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Sliding & Slicing (Penile-Disassembly) Techniques for Peyronie's Disease

The sliding and slicing techniques are a family of penile-lengthening operations. They release the tunica albuginea, often with partial disassembly of the penis, to permit corporal lengthening. Original sliding bridges dorsal and ventral tunical defects with grafts; MuST distributes smaller incisions without interposition grafts.[2][3][12] Published prosthesis-associated series include men with severe erectile dysfunction and marked penile shortening, with or without Peyronie's disease (PD); complex deformity may be present, and malleable or inflatable prostheses have been used. In the original MuST cohort, 83/138 (60.1%) had PD.[2][3] They are among the most extensive operations in the PD reconstructive armamentarium. Glans hypoesthesia and, in the worst cases, glans necrosis are the complications tied to mobilizing the neurovascular bundle and glans.[1][2][3][4]

For the broader PD framework see the Peyronie's Disease overview and the AUA guideline.[7] For the standard plaque-incision and grafting alternative see Plaque Incision / Excision with Grafting.

Investigational positioning. The SMSNA 2024 position statement on cosmetic penile enhancement addresses sliding and slicing techniques. The SMSNA considers sliding and slicing investigational and recommends IRB oversight, experienced prosthetic surgeons, and counseling about potentially severe complications.[1] Counseling addresses glans hypoesthesia, partial necrosis and, in the worst case, glans loss. The EAU 2026 guideline goes further: it recommends against the sliding technique because of reported glans necrosis from concomitant release of the neurovascular bundle and urethra , and says that newer variants (MoST, MuST, multiple-incision technique) should be used only by experienced high-volume surgeons after full counseling. It also recommends against penile prosthesis, penile disassembly or sliding for men who simply seek lengthening .[8]

Conceptual Framework — What "Sliding" and "Slicing" Mean​

Both techniques release the tunica albuginea for corporal expansion. Original sliding covers its larger defects with grafts; MuST distributes the incisions and avoids interposition grafting.[2][3][12] The "sliding" and "slicing" labels refer to two different ways of releasing the tunica.

  • Sliding (Rolle 2012). The tunica is incised on the ventral and dorsal aspects, the corpora are "slid" apart to gain length, and the dual dorsal-ventral defect is bridged with two patch grafts (porcine small intestinal submucosa in the original report). An IPP is implanted simultaneously to splint the reconstruction. The original report described three patients (mean length gain 3.2 cm, follow-up 13 months).[2]
  • Slicing, multiple-slit technique (MUST; Egydio 2018). MuST uses multiple paired dorsal and ventral hemicircumferential tunical incisions, with small longitudinal slits where girth restoration is needed. Its distributed small defects avoid the interposition graft used in original sliding.[3][12] The intent is to avoid the glans ischemia risk of full disassembly. The originating series reported 138 patients (60% with PD; 103 malleable and 35 inflatable devices), a mean length gain of 3.1 cm at a median follow-up of 15.2 months, and one glans necrosis.[3]
  • Penile-disassembly technique (Perovic 2001). This is the historical antecedent. The corpora cavernosa are separated from the glans, neurovascular bundle and urethra, the deformity is repaired on the free corpora, and the structures are then reassembled. The original series (46 patients with PD, mean follow-up 27 months) reported complete straightening in 40/46 (87%), mild recurrent deviation in six, and postoperative shortening in 9%; incisional grafts used penile skin or saphenous vein.[4] It was described for severe deviation under the glans cap, hourglass deformity and multiple plaques.[4]
  • Egydio geometrical-principle relaxing incision (2004). This related single-incision approach uses geometric principles to determine incision shape. It is less extensive than full disassembly and lies between standard plaque incision and grafting and the sliding family.[5]

Indications​

The originating sliding and MuST series describe men with marked shortening and erectile dysfunction; the MuST cohort included men without PD.[2][3]

