Clinical effect of microscopic plaque grinding combined with graft repair in the treatment of Peyronie's disease: a retrospective cohort study.

BACKGROUND: Peyronie's disease (PD) causes debilitating penile curvature. For moderate-to-severe cases failing conservative therapy, plaque incision/excision with graft repair is a surgical option for selected patients, but it carries risks of erectile dysfunction and penile shortening. AIM: To report outcomes of a modified technique combining microscopic plaque grinding with a high-speed micro-burr and graft reconstruction (autologous tunica vaginalis or bovine pericardial patch) in moderate-to-severe PD. METHODS: This was a single-center retrospective cohort study of 45 patients (curvature >60° or compound deformities) treated between January 2021 and December 2025. The median follow-up was 11.5 months (range 6-24 months). Outcomes included penile straightening rate, erectile function (International Index of Erectile Function-5 [IIEF-5]), disease-specific bother, complications, and patient satisfaction. INTRODUCTION: Outcomes: The primary outcome was satisfactory penile straightening (residual curvature ≤10°). Secondary outcomes included IIEF-5 score, bother score, satisfaction, and complication rates. RESULTS: Satisfactory penile straightening (residual curvature ≤10°) was achieved in 91.1% (41/45); 8.9% had residual curvature between 10° and 20°, which was considered acceptable and did not affect sexual function. International Index of Erectile Function-5 remained stable (preoperative: 20.8 ± 2.1 vs. postoperative: 20.4 ± 2.0, P = 0.360). Transient glans hypoesthesia occurred in 75.6% and resolved within a median of 2.0 months (range 0.7-2.8). Subjective penile shortening was reported by 53.3%, whereas objective measurement showed a mean increase of +1.4 cm in stretched penile length. The Peyronie's Disease Questionnaire symptom bother score decreased significantly from a median of 13 to 2 (P < 0.001). The satisfaction rate (score ≥ 4) was 93.3%. No significant differences were observed between graft types (autologous tunica vaginalis n = 34 vs. bovine pericardial patch n = 11). CLINICAL IMPLICATIONS: This technique offers effective curvature correction with preserved erectile function in selected patients with moderate-to-severe PD. STRENGTHS AND LIMITATIONS: Strengths include (1) the use of microsurgical technique and electric plaque grinding, (2) meticulous tunica vaginalis repair and Buck's fascia reconstruction, (3) independent outcome assessment, and (4) complete follow-up exceeding 6 months. Limitations include the single-center retrospective design, small sample size, and non-randomized graft selection. CONCLUSION: Microscopic plaque grinding with graft repair appears to be a preferred surgical approach for curvature correction while maintaining stable erectile function in selected patients. Larger prospective studies are needed to confirm these findings.