Treatment of Peyronie’s Disease

Intralesional verapamil is one of the treatment options available for peyronie’s disease. It is not FDA approved for this indication and therefore is considered an “off label” treatment. Published data suggests that 50% of patients will have some improvement in penile curvature and 50% will not. If curvature improvement is present usually modest, maybe 10-15 degree improvement. Occasionally, significant improvement can occur. It is a series of six injections which occur every two weeks. Side effects are uncommon and include mild swelling and bruising to the penis. There’s no limitation sexually in between treatments.

Collagenase or Xiaflex” is FDA approved for patients with peyronie’s disease and curvature between a30-90 degrees angle. The published data suggests that 70% of men will have a combination of improvement of patient bother and/or improvement in curvature after four treatments cycles. Each cycle consists of two collagenase injections separated by 3- 7days. This is followed by penile modeling or “bending of the penis (done 3x daily for 30 seconds)- every day starting 2 days after the second treatment. This cycle is repeated 4 times. There should be no sexual activity for 4 weeks after the second treatment in the cycle.

Patients may experience side effects that include bruising, swelling. Sometimes this can be significant. There is a risk of hematoma or development of bleeding within the penis. In rare cases, there can be an injury to the penis with a “penile fracture” that may require surgical repair. Luckily, this only occurs in about one out of 250 cases.

This surgical procedure allows for improvement in curvature to the penis. It is usually performed as an outpatient procedure and involves putting stitches on the opposite side of the penis that is curved. It does not remove the scar tissue. In the experience of the Yale Urology, we can correct approximately 65° curvature to the penis with this therapy. Post operatively, no sexual activity or stimulation is allowed for approximately six weeks. Risks to the procedure involves incomplete correction of curvature, a small risk of temporary or permanent changes in sensation to the penis, and rare risk of erectile dysfunction. Almost all patients will experience some degree of shortening to the penis that usually is about 3/4 of an inch. Most patients are very happy with the results of this procedure as long as they accept the risks described above.

This operation is usually recommended in patients who have over a 70° curvature to the penis. It is recommended that this be performed by a urologist who has expertise in reconstructive surgery or sexual medicine. It is an outpatient procedure and sexual activity can be resumed approximately six to eight weeks after surgery. Risks to this procedure includes temporary or permanent numbness to the penis. Risk of postoperative erectile dysfunction ranges somewhere between 10 and 50% based on the pre-operative findings on duplex Doppler ultrasound. Other risks include incomplete straightening and some shortening of the penis.

For patients with a combination of non resolvable erectile dysfunction and penile curvature from peyronie’s disease, a penile prosthesis is the recommended treatment of choice.

The Yale Urology team offers all these treatments in men who have intact erectile function and peyronie’s disease. We have extensive experience with all these treatment options.