From the Guidelines
Treatment for Peyronie's disease should prioritize intralesional collagenase clostridium histolyticum (Xiaflex) as the first-line therapy for patients with stable disease and significant curvature, as it has been shown to reduce curvature by a mean of 17° in clinical trials 1. When considering treatment options for Peyronie's disease, it is essential to evaluate the severity of symptoms, degree of curvature, and presence of erectile dysfunction.
- For patients with mild cases, observation may be sufficient, as some cases may resolve without intervention.
- For persistent or severe cases, several treatment options exist, including:
- Oral medications: pentoxifylline (400mg twice daily) and colchicine (0.6mg twice daily) may help reduce inflammation and scarring.
- Injectable treatments: collagenase clostridium histolyticum (Xiaflex) is the only FDA-approved medication for Peyronie's, and verapamil injections (10mg every two weeks) may also be effective.
- Surgical options: plication procedures, plaque incision or excision with grafting, or penile implants may be considered for patients with stable disease and significant curvature affecting sexual function.
- Non-surgical physical treatments: penile traction therapy devices may help stretch the scarred tissue and improve penile length. It is crucial to note that treatment choice depends on disease phase (active/inflammatory vs. stable), severity of symptoms, degree of curvature, and presence of erectile dysfunction, and early intervention during the acute inflammatory phase may prevent progression to more severe deformity 1. Intralesional interferon α-2b may also be considered as a treatment option, as it has been shown to improve curvature, plaque size, and penile pain in patients with stable disease 1. However, intralesional collagenase clostridium histolyticum (Xiaflex) remains the most effective treatment option, with a modest difference of 7.7° in curvature reduction compared to placebo 1.
From the Research
Treatment Options for Peyronie's Disease
- Oral therapies, such as vitamin E and para-aminobenzoate, are commonly prescribed, although there is limited evidence to support their effectiveness as monotherapy 2, 3, 4.
- Intralesional injections, including verapamil, interferon-α-2b, and collagenase, have shown modest improvements in symptoms, particularly when used early after symptom onset 2, 3, 4, 5.
- Penile traction therapy and external energy therapy may also be used to improve symptoms 2, 6.
- Surgical interventions, such as penile plication, plaque incision or excision with or without grafting, and penile prosthesis implantation, are typically reserved for patients with severe or stabilized symptoms 2, 6, 3, 4.
Considerations for Treatment
- The choice of treatment depends on the severity and stability of symptoms, as well as patient preferences and expectations 2, 6.
- Conservative therapy is often recommended during the active phase of the disease, with more invasive treatments reserved for the passive phase 6, 4.
- Patients should be thoroughly counseled about the potential benefits and risks of each treatment option, including side effects such as penile shortening, sensation changes, and erectile dysfunction 2, 6.
Efficacy of Treatment Options
- Studies have shown that intralesional injections with interferon alpha-2B can improve penile curvature, pain, and plaque size 5.
- Combination therapy with intralesional interferon alpha 2B and oral vitamin E has also been shown to be effective in improving symptoms 5.
- Surgical interventions can provide significant improvements in penile curvature and sexual function, but may be associated with side effects such as penile shortening and erectile dysfunction 2, 6, 3, 4.