Peyronie's Disease: Curvature, Pain and ED

The erectile chambers are wrapped in a tough, elastic sheath called the tunica albuginea. In Peyronie's disease, fibrous scar tissue — a plaque — forms within that sheath. Scar tissue does not stretch. When the penis becomes erect and the rest of the sheath expands, the scarred segment does not, and the penis bends towards it.

The trigger is thought to be repetitive minor trauma during intercourse in men predisposed to abnormal wound healing. Most men cannot identify a specific injury.

• Curvature — most often upward, but it can be to either side or downward.
• A palpable lump or firm band along the shaft, usually on the upper surface.
• Pain, particularly with erection, during the active phase.
• Shortening of the erect penis.
• Indentation or hourglass narrowing at the plaque, sometimes with instability during sex.
• Erectile dysfunction — from the mechanical deformity, associated vascular changes, and the anxiety the condition creates.

Observation

A minority of cases improve spontaneously. Reasonable when curvature is mild, painless and sex is still possible.

Collagenase clostridium histolyticum injections

The only FDA-approved drug treatment for Peyronie's disease. Injected into the plaque over a course of treatment cycles, for men with stable disease and curvature above a threshold. Corporal rupture is a rare but serious complication, so it must be given by a trained clinician.

Traction therapy

Mechanical devices worn for defined periods daily. Evidence is modest but improving, and it is sometimes combined with injection therapy. Requires substantial commitment over months.

Intralesional verapamil or interferon

Alternative injectable options used in some centres, with a weaker evidence base than collagenase.

Surgery

For stable disease with deformity that prevents intercourse. Options include plication on the opposite side, plaque incision or excision with grafting, or — where ED is also significant — a penile implant that straightens the penis at the same time.

Oral treatments

Vitamin E, colchicine and pentoxifylline have been widely used historically. Guideline support is weak, as trial results have generally been disappointing.