Peyronie's Disease
Peyronie's disease is a fibrotic plaque of the tunica albuginea that bends the penis on erection; the single most important management principle is timing — don't operate in the active phase, correct only once stable.
The big picture
Peyronie's disease is a fibrotic plaque of the tunica albuginea — the tough sheath around the corpora cavernosa — that makes the penis bend (and often shorten or develop a waist) during erection. The single most important management principle is timing: there is an active phase when the disease is still changing (don't operate) and a stable phase when it has settled (now you can). Get the phase right and the treatment choice follows.
The framework: a tunical plaque → curvature → distinguish active vs stable phase → conservative/medical (active) vs surgical correction (stable, if function is impaired).
Mechanism pathway
Tap any step to see why it happens.
The penis — cross-section
The penis — cross-section (layers from outside in)
Read it from the outside inward: skin → dartos/superficial fascia → Buck's (deep) fascia wrapping all three bodies, then a tunica albuginea around each erectile body. The two dorsal corpora cavernosa do the erecting; the ventral corpus spongiosum carries the urethra.
Diagnostic algorithm
Each step answers one question. Tap to expand.
Drug selector
Collagenase Clostridium histolyticum
FDA-approved- Targets
- An enzyme that degrades the collagen of the plaque
- Onset
- —
- Use when
- Intralesional injection; the best-studied/FDA-approved injectable for Peyronie's with adequate curvature (active phase / mild functional disease)
- Side effects
- —
Board traps
Peyronie's = a fibrotic plaque of the tunica albuginea → penile curvature (± shortening, waisting, pain, ED).
Two phases: active (pain, evolving deformity — DON'T operate) vs stable (settled).
Operate only after the disease has been stable ~3–6 months.
Plication = milder curves, risk of shortening; grafting = severe curves, risk of erectile dysfunction; prosthesis if coexisting ED unresponsive to medication.
Three intralesional agents are options: collagenase Clostridium histolyticum (degrades plaque collagen), verapamil (CCB; inhibits fibroblast/ECM synthesis, raises collagenase activity), and interferon alfa-2b (cuts fibroblast proliferation + collagen, raises collagenase) — alongside penile traction.
Associated with Dupuytren's contracture.