Treatment for Peyronie's Disease
Treatment options for patients with Peyronie's disease are limited. The goals of treatment are to reduce pain and maintain sexual function.
Surgery is the only effective treatment for Peyronie's, and because the condition may resolve on its own, physicians often advise waiting 1 or 2 years before choosing this option.
Nonsurgical treatment should be implemented within 6 months of the onset of symptoms and before the plaque has calcified. Vitamin E supplements and para-aminobenzoate tablets (e.g., Potaba) may be taken for several months. Medications such as a calcium channel-blocker (e.g., verapamil), an enzyme that breaks down connective tissue (collagenase), and steroids (e.g., cortisone) may be injected into plaque or delivered by iontophoresis.
Iontophoresis is a painless method of delivering medication to localized tissue using electrical current. Since like electrical charges repel, a positive charge applied to a positively-charged solution repels the medication into the tissue. Low-dose radiation (high-energy rays) therapy may reduce pain, but it does not effectively diminish plaque.
In December 2013, the U.S. Food and Drug Administration (FDA) approved the first non-surgical, FDA-approved treatment option for men with Peyronie's that causes erection curvature deformity of at least 30 degrees. Collagenase clostridium histolyticum (Xiaflex) injection is a biologic medication that also is used to treat Dupuytren's contracture.
When used to treat Peyronie's disease, Xiaflex is only available through a restricted Risk Evaluation and Mitigation Strategy (REMS) program due to the possibility of serious adverse reactions and injuries. The medication is injected directly into the collagen-containing structure of the penis by a medical professional with experience in treating male urological diseases. Treatment consists of a maximum of 4 injection cycles and studies show that treatment can significantly reduce symptoms.
Xiaflex works by breaking up collagen build-ups that cause penile curvature deformities. Side effects include penile pain, swelling, and bruising.
Surgery to Treat Peyronie's Disease
Surgical treatment may be used in severe, persistent cases of Peyronie's that have not responded to nonsurgical treatment. Surgery may be considered one year after the onset of the condition. Procedures involve the removal (excision) of hardened tissue and skin graft, the removal or pinching (plication) of tissue opposite the plaque to reduce curvature (called the Nesbit procedure), a penile implant, or a combination of these.
The removal of plaque requires a skin graft from another area of the patient's body and may result in a partial loss of erectile function (e.g., less rigidity). The Nesbit procedure reduces the length of the erect penis.
Penile implant involves implanting a device in the corpora cavernosa that increases rigidity. This procedure may be combined with incisions and skin grafts, or plication to effectively reduce curvature.
During the recovery period, patients are prescribed medication that prevents them from having an erection and are advised to avoid sexual activity. Antibiotics are also prescribed to reduce the risk for infection.
Complications of Surgery to Treat Peyronie's Disease
Complications that may develop as a result of surgery include the following:
- Adverse reaction to anesthesia
- Damage to the tube that carries urine and semen from the body (urethra)
- Excessive bleeding
- Neurovascular damage resulting in a lack of sensation
- Prosthesis malfunction
- Scar tissue resulting in impotence
Peyronie's Disease Prognosis
The prognosis for maintaining sexual function is good when treatment is started within 6 months of the onset of symptoms.