There are various treatment options for Peyronie’s disease depending on the progression of the disease:
a) There is very little evidence that medical treatment is effective during the beginning phase of the disease. Treatment options such as oral medication, topical treatments and supplements such as oral vitamin E, Tamoxifen, Pentoxyphilline, Potassium Paraaminobenzoate, Colchicine and Verapamil have been offered to patients with no proven success on reducing penile curvature or plaque size, however they may help with pain management and potentially slowing the progression of the disease.
b) There may be rationale for penile stretching and straightening exercises during the acute phase of the disease. This can be achieved either by enhancing natural erections with the administration of Phosphodiesterase Type 5 Inhibitors such as Sildenafil, Tadalafil and Vardenafil, or mechanically, with the use of a vacuum or stretching device. Either treatment on its own is unlikely to show an enormous benefit, and should be performed together to get any result. The evidence of the effectiveness of the use of the vacuum pump or penile stretching device in isolation to mechanically straighten the penis is minimal. In the best-case scenario, the regular use of these devices may just slightly reduce penile curvature, which would be beneficial only in very selected patients (under 10%).
c) Injections of the Collagenase of the Clostridium Histolyticum (Xiapex®) is one of the latest treatment options available for Peyronie’s and the first non-surgical therapy that has proved effective in treating Peyronie’s plaque. These injections treat the curvature by “chemically” softening the plaque and restoring some of the length lost due to the scarring process. Xiapex® injections provide better results if combined with the regular use of a vacuum pump or of the penile stretching device in order to provide extra stretch of the plaque softened by the Collagenase of the Clostridium Histolyticum. These should be performed at 4 weeks intervals and the residual curvature should be assessed after the third injection, once the healing process at the level of the plaque is likely to be complete. If significant deformity persists, the cycle injection/stretching can be repeated. In expert hands, Xiapex® injections are a simple and safe procedure and can be performed in the outpatients’ clinic and would typically be the first line of treatment (subject to Consultant doctors diagnosis).
d) Surgery represents the gold standard treatment for Peyronie’s Disease and its aim is to guarantee a penis straight and hard enough to allow the patient to engage in penetrative sexual intercourse without pain or discomfort. The choice of the best surgical approach, apart from patients’ preference, should take in consideration the quality of erection and the degree of deformity and shortening. In patients with preserved erections, the curvature can be corrected either by shortening the longer side of the penis, which has not been affected by Peyronie’s Disease, or lengthening the shorter side incising the plaque and interposing a graft. Both procedures can be performed as a day case. Before the introduction of Xiapex, surgery was the only effective treatment for penile curvature caused by Peyronie’s and still remains the most successful for most patients. Surgery should only be performed after the disease progress has stopped which usually occurs 12 months from onset (chronic phase).