Peyronie's Disease in Active Phase with Pain on Erection and Progressive Deformity
Clinical scenario
This protocol applies to patients with Peyronie's disease in the active phase — presenting with pain on erection, worsening penile deformity, or progressive curvature. Active disease is more likely when symptom duration is shorter, pain on erection is present, or a recent change in penile deformity has occurred.
Patient population
Conservative management is primarily directed at patients in the early or active stage of the disease, as an adjunct to relieve pain and prevent progression — or for patients who decline other treatment options during the active phase.
Treatment approach
For active-phase Peyronie's disease with penile pain and progressive curvature, management may include oral anti-inflammatory therapy or a non-invasive physical treatment modality — the complete, structured regimen is available in the full protocol.
Treatment goals: Resolution of penile pain on erection and stabilisation of penile curvature for at least three months.
References
- Patients who are still likely to have active disease are those with a shorter symptom duration, pain on erection, or a recent change in penile deformity.
- Conservative treatment of PD is primarily focused on patients in the early stage of the disease as an adjunct treatment to relieve pain and prevent disease progression, or if the patient declines other treatment options during the active phase.
- In patients with active-phase PD, nonsteroidal anti-inflammatory drugs (NSAIDs) may be considered for the management of penile pain.
- Retrospective studies shown that sildenafil 25mg and tadalafil 5mg daily were able to reduce pain during the active phase of the disease with some improvements, including in terms of curvature decrease.
- Use nonsteroidal anti-inflammatory drugs to treat penile pain in the acute phase of PD.
- Use extracorporeal shockwave treatment (ESWT) to treat penile pain in the acute phase of Peyronie's disease (PD).
- Resolution of pain and stability of the curvature for at least three months are accepted criteria of disease stabilisation as well as patients' referral for specific medical therapy or surgical intervention, if indicated.
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