Peyronie’s Disease (PD)

What is Penile curvature (Peyronie’s Disease) ?

DR. Amy PEARLMAN EXPLAIns

Penile curvature (Peyronie’s Disease) can happen when scar develops in the penis. Because scar tissue doesn’t stretch as well as normal, healthy tissue, the penis may bend in the direction of the scar tissue or create a “waist” (hourglass) where the shaft of the penis doesn’t expand as much as other parts of the penis. Penile curvature repair is recommended when these changes in the penis make it difficult, impossible, or painful to have penetrative intercourse.

PROCEDURE BENEFITS

A wide variety of treatment options are available (i.e., conservative, procedural, surgical) to meet each person’s unique goals.

How to prepare for treatment

Depending on your work, you may need to take several weeks off following your surgery. 

No specific preparation is required for Xiaflex ® injections.

What treatments are available?

A traction device that can be self-applied to stretch the penis to help minimize penile length loss and improve curvature in some men. Traction therapy can also be used in combination with injection therapy. 

 

Intralesional collagenase clostridium histolyticum (Xiaflex ®) is the only FDA-approved injection medication for PD. 

    • This regimen includes several in-office injections and modeling visits which take place over a 6-month period.
    • If injections do not provide adequate results, surgical options to fix residual curvature can still be performed. 

Surgical options under general anesthesia include:

  • Penile plication: Suture(s) is placed along the longer side of the penis to straighten it

Plaque incision or excision with grafting: 

    • A cut(s) is made in the scar tissue allowing the penis to stretch out 
    • A piece of graft material may be used to cover up this defect 

Penile implant surgery with curvature repair: 

    • Sometimes the implant, alone, provides enough rigidity to fix the curvature. 
    • If significant curvature remains after penile implant placement, additional maneuvers in the operating room can fix the curvature.

Am I good a candidate for treatment?

Candidates for Xiaflex ® injections are those with:

    • Penile curvature >30° and <90°
    • Palpable penile scar
    • Intact erectile function (with or without the use of medications or vacuum pump)

Candidates for penile plication are those with:

    • Any direction and degree of curvature
    • Sufficient penile length so that some additional length loss can be tolerated

Candidates for plaque incision or excision with grafting:

    • Usually reserved for more severe curvature (>60°) and/or those with an hourglass deformity

Candidates for penile implant surgery with curvature repair are those with:

    • Penile curvature and inadequate erections despite therapy for erectile dysfunction 

FAQ

FREQUENTLY ASKED QUESTIONS

Most of the time, we don’t know the exact cause. We think it occurs from repeated injury to the penis, which may occur during sexual activity or from trauma to the area. Some men remember a specific event that occurred, after which they noticed a change in their penis, whereas others looked down one day and noticed a change. 

Traction therapy, in conjunction with Xiaflex®, may improve your response to injections. 

No sexual activity (include self-stimulation) between the first and second injection of each cycle and for FOUR weeks following the second injection.

It is difficult to predict how the length of the penis will change with plication surgery. To minimize penile shortening associated with this procedure, the goal during surgery is to improve the curvature enough for a good, functional outcome without reducing unnecessary length.

  • Worsening erectile function
  • Decreased blood flow to the tip of the penis
  • Reduced sensation to the penis 



CHOOSING THE RIGHT PROVIDER

Dr. Pearlman is fellowship-trained in penile reconstruction, including penile curvature repair. She believes in providing comprehensive care when it comes to the treatment of male sexual health concerns. As a result, she will discuss all treatment options with you prior to consideration of penile curvature repair so that she can help you come up with a treatment plan to best meet your sexual and quality of life goals. 



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