This protocol applies to patients with stable Peyronie's disease whose symptoms have been clinically unchanged for at least three months and who retain sufficient penile rigidity for coitus — with or without pharmacotherapy and/or vacuum device therapy — and do not have erectile dysfunction refractory to those measures.
Stable disease phase: symptoms quiescent or clinically unchanged for at least three months (by patient report or clinician documentation). Penile rigidity adequate for coitus, with or without pharmacotherapy and/or vacuum device assistance. No erectile dysfunction refractory to pharmacotherapy and/or vacuum device therapy.
The evidence-based protocol for this scenario centres on intralesional injection therapy — administered through a structured course that incorporates clinician-guided penile modelling. Multiple evidence-supported agents are available within this class; the specific choice, complete regimen, and modelling schedule are detailed in the full protocol.
In the patient with stable disease, symptoms have been clinically quiescent or unchanged for at least three months based on either patient report or clinician documentation.
Clinicians may administer intralesional collagenase clostridium histolyticum in combination with modeling by the clinician and by the patient for the reduction of penile curvature in patients with stable Peyronie's disease, penile curvature >30° and <90°, and intact erectile function (with or without the use of medications).
Clinicians may administer intralesional interferon α-2b to patients with Peyronie's disease.
Clinicians may offer intralesional verapamil for the treatment of patients with Peyronie's disease.
At one year of follow-up, in the collagenase groups, curvature was reduced by mean 17 degrees. Average curvature reduction was 13.5 degrees in the interferon group compared to 4.5 degrees in the placebo group. Average plaque size reduction was 2.6 cm² in the interferon group compared to 0.9 cm² in the placebo group. Penile pain resolved in 21 of 31 (67.7%) patients in the interferon group who reported pain at baseline but in only 9 of 32 (28.1%) of patients in the placebo group who entered the study with pain.
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