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Traditionally patients with Peyronie's disease (PD) and refractory erectile dysfunction (ED) or with complex curvature, mild ED and a short penis are offered penile prosthesis implantation in order to guarantee a penis that is straight and rigid enough to engage in penetrative sexual intercourse [1,2].

Although this technique is highly reproducible and yields excellent functional results in terms of rigidity and curvature correction, satisfaction rates in these patients are lower than those of the general implant population, as they are more likely to be dissatisfied with the size of their penis [3]. In particular, in a recent series, up to 54% of patients felt that surgery had led to further loss of length, and 48% were dissatisfied with postoperative penile length [4].

Similarly to penile prosthesis implantation, with or without additional straightening manoeuvres, the technique described in the present series led to adequate straightening of the penis in 97% of cases, and was associated with much higher satisfaction rates, as the technique does not cause any further shortening but instead guarantees a mean gain in length of 3.6 cm. Similar encouraging results with the same technique have already been described in a previous multicentre study [5].

The authors need to be congratulated for the excellent results achieved in the present series, especially in terms of satisfaction in such a difficult group of patients; however, length and girth restoration is a technically challenging and time-consuming procedure requiring a complete dissection of Buck's fascia and of the urethra and the use of grafts for tunical reconstruction. It is, therefore, potentially associated with a higher complication rate and should only be performed by experienced implanters.

The use of malleable prostheses in >70% of the cases in this series may be why the complication rates are low, as the procedure is simplified. Change to an inflatable variety can always occur at a later date with the length gain maintained.

Larger series will confirm the long-term reliability of simultaneous prosthesis implantation and penile length and girth restoration. In the meantime, this technique should be offered to those with severe penile shortening, but only after adequate counselling and only to highly motivated patients.

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