Treating Peyronie’s Disease Without Surgery
March 7, 2016
Peyronie’s Disease is a condition where plaques form underneath the skin of the penis and lead to a curvature of the organ. There are both surgical and non-surgical treatments for Peyronie’s Disease.
How to treat Peyronie’s without surgery
In about 13% of cases, Peyronie’s Disease goes away without treatment. Many physicians recommend conservative (non-surgical) treatment for at least the first 12 months after symptoms present.
There are different options for treatment depending on the severity of your disease. Men who have a minimal curvature (< 30 degrees) can benefit from conservative therapy. Men with a more severe curvature (> 30 degrees) or those who are unable to have intercourse due to the condition would benefit from either injectable treatment or surgery.
Conservative treatment options
PDE-5 Inhibitors (Cialis, Viagra, Levitra, etc.) – These are oral medications that delivers increased blood flow to the penile tissue, thereby increasing oxygenation. More oxygen to tissue assists in wound healing, and since Peyronie’s disease is a disease of poor wound healing this type of medication is helpful. Out of the PDE-5 inhibitors, Cialis 5mg is recommended due to its daily use and rehabilitation of tissue.
Pentoxifylline – Pentox is also an oral medication, part of the PDE inhibitor class. It works by reducing inflammation and inhibiting fibrosis (scarring).
L-arginine – This amino acid is an over the counter supplement, available at most grocery or nutrition stores. It works by increasing nitric oxide in tissue, and has also been shown to cause inhibition of collagen synthesis. Nitric oxide causes vasodilation, which means the blood vessels of the penis increase in diameter and are able to deliver more blood flow to the penis. The more blood flow, the more oxygenation that is available for tissue healing.
Testosterone – Erectile function is dependent on testosterone. As part of your work-up for Peyronie’s disease, we may check testosterone levels. In some cases where testosterone supplementation is appropriate, it can be used as part of the treatment for Peyronie’s disease by assisting with increased blood flow for erections.
Penile stretching – Penile stretching or “traction therapy” is thought to help with reduction of curvature when combined with oral medications. There is an at-home stretching device that is used daily to accomplish this therapy. A study (2007) using external penile traction therapy demonstrated measured improvements in girth, length and curvature after 6 months of daily stretch therapy lasting from 2-8 hours per day.
Injecting a drug directly into the plaque of Peyronie’s disease is an attractive alternative to oral medications. Injection permits direct introduction of drugs into the plaque, permitting higher doses and more local effects.
Xiaflex® – Xiaflex is an effective, new option that has recently been FDA approved for men with a penile curvature of about 30 degrees or more with a fibrous, palpable lesion. This is an injectable treatment that is administered in the clinic, and requires close follow-up. Xiaflex contains collagenase, which is an enzyme that degrades collagen, the fibrous material that Peyronie’s plaques are made of. It is administered as a series of two injections, for up to four cycles. After artificially inducing an erection in our clinic, the medication is injected directly into the penile plaque. After administration, we will instruct you on at home stretching and straightening of the penis that is required after you receive the injections. Side effects may include penile bruising, pain, and fracture.
Patients who may be eligible for Xiaflex exhibit the following symptoms:
Penile curvature of about 30 degrees or more
Palpable lesion (meaning you are able to feel the plaque)
Stable phase (symptoms present for > 8-12 months , and no longer painful)
Other penile injections such as verapamil and interferon have also used in the treatment of Peyronie’s Disease.