Your doctor might recommend a wait-and-see (watchful waiting) approach if:
- The curvature of your penis isn't severe and is no longer worsening
- You can still have sex without pain
- Pain during erections is mild
- You have good erectile function
If your symptoms are severe or are worsening over time, your doctor might recommend medication or surgery.
The goals of treatment with medication include reducing plaque formation and pain, as well as minimizing curvature of the penis.
There is one medication approved by the Food and Drug Administration for the treatment of Peyronie's disease. It's called collagenase Clostridium histolyticum (Xiaflex). This medicine is approved for use in men with a palpable lump from plaque in the penis that causes a curvature of at least 30 degrees during erection.
The treatment works by breaking down the buildup of collagen that causes penile curvature. It involves a series of in-office injections, directly into the penile lump, as well as penile modeling — brief exercises to gently stretch and straighten the penis.
In clinical trials, this collagenase therapy significantly reduced curvature and bothersome symptoms associated with Peyronie's disease in many participants. Discuss potential side effects of this medication with your doctor, as some of them can be serious.
Examples of off-label use of medications for Peyronie's disease include an oral medication called pentoxifylline (Trental), verapamil (injections or topical gel) and interferon (injections).
Most experts recommend against surgery during the early inflammatory phase of Peyronie's disease. Your doctor might suggest surgery if the deformity of your penis is severe, especially bothersome, or prevents you from having sex. Surgery usually isn't recommended until the curvature of your penis stops increasing.
Surgical methods include:
- Suturing (plicating) the unaffected side. A variety of procedures, such as Nesbit plication, can be used to suture (plicate) the longer side of the penis (the side without scar tissue). This can straighten the penis, but it might result in actual or perceived penile shortening. In some cases, plication procedures cause erectile dysfunction.
- Incision or excision and grafting. Generally used in cases of more severe curvature, this procedure is linked to greater risks of worsening erectile function compared with plication procedures. The surgeon makes one or more cuts in the scar tissue, sometimes removing some of that tissue, allowing the sheath to stretch out and the penis to straighten. The surgeon may sew in a piece of tissue (graft) to cover the holes in the tunica albuginea, a membrane within the penis that helps maintain an erection.
- Penile implants. Surgically inserted penile implants replace the spongy tissue that fills with blood during an erection. The implants might be semirigid — manually bent down most of the time and bent upward for sexual intercourse. Another type of implant is inflated with a pump implanted in the scrotum. Penile implants might be considered if you have both Peyronie's disease and erectile dysfunction.
The type of surgery will depend on your condition. Your doctor will consider the location of scar tissue, the severity of your symptoms and other factors.
A technique known as iontophoresis uses a weak electrical current to deliver a combination of verapamil and dexamethasone noninvasively through the skin. Research shows conflicting results.
Several nondrug treatments for Peyronie's are being investigated, but evidence is limited on how well they work and possible side effects. These include using intense sound waves to break up scar tissue (shock wave therapy), devices to stretch the penis (penile traction therapy) and vacuum devices.
Oct. 18, 2014
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