Treatment of Stable Peyronie's Disease with Palpable Dorsal Penile Plaques
This page addresses the structured management of stable Peyronie's disease presenting with palpable, non-calcified dorsal penile plaques and dorsal or lateral curvature of 30–90°, in patients without erectile dysfunction refractory to pharmacotherapy.
Clinical Scenario
- Stable phase of Peyronie's disease
- Palpable dorsal penile plaques — non-calcified
- Dorsal or lateral penile curvature between 30° and 90°
- No erectile dysfunction refractory to pharmacotherapy
- Patient requests non-surgical treatment
Treatment Approach
For this presentation, the evidence-based approach involves intralesional collagenase clostridium histolyticum delivered in structured injection cycles. Mechanical adjunct therapies may be incorporated as part of a multimodal strategy.
The complete cycle structure, protocol variants, injection schedules, and mechanical adjunct details are available in the full structured protocol.
Treatment Goals
- Decrease in penile curvature
- Decrease in penile plaque diameter and plaque length
References
- Use intralesional therapy with collagenase clostridium histolyticum in patients with PD and dorsal or lateral curvature > 30˚, who request non-surgical treatment.
- In 2014, the EMA-approved CCH for the non-surgical treatment of the stable phase of PD in men with palpable dorsal plaques in whom abnormal curvature of 30-90° and non-ventrally located plaques are present.
- The original treatment protocol in all studies consists of two injections of 0.58mg of CCH 24-72 hours apart every six weeks for up to four cycles.
- A modified short protocol consisting of administration of a single (0.9mg, 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.
- 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.
View source ↗