Peyronie's Disease Challenges and Solutions

First, Dr. Clavell explains that Peyronie’s patients have extremely variable presentations. They can have distal or proximal curvatures, penile shortening, pain, hourglass deformities, and calcified plaques. However, Dr. Clavell believes that listening to the patient is the most important thing a urologist can do, as most patients take years to seek treatment and may be very distraught about their diagnosis. He notes that most men he sees are already in a stable phase (3 months of no change in curvature), as they are referred to him by other urologists. He also notes that penile pain is not unique to Peyronnie’s disease; patients need to also have an acquired penile deformity as well to be given an accurate diagnosis.

Dr. Clavell emphasizes that the treatment option and duration should be based on the degree of bother and degree of erectile function, instead of by the degree of curvature. Then, Dr. Clavell summarizes the surgical and non-surgical options for Peyronie’s disease. He notes that medications, such as pain medication and Cialis are always available. Additionally, non-pharmacological penile rehabilitation therapies, such as traction therapy and vacuum therapy have helped some of his patients. He notes that traction therapy combined with Xiaflex injections can be useful in patients who can still maintain good erections; however, injections should not be used in men with erectile dysfunctions or calcified plaques. In these patients, a penile prosthesis is indicated.

Other complex cases that will require surgery are Peyronie’s patients with severely calcified plaques, severe deformities, two points of angulation, corporal wasting, and an unstable penis. Besides penile implantation surgery, two other surgical options for Peyronie’s disease are grafting and plication surgery. The risks of all surgeries should be discussed with patients. Finally, Dr. Clavell explains his advanced surgical techniques for penile implant surgeries, such as alternative incision sites and the modified sliding technique.