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Management of Peyronie's Disease

Treatment of Peyronie's disease

 

Surgery - Penile Plication

 

The standard treatment for correction of significant Peyronie's disease is surgical plication. This involves a general anaesthetic, and a procedure where we plicate or crimp the penis opposite the point of maximum curvature. This works well but does have some risk. The main risk with this type of surgery is a degree of penile shortening. This is proportional to the amount of curvature that you have i.e. the greater curvature, the greater penile shortening. There is always also a risk of erectile dysfunction, although this is rare. There also can be recurrent or persistent curvature after surgery. Timing of surgery is very important. Curvature can progress for 12-18 months after it first occurs. We need to ensure that the curvature has stopped progressing before we proceed with surgery. 

 

Xiaflex–Collagenase injections.

 

Xiaflex is a new treatment which is less invasive than surgery. In the right cases, it can be a very effective treatment. It is best for dorsal or lateral curvature of no more than 60°. If there is more severe curvature than this, surgery is a better option. The advantage of Xiaflex is that it is less invasive. The process involves giving you an injection to create an erection. We mark the point of maximal curvature, place some local anaesthetic, and inject the scar tissue with collagenase. This helps to soften the plaque, and reduce the effect of the scar causing curvature of the penis. We start with 2 injections a week or two apart and then reassess things after you have done a period of penile modelling. It is likely that you would need 4 injections in total, but some men only need two. This reduces the cost of the treatment. Collagenase is not covered by insurance, and is expensive. It does however have some benefits for men and that it does not affect penile length, and is less invasive than surgery.

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