The aim of the study was to present the selection criteria for surgical techniques for the treatment of patients with Peyronie's disease. A total of 55 men with Peyronie's disease were surgically treated. We created specific criteria for selection of the appropriate surgical technique. All patients had a stable disease for 6 months and impossible vaginal intromission. All patients had subjective (as reported by the patient) and/or objective normal penile rigidity (as observed after intracavernous administration of alprostadil). Also, they all underwent drug therapy, which was unsuccessful. Among them, 40 patients with penile curvature of <60 degrees and erect penile length of >13 cm underwent Nesbit's operation, whereas plaque excision and grafting with polytetrafluoroethylene patch was performed in 15 patients with penile curvature of > or =60 degrees and/or erect penile length of < or =13 cm. At a mean (+/-s.d.) follow-up of 81.1+/-33.8 and 78.7+/-32.8 months, respectively, straightening of the penis was achieved in 35 out of 40 (87.5%) and 12 out of 15 (80%) patients, respectively, whereas erectile dysfunction developed in two out of 40 (5%) and one out of 15 (6%), respectively. Shortening of the penis occurred in all 40 patients undergoing Nesbit's operation, and in none of the patients undergoing plaque excision. Six out of 40 (15%) patients undergoing Nesbit's operation reported subjective perception of penis shortening, whereas none of the patients undergoing plaque excision complained of this discomfort. In conclusion, we recommend the selection of surgical technique based on penile length and degree of curvature. Nesbit's operation is an appropriate surgical technique for the treatment of patients with erect penile length of >13 and deviation of <60 degrees , whereas the plaque excision and grafting with polytetraflouroethylene patch is a technique of choice in the treatment of patients with erect penile length of < or =13 and/or deviation of > or =60 degrees.