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Diagnosis and treatment are similar for congenital penile curvature and Peyronie’s disease. There is no clear function or angle of curvature that demands treatment. Personal aesthetics, pain, and the inability to have sex are reasons for treatment. Treatment can include:
- Watchful waiting
- Drug therapy
It is important to determine whether the disease is still active. This will influence medical treatment or timing of a surgery. The disease is considered to be stable when the pain has gone away and penile curvature has not increased for at least 3 months.
A wait-and-see approach may be recommended if:
- Penile curvature is not severe and is not increasing.
- There is no pain in the penis during sex.
- Pain is mild during erections.
- Erectile function is good.
- The plaque has not stabilised yet.
You will have to see your doctor regularly or if you notice any changes. If symptoms are severe or worsen over time, your doctor might recommend medication or surgery.
*Based on expert opinion
Drug treatments are typically used for early-stage disease or for patients who are unfit or unwilling to undergo surgery. The goals of treatment with medication include reducing plaque formation and pain and minimizing curvature of the penis.
Although many drug options are available, they may not work for you. You can talk with your doctor about suitable options. Drug treatments can be divided into oral drug treatment, penile injections, and other topical treatments.
Drug treatment options
|Potassium para-aminobenzoate||May prevent advancement of penile curvature but does not correct or improve existing curvature|
|Tamoxifen||May be tried|
|Vitamin E||May be tried|
Acetyl esters of carnitine
Phosphodiesterase type 5 inhibitors (PDE51)
|Are not currently recommended|
|Verapamil||May be useful to stabilise or even decrease curvature|
|Clostridium collagenase histolyticum (CCH)||
|Steroids||Are not currently recommended|
|Extracorporeal shock wave treatment||Might work directly (shock waves damage the plaque) or indirectly via improved blood supply|
|Traction and vacuum devices||Are used to stretch the penis and oppose the curvature; application of both traction and vacuum devices takes several hours per day over the course of months|
Surgery is reserved for men with severe, disabling penile deformities that make it hard to have sex.
Most health care providers suggest putting off surgery until the disease has stopped getting worse, and the patient has been pain-free for at least 3 months.
There are 3 types of surgery:
- Penile shortening (making the side of the penis opposite the plaque shorter)
- Penile lengthening (making the side of the penis that curves longer)
- Placing a prosthetic device inside the penis
Surgery may correct the curvature of your penis, but it carries risks. Penile extending devices have been reported to improve length after shortening operations if used for several hours a day over the course of months. The type of surgery will depend on your condition. Your doctor will consider:
- Your personal preference
- Location of scar tissue
- Severity of your symptoms
- Response to medication in case of erectile function
- Penile length
Possible side effects of penile curvature surgery:
- Failed procedures with the need for reoperation (the operation can fail for several reasons, including new plaque formation or active disease, shrinking of the graft, loosening of the sutures)
- Penile shortening
- Erectile dysfunction
- Risk of recurrent curvature
- Palpable knots and stitches underneath the skin
- Need for circumcision during surgery