From the Guidelines
Peyronie's disease treatment should prioritize intralesional collagenase clostridium histolyticum (Xiaflex) as the first-line therapy 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
When considering treatment for Peyronie's disease, it's essential to evaluate the severity and stage of the condition. The following options are available:
- Watchful waiting for mild cases or early stages, as some cases may resolve spontaneously
- Medical treatments, including oral medications like pentoxifylline or colchicine, although evidence for their effectiveness is limited
- Injectable treatments, such as collagenase clostridium histolyticum (Xiaflex), verapamil, and interferon injections
- Surgical options, including plication procedures, plaque incision or excision with grafting, or penile implants, for severe cases with significant curvature or erectile dysfunction
Key Considerations
- Treatment is most effective during the acute inflammatory phase (first 6-12 months) before the plaque calcifies
- Patients should discuss options with a urologist specializing in sexual medicine to determine the most appropriate approach based on their specific symptoms, disease stage, and impact on sexual function
- Clinicians should counsel patients on the potential benefits and risks associated with each treatment option, including the likelihood of adverse events and the probability of successful outcomes 1
Evidence-Based Recommendations
- Intralesional collagenase clostridium histolyticum (Xiaflex) is the only FDA-approved medication for Peyronie's disease and has been shown to be effective in reducing penile curvature 1
- Verapamil and interferon injections are alternative options, although evidence for their effectiveness is limited 1
- Surgical options, such as plication procedures and plaque incision or excision with grafting, may be considered for severe cases with significant curvature or erectile dysfunction 1
From the Research
Treatment Options for Peyronie's Disease
- Oral therapies:
- Para-aminobenzoate (Potaba) and tocopherol (vitamin E) are commonly used, with some evidence suggesting that para-aminobenzoate may decrease plaque size and curvature 2
- Other oral therapies, such as colchicine, tamoxifen, propoleum, and acetyl-L-carnitine, have been used less frequently, with acetyl-L-carnitine showing some promise in reducing erectile pain and inhibiting disease progression 2
- Intralesional injection therapy:
- Interferon-alpha-2a or -2b, verapamil, or collagenase are commonly used, with interferon-alpha-2b showing significant efficacy in decreasing penile curvature, plaque size, penile pain, and plaque density 2, 3
- Collagenase clostridium histolyticum is currently the only Food and Drug Administration-approved drug for the management of patients with PD and a palpable plaque with dorsal or dorsolateral curvature >30° 4
- Surgical therapy:
- Reserved for patients who have not responded to conservative medical therapy for 1 year and who are precluded from sexual intercourse 2, 5, 4, 6
- Procedures commonly performed include the Nesbit procedure, penile plaque incision/excision with or without grafting, and implantation of a penile prosthesis 2, 5, 4, 6
- A surgical algorithm can be used to determine the optimal surgical approach based on factors such as penile rigidity, degree of curvature, and erectile response to vasoactive penile injections 5
Minimally Invasive Treatments
- Iontophoresis, extracorporeal shockwave therapy, and radiation therapy have shown mixed or negative results and are not currently recommended 3, 4
- Traction therapy may be used as part of a multimodal approach to prevent PD-associated loss of penile length, but its efficacy is dependent on patient compliance 4