  • Severe penile shortening is a primary patient concern, in addition to curvature.
  • Complex deformity (hourglass, hinge or biplanar curvature) may accompany shortening, but the original three-patient sliding series included men without major curvature, and complex deformity was not required in the MuST cohort.[2][3]
  • Curvature with significant shortening was represented in the originating series; the EAU notes that the >60° definition of severe curvature has not been validated, and the MuST PD subgroup had a mean curvature of 55° (range 0–90°).[2][3][8]
  • Concurrent erectile dysfunction is treated with a penile prosthesis that also supports the reconstruction; the original sliding and MuST series used prostheses, including malleable and inflatable devices.[2][3][11]
  • The patient is counseled about glans sensory loss and ischemia.[1][8] In Wilson et al.’s 21-case glans-necrosis series, arteriosclerotic cardiovascular disease, diabetes, smoking, prior prosthesis explantation and radiation were frequent; the authors advise avoiding high-risk adjunctive maneuvers in prosthesis candidates with these factors.[13]

These techniques are not used for cosmetic length augmentation in men with normal anatomy and normal erectile function. For men with normal anatomy who seek length enhancement, the cosmetic male decision framework begins with objective measurement and assessment for penile dysmorphic disorder.[1][8]

Surgical Components — Common Steps Across Variants​

StepDetail
1. ApproachSubcoronal (degloving) incision allows full exposure of all aspects of the penile shaft and is the preferred approach when significant tunical work is anticipated. A trans-scrotal degloving route (a 4–5 cm ventral transverse scrotal incision, with distal dissection beneath superficial Buck's fascia to complete shaft degloving) has also been described and used for corporoplasty, including sliding/slicing techniques; in an 89-patient mixed corporoplasty series assessed through 3 months, no circumcision was required and investigators reported no preputial edema, skin necrosis or loss of glans sensitivity; six men had self-resolving sub-dartos hematomas. The single-center, developer-reported series did not compare the two routes head to head.[9][10]
2. MobilizationThe dorsal neurovascular bundle and urethra are mobilized off the tunica albuginea to the extent the chosen variant requires. Perovic disassembly is the most extensive; MUST is less extensive.
3. Tunical openingOriginal sliding uses two lateral longitudinal tunical incisions joined by dorsal and ventral hemicircumferential cuts; MuST uses multiple paired hemicircumferential incisions with short longitudinal slits for focal girth restoration; Egydio’s 2004 technique uses a single geometric relaxing incision.[2][3][5][12] A described MuST variant uses a meshed-graft pattern: transverse hemicircumferential tunical incisions connected by two longitudinal incisions, with interspersed cuts about 0.8 cm long made while a dilator applies tension from within the corpora, preserving the lateral neurovascular plexus during distal dissection; longitudinal incisions or a double-Y pattern have been added for hourglass deformity, and for severe calcified curvature a single larger incision at the point of maximal curvature, with additional smaller incisions added only if neurovascular-bundle length permits, has been described. This is an operative variant without its own comparative outcome data.[10]
4. Length gainAchieved by allowing the corpora to "slide" apart longitudinally under stretch / IPP cylinder expansion.
5. Defect coverageOriginal sliding used porcine small-intestinal submucosa grafts. The 28-patient extension used porcine SIS or acellular porcine dermis with inflatable devices and collagen-fibrin sponge with malleable devices. MoST uses fascial coverage; MuST disperses smaller tunical defects without interposition grafts.[2][3][11][12]
6. Prosthesis implantationA penile prosthesis is placed concurrently for erectile dysfunction and corporal support; published series used both malleable and inflatable devices.[3][11] For PD prosthetic surgery, AUA 2015 recommends an inflatable device .[7]
7. ClosureReconstitution of Buck's fascia and dartos; subcoronal skin closure.

Outcomes — Honest Framing​

Primary outcomes are mainly reported in small, developer-involved series.[14] A 2024 systematic review of 15 penile-length-preservation studies (1,186 recipients across several techniques) reported an overall postoperative complication incidence of 21.7% among 1,161 cases with complication data and functional outcomes in only five studies; the complication figure combines techniques.[14] No randomized trials compare sliding or slicing techniques with plaque incision and grafting alone or with grafting plus IPP. Reported outcomes include:[2][3]

