Peyronie's Disease Treatment

Peyronie's Disease: Treatment at The Men's Clinic at UCLA

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.

Medical Management for Peyronie's Disease

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, most non-FDA approved.  Many 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% chance 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.   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.  

Medical Management for Peyronie's Disease: Xiaflex

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.  However, as of 2013, Xiaflex received FDA approval as an 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. Dr. Mills at The Men's Clinic at UCLA is a national leader in using Xiaflex, the first drug to be approved by the U.S. Food and Drug Administration (FDA) for the treatment of Peyronie's Disease.

Surgery Treatment for Peyronie's Disease

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 the treatment of Peyronie’s Disease.

• Penile Plication for Peyronie's: This is the most straightforward surgical approach.  Most often under a general anesthesia, the surgeon makes an incision around the crown of the penis, usually along the man’s circumcision line, if he was circumcised, and pulls down the skin to expose the fibrous coating of the penis where the plaque is.  Usually, the surgeon gives the man an erection in the operating room using an injection medicine.  Once the surgeon observes the degree of curvature, he or she will place a number of stitches opposite the curve to rescaffold the penis against the direction of the curve.  Once the sutures are tied down, the tissue bunches together and pulls against the curve.  In the carefully selected patient, this is a very successful operation.  The main downside to the surgery is men can lose some length.  Therefore, it’s not a surgery for everyone.
• Penile plaque excision and graft surgery for Peyronie's: This surgical option is far more involved.  Penile plaque excision and graft surgery involves a similar incision to the plication surgery.  After incision, the surgeon excises the plaque and places a patch.  This is where the complexity starts.  The plaque sits underneath a complex neurovascular bundle where the sensation nerves and some of the penile blood vessels run.  One of the trickiest parts of this surgery is to elevate this bundle without cutting any of the fibers to expose the plaque.  Injury to these fibers can lead to penile numbness, impotence and long lasting fluid collections called lymphedema.  The other tough part of this operation is figuring where to get the patch.  Surgeons have tried many materials ranging from tissue harvested from the patient’s own body, artificial materials, animal tissue and lastly tissue harvested from human cadavers.  With this many options and surgeon opinions, one may rightly assume there is no consensus on the best material.  Risks of plaque incision and grafting include temporary or permanent penile numbness, reduced erection strength, scarring and shortening.  In the right surgeon’s hands, however, this represents a powerful and effective treatment option.
• Penile Implant for Peyronie's: If a man suffers from both Peyronie’s and erectile dysfunction, a penile implant (link to penile implant) with intraoperative modeling is likely the best surgical option.  Surgeons have been placing implants for over 40 years.  An implant can correct the Peyronie’s deformity because the cylinders will act as I beams to straighten the penis.  Once the surgeon places the implant, he or she can hold pressure over the erect implant and bend the penis against its curve.  With the cylinders in place, the penis has a good chance of holding straight once the man heals.

At The Men’s Clinic at UCLA, 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.