Nesbit procedure is a common and often used technique for penile straightening. However, it inevitably leads to a loss of penis length. The surgical technique is one of the plication methods to which many modifications exist.
Straightening the penis through shortening
The Nesbit procedure is widely considered to be the standard treatment method for Peyronie’s disease. It has been developed in 1964 and has since been modified several times. The objective is to straighten the penis by shortening penis length. Peyronie’s disease is already accompanied by loss of length in 80% of the cases. Therefore, it is understandable that any further loss of length puts a great strain on many patients’ well-being.
The two sides of penile curvature
Visualising the curvature through diagrams can help understanding the issue better.
There are two sides to penile curvature: a longer one (convex) and a shorter one (concave).
– The two sides of penile curvature –
The plaque, which causes the curvature, is located on the shorter/concave side. It reduces elasticity of the erectile tissue which can then no longer extend accordingly. This leads to the development of the penile curvature, indentations and subsequently a loss of penis length.
The longer/convex side of the curvature is not affected by Peyronie’s disease. This side usually retains the original penis length as prior to the onset of the disease.
The Nesbit procedure
During the Nesbit procedure, the longer/convex side on the curvature is shortened until the penis is straight. Inevitably, straightening the penis causes a loss of length.
– The Nesbit procedure –
If the curvature is not very pronounced, the loss of length is limited. However, more severe cases might suffer more loss.
The Nesbit procedure is a great and safe method for treating penile curvature. It is necessary to consult a doctor with experience and expertise, to succeed in straightening the penis.
Risks of the procedure are: erectile dysfunction, recurrence of the curvature, insufficient straightening and the loss of penis length, which can be perceived as bothersome.
The Nesbit & Plication procedure
| Straightening of the penis | 58-100% |
| Shortening of the penis | 41-90% |
| Recurrence of the curvature, following the surgery | 10-27% |
| Somatosensory dysfunction | 2-21% |
| Erectile dysfunction following the surgery | 2-23% |
Source: EAU Guidelines 2017
To decrease risks and the loss of penis length during the surgical procedure, the technique has been continuously modified. Dr. Kuehhas has contributed in the development of the so-called STAGE technique (Superficial Tunica Albuginea Geometric-Based Excision). It is mainly applied in treating congenital penile curvature, however, it can also beneficial in the treatment of Peyronie’s disease.
- If quality of erection is not affected by the penile curvature, the Incisions and Grafting technique might offer appropriate treatment. The objective of this technique is to straighten the penis while also avoiding loss of penis length
- If a patient also suffers from severe erectile dysfunction, placement of a penile prosthesis might be necessary to achieve the desired results.
Dr Franklin Kuehhas is a medical specialist in the field of urology and andrology. He received his specialization training at the University College London. He also underwent his training at the prestigious University Hospital in Heidelberg (Germany) and at the University Hospital of Vienna (Austria). Dr Kuehhas focuses on the treatment of congenital and acquired penile curvatures (Peyronie’s disease). His research activities have resulted in many publications and improvements of surgical techniques such as the STAGE technique for congenital penile curvature treatment.