Peyronie's Disease

Publication Date: September 1, 2015
Last Updated: March 14, 2022

GUIDELINE STATEMENTS

Diagnosis

1. Clinicians should engage in a diagnostic process to document the signs and symptoms that characterize Peyronie’s disease. The minimum requirements for this examination are a careful history (to assess penile deformity, interference with intercourse, penile pain, and/or distress) and a physical exam of the genitalia (to assess for palpable abnormalities of the penis). (Clinical Principle, )
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2. Clinicians should perform an in-office intracavernosal injection (ICI) test with or without duplex Doppler ultrasound prior to invasive intervention. (Expert Opinion, )
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3. Clinicians should evaluate and treat a man with Peyronie’s disease only when they have the experience and diagnostic tools to appropriately evaluate, counsel, and treat the condition. (Expert Opinion, )
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Treatment

4. Clinicians should discuss with patients the available treatment options and the known benefits and risks/burdens associated with each treatment. (Clinical Principle, )
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5. Clinicians may offer oral non-steroidal anti-inflammatory medications to the patient suffering from active Peyronie’s disease who is in need of pain management. (Expert Opinion, )
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6. Clinicians should not offer oral therapy with vitamin E, tamoxifen, procarbazine, omega-3 fatty acids, or a combination of vitamin E with L-carnitine.
  • vitamin E
(Moderate, B)
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  • omega-3 fatty acids
(Moderate, B)
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  • Vitamin E + propionyl-L-carnitine
(Moderate, C)
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  • tamoxifen
(Moderate, C)
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  • procarbazine
(Moderate, )
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7. Clinicians should not offer electromotive therapy with verapamil. (Moderate, C)
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8. Clinicians may administer intralesional collagenase clostridium histolyticum in combination with modeling by the clinician and by the patient for the reduction of penile curvature in patients with stable Peyronie’s disease, penile curvature >30° and <90°, and intact erectile function (with or without the use of medications). (Moderate, B)
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9. Clinicians should counsel patients with Peyronie’s disease prior to beginning treatment with intralesional collagenase regarding potential occurrence of adverse events, including penile ecchymosis, swelling, pain, and corporal rupture. (Clinical Principle, )
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10. Clinicians may administer intralesional interferon α-2b in patients with Peyronie’s disease. (Moderate, C)
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11. Clinicians should counsel patients with Peyronie’s disease prior to beginning treatment with intralesional interferon α-2b about potential adverse events, including sinusitis, flu-like symptoms, and minor penile swelling. (Clinical Principle, )
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12. Clinicians may offer intralesional verapamil for the treatment of patients with Peyronie’s disease. (Conditional, C)
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13. Clinicians should counsel patients with Peyronie’s disease prior to beginning treatment with intralesional verapamil about potential adverse events, including penile bruising, dizziness, nausea, and pain at the injection site. (Clinical Principle, )
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14. Clinicians should not use extracorporeal shock wave therapy (ESWT) for the reduction of penile curvature or plaque size. (Moderate, B)
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15. Clinicians may offer extracorporeal shock wave therapy (ESWT) to improve penile pain. (Conditional, B)
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16. Clinicians should not use radiotherapy (RT) to treat Peyronie’s disease. (Moderate, C)
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17. Clinicians should assess patients as candidates for surgical reconstruction based on the presence of stable disease. (Clinical Principle, )
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18. Clinicians may offer tunical plication surgery to patients whose rigidity is adequate for coitus (with or without pharmacotherapy and/or vacuum device therapy) to improve penile curvature. (Moderate, C)
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19. Clinicians may offer plaque incision or excision and/or grafting to patients with deformities whose rigidity is adequate for coitus (with or without pharmacotherapy and/or vacuum device therapy) to improve penile curvature. (Moderate, C)
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20. Clinicians may offer penile prosthesis surgery to patients with Peyronie’s disease with erectile dysfunction (ED) and/or penile deformity sufficient to prevent coitus despite pharmacotherapy and/or vacuum device therapy. (Moderate, C)
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21. Clinicians may perform adjunctive intraoperative procedures, such as modeling, plication or incision/grafting, when significant penile deformity persists after insertion of the penile prosthesis. (Moderate, C)
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22. Clinicians should use inflatable penile prosthesis for patients undergoing penile prosthetic surgery for the treatment of Peyronie’s disease. (Expert Opinion, )
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Recommendation Grading

Overview

Title

Peyronie's Disease

Authoring Organization

Publication Month/Year

September 1, 2015

Last Updated Month/Year

January 10, 2024

Supplemental Implementation Tools

Document Type

Guideline

Country of Publication

US

Intended Users

Nurse, nurse practitioner, physician, physician assistant

Source Citation

Nehra, Ajay et al. “Peyronie's Disease: AUA Guideline.” The Journal of urology vol. 194,3 (2015): 745-53. doi:10.1016/j.juro.2015.05.098