Peyronie’s Disease: Is Surgery Your Only Option?

Every day I see men who arrive at my clinic with concerns about a “curved penis”, “shorter penis” or “penile deformity”. Even more so, they come in already knowing they have Peyronie’s Disease. Some men diagnosed with Peyronie’s arrive seeking a second opinion after their original urologist told them there is nothing that can be done.

Depending on the specific situation, there are different options that we can offer to help restore function. Most importantly, it does NOT involve surgery!

When Should You Treat Peyronie’s Disease?

Peyronie’s can be broken up into 2 phases: Active and Stable

The active phase is characterized by an actively changing deformity and/or pain. This means that if you feel like the curvature has worsened within the last 3 months, you may still be in the active phase.

Urology experts often try to wait until the curvature has stabilized before they offer any “invasive” procedures to correct it. This is because treating it too early can lead to recurrence. And as you can imagine, we would like to avoid performing more than 1 surgery.

Are There Oral Medications That Can Help with Peyronie’s Disease?

There are several medications that experts have researched for the treatment of Peyronie’s.  Most of these medications theoretically help reduce collagen (or scar tissue) buildup.  However, there have been multiple flaws in these studies, and none have been very promising.

However, there was a recent study published in 2022 that suggested using a daily dose of Tadalafil (also known as Cialis) for Peyronie’s during the active phase. This study suggested that this medication can help prevent the curvature from getting worse. Other than Tadalafil, there are no known oral or topical medications proven to help improve penile curvature.

What Options Do I Have to Improve My Curved Penis?

There are two major groups of treatment: Surgery and Non-Surgery.

How Does Peyronie’s Disease Develop?

The penis has an elastic sheath, called the tunica albuginea, that stretches with an erection.   Peyronie’s is a condition in which collagen, or scar tissue, forms on the tunica albuginea that surrounds the erectile bodies of the penis. This scar tissue does not allow the penis to stretch. It limits the elasticity of the penis. We call that scar tissue a Peyronie’s plaque.  Therefore, the goal of any treatment is to attempt to either break the plaque, stretch the plaque or try to “even things out” by restricting the side that is not causing the curvature.

What is Injectable Therapy for Peyronie’s Disease?

Currently, there is only one medication that is FDA-approved for the treatment of Peyronie’s plaque. This medication is known as Xiaflex or Collagenase Clostridium Hystoliticum. This medication utilizes an enzyme, collagenase, that breaks down collagen. Xiaflex breaks down the Peyronie’s plaque to allow the penis’ elastic sheath to expand. However, this requires “modeling” for it to work and that’s where traction therapy comes in. Your doctor will give you instructions on how to stretch and model your penis at home to maximize your results.  Research has shown that Xiaflex can help improve curvature by 30%. When combined with RestoreX traction therapy, it can sometimes improve curvatures by 50%.  This means that if you have a curvature that is 60 degrees, you may end up with close to a 30-degree curvature.

What is the Xiaflex Treatment Protocol?

Xiaflex is administered by your urologist or provider. The Xiaflex protocol involves a total of 8 injections that are administered in 4 separate cycles. Each cycle consists of 2 injections that are administered 2 to 3 days apart. In our office, we will first numb the area and then give you the injection. The entire process takes less than 5 minutes. After the injection, we will place a small dressing and you will be able to go back home or to work.  If you are interested in Xiaflex therapy, be sure to ask me if this treatment is right for you.

How do I know if I am a Candidate for Xiaflex Injections?

These are the criteria to be a candidate for Xiaflex injections:

1. Have penile curvature of 30 degrees or more.
2. Have a palpable plaque.

Does Insurance Cover Xiaflex injections?

Some insurances require the curvature to be in the “stable phase” for the treatment to be approved. Moreover, Xiaflex is not indicated for the treatment of hourglass deformity. The limiting factor for Xiaflex is cost. This is an expensive medication. However, most insurance carriers cover Xiaflex injections. Your provider needs to obtain authorization from your insurance before the treatment. After your consultation and evaluation, we will submit all the information to your insurance. Once we obtain the authorization and receive the injection vials, we will start the therapy.

