Peyronie's disease is the formation of fibrous scar tissue (plaque) in the tunica albuginea, the sheath surrounding the erectile bodies. Because scar does not stretch as the penis becomes erect, the result is curvature, indentation or hourglass narrowing, shortening, and often pain.
The two phases
| Acute (active) phase | Chronic (stable) phase | |
|---|---|---|
| Duration | Roughly the first 6–18 months | After the deformity stops changing |
| Features | Pain, changing curvature, evolving plaque | Stable curvature, pain typically resolved |
| Approach | Non-surgical management; surgery deferred | Xiaflex or surgical correction as appropriate |
The distinction matters: operating during the active phase risks correcting a deformity that then continues to change. Stability — typically at least three to six months without change — is generally required before surgical correction.
Xiaflex (collagenase clostridium histolyticum)
Xiaflex is the only FDA-approved non-surgical treatment for Peyronie's disease. It is an enzyme injected directly into the plaque, where it breaks down the collagen that makes up the scar, allowing the plaque to soften and the curvature to improve.
Candidacy. Xiaflex is indicated for men with a palpable plaque and curvature of at least 30 degrees, with stable disease. It is not used for ventral (downward) curvature or for plaques that cannot be felt.
The treatment course. Treatment is given in cycles: two injections spaced a few days apart, followed by penile modeling performed in the office, repeated for up to four cycles. A home stretching and modeling regimen between cycles is part of the protocol and materially affects results.
Realistic results. In the registration trials, men treated with Xiaflex achieved an average curvature improvement in the range of about one third from baseline, with corresponding improvement in bother scores. That is meaningful, but it is important to understand what it means in practice: a 60-degree curve typically improves to something in the neighborhood of 40 degrees rather than becoming straight. For men who want maximal straightening, surgery achieves more.
An honest comparison
Xiaflex: no surgery, no anesthesia, preserves length; partial correction; requires a multi-month course of visits; small but real risk of corporal rupture, which is why the modeling protocol and activity restrictions must be followed exactly.
Surgery: greater and more predictable straightening in a single operation; requires anesthesia and recovery; plication may shorten slightly, and grafting carries some risk to erectile function.
Surgical options
- Plication — sutures placed on the side opposite the curve to straighten the penis. Straightforward and reliable, with the trade-off of slight shortening. Best for good erectile function and moderate curvature without significant indentation.
- Plaque incision or excision with grafting — the plaque is opened and the defect patched with a graft. Preserves length better and handles severe curvature and hourglass deformity, with some risk of postoperative erectile dysfunction.
- Penile prosthesis with straightening — when Peyronie's disease occurs together with erectile dysfunction, an implant corrects curvature and restores rigidity in one operation. This is often the best choice for that combination.
What does not work
Oral vitamin E, topical creams and gels sold online, and most supplement regimens have not shown meaningful benefit in controlled studies. Traction therapy has some supporting evidence, particularly for length preservation, but requires consistent daily use over months.
Common questions
What is Xiaflex and how does it work?
Xiaflex (collagenase clostridium histolyticum) is the only FDA-approved non-surgical treatment for Peyronie's disease. It is an enzyme injected into the scar plaque that breaks down collagen, allowing the plaque to soften and the curvature to improve.
How much straightening can I expect from Xiaflex?
In the registration trials, average curvature improvement was roughly one third from baseline. Practically, a 60-degree curve often improves to around 40 degrees rather than becoming straight. Surgery achieves greater and more predictable correction for men who want maximal straightening.
Am I a candidate for Xiaflex?
Candidates generally have a palpable plaque, curvature of at least 30 degrees, and stable disease. Xiaflex is not used for downward (ventral) curvature or for plaques that cannot be felt on examination.
When is surgery better than injections?
Surgery is generally preferred for severe curvature, significant hourglass or indentation deformity, curvature that prevents intercourse, or when Peyronie's disease occurs alongside erectile dysfunction — in which case a penile implant can correct both problems in one operation.
Will Peyronie's disease go away on its own?
A minority of men experience some spontaneous improvement, but most have curvature that stabilizes and persists. Pain from the active phase typically resolves over time even when the curvature does not.
Does Peyronie's disease cause erectile dysfunction?
It commonly coexists with ED, both because of the underlying vascular changes and because the deformity itself can interfere with function. When both are present, treatment planning should address them together.
Do supplements or creams help?
Oral vitamin E, topical creams, and most supplement regimens have not demonstrated meaningful benefit in controlled trials. Traction therapy has some supporting evidence, especially for preserving length, but requires consistent daily use over many months.
How long do I have to wait before surgery?
Surgical correction is generally deferred until the disease is stable — typically at least three to six months without change in curvature, and usually with pain resolved. Operating during the active phase risks correcting a deformity that continues to evolve.
Related procedures
Discuss your options with Dr. Azad
Referrals are welcome but not required. Bring any records from prior procedures — operative notes, imaging, or urethrograms — and we will review them together.
504-988-5271Dr. Babak Azad — Reconstructive Urology, Metairie & New Orleans, LA