In a very few cases (about 13 out of 100), Peyronie's disease goes away without being treated. Most health care experts suggest treating the disease without surgery for the first 12 months after the disease is first noticed. Men with small plaques, not much curving of the penis, no pain and no problems with sex may not need to be treated. If you need to be treated, there are many choices.
Drug therapy may help men who are badly affected by the disease during the acute phase. Most society guidelines do not recommend oral drugs because long-term studies have not shown convincing benefit.
Oral vitamin E
Vitamin E is an antioxidant that is popular because of its mild side effects and low cost. Studies as far back as 1948 show that taking vitamin E may make plaques smaller and help straighten the penis. But most of these studies did not compare a group of people using vitamin E to a group of people who did not (a control group). A few studies of vitamin E that used a control group suggest that vitamin E doesn't work better than placebo. (A placebo is a pill with no drugs in it - a "sugar pill.")
Small studies with placebo controls show that this vitamin B-complex helps reduce plaque size, but not the curve. Unfortunately, it is costly and patients need to take 24 pills per day for 3 to 6 months. It also can upset your stomach, so many men stop taking it.
This non-steroidal, anti-estrogen drug has been used to treat desmoid tumors, which are like the plaques in Peyronie's disease. There are only a few controlled studies of this drug and they haven't shown that tamoxifen works better than placebo.
Colchicine is an anti-swelling agent that has been shown to be slightly helpful in a few small studies without controls. Many patients taking colchicine get stomach problems and stop taking the drug. It hasn't been proven to work better than placebo.
Carnitine is an antioxidant drug that lowers swelling to help wounds heal. Studies without controls show some benefit. But a recent controlled study didn't show it to work better than placebo.
Injecting a drug right into the plaque brings higher doses of the drug to the problem than when a drug is taken by mouth. Plaque injection is often used for men with early Peyronie’s disease or those who aren't sure they want to have surgery. The skin is often numbed before the shot to reduce pain.
Verapamil is mostly used to treat high blood pressure. Some studies suggest that verapamil injection may work for penile pain and curving. Verapamil appears to be a good, low-cost option for the treatment of Peyronie's disease. More controlled studies are needed to prove how well it works.
Interferon is a protein made in the body that helps control swelling. It has been shown to help control scarring, perhaps by slowing down the rate that scar tissue builds and by making an enzyme that breaks down the scar tissue. A large-scale test of interferon injection for Peyronie's disease showed that this treatment might help.
Collagenase is made in the body and breaks down certain scar tissues. Studies have shown that injecting collagenase into plaques helped fix Peyronie's disease. This drug is now approved in the U.S. by the FDA for treatment of men with penises curving more than 30 degrees.
Other ways to treat Peyronie's disease are being studied. But there isn't enough data on them yet to prove they work.
Some small studies have shown that stretching the penis daily for at least 6 months may help restore length and curving.
Treating the penis with ultrasound, radiation, shockwaves, heat and verapamil on the skin are also being studied. These, for the most part, are not proven and are not recommended by experts in the field.
Surgery for Peyronie's Disease
Surgery is reserved for men with more severe, disabling penile deformities that make it hard to have sex. Most health care providers suggest putting off surgery until the plaque and curving have stopped getting worse and the patient has shown no worsening for at least 9 to 12 months.
Before surgery, your health care provider may check the blood flow in the penis by injecting a drug that will make it stiff and may also look at the inside of the penis using ultrasound. These tests help show what is going on inside your penis (such as whether there is also ED) so your health care provider can decide which type of surgery is best for you.
There are 3 basic ways to fix Peyronie's disease with surgery:
- making the side of the penis opposite the plaque shorter
- making the side of the penis that curves longer
- placing a prosthetic device inside the penis if the man has both Peyronie’s disease and erectile dysfunction
Surgery to Shorten the Side of the Penis Opposite the Plaque/Curve
This type of surgery can be done either by cutting out small pieces of tissue on the outside of the curve and sewing it closed or by folding the tissue and pulling it together with surgical thread. The surgery is most often safe, easy for the surgeon to do and has a low risk of problems (such as bleeding or making ED worse). A drawback is that this type of surgery can make the penis shorter. This surgery is better for men with mild or no ED, mild-to-moderate penile curving and a long penis.
Surgery to Make the Side of the Penis that is Curved Longer
This type of surgery is used when the penile curve is severe, the plaque becomes calcified or the shaft has become very narrow. The surgeon cuts the plaque to ease tension and may remove some of the plaque. The space that is left is then filled with a graft. In most cases, this surgery will not make the penis much shorter. But it is harder for the surgeon to do and there is a risk it could make ED worse. This surgery is often only recommended for cases of severe deformity in men who are able to get erections hard enough for sex.
Penile Prosthetic Devices
An inflatable pump or malleable silicone rods placed inside the penis are good options for men with Peyronie's disease and moderate-to-severe ED. In most cases, this will straighten the penis and allow it to get stiff enough for sex. If the device doesn't straighten the penis enough, the surgeon may straighten it more by modeling the plaque against the stiff prosthesis or by cutting the plaque and using a graft to cover the opening.