Peyronie's Disease in Active Phase When Initial Conservative Treatment Has Not Resolved Pain on Erection or Stabilised Penile Curvature
This protocol addresses patients in the active phase of Peyronie's disease — those with a shorter symptom duration, ongoing pain on erection, or a recent change in penile deformity — in whom a first-line conservative approach has not achieved the required clinical targets.
Clinical Scenario
Active-phase Peyronie's disease is characterised by pain on erection, deterioration of penile deformity, or progressive penile curvature. Patients in this phase are prioritised for active treatment to relieve pain and prevent further disease progression.
Why This Protocol Applies — Prior Treatment Fell Short
An initial conservative approach — which may have included nonsteroidal anti-inflammatory drugs for penile pain, tadalafil for pain and curvature progression reduction, or low-intensity extracorporeal shockwave treatment for penile pain — was unable to achieve resolution of penile pain on erection and stabilisation of penile curvature for at least three months. This protocol is the structured next step when those targets are not met.
Treatment Direction (Partial Overview)
The protocol involves intralesional injection therapy combined with mechanical penile therapy. The selection of agent, the specific injection approach, and how these are integrated into a multimodal strategy — along with the clinical targets of reducing penile curvature and decreasing plaque dimensions — are set out in full in the structured regimen.
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.
- The original treatment protocol in all studies consists of two injections of 0.58 mg of CCH 24–72 hours apart every six weeks for up to four cycles.
- A modified short protocol consisting of administration of a single (0.9 mg, one vial) injection per cycle distributed along three lines around the point of maximum curvature up to three cycles, separated by four-weekly intervals, has been proposed and rapidly popularised replacing physician modelling with a multi-modal approach through penile stretching, modelling and VED at home.
- Use intralesional hyaluronic acid either alone or in combination with other treatments to reduce pain and/or penile curvature in acute phase PD, although outcome data are still limited.
- Offer penile traction devices and vacuum devices to reduce penile deformity or as part of a multimodal therapy approach, although outcome data is limited.
- Intralesional treatment with collagenase clostridium histolyticum showed significant decreases in penile curvature, plaque diameter and plaque length in men with acute and stable disease.