Abstract Plaque incision and grafting is a well-established treatment for severe or complex Peyronie’s disease and preserved erectile function. This retrospective single-centre cohort study evaluated 325 patients undergoing the procedure between 2009 and 2024 at a high-volume centre. Median pre-operative curvature was 80° (IQR 60–90°) and 46.8% (152/325) had complex deformities (wasting 36.6%, hourglass 10.2%). 90.2% (293/325) completed follow-up (median 9.8 months) and were included in outcome analysis. Overall satisfaction was 87.0% (255/293), with 90.1% (264/293) resuming penetrative intercourse. Perceived length reduction occurred in 29.4% (86/293) and hypoaesthesia in 15.4% (45/293). Patients were stratified by baseline erectile status: 72.4% (212/293) had normal pre-operative erectile function and 27.6% (81/293) had pre-existing erectile dysfunction (ED). New-onset ED occurred in 22.2% (47/212) of previously potent men. Among men with pre-existing ED, 37.0% (30/81) improved and 13.6% (11/81) worsened. Multivariable regression showed cardiovascular and metabolic comorbidities were significantly associated with post-operative ED, whereas graft size and complex deformity did not. Re-operation was required in 8.5% (25/293). These findings suggest functional decline can be driven by systemic health in addition to surgical technique. Integrating cardiovascular and metabolic risk assessment into counselling is therefore essential. Management at a high-volume centre remains key to optimising outcomes.
Sarna et al. (Mon,) studied this question.