Everything Patients Need to Know About Peyronie’s Treatments

Patients may have questions about their options for managing and treating Peyronie’s disease. According to most urological societies, providers are advised to inform patients of their options to the fullest extent possible. Meaning, informing patients about risks, benefits, and efficacy of each option available, whether they’re experimental or not. In order to inform patients to the fullest extent, it’s important to know about each available option. This article intends to outline the basics of each option, including potential risks, benefits, and efficacy, with regard to AUA and CUA recommendations.

Non-Surgical Options

Only a few non-surgical practices have been approved by both the AUA and CUA for clinical use. Multimodal methods should be considered for better chances of efficacy.

• Collagenase intralesional injections have a moderate recommendation. This involves injecting through the most acute area of fibrous plaque, laterally, accompanied by both clinician manual modelling, and at-home modelling. This method should only be recommended for patients with a curvature over 30°, with good erectile function a stable disease state, and the presence of non-calcified plaque on ultrasounds. Potential complications include penile bruising, swelling, pain, failure of treatment, and (very rarely) corporal rupture. Generally, this method has resulted in patient satisfaction rates of about 50-67% and can result in improved curvature, but not necessarily improved length.
• Verapamil injections have a weak, conditional recommendation. Some studies have shown some potential benefits to curvature and pain while others have not shown much improvement. There are fewer studies available, but it is generally a well-tolerated procedure with limited side effects such as penile bruising and swelling.
• Penile traction has a Grade C recommendation by the CUA and is included in the AUA’s Core Curriculum on Peyronie’s Disease as a reasonable clinical trial option. This involves the patient wearing a device for a minimum of 30-90 minutes per day, typically for about 3 months, although there is no standardized method. If patients cannot fully commit, then it is not recommended that they use this method. This may be recommended for those in both the acute and chronic phases of Peyronie’s disease, but found to be most helpful when used early, and best when used in combination with other methods. Most studies have reported an average improvement in curvature of roughly 33%, with patients reporting improvements in penile length, curvature, and successful sexual intercourse with no adverse effects.

Surgical Options

All surgical options are well-informed with moderate recommendations by both the AUA and CUA. Surgery is the most consistent way to fully straighten the penis, but surgery does have the potential for side effects. Also, some patients prefer to exhaust less invasive options before considering surgery and others may not be willing to consider surgery at all. Surgery is generally considered when patients are in the stable or chronic phase.

• Penile plication is best for patients with good erectile function and pre-operative penile rigidity without medication, and with an uncomplicated curve between 30° and 60° with no significant deformity. Patients should be aware that this surgery may reduce the perceived length of their penis in matching the length of the shortened side, as well as present the potential for penile instability, pain, persistence or recurrence of curve, hematoma, urethral injury, and/or sensory loss. Patients should avoid sexual activity for 4-6 weeks after surgery.
• Plaque incision or excision with grafting is best for patients with normal erectile function with or without medication, complex penile curvature of less than 60°, large plaque(s), short penile length, and other deformities. Post-operatively, patients may need assistance via vacuum erection devices, PDE5 inhibitors, and penile traction to help minimize loss of length and potential resulting erectile dysfunction. Other complications may include infection requiring graft removal, hematoma, pain, and recurrence of curvature.
• Penile prosthesis placement is recommended for Peyronie’s disease when significant erectile dysfunction is present. The prosthesis may be performed in combination with other procedures such has manual modeling (bending), plication, or incision/grafting. Providers should establish if patients would prefer a completely straight penis, or if the functionally straight measurement of 20° is acceptable. Patients should be aware of complications such as infection, mechanical failure, and risk of corporal perforation. Generally, penile curvature should improve over time with repeated activation of the device.

Conclusion

It’s important to be aware of the endorsed options available to patients seeking therapy or management of Peyronie’s disease. Some methods are more effective and have stronger recommendations than others. Be wary of those that are still in clinical trial phases and always be sure to inform patients of this factor, as well as of any complications that accompany their options. Inform patients about their options based on clinical assessments and disease progression, as not all options are suitable for all patients.

References:

2018 Canadian Urological Association guideline for Peyronie’s disease and congenital penile curvature. View of 2018 Canadian Urological Association guideline for Peyronie’s disease and congenital penile curvature. (2018). https://cuaj.ca/index.php/journal/article/view/5255/3656

Peyronie’s Disease (2015). Peyronie’s disease guideline - american urological association. (2015). https://www.auanet.org/guidelines-and-quality/guidelines/peyronies-disease-guideline

Sandean, D. P., Leslie, S. W., & Lotfollahzadeh, S. (2024, October 6). Peyronie disease. StatPearls [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK560628/