From the Guidelines
Treatment for Peyronie's syndrome should prioritize intralesional collagenase clostridium histolyticum (Xiaflex) as the first-line therapy for patients with curvature between 30° and 90° and intact erectile function, due to its moderate recommendation and evidence strength grade B, as established by the AUA guideline 1.
Overview of Treatment Options
Treatment options for Peyronie's disease include both non-surgical and surgical approaches, depending on disease severity and phase.
- In the acute phase (first 6-12 months), oral medications like pentoxifylline, colchicine, or potassium para-aminobenzoate may be prescribed to reduce inflammation and plaque formation, though evidence for their effectiveness is limited.
- Injectable treatments directly into the plaque include collagenase clostridium histolyticum (Xiaflex) and verapamil injections.
- Non-drug approaches include penile traction therapy devices worn for several hours daily over months to gradually stretch and remodel the plaque.
Surgical Options
For stable disease with significant curvature or erectile dysfunction, surgical options include:
- Plication procedures to straighten the penis
- Plaque incision or excision with grafting for more severe cases
- Penile prosthesis implantation for men with both Peyronie's and erectile dysfunction
Considerations for Treatment Choice
Treatment choice depends on disease phase, curvature severity, erectile function, and patient preferences, with best results typically achieved through a combination of approaches under urological specialist care, as noted in the AUA guideline 1.
Recent Guidelines and Recommendations
Recent guidelines, such as those from the AUA, emphasize the importance of counseling patients about potential adverse events associated with treatments like intralesional verapamil and intralesional interferon α-2b 1.
Additional Considerations
For patients with erectile dysfunction, options like vacuum erection devices, intracavernosal injection, and intraurethral suppositories may be considered, with referral to a sexual medicine clinician recommended for second- and third-line therapies, as noted in updates to the NCCN Guidelines for survivorship 1.
From the Research
Treatment Options for Peyronie's Syndrome
The treatment options for Peyronie's syndrome can be categorized into several approaches, including:
- Conservative therapy, which is the most common recommendation during the active phase of the disease 2
- Oral and topical medications, such as vitamin E and para-aminobenzoate (Potaba), although their efficacy is not well established 3, 4
- Intralesional injection therapies, including interferon alpha-2B, verapamil, and collagenase, which have shown some benefit in decreasing penile pain and curvature 3, 4, 5
- External energy therapies, such as extracorporeal shock wave lithotripsy, which may improve penile pain but has mixed results for penile curvature 3, 5
- Surgical interventions, including tunical plication, plaque incision or excision with or without grafting, and penile prosthesis implantation, which are typically reserved for the passive phase of the disease or for patients who do not respond to conservative therapy 2, 6
Considerations for Treatment
When considering treatment options for Peyronie's syndrome, it is essential to:
- Evaluate the extent of the patient's symptoms and bother 2
- Discuss treatment goals, therapeutic options, and expectations with the patient 2
- Consider the disease phase, with conservative therapy typically recommended during the active phase and more invasive treatments reserved for the passive phase 2
- Be aware of the potential side effects and complications associated with each treatment option, such as penile shortening, sensation changes, and erectile dysfunction 6