Peyronie’s disease involves the formation of fibrous scar tissue, or plaque, within the penis, which can cause curvature, indentations, loss of length, and pain with an erection. These changes can cause stress and impact sexual function, leading many to seek treatment. While surgery is an option, non-surgical approaches are often considered first to manage symptoms without invasive procedures.
Understanding Peyronie’s Disease Development
Peyronie’s disease originates in the tunica albuginea, the fibrous sheath surrounding the penis’s erectile bodies. The condition’s defining feature is plaque, a segment of flat, inelastic scar tissue. Because this plaque doesn’t stretch during an erection, it causes the penis to bend, shorten, or develop an indentation. In some cases, the plaque can accumulate calcium and become hard.
The leading theory suggests the cause is repeated minor injury to the penis, often during sexual activity. This damage can trigger a disorganized healing process, resulting in the formation of fibrotic plaque. A genetic predisposition also appears to make some men more susceptible to the condition.
The disease progresses through two phases. The acute phase lasts six to 18 months and involves active inflammation, plaque formation, and changes in penile curvature, often with pain. In the subsequent chronic phase, the plaque and curvature stabilize, inflammation subsides, and pain often lessens or resolves.
Oral and Topical Medications
Oral and topical medications are the most accessible treatments for Peyronie’s disease. Oral agents like potassium para-aminobenzoate (Potaba), colchicine, and L-carnitine have been explored for their potential antifibrotic effects.
However, scientific evidence supporting the effectiveness of most oral medications in reducing penile curvature is limited. Studies show these treatments, including the once-common vitamin E, are underwhelming for reversing existing deformity. While some oral agents might help reduce pain in the acute phase, they are not considered effective for correcting the bend itself.
Topical treatments, like verapamil gel, aim to deliver medication directly to the plaque by disrupting collagen production. The primary challenge with topical therapies is poor absorption through the skin. Consequently, studies have shown that topical verapamil is not effective because it fails to penetrate deeply enough to impact the plaque.
Injectable Therapies
Injecting medication directly into the penile plaque is a more direct approach. The primary option is collagenase clostridium histolyticum (CCH), marketed as Xiaflex. It is the only FDA-approved injectable for Peyronie’s disease in men with a palpable plaque and curvature of at least 30 degrees.
Xiaflex is an enzyme that breaks down the collagen causing the curvature. The protocol involves up to four treatment cycles, each consisting of two injections. These are followed by penile modeling, which includes in-office procedures by a provider and gentle stretching exercises performed by the patient at home.
Other medications are used “off-label,” meaning they are not specifically FDA-approved for Peyronie’s disease. Verapamil, for example, can be injected into the plaque, and studies show some success in improving symptoms. However, the evidence is not as robust as it is for CCH.
Interferons are another off-label injectable treatment thought to reduce fibrous tissue. Like verapamil, interferon injections have shown some benefit in studies. They are considered a secondary option to CCH due to less consistent results.
Mechanical and Wave Therapies
Physical methods like penile traction therapy (PTT) apply force to the penis. PTT involves wearing a mechanical device for several hours daily over many months. The device applies a sustained stretching force to break down plaque and stimulate healthy tissue growth.
Consistent use of a traction device can lead to modest improvements in both penile length and curvature. PTT’s effectiveness is enhanced when combined with injectable therapies like Xiaflex. The stretching may make the plaque more susceptible to the medication, leading to better overall outcomes.
Extracorporeal shockwave therapy (ESWT) uses low-intensity acoustic waves directed at the penile plaque. The theory is that these waves can break down fibrous tissue and stimulate healing.
Studies have concluded that ESWT is not effective at reducing penile curvature. However, reports show it can be beneficial for alleviating pain, particularly during the acute inflammatory phase. For men whose primary symptom is pain rather than curvature, ESWT may be considered.
When to Consider Other Options
Non-surgical treatments are the first line of defense, particularly for men in the acute phase or those who wish to avoid an operation. The goal is to manage pain, prevent the condition from worsening, and achieve a reduction in curvature that improves sexual function.
The decision to pursue surgery depends on several factors. A primary consideration is disease stability, as injections are reserved for the chronic phase when the curvature is stable. The severity of the deformity and its impact on sexual intercourse also guide the decision.
If the deformity remains severe and interferes with sexual function after non-surgical treatments, a consultation with a urologist is the next step. Surgery is considered when these methods have not provided sufficient improvement and a man’s quality of life remains impacted.