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Peyronie Disease

by Patrick J. Shenot, MD

Peyronie disease is fibrosis of the cavernous sheaths leading to contracture of the investing fascia of the corpora, resulting in a deviated and sometimes painful erection.

Peyronie disease occurs in adults. The cause is unknown but appears to be similar to that of Dupuytren contracture and may be related to past trauma, possibly during intercourse. The contracture usually results in deviation of the erect penis to the involved side, occasionally causes painful erections, and may prevent penetration. Fibrosis may extend into the corpus cavernosum, compromising tumescence distally.

Diagnosis is made clinically. Ultrasound or other examination of the erect penis may be used to document the fibrosis.

Resolution may occur spontaneously over many months. Mild Peyronie disease that does not cause sexual dysfunction does not need treatment.

Treatment of Peyronie Disease

  • Oral vitamin E and K para-aminobenzoate

  • Surgical replacement of fibrosis with patch graft

  • Local injections of verapamil, high-potency corticosteroids, or collagenase clostridium histolyticum

  • Ultrasound or radiation therapy or a prosthesis

Treatment results are unpredictable. Oral vitamin E and K para-aminobenzoate have had varied success. Surgical removal of the fibrosis and replacement with a patch graft may be successful or may result in further scarring and exaggeration of the defect. A series of local injections of verapamil or high-potency corticosteroids into the plaque may be effective, but oral corticosteroids are not. For a penile curvature of > 30° accompanied by a palpable plaque, one or more injections of collagenase clostridium histolyticum into the plaque followed by manual penile remodeling may be used.

Ultrasound treatments can stimulate blood flow, which may prevent further scarring. Radiation therapy may decrease pain; however, radiation often worsens tissue damage. To assist penetration, a penile prosthesis may be implanted but may require a patch procedure to straighten the penis.

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