Abstract Introduction Peyronie’s disease is characterized by the formation of fibrous plaques in the tunica albuginea, resulting in penile curvature and deformity. Surgical correction remains the gold standard for patients with significant curvature who do not respond to medical therapy. The Nesbit procedure is widely performed for dorsal curvature but may lead to penile shortening and, in some cases, recurrence of deformity. Management of recurrent curvature following prior shortening surgery poses a significant reconstructive challenge. Objectives To describe the surgical management and outcomes of a patient with recurrent penile deformity following a previous Nesbit procedure, emphasizing the role of plaque incision and grafting as a salvage approach. Methods A 64-year-old male with a two-year history of Peyronie’s disease presented with recurrent penile deformity one year after undergoing a Nesbit procedure. Physical examination revealed a 40° dorsal and 35° right lateral curvature. Corpora cavernosa lengths were 12.5 cm (right) and 13 cm (left). Given the significant recurrent curvature and prior shortening procedure, a tunical lengthening approach with plaque incision and grafting was selected. A dorsal longitudinal incision was employed to optimize exposure and minimize neurovascular bundle dissection. The tunical defect was reconstructed using a bovine pericardium graft due to its biocompatibility, low antigenicity, and favorable mechanical properties. Results Postoperative outcomes were favorable, with satisfactory penile straightening and preservation of length. Erectile function remained adequate with PDE-5 inhibitor use. Literature supports these findings—a study reported a 93.3% success rate for plaque incision and grafting after failed Nesbit procedures, while another demonstrated 85.7% success for salvage plication. Both studies highlight that careful surgical selection and approach are critical for optimal results. Conclusions Plaque incision and grafting serve as an effective salvage option for recurrent penile deformity after failed Nesbit procedures. This technique maintains penile length, achieves functional straightening, and provides satisfactory aesthetic outcomes. The dorsal longitudinal incision offers superior surgical exposure, reduces neurovascular manipulation, and enhances safety in revision settings. Disclosure No
Gürcan et al. (Mon,) studied this question.