Peyronie's Disease

What Peyronie's disease is

Peyronie's disease is a condition in which fibrous scar tissue forms inside the penis, typically in the tunica albuginea. Over time this plaque can cause the penis to curve or change shape during erections, and it may also cause pain, loss of length, or difficulty with penetration.¹

It is more common than many men realise. The exact cause is not fully understood, but repeated minor injury to the penis and individual tissue-healing differences are thought to play a role.¹

Symptoms

Peyronie's disease typically goes through two phases:

• Active (inflammatory) phase – often several months during which a lump or plaque develops, curvature changes, and erections may be painful.
• Stable (chronic) phase – the plaque becomes firmer, pain usually settles, and the curvature stabilises.

Common symptoms include:

• A lump or area of hardness felt in the shaft of the penis.
• Curvature, narrowing or hinging of the erect penis.
• Pain with erection, especially in the early phase.
• Loss of erectile rigidity or erectile dysfunction.
• Distress or anxiety about appearance or sexual function.

Assessment

Assessment at Urology NSW usually includes:

• A detailed history, including the onset, any injury, and the impact on sexual function and wellbeing.
• A physical examination to locate any plaques and estimate curvature.
• Photographs of the erect penis or a penile duplex ultrasound in selected cases, to map curvature and assess blood flow.¹
• Assessment for associated erectile dysfunction, as the two conditions commonly coexist.

Management options

There is no single "best" treatment for every man; the aim is an individualised plan based on the phase of disease, degree of curvature, impact on function, and each patient's preferences.

Conservative and medical options

• Observation – for mild or non-progressive disease not affecting function.
• Oral medications – several oral agents have been trialled for Peyronie's disease. Evidence is mixed and guidelines note that most provide only modest benefit.^{1, 2}
• Intralesional injection therapy – injections into the plaque (for example with collagenase clostridium histolyticum, where available and appropriate) can reduce curvature in selected patients.² Availability and suitability are decided case by case.
• Traction or vacuum-based therapy – may be used alone or alongside injection therapy.

Surgical options

Surgery is generally considered when disease has been stable for at least 6 to 12 months, curvature is interfering with intercourse, and conservative treatments have not provided enough benefit.¹ Options include plication procedures (shortening the longer side to straighten the penis), plaque incision or excision with grafting, and, where severe ED coexists, penile prosthesis implantation.

Each surgical approach has its own trade-offs, including risks of penile shortening, altered sensation, and erectile changes, which are discussed in detail with any patient considering surgery.

Why assessment matters

Peyronie's disease commonly causes distress beyond the physical change. Many men also have some degree of erectile dysfunction. An assessment at Urology NSW's one-stop clinic lets Dr Kooner and the men's health pharmacist work through both aspects together, rather than treating them in isolation.

How to access care

• Contact Urology NSW to arrange a consultation.
• Request a second opinion if you have already been assessed elsewhere.
• Call the rooms on 02 8382 6980.