What is the treatment for a 43-year-old man with a history of penile fracture, now presenting with painful erections and a 70° penile curvature?

Treatment for Penile Curvature Following Penile Fracture

For a 43-year-old man with a history of penile fracture presenting with painful erections and 70° penile curvature, surgical correction is the recommended treatment option as the condition appears to be in the stable phase with significant curvature. 1

Disease Assessment and Classification

• This patient's presentation suggests stable Peyronie's disease secondary to penile fracture trauma that occurred one year ago
• The significant curvature (70°) and pain with erection indicate the need for intervention
• According to AUA guidelines, treatment should be guided by:
  • Disease phase (active vs. stable)
  • Degree of curvature
  • Presence of pain
  • Erectile function status 2, 1

Treatment Algorithm

First-line Treatment Options

1. Surgical Correction

   • Given the severe curvature (70°) and stable disease (one year post-injury), surgical intervention is most appropriate 1
   • Surgical options include:
     • Tunical plication techniques - preferred for this degree of curvature without erectile dysfunction 1, 3
     • Superficial excision of tunica albuginea - offers good functional and cosmetic results with mean correction of 32° 4

2. Intralesional Therapy (if surgery is declined)

   • Collagenase clostridium histolyticum (Xiaflex) with modeling

     • FDA-approved for stable Peyronie's disease with curvature 30-90°
     • Average curvature reduction of 17° (modest compared to the 70° curvature in this case)
     • Most common side effects: penile ecchymosis, swelling, and pain 2, 1

   • Intralesional interferon α-2b

     • Alternative option with average curvature reduction of 13.5° 1
     • Less effective for severe curvature cases

Pain Management

• NSAIDs for pain control during treatment
• Pain should be assessed using a visual analog scale and periodically reassessed 2

Important Considerations and Caveats

• Surgical outcomes: Patients should be counseled that:

  • Complete restoration of pre-disease penile dimensions is often not achievable
  • Some degree of penile shortening may occur with surgical correction
  • Potential complications include recurrence, erectile dysfunction, and penile numbness 5

• Post-penile fracture complications: Patients with previous penile fracture have higher rates of complications including painful erection (10.8% in surgically treated cases, higher in conservatively managed cases) 6

• Ineffective treatments to avoid:

  • Oral therapies including vitamin E, tamoxifen, procarbazine, omega-3 fatty acids are not recommended 2
  • Electromotive therapy with verapamil is not recommended 2

• Psychological support: Address psychological distress related to body image and sexual function 1

The severity of curvature (70°) in this case makes surgical correction the most appropriate option, as intralesional therapies typically provide only modest improvement and would be insufficient for such significant deformity.