Objectives: Implant with grafting is the gold standard approach to men with severe curvature and concurrent severe erectile dysfunction. Hatzichristodoulou et al have shown excellent results with the use of Tachosil, an equine graft coated with fibrinogen and thrombin that is self-adherent and does not require suture fixation for Peyronie’s repair without implant. We review our initial series of patients who received a Tachosil graft in addition to an IPP, an expeditious approach that obviates possible device puncture. Methods: Surgical technique involved a circumcision incision without or without separate peno-scrotal incision for implant placement. The IPP (Coloplast Titan) was placed first and inflated to reveal true degree of curve (often greater than preoperative Doppler curve assessment). The dartos layer was dissected off and preserved providing coverage of the tachosil graft. The neurovascular bundle was next elevated if necessary which often resulted in significant dorsal curve improvement. Plaque incision(s)/partial excisions were performed at the point(s) of maximum deflection. Upon re-inflation the new enlarged defect was covered with a tachosil graft. The tachosil was then molded to the penis and covered with previously preserved dartos layer. A catheter and compressive dressing are left overnight. The device was left inflated for 4 weeks following the procedure. Results: Ten patients underwent IPP with tachosil graft. Average age of patients was 56. The average pre-operative curvature was 70 degrees (45-120) on doppler. Curvature was multiplanar dorsolaterally (left) in 8/10 patients. Average operative time was 195 minutes with < 100 ml of blood loss. Mean follow up time is 8 months. To date, all patients are using their prostheses for intercourse with no infections or signs of device aneurysm. Curvature correction was < 30 degrees in 7/8 patients with one patient with residual 40 degree leftward curvature with max inflation. 8/10 patients have leftward deflection with the device uninflated. Two patients had Xiaflex injections prior to their procedure which did not appreciably influence the difficulty of the case. Conclusions: Our preliminary results reveal Tachosil to offer a feasible, fast and safe alternative to grafting with IPP that does not require the graft to be sewn in place.