Tunical lengthening procedures refers to procedures where the plaque is either incised or partially removed and a graft material used to cover the defect. In the past surgeons have tried unsuccessfully to harvest tissue from other areas of the body to repair the defect. This technique lost popularity among surgeons because it involved removing tissue from another part of the body which in addition of being time consuming can result in complications of the donor or secondary surgical site.
The most common synthetic graft currently used by surgeons is called Tutoplast made by Coloplast. It consists of processed human or bovine pericardium.
Few patients however are candidate for tunical lengthening procedures because the indications for it are quite narrow. Patients must have severe PD with curvatures greater than 70 degrees, with severe narrowing and hinging of the shaft and very strong unassisted erections. In addition, patients must accept that narrowing of the penile shaft may persist after the repair with tethering and induration of the skin overlying the graft as well areas of numbness of the skin of the penile shaft and glans penis. Finally, the risk of post-operative ED is significant requiring use of oral ED drugs or placement of a penile implant. For these reasons, tunica lengthening procedures should only be performed by experienced PD specialists (less than ½ dozen in the world) in order to minimize these devastating complications. Tunical excision and grafting are very complicated procedures which require a lot of skill and experience, that very few doctors have (because of the low volume of patients that are candidates for it). There isn’t one published peer reviewed publication by experts in this field that has more than 100 patients. Tunical lengthening procedures are much more involved, invasive and complex than insertion of a penile implant for example and in my experience when patients have severe curvatures, penile implantation has a much higher success rate and overall patient satisfaction with much fewer complications.