Skip to main content

Peyronie's Disease (Procedures)

Peyronie's disease (PD) is an acquired fibrosing disorder of the tunica albuginea of the corpora cavernosa that often produces a palpable plaque and can cause penile deformity (curvature, hinge, hourglass, indentation), pain on erection, shortening, and, in a substantial minority of men, concurrent erectile dysfunction. It belongs to a family of fibrosing disorders that includes Dupuytren contracture and plantar (Ledderhose) fibromatosis.[1][2]

Contemporary prevalence estimates range from about 0.5% to 20% (the AUA guideline cites 0.5–20.3%) depending on population and ascertainment method; in a 1950–1984 Rochester cohort, mean age at diagnosis was 53 years.[4][34] Many men remain undiagnosed due to embarrassment and the mistaken belief that no treatment exists.[3]

Management follows the 2015 AUA Peyronie's Disease Guideline and the EAU sexual and reproductive health guidelines (2025 update; strength ratings as restated in the March 2026 limited update). A 2026 BJU Guideline-of-Guidelines review compares these with the CUA and ISSM guidance.[4][5][6]

The subsection articles cover each surgical pathway:

Disease Phases​

The distinction between phases determines what treatments are appropriate.

PhaseDurationFeaturesManagement focus
Acute / activeOnset through ~12–18 monthsPainful erections; evolving deformity; inflammation; plaque formationMedical / intralesional / mechanical therapy; surgery not recommended (outcomes unknown)
Chronic / stableOften after 12–18 months; defined by symptoms unchanged for at least 3 monthsDeformity nonprogressive; pain often improves but may persist; plaque may calcifySurgical correction if deformity interferes with function[4]

Stability. The AUA defines stable disease as symptoms clinically quiescent or unchanged for at least 3 months by patient report or clinician documentation; pain may persist but is less common and usually occurs with erection. Lesions typically stabilize 12–18 months after symptom onset, and most surgical series required at least 12 months of symptoms and 3–6 months of stable curvature. Surgical outcomes in active disease are unknown, so the panel comments only on stable disease.[4] Many surgeons also require pain-free erections and stable curvature on serial measurement before operating.

Pathophysiology​

The current working model: repetitive microvascular trauma to the tunica albuginea during buckling of the erect or semi-erect penis (intercourse being the most common context) triggers a dysregulated wound-healing response in genetically predisposed men.[2][7][8]

Cascade​

  1. Initiating injury. Microtears in the tunica albuginea with extravasation of plasma proteins
  2. Inflammatory phase. Fibrin deposition, macrophage recruitment, IL-1 / IL-6 / TGF-β overexpression, elastase release
  3. Proliferative phase. Fibroblast and myofibroblast recruitment; aberrant extracellular matrix deposition
  4. MMP/TIMP imbalance. Elevated TIMPs and suppressed MMPs tilt the matrix toward deposition rather than remodeling[8]
  5. Collagen remodeling. Tunical collagen shifts from predominantly type I to type III
  6. Chronic plaque formation. Densely fibrotic, often mineralized over time

Genetic and comorbid associations​

  • Dupuytren contracture. Shared fibroblast and myofibroblast biology; an older clinical-literature review recorded Dupuytren contracture on examination in 10% of men with PD[35]
  • Plantar (Ledderhose) fibromatosis. Less common but overlapping
  • Diabetes, hypertension, dyslipidemia. Modest associations; may reflect shared vasculopathic or inflammatory substrate
  • Low serum testosterone. Associated but causal role unclear. An earlier pilot study suggested a significant relationship between low testosterone and PD, but larger, more recent cross-sectional studies found testosterone levels are not associated with the magnitude of curvature in men with PD.[20][21]
  • Prior pelvic or prostate surgery. Post-prostatectomy PD is a recognized entity
  • Pelvic radiation. Rare but reported association

Clinical Presentation​

Symptoms​

  • Penile curvature. Direction and degree vary; in one untreated cohort with documented baseline curvature, 72% were dorsal, 17% ventral and 11% lateral.[36] Bidirectional or complex deformity is also described.[2]
  • Palpable plaque. Often dorsal, 1–3 cm typical; may be linear, nodular, or sheet-like
  • Penile pain. In an untreated cohort, all men who reported pain improved and 89% reported complete resolution at follow-up (mean disease duration 18 months)[36]
  • Penile shortening. In an untreated cohort, mean stretched flaccid length declined from 12.2 to 11.4 cm by follow-up (mean disease duration 18 months)[36]
  • Complex deformity. Indentation, hinge effect (buckling at a focal point), hourglass, biplanar curvature
  • Erectile dysfunction. In an untreated cohort, 32% reported some degree of ED at presentation[36]; ED can predate or accompany PD[2]
  • Psychosocial distress. Emotional distress was reported by up to 81% of men with PD; the AUA review separately reports depressive symptoms in 48% and relationship difficulties in 54%[4][9]

The patient conversation​

Men with PD consistently report feeling that providers dismissed their concerns or failed to appreciate the functional and psychological impact.

