What to Consider for Peyronie’s Disease Treatment

Peyronie’s disease (PD) occurs in up to 18% of men and is characterized by the development of fibrous plaque on the tunica albuginea in the penis. This plaque, often caused by microtrauma from surgery, sex, or other experiences, can cause the penis to curve or deform when erect.

This article aims to provide an overview of the American Urological Association (AUA) and Canadian Urological Association (CUA) guidelines regarding PD and its treatments.

The AUA and CUA guidelines are relatively similar, specifying that specific treatment depends on the degree of curvature, presence of erectile dysfunction, and stage of disease.

There are currently no treatments recommended for the acute or active phase of PD (when the plaque is still forming); however, new research has been investigating options for treating the active phase. All recommended treatments as of 2018 are meant for the chronic or stable phase of PD (when the plaque has hardened).

What to Consider

Oral medications, including non-steroidal anti-inflammatories (NSAIDs) for erectile pain during the active phase, and PDE5-i for erectile dysfunction (ED).

Collagenase intralesional injections involve injecting into the most acute area of fibrous plaque, laterally, accompanied by both clinician-manual modelling and at-home modelling. This method should only be recommended for patients with a curvature between 30° and 90°, with good erectile function, a stable disease state, and the presence of non-calcified plaque on ultrasounds.

Verapamil intralesional injections are currently considered part of the standard of care in many places. Some studies have shown some potential benefits to curvature and pain, while others have not shown much improvement. Both the CUA and AUA recommend conditional use of these injections.

Penile traction has a Grade C recommendation by the CUA and is included in the AUA’s Core Curriculum on Peyronie’s Disease as a reasonable option. This may be recommended for those in both the acute and chronic phases of PD, but is most helpful when used early, and best when used in combination with other methods. If patients cannot fully commit, then it is not recommended that they use this method. Most studies have reported an average improvement in curvature of roughly 33%, with patients reporting improvements in penile length, curvature, and successful sexual intercourse.

Penile plication is best for patients with good erectile function and pre-operative penile rigidity without medication, and with an uncomplicated curve between 30° and 60° with no significant deformity.

Plaque incision or excision with grafting is best for patients with normal erectile function with or without medication, complex penile curvature of less than 60°, large plaque(s), short penile length, and other deformities.

Penile prosthesis placement is recommended for PD when significant erectile dysfunction is present. The prosthesis may be performed in combination with other procedures such as manual modeling (bending), plication, or incision/grafting. Providers should establish if patients would prefer a completely straight penis or if the functionally straight measurement of 20° is acceptable. Generally, penile curvature should improve over time with repeated activation of the device.

What to Avoid or Recommend Experimentally

Oral therapy with vitamin E, tamoxifen, procarbazine, omega-3 fatty acids, or a combination of vitamin E with L-carnitine. Recent research has studied tamoxifen as an option for the acute phase, but the results do not provide strong evidence yet.

Verapamil gel or electromotive therapy is not recommended by either association.

Extracorporeal shock wave therapy (ESWT) has a conditional recommendation for the treatment of penile pain only. However, research is continuously evolving in this area.

Radiation therapy should not be used in any case.

Platelet-rich plasma (PRP) is not recommended for the treatment of PD due to a lack of reliable data. However, more recent research shows potential and therefore may be considered experimentally.

Key Takeaways

• Peyronie’s disease has a higher prevalence rate than one might think and causes distressing sexual dysfunction and pain.
• Decisions for treatment modalities should be a collaborative process with the patient, and should consider the degree of curvature, disease progression, and presence of erectile dysfunction.
• Research is constantly evolving regarding PD treatments. These could be considered for experimental or investigational therapy.
• The AUA and CUA have roughly the same recommendations for PD treatment. Only minor differences occur, likely due to cultural or political differences.
• Choosing the right therapeutic option for patients does not have to be stressful.

Resources

Bella, A. J., Lee, J. C., Grober, E. D., Carrier, S., Benard, F., & Brock, G. B. (2018). 2018 Canadian Urological Association guideline for Peyronie’s disease and congenital penile curvature. Canadian Urological Association Journal, 12(5). https://doi.org/10.5489/cuaj.5255

Nehra, A., Alterowitz, R., Culkin, D. J., Faraday, M. M., Hakim, L. S., Heidelbaugh, J. J., Khera, M., McVary, K. T., Miner, M. M., Nelson, C. J., Sadeghi-Nejad, H., Seftel, A. D., Shindel, A. W., & Burnett, A. L. (2015). Peyronie’s Disease (2015). Peyronie’s disease guideline - american urological association. (2015). https://www.auanet.org/guidelines-and-quality/guidelines/peyronies-disease-guideline

Sandean DP, Leslie SW, Lotfollahzadeh S. Peyronie Disease. [Updated 2024 Oct 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560628/

Shah, M., Megson, M., Al-Mitwalli, A., Fratangelo, R., Shergill, P., Shahzad, R., Di Giovanni, A., Zhang, J., Lee, W. G., Ralph, D. J., & Cellek, S. (2026). Evaluation of a combination of off-label PDE5 inhibitor and tamoxifen in acute Peyronie’s disease. The Journal of Sexual Medicine, 23(6). https://doi.org/10.1093/jsxmed/qdag120