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

The sliding and slicing techniques are a family of penile-lengthening operations that share a defining principle — partial disassembly of the penis followed by tunical-defect bridging with interposition grafts — performed almost exclusively in the setting of Peyronie's disease (PD) with severe deformity, hourglass / hinge / complex curvature, or marked length loss, typically combined with simultaneous inflatable penile prosthesis (IPP) implantation. They are the most aggressive operations in the PD reconstructive armamentarium and are reserved for specialized centers because the dominant complication — glans hypoesthesia or, in worst cases, glans necrosis — is uniquely tied to the disassembly step.^[1][2][3][4]

This page sits in the Peyronie's Disease subsection — these techniques have been moved out of the cosmetic atlas because the contemporary evidence base, society positioning, and patient population are PD-driven, not cosmetic. For the broader PD framework see the Peyronie's Disease overview. For the standard plaque-incision + grafting alternative see Plaque Incision / Excision with Grafting.

Investigational positioning

The SMSNA 2024 position statement classifies sliding / slicing techniques as investigational and recommends performance only in the context of clinical research and at specialized centers.^[1] Glans-related complications — hypoesthesia, partial necrosis, or in the worst case full glans loss — are the defining risk and are uniquely tied to the disassembly step. Patient counseling must explicitly address this risk.

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

Both techniques share the same underlying principle: the corpora cavernosa are disconnected from adjacent anatomic structures to allow expansion of the tunica albuginea, after which the resulting tunical defect is bridged with an interposition graft. The "sliding" and "slicing" labels refer to two different ways of releasing the tunica.

Sliding (Rolle 2012) — the corpora are separated from the glans / dorsal neurovascular bundle / urethra; multiple horizontal tunical incisions are made on both dorsal and ventral aspects; the corpora are then "slid" apart longitudinally to gain length; the dual dorsal-ventral tunical defect is bridged with two patch grafts; an IPP is implanted simultaneously to splint the reconstruction.^[2]
Slicing — multiple-slit technique (MUST; Egydio 2018) — the tunica is incised through multiple parallel transverse slits along its convex side without complete corporal-glans disassembly; the slits open under intracorporal expansion / IPP cylinder placement; the multiple small defects are bridged with a single sheet graft; this is intended to reduce the glans-ischemia risk inherent to full disassembly.^[3]
Penile-disassembly technique (Perovic 1998 / 2003) — the historical antecedent; originally described for severe PD with shortening, the corpora cavernosa are completely separated from the urethra and the glans / NVB are mobilized; the technique forms the conceptual platform from which the Rolle and Egydio variants evolved.^[4]
Egydio geometrical-principle relaxing incision (2004) — a related single-incision approach that uses geometric principles to determine incision shape; less aggressive than full disassembly; intermediate between standard plaque-incision-and-grafting and the sliding family.^[5]

Indications

Sliding / slicing techniques are reserved for the subset of PD patients in whom:^[2][3][6][7]

Severe penile shortening is a primary patient concern, in addition to curvature.
Complex deformity is present — hourglass, hinge, biplanar curvature — that is not adequately addressed by simple plication or single-axis grafting.
Severe curvature (typically > 60°) combined with significant shortening.
Concurrent erectile dysfunction refractory to medical therapy is present, because IPP implantation is performed concurrently to splint the reconstruction. Sliding / slicing as standalone non-prosthesis operations are uncommon in current practice.
The patient understands and accepts the higher complication risk — particularly glans hypoesthesia / ischemia — relative to standard plication or plaque-incision-and-grafting.

These techniques are not appropriate for cosmetic length augmentation in men with normal anatomy and normal erectile function, which was the prior cosmetic-atlas framing. Such patients are managed with the cosmetic male decision framework (penile traction therapy first, then SLD ± suprapubic lipectomy if anatomically indicated).

Surgical Components — Common Steps Across Variants

Step	Detail
1. Approach	Subcoronal (degloving) incision allows full exposure of all aspects of the penile shaft and is the preferred approach when significant tunical work is anticipated.
2. Mobilization	Dorsal neurovascular bundle and urethra are mobilized off the tunica albuginea to the extent required by the chosen variant — most extensive for Rolle sliding and Perovic disassembly, less for MUST.
3. Tunical opening	Horizontal slits (Rolle), multiple parallel slits (MUST), or geometric relaxing incision (Egydio 2004).
4. Length gain	Achieved by allowing the corpora to "slide" apart longitudinally under stretch / IPP cylinder expansion.
5. Graft interposition	Bovine pericardium, porcine SIS, collagen matrix, dermis, saphenous vein, or tunica vaginalis bridge the resulting defect(s).
6. IPP implantation	Performed concurrently to splint the reconstruction and address concurrent ED.
7. Closure	Reconstitution of Buck's fascia and dartos; subcoronal skin closure.

