Does treatment for Peyronie's disease affect penis size?

Treatment of Peyronie's Disease and Its Impact on Penis Size

Treatments for Peyronie's disease can potentially affect penis size, with surgical interventions carrying the highest risk of penile shortening, while non-surgical options have minimal to no impact on length.

Understanding Peyronie's Disease and Penis Size Concerns

Peyronie's disease (PD) is characterized by the formation of fibrous plaques in the tunica albuginea of the penis, resulting in penile curvature, pain, and potential erectile dysfunction. Penis size concerns are common among patients with PD for two main reasons:

1. The disease itself can cause perceived or actual penile shortening due to:

   • Fibrotic plaques that prevent full expansion of penile tissue
   • Curvature that reduces functional length

2. Treatment interventions may impact penile dimensions:

   • Some surgical approaches inherently cause shortening
   • Non-surgical approaches have varying effects on penile length

Non-Surgical Treatment Options and Their Impact on Penis Size

Intralesional Injections

• Collagenase Clostridium Histolyticum (Xiaflex)

  • Recommended for patients with stable disease (unchanged for ≥3 months), curvature 30-90°, and intact erectile function 1, 2
  • Impact on size: Minimal risk of penile shortening; may actually improve functional length by reducing curvature
  • Average curvature reduction: 17° (vs. 9.3° with placebo) 1
  • Adverse events: Penile ecchymosis, swelling, pain (84.2% of patients), and risk of corporal rupture 1, 2

• Interferon α-2b

  • Moderate recommendation for stable disease 1
  • Impact on size: No documented effect on penile length
  • Curvature reduction: 13.5° (vs. 4.5° with placebo) 1
  • Adverse events: Flu-like symptoms, sinusitis, minor penile swelling 1

• Verapamil (Intralesional)

  • Conditional recommendation with weak evidence 1
  • Impact on size: No documented effect on penile length
  • Adverse events: Penile bruising, dizziness, nausea, injection site pain 1

Other Non-Surgical Approaches

• Penile Traction Therapy

  • May be used alone or in combination with other treatments 3
  • Impact on size: Potential for modest length preservation or improvement
  • When combined with oral therapy, showed significant decrease in curvature (55.8° to 41.4°) 3

• Oral Medications

  • Most oral therapies (vitamin E, tamoxifen, omega-3 fatty acids) are not recommended due to lack of efficacy 1
  • NSAIDs may be offered for pain management during active phase 1, 2
  • Impact on size: No documented effect on penile dimensions

Surgical Interventions and Their Impact on Penis Size

Plication Procedures

• Indication: Stable disease with adequate erectile function and less severe curvature 1
• Impact on size: Typically results in some penile shortening (1-2 cm on average) 4
• Technique: Involves shortening the longer side of the penis opposite to the curvature

Plaque Incision/Excision with Grafting

• Indication: More severe curvature, hourglass deformity, or significant shortening 1
• Impact on size: Better preservation of penile length compared to plication, but risk of erectile dysfunction
• Technique: Involves lengthening the shorter side of the penis by incising/excising the plaque and placing a graft

Penile Prosthesis Implantation

• Indication: PD with concurrent erectile dysfunction 1, 4
• Impact on size: May result in some shortening, but functional length can be preserved
• Technique: Often combined with modeling or other straightening procedures

Treatment Algorithm Based on Disease Phase and Penis Size Concerns

Active Phase (0-18 months)

1. Conservative management is recommended during this phase 5, 6
   • NSAIDs for pain management 1
   • Avoid invasive treatments while disease is evolving
   • Document changes in curvature and length

Stable Phase (>3-6 months of stability)

1. For patients with mild-moderate curvature (30-90°) and intact erectile function:

   • First-line: Intralesional collagenase with modeling 1, 2
   • Alternative: Intralesional interferon α-2b 1
   • Consider adding penile traction therapy to minimize length loss 3

2. For patients with severe curvature (>90°) or hourglass deformity:

   • Surgical intervention with grafting techniques to preserve length 1

3. For patients with concurrent erectile dysfunction:

   • Penile prosthesis implantation with modeling 1

Important Considerations and Pitfalls

• Timing is crucial: Treating during the active phase may lead to unpredictable outcomes and unnecessary interventions 2, 5
• Set realistic expectations: Inform patients that complete restoration of pre-disease penile dimensions is often not achievable
• Document stability: Ensure disease has been stable for at least 3 months before invasive treatments 1, 2
• Avoid ineffective treatments: Many oral therapies lack evidence and may delay effective treatment 1
• Psychological impact: Address psychological distress related to body image and sexual function

Conclusion

When treating Peyronie's disease, the impact on penis size varies significantly based on treatment approach. Non-surgical options generally have minimal impact on penile length, while surgical approaches (particularly plication) carry a higher risk of shortening. The treatment decision should be guided by disease phase, severity of curvature, presence of erectile dysfunction, and patient preferences regarding the trade-offs between curvature correction and length preservation.