Management of Peyronie's disease depends on several factors: duration, degree of deformity, presence of pain or ED, and stage of disease. No surgical treatment is advisable before at least 12 months from onset, with the stabilization of the disease for at least 3 months. Clinical manifestations of the early stage include a palpable extended plaque with pain and penile deformity during erection. Manifestations of the late stage are a harder and more localized plaque (sometimes associated with calcification), stable penile deformity, and possible ED in about 30% of these cases.
In a case of minimal deformity with no pain or discomfort, no treatment is indicated; the patient is simply reassured and receives periodic follow-up. In a case of pain, marked curvature, and possible ED, conservative management with oral medications, locally applied electroshock wave lithotripsy or intralesional injections may be attempted, although they are usually associated with varying degrees of success.
Several medications, such as colchicine, vitamin E, potassium aminobenzoate, tamoxifen, acetyl-L-arginine, steroids, antihistamines, and others, alone or in combination, have been tried with varying success rates, but to no definitive benefit, except occasional moderate improvement of pain and curvature, or the prevention of progression in the early stages of the disease. Injection of verapamil or interferon alpha-2 B in the plaque every 2 weeks for 12 weeks or more has yielded mixed results. One study reported decreased penile curvature in about 60%, increased penile girth in about 83%, and improved sexual function in 71%; another reported no apparent benefit compared to. Combined verapamil injection and oral propionyl-L-carnitine was more effective than either treatment alone.
Recently, experimental injection of subtypes of the enzyme collagenase into the plaque yielded preliminary good results and may become the future treatment of choice. Using ESWL on the plaques resulted in marked improvement in about 50% of cases, with patient satisfaction of 64%.
In the late stage with duration over 12 months, penile deformity severe enough to preclude penetration, and failure of all conservative treatments, surgical intervention may be indicated, if accepted by the patient after an explanation of all the benefits and risks. In the absence of ED and the presence of penile curvature of less than 60 degrees, with difficulty in penetration, provided the length of the penis is adequate, plication yields good results in the majority of cases. If the curvature is over 60 degrees and/or the penis is small, making an incision in the plaque and grafting with various natural or synthetic materials.