Treatment of Stable Peyronie's Disease with Erectile Dysfunction Refractory to PDE5 Inhibitors and Vasoactive Injections
Clinical Scenario
This protocol addresses men with stable Peyronie's disease and concomitant erectile dysfunction (ED) whose erections have not responded to pharmacotherapy — including PDE5 inhibitors and intracavernous injections of vasoactive agents.
Surgery is indicated only when the disease is stable and the penile deformity compromises sexual intercourse.
Treatment Approach
In this specific population, the structured protocol centres on a surgical prosthetic approach. The full protocol specifies device selection, whether adjunct straightening manoeuvres are needed, and the complete decision algorithm.
Complete regimen details — including procedural options and selection criteria — are available through the structured protocol below.
Clinical Goal
The primary target is achieving residual penile curvature less than 30 degrees following prosthesis implantation.
References
- Use penile prosthesis implantation, with or without any additional straightening procedures (modelling, plication, incision or excision with or without grafting), in PD patients with ED not responding to pharmacotherapy.
- Penile prosthesis implantation is typically reserved for the treatment of PD in patients with concomitant ED not responding to conventional medical therapy (PDE5I or intracavernous injections of vasoactive agents).
- Perform surgery only when Peyronie's disease (PD) is stable and sexual intercourse is compromised due to the deformity.
- If the intra-operative curvature after placement of the prosthesis is < 30° no further action is indicated, since the prosthesis itself will act as an internal tissue expander to correct the curvature during the subsequent six to nine months.
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