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Peyronie's disease

Key sources
The following summarized guidelines for the evaluation and management of Peyronie's disease are prepared by our editorial team based on guidelines from the European Association of Urology (EAU 2023), the European Society for Sexual Medicine (ESSM 2022), and the American Urological Association (AUA 2015).
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Guidelines

1.Diagnostic investigations

History and physical examination: as per EAU 2023 guidelines, elicit a medical and sexual history in patients withPeyronie's disease, including duration of the disease, pain on erection, penile deformity, difficulty in vaginal/anal intromission due to disabling deformity, and erectile dysfunction.
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  • Diagnostic imaging

2.Diagnostic procedures

Intracavernous injection test: as per EAU 2023 guidelines, perform intracavernous injection testing in the diagnostic evaluation ofPeyronie's disease to provide an objective assessment of penile curvature with an erection.
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3.Medical management

Management of pain: as per EAU 2023 guidelines, consider offering NSAIDs
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and extracorporeal shockwave therapy for the treatment of penile pain in the acute phase ofPeyronie's disease.
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  • Management of erectile dysfunction

  • Agents with no evidence for benefit

4.Therapeutic procedures

Indications for conservative treatment: offer conservative treatment in patients not fit for surgery or when surgery is not acceptable to the patient.
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  • Intralesional injections (collagenase clostridium histolyticum)

  • Intralesional injections (interferon alpha-2b)

  • Intralesional injections (verapamil)

  • Intralesional injections (corticosteroids)

  • Intralesional injections (platelet-rich plasma and hyaluronic acid)

  • Electromotive drug administration

  • Penile traction and vacuum devices

  • Extracorporeal shock wave therapy

  • Radiotherapy

5.Surgical interventions

Surgical reconstruction: as per EAU 2023 guidelines, perform surgery only whenPeyronie's disease has been stable for at least 3 months (without pain or deformity deterioration), usually after 12 months from the onset of symptoms, and intercourse is compromised due to deformity.
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  • Penile prosthesis

6.Patient education

General counseling: as per EAU 2023 guidelines, discuss with patients all the available treatment options and expected results before starting any treatment.
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7.Follow-up and surveillance

Revision surgery: recognize that none of the straightening procedures currently available has proven superior with regards to preventing curvature recurrence.
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