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:
- Have penile curvature of 30 degrees or more.
- 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.