Peyronie’s disease (PD) is a connective tissue disorder characterized by the development of scar tissue, known as plaque, within the tunica albuginea—the sheath surrounding the erectile bodies of the penis. This inelastic scar tissue prevents the affected area from stretching during an erection, causing the penis to bend, curve, or shorten. This condition can lead to pain and difficulty with sexual function. While surgical options exist for severe cases, many patients seek non-surgical interventions to reduce curvature and manage symptoms.
Diagnosis and Initial Management
Peyronie’s disease progresses through two distinct phases that guide treatment decisions. The initial Acute phase typically lasts between six and 18 months. During this time, scar tissue is actively forming, inflammation is present, and patients often experience pain with erections and worsening penile curvature.
The Acute phase transitions into the Chronic phase once inflammation subsides and plaque formation stabilizes. Pain usually resolves, and the curvature becomes fixed. For patients presenting in the Acute phase with mild curvature (less than 30 degrees) that does not interfere with sexual intercourse, physicians may recommend “watchful waiting,” as a small percentage of cases can show spontaneous improvement.
Systemic Oral Medications
Oral medications are systemic treatments, meaning they affect the entire body, and are typically considered a first-line option, especially in the Acute phase. These drugs are generally thought to work by reducing inflammation, decreasing oxidative stress, or inhibiting the production of scar tissue. However, the overall efficacy of oral agents in significantly reducing penile curvature has been limited or controversial.
Examples include Pentoxifylline, a drug that improves blood flow and possesses anti-fibrotic properties that may help slow plaque progression. Potassium Aminobenzoate (Potaba), a B-complex vitamin derivative, is theorized to exert an anti-fibrotic effect by increasing tissue oxygen uptake. Antioxidants, such as high-dose Vitamin E, have also been used to reduce the oxidative stress believed to contribute to initial tissue damage.
Intralesional Injection Therapy
Intralesional injection therapy involves the direct delivery of medication into the fibrous plaque. This localized approach maximizes the concentration of the drug at the site of the scar tissue while minimizing systemic side effects. The most widely used agent is Collagenase clostridium histolyticum (CCH), which is the only medication approved by the U.S. Food and Drug Administration for Peyronie’s disease.
CCH is a biologic agent containing two purified collagenases that specifically target and break down collagen—the main structural component of the plaque. The enzyme works by cleaving the strong helical structure of the collagen fibers, effectively weakening the hardened scar tissue. The treatment protocol involves a series of cycles, typically consisting of two injections into the plaque spaced several weeks apart.
Following the injection, a mechanical process called penile modeling is performed by the physician and continued by the patient at home. This involves gentle stretching and manipulation of the penis. Modeling helps physically break down the enzyme-weakened plaque and stretch the damaged tunica albuginea to reduce curvature. Clinical trials show that CCH therapy can achieve a significant average reduction in penile curvature, often around 34%, for patients with stable disease and a curvature of at least 30 degrees.
Other Injectable Agents
Other injectable agents are sometimes utilized, including Verapamil and Interferon alfa-2b, though they are less common and typically reserved for specific situations. Verapamil, a calcium channel blocker, is thought to decrease collagen production and increase the activity of enzymes that break down collagen. Interferon alfa-2b is an immune system protein with anti-proliferative effects that may help reduce the size and density of the plaque.
Mechanical and Device-Based Treatments
Mechanical treatments involve applying physical force to the penis to remodel scar tissue and counteract curvature. Penile Traction Therapy (PTT) utilizes a device worn on the penis that applies sustained, low-level tension over time. This consistent mechanical stress encourages the stretching and lengthening of the tunica albuginea on the side of the plaque.
The goal of PTT is to physically lengthen the constricted tissue, reducing the severity of the curvature and potentially restoring lost penile length. Success requires adherence to a strict usage regimen, often wearing the device for several hours daily over many months. PTT can be used alone or in conjunction with CCH injections to enhance results.
Vacuum Erection Devices (VEDs), or penile pumps, are another mechanical option. A VED creates a negative pressure environment around the penis, drawing blood into the erectile tissues and inducing an artificial erection. This process helps stretch penile tissues and improves blood flow and oxygenation, which may aid in tissue health. Regular VED use helps maintain penile length and elasticity and is often recommended as a rehabilitative measure following localized treatments.