  • Length restoration. Mean gains of about 3 cm were reported in the original sliding series (3.2 cm, n = 3 with PD)[2] and the mixed-etiology MUST series (3.1 cm, n = 138, 60.1% with PD; range 2–5 cm)[3]. Selection bias and the absence of independent replication limit these figures. A prospective multicenter international series of the sliding technique in 28 men with end-stage PD and severe shortening (three European tertiary referral centers, mean follow-up 37 months, range 9–60) reported a mean penile lengthening of 3.2 cm (range 2.5–4) with no late recurrence of the shaft deformity; postoperative complications were a transfusion-requiring bleed in one anticoagulated patient (3.5%, Clavien-Dindo II) and prosthesis infection requiring removal in 2 (7%, Clavien-Dindo III). This is a larger, developer-involved multicenter extension of the original series, without a comparison against plaque incision and grafting.[11]
  • Straightening. Originating series report straightening when combined with IPP.
  • Patient satisfaction is reported as high in the originating series. The 28-patient PD sliding study used the Peyronie's Disease Questionnaire alongside IIEF, Sexual Encounter Profile and EDITS; the mixed-etiology MuST series administered IIEF and EDITS.[11][3]

A 2020 systematic review of aesthetic augmentation phalloplasty in men without penile deformity (16 studies, 1192 patients, poor methodological quality) reported a pooled complication rate of 14.6% across all augmentation techniques. Combined length and girth procedures had the highest rate. The review included penile disassembly among other techniques, and its population was cosmetic rather than PD.[6]

Complications​

The complication profile supports performing these operations at specialized centers.

ComplicationNotes
Glans hypoesthesia / sensory lossAssociated with dorsal neurovascular bundle mobilization. Usually partial and transient, but persistent hypoesthesia has been described.
Glans ischemia / partial necrosisThe most serious complication, tied to the disassembly step. Neurovascular bundle and urethral mobilization may compromise glans perfusion. In a 21-case series of glans necrosis after penile prosthesis implantation, arteriosclerotic cardiovascular disease, diabetes, smoking, prior prosthesis explantation or radiation, subcoronal incision, and occlusive wrapping were common.[13] One glans necrosis occurred in the 138-patient MUST series.[3] A dusky glans after prosthesis placement warrants urgent evaluation for ischemia and consideration of immediate implant removal in patients with preoperative risk factors.[13] In a 21-case series of glans necrosis after prosthesis implantation, 17 men managed expectantly with the implant retained sustained significant glans loss, while four managed with immediate removal healed without sequelae.[13]
Wound dehiscence and graft lossReported in case series and managed with revision or staged reconstruction.
Erectile dysfunction (de novo or worsening)Graft-related veno-occlusive risk applies, as with standard plaque incision and grafting. When an IPP is implanted concurrently, the ED is treated at the same operation.
Recurrence of curvatureThe IPP cylinders support the reconstruction; comparative evidence has not established whether this lowers recurrence relative to grafting without IPP.[11][14]
Durability of restored lengthDurability remains uncertain; median follow-up was 15.2 months (range 6–36) in the mixed-etiology MUST series[3], and mean follow-up was 37 months (range 9–60) in the 28-patient sliding series[11].
Standard IPP-related complicationsMechanical malfunction, infection, erosion and fibrosis. Published series do not compare these rates with PD-IPP without disassembly.
Investigational positioning (SMSNA 2024)SMSNA 2024 considers sliding and slicing techniques investigational, recommends IRB oversight, and counseling reflects this.[1]

Where Sliding / Slicing Sit in the PD Surgical Algorithm​

ScenarioStandard pathwayWhere sliding / slicing fit
Stable PD with intercourse-limiting less-severe curvature without complex deformity, adequate erectile function and penile lengthTunica plication [8]Not indicated
Stable PD with adequate erectile function and intercourse-limiting severe curvature, complex deformity or inadequate penile lengthPlaque incision / excision + grafting[8]Not indicated
PD + ED refractory to medical therapy, mild–moderate residual curvatureIPP + manual modeling ± plicationNot indicated
PD + ED refractory + severe complex deformity + significant shorteningProsthesis with established adjunctive straightening, including plaque incision and grafting when neededEAU 2026 gives a strong recommendation not to use the original sliding technique because of life-changing complications such as glans necrosis. MuST/MoST are limited to experienced high-volume surgeons after full counseling; SMSNA calls sliding/slicing investigational under research oversight.[1][8]
Cosmetic length concern with normal anatomy and normal erectile functionCosmetic male framework: objective measurement and dysmorphic-disorder screening before indication-specific counseling[1][8]Not indicated: EAU 2026 recommends against sliding or penile disassembly for men seeking lengthening alone [8]

