Manage Peyronie's Disease Beyond Improving Curvature: Insights from the 27th SMSNA Annual Meeting
On Friday, October 9, at the 27th Annual SMSNA Fall Scientific Meeting, Drs. Raevti Bole, Lawrence Jenkins, and Matthew Ziegelmann discussed the management of penile shortening, pain, and indentation deformity in Peyronie's disease (PD).
Dr. Ziegelmann presented a case study of a 54-year-old patient with PD who experienced penile shortening. He explained that many patients report dissatisfaction with their penile length, sexual performance, and self-image. One of the most challenging yet important aspects of PD treatment is patient counseling, particularly helping men understand that their penis may not return to its original length. Although several oral therapies are available, oral monotherapy is generally not recommended for treating PD deformity. However, pentoxifylline may be used off-label to address fibrosis, while tadalafil is commonly used to treat PD-related erectile dysfunction (ED). Nonsurgical options also include penile traction therapy and vacuum erection devices, although improvements in length may not meet patient expectations. Injections have not been proven to restore penile length, and surgery is not generally the preferred approach for shortening alone. For his patient, Dr. Ziegelmann recommended tadalafil, traction therapy, and realistic expectations about treatment outcomes.
Dr. Jenkins presented a case involving pain during erections or penetration. He explained that pain may resolve as PD progresses beyond its active phase, although penile curvature may persist. He recommended first identifying the location of the pain and plaque, along with reviewing the patient's history of injections, traction therapy, or other treatments. Several treatment options are available, although not all are supported by sufficient evidence or FDA approval. Dr. Jenkins noted that pain persisting beyond the inflammatory phase of PD may indicate another underlying condition. He also emphasized the importance of early intervention for pain, as surgery is generally considered once the disease has stabilized and curvature is no longer changing. In his patient's case, addressing the pain within the first year may have been beneficial.
Dr. Bole discussed a patient with penile deformity resulting in loss of girth and length. She explained that volume loss and indentation deformities are common concerns in PD and may reduce sexual activity independently of penile curvature. Hinge deformities, which can cause instability during penetration, are particularly challenging. Dr. Bole recommended assessing erectile function and using structured questions to better understand how the deformity affects the patient. Although traction therapy may provide benefits, it may not be sufficient on its own. For her patient, plication alone was unlikely to adequately address the deformity. Dr. Bole reviewed several surgical grafting techniques and emphasized that treatment selection should account for erectile function and other health conditions. Patients with ED that does not respond to treatment may require a different surgical approach. In her case study, the surgical team used grafting to address the deformity and instability of the tunica albuginea, with appropriate patient counseling about expected outcomes.
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