Peyronie's disease is a poorly understood scarring condition of the tunica albuginea that often causes pain and deformity of the penis. When Peyronie's disease is present predominantly unilaterally, bending of the penis to 1 side occurs. With bilateral or circumferential disease the tunica albuginea does not expand, and penile shortening and/or narrowing occurs. We performed unilateral or bilateral penile lengthening procedures on 22 patients with penile shortening due to Peyronie's disease who refused a procedure, such as tucks or the Nesbit operation, that might result in further penile shortening. Five men underwent incision of the plaque and dermal patch without implantation of a penile prosthesis, while 8 underwent penile implantation plus incisions in the tunica albuginea without patches, and 5 underwent circumferential incision of the tunica albuginea and its septum with patching and placement of a penile implant. (Average length gain with circumferential incision was 1.5 inches with this procedure.) There were 18 patients available for followup: 1 had penile skin slough secondary to a compression dressing, 2 required removal of the implant and replacement at a later date, and 2 had progressive penile shortening after dermal patch requiring subsequent prosthesis implantation. Penile lengthening procedures to correct functionally significant penile shortening can be performed successfully, although significant complications were experienced.