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      Drugs & Diseases > Urology

      Peyronie Disease Guidelines

      Updated: Jan 28, 2023
      • Author: Eli Lizza, MD; Chief Editor: Edward David Kim, MD, FACS  more...
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      Guidelines

      Guidelines Summary

      The following organizations have released guidelines for the diagnosis and treatment of Peyronie disease (PD).

      • American Urological Association (AUA) [138]
      • Canadian Urological Association (CUA) [139]
      • European Society for Sexual Medicine (ESSM) [140]

      The AUA and CUA guidelines concur on all major recommendations. The ESSM guidelines focus solely on surgical treatment.

      Next:

      American Urological Association Guidelines

      Diagnosis

      AUA recommendations for diagnosis of PD include the following [138] :

      • 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 [138] :

      • 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) 
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      European Society for Sexual Medicine Guidelines

      The European Society for Sexual Medicine (ESSM) published a position statement on the surgical treatment of Peyronie disease (PD) in 2022. The ESSM notes that while surgery is the gold standard treatment, it does not repair damage caused by PD and may not result in restoration of the penis to its original dimensions and function. [140]  

      The ESSM recommends that patients receive detailed pre-surgical counseling covering the benefits, adverse effects, and complications of each surgical treatment option with a goal of setting realistic expectations for treatment outcomes. In addition, psychological, emotional, and relationship issues attributable to PD should be addressed. [140]

      The guidelines recommend surgery for the treatment of PD in patients with both of the following [140] :

      • Curvature and/or penile deformity and/or inadequate quality of erections that do not allow satisfactory sexual intercourse, or when the deformity causes severe bother 
      • Stable disease for at least six to twelve months

      Specific recommendations related to surgical techniques include the following [140] :

      • Tunical plication (shortening procedures) can be offered to reduce curvature.
      • In select patients with adequate erections, curvature of more than 60 degrees, ossified plaque, significant waist deformity, or when plication surgery may potentially cause loss of more than 20% of overall penile length, grafting techniques are an option.
      • The use of Dacron and Gore-Tex for grafting should be strongly discouraged.
      • Only patients with refractory ED or distal flaccidity unresponsive to pharmacologic treatment or those with complex deformities should be offered penile prosthesis implantation.
      • Inflatable prostheses are associated with superior results in terms of curvature correction, rigidity, girth restoration, and concealability compared with semirigid prostheses.
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