Peyronie’s Disease, is a complex condition with no clear cause and a multitude of treatment 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. Furthermore, individual urologists will have different treatment plans depending on their comfort with medical and surgical management of Peyronie’s. Let’s explore these available treatment options.
When it comes to treating Peyronie’s disease, the usual medication includes a drug injected into the penis or a surgery for cases where one is experiencing more pain or penis curvature over time. Clostridium hystolyticum (Xiaflex) is the only FDA-approved non-surgical treatment option for Peyronie’s disease. Xiaflex is approved for men with a penile curvature of more than 30 degrees during erection. This treatment involves a series of penile injections that break down the buildup of collagen.
Your doctor might suggest surgery if the deformity of your penis is severe, sufficiently bothersome, or prevents you from having sex. Surgery usually isn’t recommended until you’ve had the condition for at least one year and the curvature of your penis stops increasing and stabilizes for at least six months. Common surgical methods include:
- Grafting removes plaque and replaces it with a patch of skin, a vein or other material to straighten or restore lost length. Numbness and ED are potential complications.
- Plication removes or pinches a piece of the tunica albuginea from the side of the penis opposite the plaque to straighten the penis. While less likely to cause numbness or ED, it cannot restore length or girth to the penis.
- Penile prosthesis implantation is an option for men with both Peyronie’s disease and ED. The implant usually straightens the penis: if it does not, it can be combined with one of the other surgical options.
Vitamin E can help treat fibrosis, or the development of excessive connective tissue, making it a commonly recommended treatment for Peyronie’s Disease. Patients should only take vitamin E under the strict supervision of their doctors because high doses may be unsafe. Other oral medications include:
Pentoxifylline – Pentox is also an oral medication, part of the PDE inhibitor class. It works by reducing inflammation and inhibiting fibrosis (scarring).
PDE-5 Inhibitors (Cialis, Viagra, Levitra, etc.) – These are oral medications that deliver increased blood flow to the penile tissue, thereby increasing oxygenation. More oxygen to tissue assists in wound healing, and since Peyronie’s disease is a disease of poor wound healing this type of medication is helpful. Out of the PDE-5 inhibitors, Cialis 5 mg is recommended due to its daily use and rehabilitation of tissue.
L-arginine – This amino acid is an over the counter supplement, available at most grocery or nutrition stores. It works by increasing nitric oxide in tissue, and has also been shown to cause inhibition of collagen synthesis. Nitric oxide causes vasodilation, which means the blood vessels of the penis increase in diameter and are able to deliver more blood flow to the penis. The more blood flow, the more oxygenation that is available for tissue healing.
Radiation therapy, which involves using high-energy waves, has been used to reduce pain caused by Peyronie’s disease. Radiation therapy is performed at hospitals. Although this treatment has been shown to alleviate pain, it does not decrease the plaque in the penis. It may also cause many side effects, including fatigue, erectile dysfunction (ED), and decreased testosterone levels.
External/mechanical therapies include penile traction devices, and vacuum erection devices, as well as manual molding, stretching and massaging the penis. They are a very important part of the process, helping to lengthen and straighten the penis after the scar tissue has been weakened by the injections. A vacuum erection device can be used twice daily for 10 minutes. In a small study of 31 patients, 21 showed a reduction in curvature between 5-25 degrees.