Stages of Peyronie's disease
- dr Nikola Stanojević
- Apr 19
- 5 min read
How can I recognize which stage of Peyronie's disease I'm in?
Peyronie's disease is an acquired deformity of the penis (curvature, narrowing, or shortening of the penis). It most commonly occurs in men after the age of forty. It is often caused by injury or a series of micro-injuries to the penis during sexual intercourse, but it can also be a consequence of other medical conditions such as prostate cancer, cardiovascular diseases, priapism, or diabetes.
Men who are born with congenital penile curvature should also seek advice from a urologist-andrologist about prevention and treatment methods for curvature, reducing or preventing the occurrence of Peyronie's disease later in life. It should be noted that the treatment of congenital penile curvature significantly differs from the treatment of Peyronie's disease.
How to discover if I have Peyronie's disease?
The first step in recognizing Peyronie's disease is learning about its signs and symptoms, along with a proper evaluation by a urologist-andrologist.
We must point out that Peyronie's disease can be successfully treated. The treatment method varies for each stage of the disease and depends on the specialist doctor's assessment. The earlier the disease is detected, the greater the chance of stopping it in one of its initial phases, thereby avoiding the need for surgical treatment.
Stages of Peyronie's disease
All stages of Peyronie's disease progressively manifest, typically within the first 6 months of the disease's onset. During this period, the man must be under constant supervision by a urologist-andrologist so that treatment specific to each stage can be applied.
Inflammation
The inflammatory phase is characterized by progressive penile curvature, which may be accompanied by painful erections. The appearance of plaques or nodules under the penile skin is very common during this stage.
Despite the presence of pain and discomfort, the disease has not yet entered an advanced stage and can be treated conservatively with vacuum therapy, certain types of penile massage, injections for tissue regeneration such as PRP with hyaluronic acid, and low-intensity shockwave therapy (LSWT). This treatment aims to stabilize the disease in its early phase and prevent further progression into the fibrous or calcified stages. The degree of penile curvature in this phase will be crucial in determining whether surgical intervention is ultimately required.
Early diagnosis is critical in preventing disease progression. If intensive non-surgical therapy is started in time, the disease can be halted, avoiding serious anatomical deformities of the penis.
Fibrosis
In the fibrosis phase, also called the scar phase, the plaque is already present, the penile deformity is defined and stable, and it does not progress. In the early fibrosis stage, it is still possible to act on the affected area using the enzyme Clostridium collagenase (Xiapex, Xiaflex) to break down the fibrous plaque. If the disease progresses from early fibrosis to a late stage with scar stabilization, clinical treatment significantly loses its effectiveness and may, in some cases, be considered unnecessary.
Late fibrosis and hard scar formation
Late fibrosis differs from the fibrosis phase by plaque stabilization and the formation of a definitive scar (often including calcified plaque).
Most often, the scar is located on the upper third of the penis toward the glans, causing upward, sideways, or downward curvature. If the stabilized curvature exceeds 30 degrees or makes penetrative sexual intercourse impossible, surgical treatment becomes the only option to restore the penis to its previous condition.
Peyronie's disease progression
Even several months or years after the formation of a stable penile deformity, the disease can reactivate and lead to new disorders of the penis.
Importance of treatment
Regardless of your age, treating penile curvature is important to avoid the physical and psychological consequences related to sexual dysfunction.
Perhaps due to misinformation, fear, or shame, many men do not seek specialized professionals for treatment and end up in situations of broken relationships, failed marriages, or depression. It is no secret that a healthy sexual life brings many benefits to overall health and the quality of life for both the man and his partner.
So, the advice I can give you, as one man to another, is not to give up on this important aspect of life. Consult periodically with a urologist-andrologist to recognize and prevent the disease in time.
You can take the first step: educate yourself properly, ask questions, express your concerns, and we, as a team of andrologists and genital surgeons, will meet you halfway.
Peyronie's disease – Clinical or surgical treatment
A large number of men suffering from Peyronie's disease also experience erectile dysfunction. The connection between these two problems creates the impression that Peyronie's disease has led to erectile dysfunction.
Most often, erectile dysfunction and weakened erection firmness lead to axial instability and microtrauma of the penis during sexual intercourse, resulting in penile curvature and the onset of Peyronie's disease.
Injuries to the inner sheath of the penis with scar tissue (plaque) formation lead to reduced elasticity on one side of the penis and the appearance of curvature during erection. Therefore, Peyronie's disease worsens pre-existing erectile dysfunction and, in most cases, is not the main cause of erectile dysfunction.
Treatment of Peyronie's disease and penile fibrosis
In the initial stage of the disease, the primary treatment can be specific non-surgical medication: anti-inflammatory, analgesic, and drugs that increase blood flow to the penis.
In the second phase of treatment, injections of the enzyme clostridial collagenase (Xiapex, Xiaflex), PRP with hyaluronic acid, in combination with low-intensity shockwave therapy (LSW) and vacuum therapy, can be applied.
We must once again note that Xiapex (Xiaflex) has not been available in Europe since December 2019. The product will remain registered only in the USA and Canada.
However, as a definitive treatment, surgical intervention is most often required. The goal is not only to straighten the curved penis but also to remove the fibrous plaque, restore length and girth as before the onset of the disease, and treat associated erectile dysfunction.
Treatment of Erectile Dysfunction is an integral part of Peyronie's Disease treatment
When treating Peyronie's disease, many patients require simultaneous penile implant placement to restore penile rigidity, with very high satisfaction rates among men. The penile implant (so-called penile prosthesis) provides immediate confidence and self-assurance post-operation with minimal complication risks when performed using modern, appropriate techniques.
The penile implant should be placed during the same surgical procedure that corrects the deformity, restoring length, width, and shape of the penis. The implant not only ensures surgical success but guarantees reliable, superior erections post-operatively. By implanting during the initial surgery, patients avoid disease progression, further penile shortening, and worsening erectile dysfunction.
For penile prosthesis surgery, the urologist must have sufficient experience to properly assess the disease stage and select the optimal implant type.
Patient satisfaction isn't determined by choosing more expensive or cheaper implants. The crucial factor is selecting the prosthesis type that best matches each patient's individual anatomy and expectations. The andrologist must thoroughly explain all advantages and limitations of different implant models to ensure maximum post-operative satisfaction.
Now that you know Peyronie's disease is treatable, perhaps it's time to permanently resolve your penile deformity and accompanying erectile dysfunction. What do you think?
