German Center for Urology and Phalloplasty Surgery

Congenital curvature of the penis

Surgical treatment options for curvature of the penis and our technique

Existing surgical techniques

There are basically four different surgical techniques that exist for treating curvature of the penis. We refuse to perform three of them, (techniques 1 – 3), as we are of the opinion that they are detrimental to patients.
However, for the sake of elucidation, we will explain all four methods to you. You will find them described below, along with our reasons for not performing specific techniques. We would like you to be able to make your decision freely on the basis of logic.

1st technique: Tucking techniques according to Nesbit, Essed-Schröder or Devine

To our disappointment, these are the techniques that most German doctors continue to perform. They are quick and easy to perform and require very little specialist knowledge. We cannot comprehend why patients continue to undergo these techniques even in this day and age.

In this technique, the healthy longer side is pulled and tucked using stitches, thereby shortening the penis. It is not uncommon for this to result in painful erections, particularly among younger patients, while this was previously not the case. Additionally, the strength of the erections can cause the stitches to tear after a short time.
Occasionally the surgeon tucks too much tissue, resulting in a curvature in the opposite direction and necessitating a further operation on (and additional shortening of) the penis. In most cases, the patient must remain in the hospital 5 to 7 days following this surgery so that the treating physicians can use medication to ensure as far as possible that the sutures do not tear during the first strong erections during this initial healing phase.

Moreover, cases of congenital curvature of the penis have more of an arced shape that affects the entire penis and cannot be straightened with a single purse-string suture, in contrast to an acquired curvature of the penis, in which the penis is generally bent at a sharp angle. Several purse-string sutures are therefore involved, leading to increased shortening.

2nd technique: Cross cuts/incisions with subsequent covering of the deformity with a saphenous vein graft or with artificial graft material

In this technique, the surgeon makes an incision into the shorter corpus cavernosum, allows the penis to expand and then covers the incision with a saphenous (vein) graft or a ‘patch’ (usually fascia tissue). Even though these techniques are definitely a more modern approach than the tucking technique, they are still incomplete from our perspective. The sole benefit is that the shortening of the penis is less pronounced.

3rd technique: Insertion of a (generally hydraulically-driven) penile prosthesis

Thankfully, this technique is only rarely employed. A prosthesis is inserted into the penis to maximise the tissue’s potential expansion. The results of this technique are final and irreversible, because the actual erectile tissue is effectively destroyed by the insertion of the prosthesis. The pump it uses then substitutes the normal erectile function.
The insertion of a prosthesis merely for the treatment of curvature is to be strictly rejected.

4th technique: Surgical reconstruction of the shorter corpus cavernosum

This is the surgical technique we employ to effectively treat curvature of the penis.
We reconstruct the affected parts of the corpora cavernosa through a highly involved surgery using non-artificial materials (usually high-quality collagen fleece).

According to our experience, this procedure is the only logical and sensible therapy option in the vast majority of cases.

It results in no visible scars on the penis. The scar is located in the same place as the circumcision scar so it is not noticeable on circumcised men. In rare cases it may be required to perform a simultaneous circumcision when the foreskin has become so narrow and restrictive that it could otherwise impair the results. We do not feel that generally performing circumcisions is sensible. An experienced surgeon can successfully retain the foreskin while avoiding the risk of infection or paraphimosis.

Due to the degree of difficulty involved, this technique can only be offered with satisfactory results in a few clinics in Europe that possess sufficient experience.

This technique was established over 20 years ago, so it is by no means new.

Our doctors have specialised in this technique, refining and further developing as they have performed it over the past 15 years. We are generally capable of satisfactorily treating cases that have even been pronounced irredeemable by other doctors.

We will be glad to provide you with information in a detailed and non-binding consultation on the options available for your specific case.

We are pleased that the majority of patients have grasped the benefits that our treatment offers. Our patients have tripled since 2006.

