Peyronie disease
ICD-10 N48.6 · ICD-11 GB06.2

Persistent Penile Curvature After Prosthesis Implantation in Stable Peyronie's Disease with Erectile Dysfunction Refractory to Pharmacotherapy

Clinical Scenario

This protocol applies to men with stable Peyronie's disease whose erectile dysfunction did not respond to pharmacotherapy — including PDE5 inhibitors and intracavernous injections of vasoactive agents — and in whom sexual intercourse is compromised by the penile deformity. Surgery is indicated when the disease is stable.

Previous Treatment & Unmet Goal

The preceding intervention — penile prosthesis implantation (inflatable or malleable) — was performed as the primary surgical treatment for this population. However, the key target was not achieved: residual penile curvature remained at or above 30 degrees after implantation alone. Failure to reach this threshold triggers the next corrective step described by this protocol.

Next-Step Approach (Partial Overview)

When significant curvature persists following prosthesis placement, a manual modeling technique performed with the prosthesis may be applied as an initial corrective measure. The goal is to reduce residual curvature to below 30 degrees. If this step is insufficient, the complete protocol specifies further surgical options — details are available via the structured regimen.

Target: residual curvature < 30°
Instant Access to Structured Evidence-Based Regimens

References

  1. 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.
  2. 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).
  3. Perform surgery only when Peyronie's disease (PD) is stable and sexual intercourse is compromised due to the deformity.
  4. If the curvature is > 30°, manual modelling may be proposed as a first-line treatment approach with the prosthesis maximally inflated (manually bent on the opposite side of the curvature for 90 seconds, often accompanied by an audible crack), although the supporting evidence is limited.
  5. If a deviation > 30° persists after performing this manoeuvre, correction should be performed through shortening or lengthening procedures (incision with or without grafting).
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