Treatment of Peyronie's disease

If you suspect having Peyronie’s disease, you’ve probably scanned the web and found countless treatment options already. Here we will list some, and go through each treatment based on the latest scientific evidence.

Treatment of Peyronie’s disease ranges from minimally invasive treatments to surgical intervention. Currently, there is no cure for PD, but there are treatments available that can help reduce the curvature of the penis and reduce the pain.

Which treatment is right for me? 
Finding the right treatment just for you is a matter of discussion with your doctor and largely depends on the severity of the curvature, which stage it’s in and how much it affects your life.

NON-SURGICAL TREATMENT OPTIONS1

Intralesional injection therapy 
Put simply, an intralesional treatment means injecting a medical substance directly into a body part that is affected by a disease (lesion) – in the case of Peyronie’s disease, the collagen plaque that is causing the penis to bend. Depending on the degree and severity of the curvature, intralesional treatments can be used to reduce the pain and decrease the curvature of the penis. Many of the intralesional treatments that are being used for Peyronie’s disease are already being used for other illnesses, however, only one is approved in the EU and US specifically for the treatment of Peyronie's disease.

Oral treatments 
Several oral treatments are said to help against Peyronie’s disease, from food supplements such as vitamins and omega-3 to many oral prescription medicines. However, most of them are not supported by treatment guidelines for routine use in patients with Peyronie’s disease. This has to do with their lack of scientifically proven clinical effect as a monotherapy, i.e. a treatment that is used alone without combination of other medications. Further studies on oral therapies might shed some light on whether they can play a role in combination therapy for PD.

Traction therapy 
This is intended to work by stretching the plaque mechanically using a stretching device that is worn several hours per day. Although penile stretching is said to have possible effects on curvature, both in studies and guidelines, no larger evaluation has been done comparing it to placebo. Traction therapy is therefore not recommended as an evidence-based treatment.2

SURGERY3

Surgery has been used for many years for the treatment of Peyronie's disease. It is mainly used on men with PD that is in a stable phase with a disabling deformity, in other words when the curvature is hindering sexual intercourse and a normally functioning life. Surgery is also performed on men with PD who also have erectile dysfunction.

What type of surgery is it? 
The goal of the surgery is to straighten out the curvature, preserve or restore the ability to have erections and the same time not affect the length and girth of the penis. Although, it’s important to remember that surgery won’t change the penis back to exactly how it looked and felt before PD was present. Which type of surgery that is performed is dependent on where the Peyronie’s plaque is located, degree of curvature, how much the erectile function is impaired, what the patient prefers and also the surgeon’s experience. Since Peyronie’s disease is a condition that varies in presentation from man to man, no single surgical intervention can be used on all PD-cases.

PD-surgery means working with the tunica albuginea 
The tunica albuginea is the layer of connective tissue that surrounds the cavernous body of the penis, the sponge-like tissue inside the penis that is filled with blood to create an erection.

The different surgical procedures for Peyronie’s disease are:

- Tunical shortening
- Tunical lengthening
- Penile prosthesis implantation

Tunical shortening 
This is suitable for patients with adequate penile length and a curvature of less than 60 degrees. Tunical shortening roughly means that the tunica albuginea is altered on one side of the penis, the side opposite to the plaque, so it matches the shorter side. The penis is thereby straightened out. Tunical shortening, such as the Nesbit procedure, is the most commonly performed surgery for PD.

Tunical lengthening 
Suitable for patients with a more complex curvature deformity exceeding 60 degrees, large plaques and short length of the penis. Tunical lengthening is a form of reconstructive surgery that means cutting or completely removing the plaque in the penis. The space where the plaque was located is then filled with a graft, tissue that is reassigned from the patient’s own body. Specially processed animal tissue can also be used.

Penile prosthesis implantation 
The use of a penile prosthesis is often reserved for patients with PD who also have a severe erectile dysfunction that is non-responsive to medication. There are different types of implants available, both malleable (shapable) and inflatable devices.

Sources:

  1. Sherer MD et al. (2015) Expert Opinion on Pharmacotherapy, 16:9, 1299-1311.
  2. Jordan GH, Carson CC, Lipshultz LI. BJU Int 2014;114:16–24.
  3. Culley C. Carson, Laurence A. Levine BJU Int 2014; 113: 704–713.