Stable Peyronie's Disease When Intralesional Therapy Did Not Achieve Curvature Correction: The Surgical Step
This protocol addresses the patient with stable Peyronie's disease — symptoms clinically quiescent or unchanged for at least three months — who retains adequate penile rigidity for coitus and has not achieved sufficient outcomes from a prior course of intralesional therapy.
Clinical Scenario
Stable Peyronie's disease with all of the following:
- Symptoms clinically unchanged for at least three months
- Adequate penile rigidity for coitus (with or without pharmacotherapy and/or vacuum device therapy)
- No erectile dysfunction refractory to pharmacotherapy and/or vacuum device therapy
Prior Treatment — Goals Not Achieved
The preceding line of management included intralesional therapy — collagenase clostridium histolyticum, interferon α-2b, or verapamil. Escalation to this protocol is triggered when the following goals were not sufficiently met:
- Reduction in penile curvature
- Reduction in penile plaque size
- Resolution of penile pain
Next-Step Management
For patients in this setting with adequate erectile function, the structured approach involves a surgical intervention directed at penile curvature correction. The full protocol specifies which operative approach is indicated and how patient selection determines the choice between available options.
References
- 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 offer tunical plication surgery to patients whose rigidity is adequate for coitus (with or without pharmacotherapy and/or vacuum device therapy) to improve penile curvature.
- Clinicians may offer plaque incision or excision and/or grafting to patients with deformities whose rigidity is adequate for coitus (with or without pharmacotherapy and/or vacuum device therapy) to improve penile curvature.
- The Panel interpreted these data to indicate that for most patients plication surgery results in curvature correction in the setting of a relatively low risk of serious adverse events.
- The Panel interpreted these data to indicate that, for most patients, plaque incision and/or excision with grafting results in curvature correction in the setting of a relatively low risk of serious adverse events.
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