Proteinoplasty for penile curvature - indications and benefits

Tunica albuginea plasty — a radical treatment for penile curvature

Penile curvature can cause significant discomfort and even suffering, and it cannot be fully treated with conservative methods. Medications are used only in the early stages of the condition, when fibrous plaques are still forming and the patient experiences pain.

There are several types of surgical interventions that can permanently relieve the patient from discomfort. The final decision regarding surgical treatment for penile curvature is made by the doctor, who evaluates the severity of the condition, the patient’s complaints, and medical history. The most advanced method currently is grafting — tunica albuginea plasty with the application of a graft.

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Indications for surgery

The tunica albuginea is a layer of dense elastic tissue that surrounds the corpora cavernosa (the erectile bodies). It protects them from external damage and allows them to expand evenly during an erection, making sexual intercourse possible.

In some cases—such as when the integrity of the tunica albuginea is compromised—fibrous plaques may form on it. These plaques are made not of elastic tissue but of dense scar tissue. They restrict the corpora cavernosa, preventing them from expanding naturally and filling adequately with blood. As a result, an erection causes curvature and pain.

Causes of this tissue “behavior” may include:

Local trauma to the penis due to rough friction;
Peyronie's disease, where the tunica albuginea gradually scars on its own (the exact cause is unknown).

A third indication is congenital penile curvature. Surgery is performed on patients who complain of significant aesthetic defects, physical and psychological discomfort, and an inability to have a normal sexual life.

How is tunica albuginea plasty performed?

Grafting, or flap technique, involves excising the fibrous tissue and then applying a graft—a flap of tissue—to the damaged areas of the tunica albuginea to replace the lost tissue.

Various types of grafts are used worldwide, including:

Synthetic materials;
Autografts, which are tissues taken from the patient’s own body.

The latter option is preferable because it completely eliminates the risk of graft rejection. For autografting, we typically use a flap of mucosa taken from the cheek.

After making a circular incision on the side where the deformity is most pronounced, the surgeon removes the fibrous plaques and applies the graft. All procedures are performed under high-precision optical control, which eliminates the risk of damaging healthy tissue.

A self-absorbing suture is used, which will become virtually invisible after healing, ensuring that the aesthetic aspect is also addressed.

The doctor will also advise on the recovery process and its timeline. For a certain period, it will be necessary to avoid sexual activity, strenuous physical exertion, and to be cautious when performing personal hygiene routines.

Advantages of grafting compared to other methods

The main advantage of tunica albuginea grafting — unlike Nesbit’s plication — is that the penile curvature is corrected not by shortening the penis to match the size of the fibrotic area. When a skin graft is applied, the elasticity of the tunica is restored, allowing the organ to maintain its full length.

Other advantages of the procedure:

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Excellent functional and aesthetic outcomes;
Practically no risk of injury thanks to the use of a modern surgical microscope;
Minimal residual pain during the recovery period;
Rapid restoration of normal erections.

At present, tunica albuginea grafting is the most promising method for treating penile curvature, restoring the ability to live a full life for many men.

Typical dialogue with a patient during a consultation:

Initial diagnosis of penile curvature is often performed using a photograph taken by the patient themselves—this is because determining the degree of curvature requires a sustained erection, preferably of a natural kind. This patient was invited for an in-person consultation precisely after such a remote examination.

— Do you know how it all started?

— Yes. I always thought the phrase “you can break your penis by accident” was just a saying, not reality. Actually, I probably didn’t have a fracture…

— I assure you, you would have felt it clearly and wouldn’t have doubted it.

— But there was an injury. My girlfriend likes unusual places, and they always end up being uncomfortable for sex. At one point, the angle was off, and I felt a sharp pain, but I still managed to finish.

— So the erection remained?

— Yes.

— What symptoms did you notice afterward?

— A dull ache, some itching maybe… going to the bathroom became unpleasant. There was almost no swelling. I planned to see a doctor but just ended up calling a urologist friend. He said it was a minor injury, and if it didn’t get worse, it would heal on its own, but I should still get checked. Also, no sex for a week.

— But you didn’t follow that advice?

— No, I got busy, and it went away on its own. But after some time, I noticed the first signs of curvature. I didn’t come to you right away, but now it’s almost catastrophic, sex is nearly impossible. Plus, I don’t have a steady partner, and how do you find a new one with this defect? Honestly, doctor, it’s terrible.

(Firm plaques are palpable under the fingers during the examination.) Hmm, the patient waited too long to come…

— You sustained an injury to the tunica albuginea of the penis; this is not uncommon during rough intercourse. The injury healed excessively, and connective tissue kept growing. If there are no contraindications, I can offer you surgery.

— Is it dangerous?

— No. Of course, it’s surgery under general anesthesia. If any doctor guarantees 100% results, run away—they’re a fraud. But that’s mostly a formal warning. In my experience, there has been only one case of minor complications, and that was because the patient blatantly neglected hygiene. So everything will be fine; we’ve done many such surgeries.

— And what does the procedure look like?

— It’s microsurgery. I’ll make an incision to expose the tunica albuginea, remove the fibrous plaques — those hardened spots that interfere with normal erection — and patch it using a graft from the mucous membrane inside your cheek.

— What about my cheek? — the patient looks worried.

— It will heal like after a dental procedure, for example, after a gum surgery. You might feel some discomfort for a few days, but healing is quite fast. Within one and a half to two months, you’ll be able to resume normal sexual activity, and there will be no trace of the cheek injury.