Peyronie Disease Guidelines

Updated: Dec 11, 2020
  • Author: Eli Lizza, MD; Chief Editor: Edward David Kim, MD, FACS  more...
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Guidelines

Guidelines Summary

The American Urological Association (AUA) has published a guideline for the diagnosis and treatment of Peyronie disease (PD). [127]

Diagnosis

AUA recommendations for diagnosis of PD include the following [127] :

  • The minimum requirements for clinical evaluation are a careful history and physical examination. The history should assess penile deformity, interference with intercourse, penile pain, and/or distress. The physical exam of the genitalia should assess for palpable abnormalities of the penis. (Clinical Principle) 
  • Clinicians should perform an in-office intracavernosal injection (ICI) test with or without duplex Doppler ultrasound prior to invasive intervention. (Expert Opinion) 

Treatment

AUA recommendations for treatment of PD include the following [127] :

  • Consider offering oral non-steroidal anti-inflammatory medications to the patient suffering from active PD who is in need of pain management. (Expert Opinion)
  • Do not offer oral therapy with vitamin E, tamoxifen, procarbazine, omega-3 fatty acids, or a combination of vitamin E with L-carnitine. [Moderate Recommendation)
  • Do not offer electromotive therapy with verapamil. (Moderate Recommendation)
  • Consider administering intralesional collagenase clostridium histolyticum (CCH) in combination with modeling by the clinician and by the patient for the reduction of penile curvature in patients with stable PD, penile curvature >30° and < 90°, and intact erectile function (with or without the use of medications). (Moderate Recommendation) Before beginning treatment with CCH, counsel patients regarding potential  adverse events, including penile ecchymosis, swelling, pain, and corporal rupture. (Clinical Principle)
  • Consider administering intralesional interferon α-2b in patients with PD. (Moderate Recommendation) Before beginning treatment with intralesional interferon α-2b, counsel patients about potential adverse events, including sinusitis, flulike symptoms, and minor penile swelling. (Clinical Principle)
  • Consider offering intralesional verapamil for the treatment of PD. (Conditional Recommendation) Before beginning treatment with intralesional verapamil, counsel patients about potential adverse events, including penile bruising, dizziness, nausea, and pain at the injection site. (Clinical Principle)
  • Do not use extracorporeal shock wave therapy (ESWT) for the reduction of penile curvature or plaque size. (Moderate Recommendation) However, ESWT may be offered to improve penile pain. (Conditional Recommendation)
  • Do not use radiotherapy (RT) to treat PD. (Moderate Recommendation)
  • Assess patients as candidates for surgical reconstruction based on the presence of stable disease. (Clinical Principle) 
  • To improve penile curvature in patients whose rigidity is adequate for coitus (with or without pharmacotherapy and/or vacuum device therapy) consider offering tunical plication surgery, or plaque incision or excision and/or grafting. (Moderate Recommendation)
  • Consider offering penile prosthesis surgery to patients with PD with erectile dysfunction (ED) and/or penile deformity sufficient to prevent coitus despite pharmacotherapy and/or vacuum device therapy. (Moderate Recommendation)
  • Consider performing adjunctive intra-operative procedures, such as modeling, plication, or incision/grafting, when significant penile deformity persists after insertion of the penile prosthesis. (Moderate Recommendation)
  • Use an inflatable penile prosthesis for patients undergoing penile prosthetic surgery for the treatment of PD. (Expert Opinion)