Page 106 - Remedial Andrology

Figure 11: Treatment algorithm for Peyronie’s disease

Treatment of Peyronie’s disease

Discuss natural history of the disease
Reassure patient that Peyronie’s doesn’t lead to
any form of malignancy
Discuss current treatment modalities
Shared decision-making

Active disease Stable disease
(pain, deformity deterioration, (no pain, no deformity
progressive curvature) deterioration, stable penile
curvature)

Pain control (consider NSAIDs,
tadalafil or LI-ESWT) Patient desires active
Optional: Traction therapy, treatment
intralesional CCH or IFN-α2b

No ED ED

Response
Yes to ED
treatment

Palpable dorsal plaques Adequate penile Short penis
Non calcified plaques length Severe curvature

Dorsal Curvature 30°-90° Absence of severe Complex deformities No
Contraindications for curvature (hour-glass, hinge)

surgery/patient does not Absence of complex
want surgery deformities

Intralesional Tunical shortening Tunical lengthening Penile

injection treatment: procedures procedures prosthesis

CCH or interferon
> 30° Residual
curvature

Manual
modeling

> 30° Residual < 30°
curvature

Tunical plication/ No additional
Plaque incision + straightening
grafting procedures

ED = erectile dysfunction; LI-ESWT = Low-intensity extracorporeal shockwave treatment.

SEXUAL AND REPRODUCTIVE HEALTH - MARCH 2021 105