From the Guidelines
Peyronie's disease treatment should prioritize intralesional collagenase clostridium histolyticum (Xiaflex) for patients with stable disease and penile curvature, as it has been shown to reduce curvature by a mean of 17° in clinical trials 1.
Treatment Options
The treatment of Peyronie's disease depends on the phase of the disease, severity of curvature, and presence of erectile dysfunction.
- For patients with active Peyronie's disease, oral non-steroidal anti-inflammatory medications may be offered for pain management 1.
- For patients with stable disease, intralesional collagenase clostridium histolyticum (Xiaflex) is a recommended treatment option, which has been shown to reduce penile curvature in clinical trials 1.
- Surgical options, such as plication procedures, plaque incision/excision with grafting, or penile implants, may be considered for patients with severe curvature or erectile dysfunction 1.
Key Considerations
- Treatment choice should be based on disease phase, severity of curvature, presence of erectile dysfunction, and patient preferences.
- Early intervention during the acute inflammatory phase may prevent progression, while stable disease may respond better to surgical approaches if conservative measures fail.
- Clinicians should counsel patients on the potential benefits and risks of each treatment option, including the possibility of adverse events with intralesional collagenase clostridium histolyticum (Xiaflex) 1.
Recommended Treatment Approach
Intralesional collagenase clostridium histolyticum (Xiaflex) is the recommended treatment option for patients with stable Peyronie's disease and penile curvature, due to its efficacy in reducing curvature and improving patient outcomes 1.
From the Research
Treatment Options for Peyronie's Disease
The treatment options for Peyronie's disease can be categorized into several approaches, including:
- Medical therapy: This includes oral medications such as para-aminobenzoate (Potaba) 2, tocopherol (vitamin E) 3, 4, colchicine 3, 4, and tamoxifen 4, as well as intralesional injections with interferon-alpha-2a or -2b, verapamil, or collagenase 4.
- Surgical therapy: This is typically reserved for patients who have failed conservative medical therapy and have significant penile curvature or deformity that precludes intercourse 3, 4, 5. Surgical procedures include plication (Nesbit's tuck) 3, 4, penile plaque incision/excision with or without grafting 4, 5, and implantation of a penile prosthesis 3, 4.
- Other therapies: These include topical treatments, extracorporeal shockwave therapy (ESWT) 6, radiation, and penile traction 6.
Medical Therapy
Medical therapy is often the first line of treatment for Peyronie's disease. The goals of medical therapy are to reduce penile pain, decrease penile curvature, and limit the degree of penile fibrosis. Some studies have shown that oral medications such as para-aminobenzoate (Potaba) 2 and acetyl-L-carnitine 4 may be effective in reducing plaque size and curvature, as well as improving erectile function.
Surgical Therapy
Surgical therapy is typically reserved for patients with significant penile curvature or deformity that precludes intercourse. The type of surgical procedure used depends on the severity of the curvature and the patient's overall health. Some common surgical procedures include plication (Nesbit's tuck) 3, 4, penile plaque incision/excision with or without grafting 4, 5, and implantation of a penile prosthesis 3, 4.
Other Therapies
Other therapies, such as topical treatments, extracorporeal shockwave therapy (ESWT) 6, radiation, and penile traction 6, may also be used to treat Peyronie's disease. However, the effectiveness of these therapies is not well established, and more research is needed to determine their role in the treatment of Peyronie's disease.