave therapy may be preferred.

Another important factor in the decision for surgery is pain and functional problems. Penile curvature is not only an aesthetic problem but also a functional disorder. Surgery is considered in men who experience severe pain during sexual intercourse, have erectile dysfunction, or cause discomfort in their partner.

Psychological and social effects are also taken into account. For some men, curvature may lead to loss of self-confidence, sexual reluctance, or relationship problems. In such cases, even if the degree of curvature is relatively mild, surgery may be evaluated as an option.

Before the decision for surgery is made, the patient’s general health condition and expectations are also important. Since some possible side effects after surgery (penile shortening, sensory changes, erection problems) may occur, the patient must be informed about the entire process.

How Is Penile Curvature Corrected?

Surgical treatment of penile curvature is the most effective solution especially in cases with advanced curvature or cases that lead to dysfunction during sexual intercourse. When the curvature exceeds 30 degrees or causes significant problems in daily life, surgical options come to the agenda. The methods applied include plication, Nesbit technique, grafting, and penile prosthesis.

Plication Method: It is one of the most commonly used techniques. The penis is straightened with special sutures placed on the opposite side of the curvature. Since the operation time is short, the patient can be discharged on the same day. The recovery process is also fast. However, in this method, since symmetry is achieved by shortening the longer side of the penis, some shortening in penile length may occur.

Nesbit Surgery: In this method, which is similar to the plication technique, excess tissue on the opposite side of the curvature is removed. It is a method preferred in more advanced curvatures. Compared to plication, more noticeable shortening may occur. Therefore, possible changes are explained to patients in detail before surgery.

Grafting Method: In severe curvatures, the gap formed after cutting or removing the plaque tissue is closed with tissue pieces taken from the patient or with synthetic grafts. This method provides the advantage of preserving penile length. However, it has a longer recovery period compared to other techniques and requires regular follow-up.

Penile Prosthesis: When penile curvature is accompanied by erectile dysfunction, it is the most appropriate method used both to correct the curvature and to provide erection. The prosthesis both corrects the curvature and prevents the erection problem. It is generally applied in older patients or patients with severe erectile dysfunction.

What Happens If Penile Curvature Surgery Is Not Performed?

When penile curvature is not treated, it may lead to significant problems both physically and psychologically over time. Mild curvatures usually do not impair sexual function and do not seriously affect the person’s life. However, when the degree of curvature increases, the normal structure of the penis is disrupted, and this condition both makes sexual intercourse difficult and shakes the person’s self-confidence. Especially in curvatures exceeding 30 degrees, the penis may have difficulty entering the vagina during sexual intercourse. This condition may make intercourse painful for both the man and his partner. Over time, the man may begin to avoid sexual intercourse due to fear of pain or failure.

Psychological effects are another dimension that should not be neglected. A significant change in the appearance of the penis causes loss of self-confidence in many men. This condition may lead to mental problems that can extend to decreased sexual desire, performance anxiety, and even depression. Negative effects may also be seen in the relationship with the partner. Sometimes the man may avoid having sexual intercourse because he is concerned that the curvature will be noticed, and this may cause distance between the couple.

Another risk when surgery is not performed is the progression of the curvature. If the curvature is not congenital but developed later, it may become more pronounced over the years. A curvature that is mild at first may cause the shape of the penis to deteriorate seriously over time and sexual intercourse to become completely impossible. In addition, the involvement of vascular and nerve structures may also bring erection problems along with it.

Prof. Dr. Berkan Reşorlu

Prof. Dr. Berkan Reşorlu, born in Ankara in 1979, completed his medical education at Ankara University between 1997 and 2003, and his specialization in urology at Ankara University Faculty of Medicine between 2003 and 2008. Academically, he received the title of associate professor in 2013 and professor in 2022.

He has conducted extensive case series studies in the field of endoscopic stone surgery, contributed surgeries performed on children under the age of 1 to the literature, and has gained international recognition with his stone scoring system and experimental surgical models.