TY  - EJOU
AU  - Soares, Giulia Almiron da R. 
AU  - Kelebeyev, Saveliy 
AU  - Loyola-Nieto, Fernando 
AU  - Lindenbaum, Marcelo Mass 
AU  - Bole, Raevti 
AU  - Bajic, Petar 

TI  - Beyond grafting: a systematic scoping review on tunica-preserving surgical innovations for Peyronie’s disease
T2  - Canadian Journal of Urology

PY  - 
VL  - 
IS  - 
SN  - 1488-5581

AB  -  <b>Backgrounds:</b> Peyronie’s disease (PD) leads to penile curvature, deformity, and shortening, which can significantly impair sexual function and quality of life. Conventional surgical approaches may correct curvature at the expense of penile length or erectile function. Multiple-incision-based, tunica-preserving non-grafting (TPNG) techniques, including the auxetic technique, tunical expansion procedure (TEP), and deep grid incision technique (DGIT), have recently emerged as reconstructive strategies that promote controlled mechanical expansion of the tunica albuginea. This systematic scoping review aimed to evaluate recent incision-based TPNG techniques for PD, focusing on their biomechanical rationale, technical features, reported clinical outcomes, safety profile, and current evidence limitations <b>Methods:</b> A systematic scoping review of PubMed, Cochrane and Embase was conducted to identify recent tunica-preserving technique innovations for PD treatment from 2020 to 2025. <b>Results:</b> All studies were case series. TEP showed the largest recovery of penile dimensions, with mean length gains of approximately 2.8–3.3 cm and additional girth improvement, including a mean increase of 1.6 cm in modified scrotal approaches. DGIT produced smaller but durable length gains of about 1.9 cm at three years, even in patients with complex deformities such as hinge and hourglass. Auxetic techniques achieved more modest but consistent length gains of approximately 1.4–1.5 cm, while also enabling circumferential tunical expansion and effective curvature correction. Functional outcomes were generally favorable across techniques, although reporting was variable. <b>Conclusions:</b> Tunica-preserving, incision-based techniques represent a meaningful advance in the surgical management of PD by enabling curvature correction while minimizing the size of individual defects, reducing the need for grafting, and minimizing the risk of cylinder herniation. However, outcomes remain dependent on deformity severity, tissue compliance, and postoperative rehabilitation. Larger multi-center comparative studies are needed to define optimal indications and postoperative protocols to optimize long-term outcomes.
KW  - Peyronie’s disease; tunica albuginea; tunica expansion; auxetic technique; deep grid incision

DO  - 10.32604/cju.2026.080759