Medical treatment is typically considered in the early phase of Peyronie’s disease, while surgery may be recommended when there is functional impairment or lack of response to clinical treatment.
Peyronie’s disease is characterized by the formation of fibrous plaques in the penis, which may be associated with repetitive microtrauma and individual healing factors.
In severe cases, the penis may lose function and can become thinner or lose length.
So what is the best treatment for Peyronie’s disease? That depends on the stage. Learn more below.
When Peyronie’s disease treatment is medication or surgery
Medical treatment is prescribed during the acute phase of Peyronie’s disease, when pain and inflammation may be present. The goal is to reduce symptoms and try to limit progression of the curvature.
Use of medications
The anti-inflammatory colchicine is an example of a medication used in Peyronie’s disease.
Derived from a plant called colchicum autumnale, it is also used to relieve pain and swelling in gout, an inflammation of the joints caused by excess uric acid.
Colchicine is often combined with vitamin E and may, in some cases, slow the development of fibrous plaques in the penis.
Use of injections and ointments
Collagenase injections and topical therapies may also be treatment options for Peyronie’s disease in the early stage.
A collagenase injection is applied directly into the fibrous plaques to break down collagen fibers and promote tissue expansion. This treatment is not indicated for very rigid plaques or for curvatures located close to the urethra.
The protocol may include up to four cycles, with a maximum of 3 injections per cycle, with approximate six-week intervals between cycles.
Association with penile modeling or specific physiotherapy may also be recommended to support the remodeling and tissue flexibility process.
In general, treatment lasts approximately 4 to 5 months. In some cases, there may be a partial reduction of the plaque over the cycles, although the response to treatment varies among patients.
Topical ointments may also be considered in the acute phase of Peyronie’s disease due to their potential anti-inflammatory effect.
Substances such as verapamil, betamethasone, and dexamethasone are among the most commonly used and should be applied to the affected area according to medical prescription. Treatment duration varies depending on the patient’s clinical response.
When surgery is indicated for Peyronie’s disease
According to Dr. Paulo Egydio, a specialist in penile curvature treatment, surgery may be indicated when medical treatment does not provide an adequate response or when the disease reaches the chronic phase, characterized by a significant and stable deformity.
Main surgical methods
A Peyronie’s surgery may shorten the longer side or expand the shorter side. Below are some surgical methods.
Techniques that shorten the longer side:
- Nesbit technique: removal of tissue from the longer side of the penis. The penis may become up to 5 cm shorter after the procedure.
- Egydio STAGE technique: an enhancement of the previous method. It uses geometric calculations to help define the site of surgical intervention.
- Kelami-Nesbit technique: similar to the Nesbit technique, but the location and amount of tissue removal are determined using an instrument called an Allis clamp.
- Essed-Schroeder plication technique: a penile plication approach performed on the side opposite the greatest point of curvature, indicated for downward curvatures.
Techniques that expand the shorter side:
- Egydio Geometric Principles: incisions based on geometric calculations that expand penile tissues.
- Egydio Graftless Geometric Method: expands tissues hardened by fibrosis and facilitates penile implant placement.
- Gaffney Lengthening Strategy: a technique involving multiple incisions with the goal of promoting tissue expansion while respecting anatomical structures such as nerves and the urethra.
Peyronie’s disease treatment: medication or surgery—how does the urologist decide?
The decision about Peyronie’s disease treatment—medical or surgical—is based on each patient’s specific characteristics.
This individualization is essential to align expectations and define the most appropriate therapeutic strategy.
An experienced surgeon assesses the degree of curvature and determines whether the disease is in the early phase (characterized by pain and progression of deformity) or in the stable phase, when curvature is no longer progressing and there is no more pain.
In addition, the presence of erectile dysfunction associated with Peyronie’s must be considered, as it directly influences treatment choice.
See a urologist experienced in Peyronie’s disease
When Peyronie’s surgery is performed by a properly trained and experienced physician, appropriate surgical planning can contribute to greater technical predictability of the procedure.
Experience helps guide the choice of the most appropriate technique for each case.
Dr. Paulo Egydio, a urologist specialized in penile curvature treatment, has 28 years of experience and has performed more than 6,000 surgeries.
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