Outcomes — Honest Framing

The published literature is dominated by single-center case series from the surgeons who developed each variant. There are no randomized trials comparing sliding / slicing techniques to plaque-incision-and-grafting alone or to grafting + IPP. Reported outcomes generally include:^[2][3][6][7]

Substantial length restoration — often described in the range of 2–4 cm or more in carefully selected patients, with some series reporting up to ~ 50% gain. These figures should be interpreted with caution given selection bias and the absence of independent replication.
High straightening rates — when combined with IPP, reported straightening is generally comparable to other PD-with-IPP combinations.
Patient satisfaction is generally reported as high in the originating series, but non-validated outcome instruments are typical.

Vyas 2020 PRS systematic review of aesthetic augmentation phalloplasty reported a pooled complication rate of 14.6% across all augmentation techniques, with combined length + girth procedures carrying the highest rate.^[6]

Complications

The complication profile is what justifies the "specialized-center only" framing.

Complication	Notes
Glans hypoesthesia / sensory loss	The most common complication; tied to dorsal-NVB mobilization. Usually partial and transient, but durable hypoesthesia is reported.
Glans ischemia / partial necrosis	The defining catastrophic complication; uniquely tied to the disassembly step. Risk is highest with the Rolle sliding variant because of the most extensive NVB and urethral mobilization. Vascular compromise is a surgical emergency.
Wound dehiscence and graft loss	Reported in case series; managed with revision or staged reconstruction.
Erectile dysfunction (de novo or worsening)	The graft-related veno-occlusive risk applies, similar to standard plaque-incision-and-grafting, with reported rates of 10–25%. When IPP is implanted concurrently, the procedure addresses ED at the same time.
Recurrence of curvature	Lower than non-IPP grafting because the IPP cylinders splint the reconstruction.
Length loss over time	Despite initial gains, long-term follow-up may show partial loss of restored length.
Standard IPP-related complications	Mechanical malfunction, infection, erosion, fibrosis — at rates similar to PD-IPP without disassembly.
Investigational positioning (SMSNA 2024)	All sliding / slicing techniques are formally investigational; counseling must reflect this.^[1]

Where Sliding / Slicing Sit in the PD Surgical Algorithm

Scenario	Standard pathway	Where sliding / slicing fit
Curvature ≤ 60°, intact EF, no shortening concern	Tunica plication	Not indicated
Curvature > 60° or complex deformity, intact EF	Plaque incision / excision + grafting	Not indicated
PD + ED refractory to medical therapy, mild–moderate residual curvature	IPP + manual modeling ± plication	Not indicated
PD + ED refractory + severe complex deformity + significant shortening	IPP + plaque-incision-and-grafting (PICS) or sliding / slicing technique at a specialized center	Considered — Rolle sliding / Egydio MUST when shortening is the dominant patient complaint and standard PICS is judged inadequate
Cosmetic length augmentation in a man with normal anatomy and normal EF	Cosmetic male framework — PTT first, then SLD ± suprapubic lipectomy	Not indicated — these techniques are not for the cosmetic patient

Counseling Essentials

Realistic expectations. Sliding / slicing operations restore length in carefully selected PD patients with severe shortening; they are not cosmetic operations.
Glans-ischemia risk is the defining safety concern and must be discussed explicitly.
No randomized comparative data exist. The published evidence is single-center case series from the originating surgeons.
Specialized-center care. SMSNA 2024 endorses these procedures only in clinical-research contexts and at specialized centers.^[1]
Concurrent IPP is the contemporary standard — splints the reconstruction and addresses the refractory ED that typically accompanies the indication.

References

1. Trost L, Watter DN, Carrier S, 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.2017.11.222

4. Perovic SV, Djordjevic ML. The penile disassembly technique in the surgical treatment of Peyronie's disease. BJU Int. 2003;91(6):514–519. doi:10.1046/j.1464-410x.2003.04094.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.2004.05221.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

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

Indications​

Surgical Components — Common Steps Across Variants​

Outcomes — Honest Framing​

Complications​

Where Sliding / Slicing Sit in the PD Surgical Algorithm​

Counseling Essentials​

See Also​

References​