Cared for by Dr William Akakpo
Peyronie's disease is a fibrous plaque within the tunica albuginea of the penis that causes curvature, narrowing, shortening or pain during erection. It evolves in two phases: an active inflammatory phase lasting six to eighteen months, during which the deformity may still change, followed by a stable phase where the plaque hardens and the curvature becomes fixed. Medical treatment has a role in both phases — not only to calm the inflammation while the disease is active, but also, once stabilised, to soften the plaque through intralesional injections. Surgery is reserved for the stable phase, when the deformity has been unchanged for at least three months and still interferes with intercourse. Congenital curvature, by contrast, is present since the first erections, involves no plaque and is corrected in a single operation.
While the disease is still evolving, oral and local treatments aim to relieve pain and limit progression of the deformity: anti-inflammatory medication, PDE5 inhibitors such as tadalafil, and penile traction. Low-intensity shockwave therapy helps reduce the pain of the inflammatory phase. Other options (pentoxifylline, colchicine) have a weaker evidence base, and vitamin E has not shown any benefit.
Once the curvature has stabilised, substances are injected directly into the fibrous plaque to soften it and reduce the deformity. Platelet-rich plasma (PRP), hyaluronic acid and verapamil are available in France; collagenase (Xiapex) is not marketed here. Penile traction is frequently combined with the injections to enhance their effect.
The convex side of the penis is shortened with non-absorbable sutures to straighten the shaft. It is a reliable, low-risk operation for curvatures under 60 degrees in men with good erections and sufficient length.
For severe curvature, hourglass deformity or short penile length, the plaque is incised and the defect covered with a graft. This preserves length but requires excellent baseline erectile function.
When curvature is combined with erectile dysfunction, an inflatable implant corrects both problems in a single operation, with additional modelling or grafting if required.
Spontaneous improvement occurs in a minority of men; most stabilise with a residual deformity. Surgery is proposed only once the disease has been stable for several months.
Plication shortens the longer side, so a small loss is expected — it is quantified before surgery, and grafting is proposed instead when length is already limited.
Yes, usually with plication. Results are excellent because the tissue is otherwise entirely healthy.