Peyronie’s plaque is scar tissue that forms in the tough outer layer of the penis, and getting rid of it depends on how far the disease has progressed. In the early, active phase, treatments focus on slowing plaque growth and managing pain. Once the disease stabilizes, typically after 12 to 18 months, options range from injectable enzymes that break down the scar tissue to surgery that removes or releases it. No single pill dissolves the plaque entirely, but a combination of approaches can significantly reduce curvature and restore function.
Why the Phase of Disease Matters
Peyronie’s disease moves through two distinct stages, and the right treatment depends on which one you’re in. The active phase is marked by pain during erections, changing curvature, and a plaque that’s still forming. You might notice the bend getting worse over weeks or months, or new deformities appearing, like an hourglass shape or indentation. Surgery and aggressive injectable treatments are generally not recommended during this phase because the plaque hasn’t finished developing.
The stable phase begins when pain has resolved and the curvature hasn’t changed for at least three to six months. At this point, the plaque has matured, and your options open up considerably. Ultrasound imaging can help clarify where things stand. It detects calcified plaques with 100% sensitivity and precisely maps the number, size, and location of lesions. Calcified plaques tend to respond less well to injections and may point toward surgical correction instead.
Injections That Break Down the Plaque
The most studied injectable treatment uses an enzyme called collagenase (brand name Xiaflex), which directly breaks down the collagen fibers in the scar tissue. It’s the only FDA-approved injection specifically for Peyronie’s disease. Treatment involves a series of injection cycles, each followed by a gentle manual straightening procedure performed in the office about 24 hours later. A full course is up to four cycles spaced roughly four weeks apart.
The results are meaningful but not a complete cure. Clinical trials show an average curvature reduction of about 34%. Patients who completed the full four-cycle course saw better results, averaging a 17.7-degree reduction, which translates to roughly 46% improvement. Beyond straightening, about 29% of patients reported improved ability to have intercourse, and over half were able to achieve penetration after treatment. Bother and distress scores dropped by over 40% in real-world use.
Other substances, including a blood pressure medication (verapamil) and an immune-signaling protein (interferon), have been injected directly into plaques off-label. Evidence for these is weaker, and current guidelines are less definitive about recommending them compared to collagenase.
Oral Medications
Oral treatments for Peyronie’s plaque exist, but expectations should be modest. Pentoxifylline, a drug that improves blood flow, has shown some ability to increase collagen breakdown and reduce scar formation in lab studies. A small randomized trial found it moderately reduced curvature and plaque size in early-stage disease. Another option, colchicine, works through anti-inflammatory pathways.
In practice, neither drug has shown consistent, significant plaque reduction. One comparative study found no meaningful difference in plaque size between patients taking pentoxifylline and those taking colchicine. Both are considered low-cost, low-risk options that may help most when combined with traction therapy, but they’re unlikely to eliminate established plaque on their own.
Traction Therapy
Penile traction devices apply a gentle, sustained stretch to the penis over weeks and months. They work by remodeling tissue gradually, similar to how orthodontic braces shift teeth. The commitment is significant: study protocols typically require wearing the device for 2 to 8 hours per day over 3 to 6 months. Some post-surgical protocols push this to 8 to 12 hours daily for at least four months.
Traction won’t dissolve plaque, but it can reduce curvature and counteract the shortening that Peyronie’s disease causes. It’s often used alongside injections or oral medications to improve results, and after surgery to preserve length during healing. The key factor is consistency. Patients who wear the device for more hours per day tend to see better outcomes.
Shockwave Therapy
Low-intensity shockwave therapy sends acoustic pulses into the plaque. It’s widely marketed for Peyronie’s disease, but the evidence tells a more nuanced story. The treatment is genuinely effective for pain: studies show pain disappearance in 53% of treated patients versus 7% in placebo groups, and one trial found an 85% reduction in penile pain compared to 48% with placebo.
For the plaque itself, the picture is less encouraging. Early studies suggested curvature improvements of 21% to 74%, but more rigorous randomized trials found less than 10 degrees of actual change compared to controls. International expert panels have concluded that while shockwave therapy reliably improves pain, there is no strong evidence it decreases curvature or plaque volume. If pain is your primary concern during the active phase, it’s a reasonable option. If your goal is plaque elimination, it’s not the right tool.
Surgical Options for Stable Disease
Surgery offers the most definitive correction but is reserved for stable disease, typically after at least 12 months, when the plaque is no longer changing. The approach depends on the severity of curvature, the type of deformity, and whether erectile function is intact.
Plication for Mild to Moderate Curvature
For curves under 60 degrees without complex deformities, plication is the simplest option. The surgeon shortens the longer side of the penis to match the scarred side, straightening it without touching the plaque directly. Success rates for straightening range from 79% to 100%, and patient satisfaction runs between 67% and 100%. The tradeoff is some length loss, which can be up to 3 cm in some cases. This makes adequate starting length and realistic expectations important before proceeding.
Plaque Incision or Grafting for Complex Cases
When curvature is more severe or there’s a waist or hourglass deformity, the surgeon may cut into or partially remove the plaque and patch the gap with graft material. One technique uses multiple small transverse incisions across the plaque, checking correction as each cut is made. If the incisions alone bring curvature to 10 degrees or less, no graft is needed. If the deformity persists or is complex, a graft fills the remaining defect. Patient satisfaction with this approach is high, with 42 out of 43 patients reporting satisfaction in one series.
Penile Implants for Combined Plaque and Erectile Dysfunction
When Peyronie’s disease coexists with erectile dysfunction that doesn’t respond to medication, an inflatable penile implant addresses both problems simultaneously. The implant provides rigidity, and the surgeon can model the penis over the inflated device during the procedure to correct curvature. This is typically the recommended path for men with severe curvature and poor-quality erections, as other surgical techniques depend on natural erectile function to produce good results.
Combining Treatments
Most urologists use a layered approach rather than relying on a single treatment. A typical sequence during the active phase might include oral medication combined with daily traction therapy. Once the disease stabilizes, collagenase injections can target the plaque directly, with traction continued between cycles to maximize straightening and preserve length. If injectable therapy doesn’t achieve enough correction, surgery becomes the next step. Traction is then often resumed after surgery to optimize healing and minimize shortening.
The plaque rarely disappears completely with any non-surgical treatment. The realistic goal is to reduce curvature enough to restore comfortable function and reduce the psychological burden. For many men, a combination of injections and traction achieves this without surgery. For others, surgery provides the definitive correction that less invasive options couldn’t.