Peyronie’s Disease, a disfiguring, bothersome bend in a man’s erect penis, is a complex condition with no clear cause and a multitude of treatment options. Let’s explore these options. Treatment strategies will depend on how long the man has had the condition prior to seeking medical advice, how severe the deformity is, how good his erections are and how bothered the man is by the disease. Further, individual urologists will have different treatment plans depending on their comfort with medical and surgical management of Peyronie’s.
Most Peyronie’s specialists initiate treatment with medical therapy, usually pills or topical creams to the penis. The history of pill therapy for Peyronie’s includes many drugs, none FDA approved. Lately, most specialists prescribe pentoxyphyline, a drug initially used to improve blood flow to the legs of patients with vascular insufficiency. In Peyronie’s, pentoxyphyline inhibits some of the inflammatory proteins that lead to abnormal scar formation. Many clinical trials have demonstrated pentoxyphyline has a modest effect, about a 40% chanced of improving the plaque after 6 months of therapy. It has a pretty good safety profile with not too many side effects. Older medications like colchicine have fallen out of favor due to lack of improvement and higher side effect profile. Some urologists prescribe a topical medication called verapamil, a cream you rub into the plaque on the penis once or twice a day. It’s pretty expensive and doesn’t have any good data to support its use. Some urologists and physical therapists will use an iontopheresis unit to draw the verapamil (and sometimes steroid) deeper into the plaque with an electrical current. There are a few studies out there that show this may be better than just rubbing the cream into the plaque.
Penile traction and vacuum erection devices are two therapies many urologists combine with either pill therapy or injection therapy. The traction devices have to be worn at least 4 hours a day and have to be released every 20 minutes to minimize nerve damage. A few studies demonstrate improvement in both lost penile length and penile curvature, especially combined with other therapies. Vacuum devices don’t have quite the same statistical success rates but also don’t have to be worn for so many hours. Also, if a man has erectile dysfunction associated with Peyronie’s, insurance companies often pay for the device. Both traction devices and vacuum devices cost between 200 and 400 U.S. dollars.
Intralesional therapy for Peyronie’s is in the midst of a revolution in therapy. Urologists have injected verapamil into plaques for years with modest success. Interferon injections have also been used with similar success. Neither of these therapies is FDA approved. As of 2013, there is only one FDA approved intralesional therapy. Xiaflex, collagenase, is a biological agent that a urologist injects directly into the plaque. The enzyme digests the abnormal collagen deposits in the plaque to decrease the abnormal force exerted on the penis. Men in clinical studies had a roughly 40% improvement in their curvature and reported improvements in their distress suffered from the disease. Side effects of this therapy were usually mild and included temporary pain, bruising and swelling. A few men in the clinical trials had a penile injury severe enough to need surgical correction. All of these men regained sexual function post surgery.
Lastly, if medical or office procedures don’t improve a man’s Peyronie’s Disease, there are surgical options. There are three surgical approaches for Peyronie’s.
At UCLA Health—The Men’s Clinic, your surgeon will discuss all of your options for Peyronie’s Disease so you can both make the most appropriate choice. For more information and to schedule an appointment, please call the UCLA Urology Appointment line at (310) 794-7700.