Peyronie’s disease occurs in approximately one in 100 men. The disease is usually seen in middle-aged and older men. It can be seen in 8-10% of men under the age of 40. It can be seen in young people (in their 20s). The disease is characterized by an increase in local scar tissue in the penis, resulting in penile deformity (curvature), pain and erectile dysfunction.

Stages of Peyronie’s disease

There are 2 stages of Peyronie’s disease: Knowing these stages is important for the treatment of the disease. Some treatment methods are effective in some stages. This condition must be taken into account in the treatment.

• Acute phase (acute phase, early phase): It lasts 6-18 months, surgery should definitely not be performed during this period. If surgery is performed in the acute period, the disease will recur.
• Chronic phase (chronic, stable phase, stable phase): Surgery, that is, surgical treatment should only be done during this period. If the symptoms do not change after 3 months, it means that the disease has become stable. During this period, injection treatments into the plaque can be performed, but they are not very effective.

Non-surgical treatment methods for Peyronie’s disease

Non-surgical treatment methods are preferred in the early, acute phase of the disease.

• ESWT shock wave therapy: ESWT-shock wave therapy has been used in Andrology for 10-15 years. Its use is becoming more and more widespread. ESWT treatment is a form of treatment that does not have side effects and can be used in outpatient clinic-examination conditions. It does not require anesthesia, is painless, and does not require hospitalization. This method, which is widely used in the treatment of erectile dysfunction, is also preferred in Peyronie’s disease. It is especially effective in the acute phase (early stage) of Peyronie’s disease. There are many studies showing that it improves pain in the early stage.

In our observations in our own patients, we have obtained very positive results in pain in the acute period. Pain disappeared in all of our patients. In the follow-ups, we observed that the curvature of the penis was significantly reduced in our patients. Different results have been reported in studies on reduction in plaque diameter. It has been reported that plaques disappear in very few patients. In our own patients, with ESWT treatment, the plaque disappeared completely with 6-8 sessions of treatment in very few patients. The plaque size was very small in these patients. However, in patients with large plaque diameter and in the chronic stage, we generally prefer surgery instead of ESWT treatment. Applications in the literature are also in this direction. Partial plaque reduction and improvement in curvature are observed in patients undergoing ESWT in the chronic stage, but it is not possible for plaques to disappear completely, especially in large plaques. This situation must be explained to the patients. The most important advantage of ESWT treatment in the chronic phase is that it helps to improve the erection problem that occurs due to the disease. Even if it does not provide a very serious improvement in the plaque, it can be recommended to patients because of its positive effect on erectile dysfunction.

• Penile traction therapy: Devices that are used to stretch the penis with certain weights are used here. Curvatures that may occur in the penis can be prevented by stretching methods applied several times a day, without excessive weight and without excessive strain on the penis.
• Vacuum application to the penis: The vacuum erection device applied to the penis is also used in Peyronie’s disease. The device consists of a cylindrical tube in which the penis is placed, a pump system and an elastic band. The penis is placed in this cylindrical tube to create an erection with negative pressure and the silicone ring on the cylinder is placed on the root of the penis. With this application for a short time and several times a day, excessive bending of the penis can be prevented. In a study, it was shown that the length of the penis is preserved, the curvature is reduced and the pain is relieved as a result of applying this method twice a day for 10 minutes. In this study, it was observed that the curvature did not improve in 3 patients and increased a little more. Patients who will apply vacuum should be reminded of this situation.
• Manual correction maneuvers applied to the penis: Here, when the penis is erect, the curvature is tried to be corrected by manually pressing the curvature and the opposite side of the penis. This must be demonstrated by a urologist and it must be done carefully. If this procedure is done in a traumatic way, it can lead to penile fractures. Depending on the severity of the application, there may be pain, bleeding and bruising on the penile skin. It has been reported that positive results are obtained after regular and long-term procedures.
• Massage application to the penis: It has been reported that regular and long-term massage applications to the penis with lubricating creams are effective in Peyronie’s disease. Scientific studies on this subject are limited. Even if it is to be done, it should be done consciously without applying too much force.
• Herbal treatment of Peyronie’s disease: Although there is information on the internet about herbal treatment of Peyronie’s disease, they do not have therapeutic effects. The available information is not based on scientific data. There are no articles published in world-renowned medical journals about Urology proving the effectiveness of herbal treatments. In this regard, we do not recommend herbal treatments to our patients. In addition, it may be inconvenient to use special mixtures or drugs whose contents are unknown. Medicines that are not recommended by a urologist or are not sold in pharmacies and that are not approved by the Ministry of Health should not be used. Otherwise, such drugs may do more harm than good.
• Vitamins: Previously, vitamin E was used in the treatment of the disease. Scientific studies have shown that vitamin E treatment is not effective in the treatment of Peyronie’s disease. Vitamin E does not have any positive effect on plaque formation, shrinkage, penile curvature or pain. We no longer recommend this treatment to our patients. American and European Urology Associations have also reported that vitamin E therapy has no place in the treatment of Peyronie’s disease. Apart from vitamin E, other vitamins, minerals and supplements do not have any positive effect. Such vitamins, minerals, trace elements can be used for healthy nutrition, but they do not have positive effects in the treatment of Peyronie’s disease.
• Plaque injection (injection, needle) treatment: One of the non-surgical treatment options for Peyronie’s disease is injection treatments into the plaque in the penis. Many methods have been used for this purpose, but most of them have been abandoned as they are ineffective and are no longer used today.

