From the Guidelines
Peyronie's disease with hourglass deformity can be treated through several approaches, including intralesional injections with collagenase clostridium histolyticum, which has been shown to reduce penile curvature in patients with stable disease, as demonstrated in the IMPRESS I and II trials 1.
Treatment Options
- Intralesional injections: collagenase clostridium histolyticum (Xiaflex) has been FDA-approved for the treatment of Peyronie's disease with penile curvature, and has been shown to reduce curvature by a mean of 17° in the collagenase groups, compared to 9.3° in the placebo groups 1.
- Oral medications: pentoxifylline (400mg three times daily) or PDE5 inhibitors like tadalafil (5mg daily) may be used as first-line treatments for mild to moderate cases.
- Traction therapy devices: used daily for 3-8 hours to complement other treatments by gradually stretching the affected tissue.
- Surgical options: plication procedures, plaque incision/excision with grafting, or penile prosthesis implantation may be necessary for severe hourglass deformities causing significant erectile dysfunction or preventing intercourse, with tunical plication surgery being a viable option for patients with intact erectile function or ED responsive to oral medications or vacuum pump therapy 1.
Important Considerations
- Treatment should begin during the acute inflammatory phase when the plaque is still developing, as interventions are more effective before calcification occurs.
- Patients should have realistic expectations regarding the likely magnitude of treatment effects and the probability and type of adverse events.
- Clinicians should discuss with patients the available treatment options and the known benefits and risks/burdens associated with each treatment 1.
Surgical Interventions
- Penile prosthesis surgery may be offered to patients with Peyronie’s disease with erectile dysfunction and/or penile deformity sufficient to prevent coitus despite pharmacotherapy and/or vacuum device therapy 1.
- Inflatable penile prosthesis is recommended for patients undergoing penile prosthetic surgery for the treatment of Peyronie’s disease, as it allows for modeling to maximize curvature correction 1.
From the Research
Treatment Options for Peyronie's Disease with Hourglass Deformity
- Patients with Peyronie's disease and hourglass deformity can be treated with various options, including surgical and non-surgical approaches 2, 3.
- Non-surgical management options include oral therapy, intra-lesional injections, and penile traction therapy, although the evidence for oral therapy is limited 4.
- Intra-lesional injections, such as interferon alpha-2b, have shown promise in reducing penile curvature and plaque size 5, 6.
- Surgical options, such as plaque incision or partial excision and grafting, may be recommended for patients with hourglass deformity and/or multiplanar curvature 2, 3.
- Penile prosthesis implantation may be considered for patients with refractory erectile dysfunction or significant penile shortening 2, 3.
Surgical Techniques
- Corporoplasty, including convex side-shortening procedures and concave side lengthening procedures, can be used to correct penile curvature 3.
- Partial excision or incision followed by grafting may be indicated for curvatures >60°, hourglass or hinge deformities, and short penises 3.
- Penile prosthesis placement with or without further straightening maneuvers may be recommended for patients with refractory erectile dysfunction 2, 3.