What is it?
Peyronie’s disease (or plastic induration of the corpora cavernosa) is a benign condition characterized by the formation of plaques of fibrous (scar) tissue beneath the skin of the penis, in the sheath surrounding the corpora cavernosa. This fibrosis causes deformation of the penis (curvature, narrowing, shortening) during erection, sometimes accompanied by pain.
It affects approximately 3 to 9% of men, most often after age 40, but it can occur at any age in adulthood. It is neither contagious nor cancerous.
Causes and contributing factors
Trauma: Repeated micro-trauma to the erect penis (intercourse, sports activity) leading to abnormal scarring.
Genetic factor: A predisposition to fibrosis (genetic background, sometimes associated with Dupuytren’s disease).
Other factors: Diabetes, smoking, vascular disorders, and certain treatments may contribute to its onset.
Course of the disease: two phases
Acute (inflammatory) phase: Pain during erection, evolving deformity (generally lasting about 6 months). This is the phase in which medical treatment is most useful.
Chronic (stable) phase: Pain disappears, and the plaque and curvature stabilize. This is the stage at which surgery may be considered if necessary.
Natural history
spontaneous improvement in 12% of cases, stabilization in 40%,
and worsening over time in 48%.
Treatments
Medical treatments
Useful in the acute phase to reduce pain; limited effectiveness on curvature. Certain oral treatments (anti-inflammatories, tadalafil) or local injections (verapamil, collagenase, PRP, hyaluronic acid) may be prescribed by the doctor depending on the case.
Specialized non-surgical treatments
Injections of Clostridium histolyticum collagenase, verapamil, collagenase, PRP (platelet-rich plasma), hyaluronic acid. Shockwave therapy or traction/vacuum devices, which may limit worsening of the curvature in some patients.
Surgery
Reserved for stable, bothersome forms (significant curvature, inability to have intercourse): plication (shortening the side opposite the curvature) or grafting (lengthening the retracted side), sometimes combined with a penile prosthesis in cases of erectile dysfunction.
Support
Listening, information, and psychological support if needed. The impact on intimate life and self-esteem should not be overlooked.
When to see a doctor?
It is advisable to consult a urologist as soon as pain, deformity, or discomfort during erection appears. Early diagnosis helps guide treatment more effectively, particularly during the acute phase.
PRP and Hyaluronic Acid Injections for Lapeyronie’s Disease
What is this about?
PRP (platelet-rich plasma) and hyaluronic acid (HA) are two products injected directly into the fibrous plaque of the penis as part of research into nonsurgical alternatives for Peyronie’s disease. PRP is prepared from a blood sample taken from the patient and then centrifuged to concentrate the platelets. HA is a natural component of connective tissue and is injected either alone or in combination with PRP.
Mode of action (proposed mechanisms)
- PRP: Platelets release growth factors that are thought to stimulate tissue regeneration and reduce inflammation and local fibrosis.
- Hyaluronic acid: Anti-fibrotic, anti-inflammatory, and pro-angiogenic (promoting blood vessel formation) effects observed in the laboratory, which may soften the plaque.
- These mechanisms have been well demonstrated in the laboratory (preclinical studies), but their clinical application in humans is still under evaluation.
Current Indications
PRP: This treatment is considered experimental by urological professional societies (EAU), which recommend that it be reserved for use only within supervised clinical trials.
Hyaluronic acid: The available data, which are still limited, suggest that it may be particularly beneficial during the acute (early, inflammatory) phase of the disease, rather than during the stable chronic phase.
To date, neither of these two treatments has received specific official approval for Peyronie’s disease in France. They are offered outside standard treatment guidelines, after the patient has been clearly informed.
Effectiveness
The published studies, which are still limited and heterogeneous, report varying response rates: improvement in pain, curvature, or erections in approximately 40 to 70 percent of patients, depending on the study and the criteria used.
However, a randomized, placebo-controlled trial did not confirm a net benefit of PRP compared with placebo, particularly with regard to pain. These conflicting results reflect the low methodological quality and small sample sizes of the studies available to date.
Practical Details
Route of administration: intralesional injection (into the plaque), most often ultrasound-guided, performed in an outpatient setting or during a clinic visit.
Protocol: Generally several sessions (e.g., 3 to 6 injections), often combined with penile stretching exercises using an extender.
Procedure: Local anesthesia; the procedure is brief (a few minutes per session).
Post-injection precautions: A period of sexual abstinence lasting one to four weeks is generally recommended after the injection to optimize results. It is also prohibited to expose the treated area to intense heat (hot baths, saunas) during the postoperative period.
Side Effects
- Common side effects: Local pain, bruising, swelling at the injection site—most often temporary and resolving on their own within a few days.
- Overall safety: No serious complications have been reported in studies published to date; however, the follow-up period remains limited.
- Important limitation: As with any experimental treatment, the long-term benefits and risks have not yet been fully established.