Treatments for Peyronie’s disease

This section describes the different treatments for Peyronie’s disease, considering non-surgical options and the range of procedures used to treat the disease.

Non-surgical treatments

Unfortunately there is no established and thoroughly evaluated medical treatment for Peyronie’s disease. However there are some non-invasive therapies and medication which appear to be helpful.

Medication and non-invasive treatment

Vitamin E, a relatively cheap and safe antioxidant, had been found to be effective in reducing pain for some patients. An antifibrotic agent that belongs to the vitamin B group family has also been found to improve the pain of Peyronie's plaques, but it is costly and can cause side-effects.

Injections of a calcium channel blocker have been shown to improve pain, curvature and sexual functioning. Vacuum devices are used in the treatment of curvatures caused by Peyronie's disease but their effectiveness is not fully understood.

The role of counselling

One of the important parts of the management of Peyronie's disease is counselling and discussing the treatment options fully with the patient. The psychological effects of an incurable penile deformity must not be underestimated.

Surgical treatments

Due to the lack of any effective medical treatment for established Peyronie's plaques and the resultant curvatures, surgery is the main form of treatment for the condition.

The disease should have been present for a year and stable for three to six months and surgery should only be considered if the deformity is causing difficulty with intercourse.

Nesbit procedure

The Nesbit procedure is by far the most commonly performed surgery for Peyronie's disease, with patients reporting high degrees of satisfaction and durability.

The main problem with this procedure is that it results in some penile shortening. However, it is important to note that shortening is not very extensive and it rarely affects intercourse. One study showed shortening was less than 1cm in 90 per cent of patients. Among this group, only one per cent found the shortening affected their sexual intercourse.

Incision and grafting

In order to reduce the incidence of penile shortening, the Lue procedure has been developed. This technique involves making an incision and inserting graft material into the curvature.

This is a more complex and lengthy operation, particularly as the most commonly used graft material is a saphenous vein (the vein which drains the leg and foot) taken from the patient at the time of operation. A variety of other autologous (from the patient’s own body) and synthetic graft materials have been used with varying results.

Satisfaction rates are high and erectile dysfunction is the main complication, affecting approximately 12 per cent of patients. Even with this procedure there is a risk of penile shortening. Despite this, incision and grafting is a popular procedure for patients who are anxious about their penile length.

Incision and grafting can also be used to treat deformities of the penis where Peyronie's disease causes indentation on one side. The graft is inserted into the indented area to expand the penis's circumference.

Penile prostheses

Peyronie's disease associated with erectile dysfunction presents is more challenging to treat surgically. If there is a mild degree of erectile dysfunction, it may be possible to carry out a Nesbit procedure and combine this with medication to improve erections post surgery.

For patients with significant erectile dysfunction, or who have risk factors pointing to this complication post-operatively, it is best to offer penile prosthesis insertion from the outset. This treats both the erectile dysfunction and the curvature.

Patients have reported high success and satisfaction rates from this procedure, particularly when combined with the 'modelling procedure', where the penis is flexed in the opposite direction to the curvature.

David Ralph, Harley Street Urology’s surgeon specialising in the treatment of Peyronie’s disease has extensive experience of all procedures and the largest UK experience of penile prostheses implantation.

Find out more

▸ Peyronie's disease – symptoms and causes.
▸ Harley Street Urology – experts in male sexual health.
▸ Please contact us if you would like to discuss the different treatments for Peyronie’s disease.