Basic information on our work / results

  • We are a competence and reference centre for reconstructive therapy for congenital curvature of the penis.
  • Over 2,000 cases have been treated by us so far.
  • We are leaders in the surgical technique.
  • No shortening of the penis is caused by our technique.
  • Our success rate is over 90%.
  • We have specific experience in treating difficult cases and in corrective surgery for previous

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How congenital curvature of the penis originates

The penis consists of three so-called ‘corpora cavernosa’, sponge-like columns of erectile tissue that fill with blood during an erection, making them expand and become hard.

Viewed from above, there is one corpus cavernosum stretching along each side of the penis, while the third, which also includes the glans penis, is situated below and between them.
If one corpus is shorter than the other corpora or if one side of the penis is shorter than the other side overall, it causes the penis to curve towards the shortened side when erect.

There are two types of congenital curvature of the penis: it is either already present at birth or develops during puberty (called atrophy of the corpora cavernosa), meaning that the corpora cavernosa grow to different sizes/lengths during puberty.

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Why should you have your operation performed by us?

So that your penis does NOT look like this after the operation:

Complications after surgery on the penis

A chief surgeon in a university hospital personally operated on this patient. The penis had to be nearly completely amputated afterwards due to complications.

After long and careful consideration we have decided to only show this SINGLE photo. There are many patients like this who have turned to us seeking help.

Unfortunately the most common thing patients say to us is, ‘If only I had come to you first!’

This is true in two respects: Firstly we would like to prevent such procedures to the greatest extent possible and secondly it is not possible for us to operate on patients after they have already undergone poorly performed prior surgery and to achieve results that are as good as if the operation had been performed by us from the start.
Once the penis has had to be partially amputated then it is gone forever.

3 other facts about us:

  1. Scientific reasons why you should have your operation performed by us
  2. Common sense reasons why you should have your operation performed by us
  3. Other benefits we offer

1. Scientific reasons why you should have your operation performed by us:

  • We have the most extensive surgical experience in Europe.
  • Our procedure is described as the ‘preferred’ method in the European guidelines (see the guidelines under ‘Surgical Treatment Options’).
  • The highest social court has now finally defined 50 operations per year as the MINIMUM quality requirement for highly specialised surgeries (Docket number: B 3 KR 10/12 R). If this number were also legally required in order to perform surgeries treating curvature of the penis, which it unfortunately is not (yet), then 95% of all hospitals would no longer be allowed to operate on patients with curvature of the penis at all!

As you can clearly tell from this decision, there is definitely a reason why we keep mentioning our experience and repeatedly warn against undergoing surgery performed by unpractised hands. According to internal surveys of one transplant manufacturer there is virtually NO university hospital that performs more than 10 surgeries of this type per year and no city hospital or similar facility at all performs that many.
A doctor’s title (e.g. Professor) or position (e.g. Head of Urology) does not say anything at all about that doctor’s qualification to perform a specific surgery. The doctor can hold this title without even having performed the respective surgery a single time!
It is very unfortunate that there is so often still dishonesty regarding a doctor’s purported skills and number of cases handled.

If you follow the Internet and publications for a while you will find that there are ‘suddenly’ more and more homepages, doctors’ associations, purportedly neutral sources of information, pseudoscientific articles, etc. including the topic of induratio penis plastica. Some doctors’ and clinics’ homepages are ‘suddenly’ describing our surgical technique, even though it is not even performed there at all.

2. Common sense reasons why you should have your operation performed by us:

For patients it is repeatedly one of the most difficult tasks to seek out the right doctor and correct therapy. If you visit four doctors you will normally get four different opinions that are all explained in such a way that they sound completely logical in their own right because each doctor is trying to sell the method that they personally use.
This usually means that the patient has not become any more knowledgeable from such consultations.