In Conclusion…

Peyronie’s disease does not always require surgery. Remember that we only treat Peyronie’s if it is bothersome for you and/or your partner.  If you have strong erections and are not bothered, you do not require treatment. However, if you are bothered, there are several treatment options available for you. Fortunately, there are ways to help improve Peyronie’s curvature that do not involve surgery. I am an expert in the management of Peyronie’s disease and will be happy to help you reach your goals. Call us! We can help you!

This article was authored by Dr. Jonathan Clavell. Dr. Clavell is a board-certified urologist who specializes in men’s health including erectile dysfunction, low testosterone, Peyronie’s Disease and BPH. 

Why Gatekeepers of Men? 

Erectile Dysfunction: Physical and Emotional Effect on a man and his partner

Erectile dysfunction is a term no man wishes to ever use.  We do not like talking about it.  Even more,  we wish to never experience it.

However….  When a man experiences erectile dysfunction it affects him both physically and emotionally.

What is the physical impact of erectile dysfunction?

The penis is linked to your heart.   When aroused, Your heart delivers blood to your penis through the arteries. Your penis then has “the responsibility” of keeping that blood trapped inside the penis in order to keep an erection.  If the penis is unable to bring blood in, or keep the blood trapped, the penis will experience erectile dysfunction.

The arteries going to the penis are VERY SMALL, probably smaller than the straw used to stir your morning coffee. When a man has any medical condition that can the decrease blood flow delivery from the heard and the heart is unable to deliver blood to the penis, we call it arterial insufficiency.

Now there is another problem that can happen.  The penis also needs to keep the blood TRAPPED inside the penis. Imagine your penis being a bucket of water that needs to stay full to work.  If the bucket has multiple tiny little holes, the water will not be able to stay inside the bucket.  In the penis, we call that “venous leakage”. Venous leakage can happen in both older men and younger men.  I have even seen men who were born with this problem.

What is the emotional impact of erectile dysfunction?

ED can crush a man’s confidence, self-worth and lead to depression.  A man with erectile dysfunction may pull himself away from his partner and try to avoid intimacy altogether because he may fear failure in bed.  Those who are single often avoid relationships altogether.   Therefore, if you ask me, the emotional impact of ED weighs heavier than the physical impact.  Erectile dysfunction affects relationships, self-esteem, and even work productivity (yes! There is research on this topic!).

Can I overcome ED?

My goal, as a urologist and men’s sexual health expert, is to help men learn about what is going on and how to overcome it.  There are MULTIPLE treatment options and NO MAN should be suffering from ED without finding a solution.  There are pills, injections, vacuum erection devices, psychotherapy, physical therapy and even a penile implant.  We first need to find out what is the cause and then we can find a solution.

The HARD Series…

Erectile dysfunction is hard.   The journey to overcome it is even harder. This year I was a part of a documentary series that was created to show EVERYONE what men go through and how we can help men overcome it.  This series will show Men with erectile dysfunction that they are not alone.  It will remind you that there are others who have gone through exactly what you are going through now and that there is a solution.  The Hard Series is meant to show us the truth. It is meant to show us that ED is real, that ED is extremely common.  It shows us that as a society, we need to be more open about these topics.  Erectile dysfunction is very common, and it is about time that we start talking about it.

I invite you to watch this episode in which you will see how erectile dysfunction impacted the relationship of a beautiful couple and how a simple procedure helped a man feel worthy of his relationship again.  Enjoy!

Remember….  My goal is to help bring life to your years.

Remember…. We are #gatekeepersofmen.

This article was authored by Dr. Jonathan Clavell. Dr. Clavell is a board-certified urologist who specializes in men’s health including erectile dysfunction, low testosterone, Peyronie’s Disease and BPH. 

Why Gatekeepers of Men?