Counseling Essentials​

  • Expectations. Sliding and slicing operations have restored length in selected PD patients with severe shortening.
  • Glans ischemia is the principal safety concern and is discussed explicitly.
  • No randomized comparative data exist. The primary evidence consists largely of small developer-led series, including one prospective three-center sliding study of 28 men; there are no randomized comparisons.[2][3][11]
  • Research-setting care. SMSNA 2024 recommends these procedures only with IRB oversight, in research settings, by experienced prosthetic surgeons.[1]
  • Concurrent prosthesis placement treats severe erectile dysfunction and provides corporal support; the 138-patient MuST series used 103 malleable and 35 inflatable devices.[3]

See Also​

References​

1. Trost L, Khera M, Köhler T, et al. Cosmetic penile-enhancement procedures: an SMSNA position statement. J Sex Med. 2024;21(6):573–578. doi:10.1093/jsxmed/qdae045

2. Rolle L, Ceruti C, Timpano M, et al. A new, innovative, lengthening surgical procedure for Peyronie's disease by penile prosthesis implantation with double dorsal-ventral patch graft: the "sliding technique." J Sex Med. 2012;9(9):2389–2395. doi:10.1111/j.1743-6109.2012.02675.x

3. Egydio PH, Kuehhas FE. The multiple-slit technique (MUST) for penile length and girth restoration. J Sex Med. 2018;15(2):261–269. doi:10.1016/j.jsxm.2017.11.223

4. Perovic SV, Djordjevic ML. The penile disassembly technique in the surgical treatment of Peyronie's disease. BJU Int. 2001;88(7):731–738. doi:10.1046/j.1464-4096.2001.01350.x

5. Egydio PH, Lucon AM, Arap S. A single relaxing incision to correct different types of penile curvature: surgical technique based on geometrical principles. BJU Int. 2004;94(7):1147–1157. doi:10.1111/j.1464-410X.2004.05220.x

6. Vyas KS, Abu-Ghname A, Banuelos J, Morrison SD, Manrique O. Aesthetic augmentation phalloplasty: a systematic review of techniques and outcomes. Plast Reconstr Surg. 2020;146(5):995–1006. doi:10.1097/PRS.0000000000007249

7. Nehra A, Alterowitz R, Culkin DJ, et al. Peyronie's disease: AUA guideline. J Urol. 2015;194(3):745–753. doi:10.1016/j.juro.2015.05.098

8. EAU. Guidelines on Sexual and Reproductive Health, Limited Update March 2026, sections 8.2.3.b.3, 8.2.3.b.4 and 9.3.2.c.5.

9. Austoni E, Altieri VM, Tenaglia R. Trans-scrotal penile degloving, a new procedure for corporoplasties. Urologia. 2012;79(3):200–210. doi:10.5301/RU.2012.9211

10. Cavalcanti A, Affonso GB, Magalhães RR, Nava CO. Penile Length Restoration Surgery. In: Joshi PM, Aubé-Peterkin M, Kulkarni SB, Datar G, eds. Surgical Atlas of Urethroplasty. Springer; 2024:405–418.

11. Rolle L, Falcone M, Ceruti C, et al. A prospective multicentric international study on the surgical outcomes and patients' satisfaction rates of the 'sliding' technique for end-stage Peyronie's disease with severe shortening of the penis and erectile dysfunction. BJU Int. 2016;117(5):814–820. doi:10.1111/bju.13371

12. Roadman D, Feng C, Salkowski M, Levine LA. "A contemporary systematic review of penile lengthening procedures with penile prosthesis." Transl Androl Urol. 2024;13(4):596–612. doi:10.21037/tau-23-354

13. Wilson SK, Mora-Estaves C, Egydio P, et al. "Glans necrosis following penile prosthesis implantation: prevention and treatment suggestions." Urology. 2017;107:144–148. doi:10.1016/j.urology.2017.06.020

14. Falcone M, Preto M, Morgado AR, et al. "Risk and benefits of penile length preservation techniques during penile prosthesis implantation: a systematic review by the young academic urologists sexual and reproductive health working group." Ther Adv Urol. 2024;16:17562872231215177. doi:10.1177/17562872231215177