Peyronie’s disease treatment ranges from topical creams, surgery, implants, penis pumps, traction as well as vitamin E and other therapy options.
Peyronie’s disease is a very serious condition in which the penis curves or bends, usually during an erection. The condition makes it difficult to have sex in many instances.
Although there is a wide variety of Peyronie’s disease treatment options for men who have Peyronie’s disease, a fair number of them are of limited, questionable, or unproven effectiveness and/or have not been well studied. Choosing which treatment approach to try, if any, depends on when the condition is diagnosed and the severity of the symptoms.
Fortunately, most men can opt for a nonsurgical Peyronie’s disease treatment approach, especially if Peyronie’s disease is diagnosed early (i.e., within the first six months of the start of symptoms). During the first six months of the disorder, erections can be painful. However, even without treatment, the pain usually disappears, although the same cannot be said about the bend or curve in the penis. Even with treatment, there is no guarantee a man’s penis will completely straighten.
Given the uncertainties about Peyronie’s disease treatment, men who have this disorder need to explore all their options with their urologist. In fact, several studies have indicated that men may get better results if they combine several nonsurgical treatments; for example, penile traction therapy along with injection or oral therapy (e.g., arginine, verapamil, pentoxifylline) (Abern 2010; Larson 2011)
Here is an overview of the available Peyronie’s disease treatment(s).
Watch and wait
In mild cases of Peyronie’s disease, doctors often recommend not attempting active Peyronie’s disease treatment and using a “watch and wait” approach. Some men experience a spontaneous recovery from Peyronie’s disease, although experts are not certain why this occurs. A watch and wait approach for six to 12 months, depending on a man’s symptoms, allows time for Peyronie’s disease to resolve itself or stabilize. If symptoms get worse over time, then treatment options can be discussed.
Oral and topical treatments
Several oral and topical drugs and natural supplements are available for treatment of Peyronie’s disease. The studies on these medications and supplements are limited, so be sure to discuss the benefits and risks with your healthcare provider. The treatments in this category include arginine, bromelain, carnitine, coenzyme Q10, colchicine, PABA (Potaba), pentoxifylline, tamoxifin, verapamil gel, and vitamin E.
The main goal of injection therapy for Peyronie’s disease treatment is to deliver a drug directly to the plaque (lesions) in an attempt to dissolve them. Several different drugs can be used in injection therapy, and success with this approach has been variable. Drugs used for injection therapy include corticosteroids (dexamethasone, betamethasone, triamcinolone hexacetonide), calcium channel blockers (nicardipine, verapamil), and interferon alpha-2b.
Medical devices are an option that may be used along with other treatments. The medical devices typically used for Peyronie’s disease include vacuum pumps and penile extenders (traction therapy).
Two nonsurgical procedures have been explored in the treatment of Peyronie’s disease. One is electroshock wave therapy, also known as extracorporeal shock wave therapy (ESWT), and studies have shown varying success. The other is iontophoresis, which is sometimes called electromotive drug administration (EMDA) or transdermal electromotive administration (TEA). Iontophoresis may help medications reach the plaque in the penis.
Xiaflex (collagenase clostridium histolyticum) is a prescription medication that has been approved by the Food and Drug Administration for the treatment of Peyronie’s disease in men who have plaque that can be felt and a curvature of the penis greater than 30 degrees. The drug is injected into the plaque, where it breaks down the scar tissue. Men are also encouraged to gently stretch and straighten their penis as part of the treatment process, as this facilitates reduction of the curvature.
Surgery for Peyronie’s disease
Surgery for Peyronie’s disease is reserved for men who meet certain criteria, and the most important one is severity–only men whose bent penis is so severe it interferes with sexual function should be considered for any of the surgical options. Other criteria include allowing a chance for spontaneous healing to occur, trying other treatment options, and presence of a stable (unchanging) condition. Surgical outcomes are best for men who have stable Peyronie’s disease. The three surgical options include plication (also known as the Nesbit procedure), tissue grafts, and penile implant.
Abern MR et al. Combination of penile traction, intralesional verapamil, and oral therapies for Peyronie’s disease. J Sex Med 2012 Jan; 9(1): 288-95
Larsen SM, Levine LA. Review of non-surgical treatment options for Peyronie’s disease. Int J Impot Res 2012 Jan-Feb; 24(1): 1-10