Luckily there are illnesses whose structure is so easy to understand that no medical degree is required to understand them and common sense is perfectly sufficient and constructive: Such is the case with induratio penis plastica (IPP):

In this illness the seat of the disease is a plaque in the penis that is responsible for the widest variety of symptoms (curvature, retraction, shortening, erectile dysfunction, etc.). Certainly logic and common sense dictate that the only sensible therapy for this illness lies in removing the seat of the disease, not in leaving it in place and doctoring around with another area of the penis in the hope that this will somehow generate an improvement such as with tucking techniques (Nesbit) or incisions.
This would be as if a person came limping in on his right leg and instead of treating the right leg they just kicked him in the left leg so that he would at least limp evenly.

Hospitals, speciality departments and doctors that are angry about the fact that we perform better work all too often tell their patients that we perform this technique in order to earn more money. The truth is exactly the opposite.
We are a centre specialised in surgical therapy. Naturally we could also perform the much simpler techniques involving tucking or incisions. These are so much simpler that they would also be much less expensive to perform because they would take much less time, far fewer staff members and much less specialisation of the staff. We could also perform these simple techniques in the more modest operating rooms of a public hospital and would not have to bother with a private clinic.
We would therefore earn much more if we were to perform these simpler techniques. Patients would still come to us despite this simply due to our extremely extensive experience.

This means that we actually perform a highly complex technique yet earn much less in the end than we would have from the simpler techniques. The only reason why we do this is that the removal of the seat of the illness performed by us is much more sensible, delivers much better results for patients and actually treats the illness itself.

We became doctors to treat ill patients, not simply to tinker around with them.

3. Other benefits we offer

  1. It is not just any chief surgeon but rather one of the top specialists who (always personally) performs this therapy for us in Europe. This is a basis for a perfect result!
    Even poorly trained and unspecialised medical assistants operate in public hospitals. Even private patients often do not have their operations performed personally by the chief surgeon at all!
  2. Our operations are performed by out highly trained team of top specialists.
  3. Excellently trained anaesthesiologists handle our anaesthetisations. They are especially gently and comfortable for the patient.
  4. Only the best and most advanced materials are used.
  5. We select implants and substitute materials solely on the basis of their benefit for the patient and are not subject to any limitation imposed by the hospital administration or insurance company.
  6. We operate exclusively in high-quality fully private clinics and this has very decisive benefits for patients:
  • Specially furnished operating rooms with excellent hygiene. A highly dangerous bacterial infection has NEVER occurred in our operations. Such infections are a part of the daily routine in public hospitals. According to official statistics around 30,000 patients die each year in such hospitals and there is also a high estimated figure of such deaths that are unreported.
  • There is an entire armada of staff in the operating room for both the surgical procedure as well as for hygiene.
  • A massive array of caregivers and nurses are at the station so that our patients always receive the best care.
  • Things are never hectic and there are no time restrictions of any sort.
    In public hospitals there is sometimes such detrimental hecticness that cancer patients sometimes even have the healthy lung removed instead of the cancerous one and die from this, for example. There are unbearable conditions even in some University hospitals.
    We spare our patients those types of things.
  • And much more.

We thereby offer optimal medical care targeted exclusively at the benefit of the patient.

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Additional information

Preparation for an operation

Around 3 weeks prior to your appointment you will receive an unmarked envelope by post containing your confirmation documents.

