From the Guidelines
The most effective treatment option for a patient with Peyronie's disease and a firm, palpable plaque on the dorsal surface of the mid-shaft of the penis is intralesional collagenase clostridium histolyticum (Xiaflex) injections, as it has been shown to reduce curvature by a mean of 17° in clinical trials 1. This treatment option is recommended for patients with stable disease, intact erectile function, and curvature between 30° and 90°. The injections are administered as two injections 1-3 days apart, repeated over four treatment cycles, and have been shown to be effective in reducing penile curvature and improving symptoms.
Other treatment options for Peyronie's disease include:
- Intralesional interferon α-2b, which has been shown to reduce curvature and improve symptoms in some patients 1
- Oral medications such as pentoxifylline, which may help reduce inflammation and plaque formation
- Surgical options, such as plication procedures, plaque incision/excision with grafting, or penile prosthesis implantation, which may be considered for patients with severe curvature or erectile dysfunction 1
- Physical therapy using traction devices, which may help preserve penile length
It is essential to counsel patients about the potential adverse events associated with each treatment option, including penile ecchymosis, swelling, pain, and corporal rupture with intralesional collagenase injections, and sinusitis, flu-like symptoms, and minor penile swelling with intralesional interferon α-2b 1. Treatment selection should be based on disease phase, deformity severity, erectile function, and patient preferences, with the goal of reducing pain, improving penile curvature, and restoring sexual function.
From the FDA Drug Label
The following reactions, reported in 1. 0% or less of patients, occurred under conditions (open trials, marketing experience) where a causal relationship is uncertain; they are listed to alert the physician to a possible relationship: Urogenital: gynecomastia, galactorrhea/hyperprolactinemia, increased urination, spotty menstruation, impotence The frequency of cardiovascular adverse reactions that require therapy is rare; hence, experience with their treatment is limited.
The treatment options for a patient with Peyronie's disease are not explicitly mentioned in the provided drug label for verapamil (IM) 2. Peyronie's disease treatment is not directly addressed, and the label primarily discusses the adverse reactions and treatment of cardiovascular conditions related to verapamil.
- The label does mention impotence as a possible reaction, but it does not provide information on treating Peyronie's disease.
- Injections are mentioned in the context of the patient's referral, but the label does not provide information on injection treatments for Peyronie's disease.
From the Research
Treatment Options for Peyronie's Disease
The patient's condition, characterized by a firm, palpable plaque on the dorsal surface of the mid-shaft of the penis, is most likely Peyronie's disease. The treatment options for Peyronie's disease can be stratified by disease phase, which is defined by whether symptoms (e.g., penile deformity and discomfort) are actively changing or have stabilized 3.
Conservative Therapy
Conservative therapy is the most common recommendation during the active phase, with more invasive treatments reserved for the passive phase. Conservative therapy may include:
- Oral or topical medication
- Intralesional injection
- External energy therapy These treatments may also have a role in improving symptoms during the passive phase prior to undergoing more definitive surgical treatment 3.
Intralesional Injections
Intralesional injections, such as collagenase Clostridium histolyticum (CCH), have been shown to be effective in improving penile curvature and reducing symptoms in patients with Peyronie's disease 4, 5, 6. CCH is the only FDA-approved treatment for Peyronie's disease and has been shown to improve penile curvature in men with dorsal, lateral, or ventral plaques 7.
Vacuum Therapy
Vacuum therapy, alone or in combination with CCH, has also been shown to be effective in improving PD symptoms 4. A study found that vacuum-pump therapy administered alone or in combination with modeling after CCH treatment could improve PD symptoms 4.
Surgical Interventions
Surgical interventions, such as tunical plication, plaque incision or excision with or without grafting, and penile prosthesis implantation, may be considered for patients with stabilized symptoms who have not responded to conservative therapy 3.
Patient Counseling
Attentive patient counseling is the hallmark of managing Peyronie's disease, and patients should be thoroughly evaluated and counseled on the natural disease course and treatment options to meet their goals and manage expectations 3.