The drugs used today as intraplanetary injections in Peyronie’s disease are calcium channel blockers, interferon-alpha2β and collagenase clostridium histolyticum enzyme. There is information that they stop the progression of the disease and correct the shape disorder in the penis (curvature of the penis, penile deviation). The American Food and Drug Administration (FDA) approved the use of collagenase clostridium histolyticum in Peyronie’s disease. Appropriate patients can be offered these injection treatments. None of these will cure the disease 100%. This situation should also be explained to the patient.

• PDE5i drugs: Since some of the Peyronie’s patients will also have erection problems, PDE5i group drugs can be used with this purpose.

Lifestyle changes

It may affect the treatment and natural course of Peyronie’s disease. These are also important for a healthy life.

• Stop smoking: Cigarette is a product that has serious negative effects on health in general. Nicotine and many other toxic substances in cigarettes have serious adverse effects on many organ systems. These adverse effects have been known for a long time and have been reported in serious medical journals. Excessive smoking has serious adverse effects, especially on cardiovascular diseases and erection. Studies have reported that Peyronie’s disease is more common in smokers. According to our observations, almost all of our patients smoke excessively. One of our first recommendations to our patients with Peyronie’s disease is to quit smoking. Quitting smoking will not remove the formed plaques in a short time, but it will have serious positive effects in the healing process of the disease. In addition, since Peyronie’s patients will have erection problems (erectile dysfunction, erectile dysfunction), smoking will affect this situation more negatively.
• Stopping alcohol intake: The direct relationship between alcohol intake and Peyronie’s is not known, but the importance of alcohol is emphasized in all scientific studies. The results are similar in our patients. Generally speaking, most Peyronie’s patients drink alcohol. In this regard, we strongly recommend our patients to quit alcohol. The disease is more common especially in those who smoke and drink alcohol together. Since alcohol will cause serious health problems and erection problems, just like smoking, this situation must be taken into account in the treatment. We recommend our patients to cut down on alcohol if they are taking it for an effective treatment.
• Those who have drug habit should stop it: Drug addiction, drug addiction is an important medical problem. Drug addiction is held responsible for many diseases. We did not find any significant drug addiction that could cause Peyronie’s disease in our patients.
• Regular exercise: Studies have shown that stretching exercises without too much pressure on the penis reduce bending and scar development due to Peyronie’s disease. It is necessary to repeat these exercises several times a day. There are also special devices developed for this purpose. They can also be used.

Vitamins and natural products in the treatment of Peyronie’s disease

There are studies on the treatment of Peyronie’s disease with vitamins and natural products. However, these are not very effective. In the literature, it has been shown that vitamin E and coenzyme Q therapy do not provide a significant improvement in the treatment of Peyronie’s disease.

We do not recommend these treatments to our patients too much anymore. These vitamins and supplements may help improve overall health and erection, but they are not very effective in treating Peyronie’s disease.

As a result: Various methods are used for non-surgical treatment options for Peyronie’s disease, but these are not 100% effective methods. Today, the most effective method is surgery. Timing for surgery is very important, surgery should not be performed during the acute phase. The most appropriate timing for surgery (surgery) is the stable phase of the disease, where the acute phase period ends. The recurrence rate is high after surgeries performed in the acute stage.

Prof. Dr. Emin ÖZBEK

Urology Specialist