  • Once you have confirmed your appointment with us, please refrain from smoking and drinking alcohol for 14 days prior to the operation. This is not a general statement but rather has a decisive effect on your results. Smoking significantly worsens the healing process for wounds by constricting the blood-vessel walls, while alcohol has a negative effect on the body’s metabolism.
  • 10 days before the operation you must cease taking any aspirin, ASS or other blood-thinning medications. These medications increase the risk of bruising (haematomas) and unpleasant swelling occurring.
  • You will have a detailed consultation with one of our doctors, during which there will be ample time for all of your questions to be answered. However, you should also definitely read our description of the operation beforehand in preparation.
  • You must refrain from drinking or eating anything for 6 hours before your surgery on the day of your appointment. This also applies for procedures using local anaesthesia.
  • You will then be prepared for the operation, which includes receiving an mild tranquillizer and painkiller in advance.
  • The operation itself is performed in a relaxed environment. There is no need to feel anxious, as you will not feel any pain, while the carefully selected medication you are given will ensure you will rapidly recover after the operation with no lingering unpleasant memories of it.
  • Normally you may return home after around 1-2 hours (following ambulatory surgeries). However, because you are not permitted to drive a car for the next several hours due to the medication you have received and because many of our patients arrive from quite a distance, we would advise you to spend the night in a nearby hotel (which would be cheaper than staying in the clinic)..
  • You absolutely must bring another person with you for ambulatory surgeries.

Treatment guarantee

For your own security and in full confidence of the outstanding results and quality we provide, as of 1 July 2008 all of our patients are protected by our treatment guarantee.

Any unplanned treatments and surgeries that may prove necessary will be performed by us at our location free of charge. This guarantee is valid for a period of one year after the final operation we performed.

(There is a restriction on this in Germany: As it is illegal in Germany to perform medical services at absolutely no cost, we are legally required to still charge you a minimal fee. It will approximately correspond to the actual costs for materials and medications.)

Additional benefits generally available to our patients:

  • Our surgeries are performed exclusively by highly qualified specialist surgeons with many years experience, all of whom had their qualifications scrutinised in detail before being appointed/selected.
  • A detailed consultation on the options, limitations and risks involved will take place in the pre-operative discussion.
  • The treatments are naturally carried out using the most technically advanced equipment.
  • The members of the medical staff in the operating theatre and for post-op care are highly qualified.
  • We use modern, gentle anaesthesia procedures.
  • The materials and medications used are of the highest quality.

All patients who have their initial surgery performed by us are welcome to obtain post-op examinations and advice from us at any one of our centres free of charge. This offer is valid for a period of one year after the final operation we performed.

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At our centre in Germany

Clinic services including overnight stays, care, materials, medications: about EUR 11.000,-
Anaesthesia + staff: about EUR 1.200,-
Chief surgeon, assistant + staff: about EUR 3.400,-
Total materials for the surgery: about EUR 800,-
Proportional value-added tax: about EUR 2.100,-
about EUR 18.500,-

At our centre in Palma de Mallorca, Spain

Around EUR 11,900.

The difference in price results from the different cost structures in Spain. The quality of the medical service is identical.

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Procedure & contact

You can relax knowing you have placed your query in the hands of our experienced secretarial staff. Their extensive training enables them to offer you optimal care and to coordinate all other details. Contacting us is the only thing you need to do yourself and the staff will take care of everything else for you.

Our staff will be happy to arrange an appointment for a private meeting including an examination for you. These pre-operative discussions are without obligation and are always conducted by our in-house specialist for your particular query. We offer you highly qualified medical consultation and treatment right from the start.

Your consultant

Image of Axel Birnbacher

Mr Axel Birnbacher will be glad to handle your query:

You can reach us
Monday - Friday
9:30 am - 12:30 pm
1:30 pm - 5 pm

+49 6151 606 10 34

Contact us

Contact us

You are also welcome to send us your query using our online form. However, please note that we are unable to provide advice by e-mail. Please only use this method of contact for asking general questions or requesting a return call. Thank you.

Please understand that we receive a high number of queries due to the quality of our work so that long wait times for appointments unfortunately cannot be avoided.

By submitting your request, you agree that we store and process your data for the purpose of processing your request. The legal basis for the storage is § 26 Abs. 1 BSDG-new and Art. 6 Abs. 1 f) DSGVO. Further information can be found in our privacy policy.

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Get in touch
Axel Birnbacher

(english speaking)
Plastic surgery office

+49 6151 606 10 34

+49 6151 606 10 34

Monday - Friday
9:30 am - 12:30 pm
1:30 pm - 5 pm

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