Evaluation​

Minimum diagnostic workup (AUA)​

  • Detailed history. Deformity onset, progression, precipitating trauma, pain, interference with coitus, prior treatments, erectile function (SHIM / IIEF-5)
  • Physical examination. Palpation of flaccid penis for plaque location and size, circumcision status, stretched penile length
  • Optional questionnaires. PDQ can quantify PD symptom bother; IIEF can describe erectile function but has not been validated specifically for PD.[24]

Objective assessment​

  • Intracavernosal injection (ICI) test. Standard test for erect-state assessment. Trimix or alprostadil induces full erection; curvature is measured with a goniometer along each plane; plaque palpation is most informative with the penis erect.[4][10]
  • Penile Doppler duplex ultrasound with ICI. Ultrasound identifies plaque location and calcification, but plaque-size measurement is inaccurate and operator dependent. Doppler assesses penile hemodynamics, including cavernosal arterial inflow and veno-occlusive function, when ED is suspected, particularly before incision and grafting.[24]
  • Patient-provided photographs of the maximum erection, in multiple planes, are useful for both measurement and longitudinal tracking.

Imaging​

Routine MRI is not required. Selective MRI for complex biplanar deformity, atypical plaque, or revision planning.

Natural History​

Untreated PD trajectories (Levine & Mulhall registries; Ziegelmann review):[3][9]

  • In an untreated cohort, curvature improved in 12%, remained stable in 40% and worsened in 48% at follow-up (mean disease duration 18 months)[36]
  • Among initially untreated men with penile pain, all reported improvement and 89% complete resolution at follow-up (mean disease duration 18 months)[36]
  • In one untreated cohort (n = 246), mean stretched flaccid length fell from 12.2 to 11.4 cm by follow-up at a mean disease duration of 18 months.[36]
  • Erectile dysfunction may coexist with PD and should be assessed before operative selection.[4][24]

Non-Surgical Management​

Oral therapies — limited evidence​

No oral monotherapy has strong evidence of efficacy.[1][4] Agents historically used include vitamin E, pentoxifylline, colchicine, tamoxifen, and potassium paraaminobenzoate (Potaba). The AUA advises against vitamin E, tamoxifen, procarbazine, omega-3 fatty acids and vitamin E with L-carnitine , regards pentoxifylline, colchicine, Potaba and coenzyme Q10 as unproven, and allows oral NSAIDs for pain in active disease .[4]

Intralesional injection therapy​

Collagenase clostridium histolyticum (CCH / Xiaflex) is the only FDA-approved intralesional therapy for PD. The US label covers adult men with a palpable plaque and curvature of at least 30° at the start of therapy, and contraindicates plaque that involves the penile urethra. The AUA recommendation specifies stable PD with curvature >30° and <90°; IMPRESS enrolled 30°–90°, while the FDA label requires at least 30° at treatment start and gives no upper curvature limit.[4][11][12][19]

ParameterDetail
IndicationLabel: palpable plaque and curvature of at least 30° at treatment start. AUA selection: stable PD, curvature >30° and <90° with intact erectile function ; IMPRESS enrolled 30°–90°[4][19]
ProtocolLabel: 0.58 mg into the plaque per injection. A cycle is 2 injections 1–3 days apart plus modeling; cycles repeat about every 6 weeks, up to 4 cycles (8 injections). Omit further cycles if curvature falls below 15°[19]
ModelingClinician modeling 1–3 days after the second injection of each cycle. Home program for 6 weeks: gentle straightening during spontaneous erections (hold 30 seconds) and gentle stretching of the flaccid penis three times daily. No vacuum erection device during treatment[19]
EfficacyMean curvature reduction ~17° (CCH) vs ~9° (placebo); net benefit ~8° (IMPRESS I & II)
Adverse eventsEcchymosis, penile swelling, pain, localized hematoma; corporal rupture / fracture after injection in 0.5% (5 of 1,044); another 0.9% (9 of 1,044) had symptoms for which rupture could not be excluded. This injection-specific risk is the subject of the boxed warning. Severe penile pain or swelling, marked bruising, popping or sudden loss of erection, urinary difficulty, or hematuria after injection require prompt evaluation for corporal rupture or severe hematoma; surgery may be needed.[19] Severe penile hematoma occurred in 3.7%. Prescribing requires REMS certification. Before injection, review coagulation disorders and anticoagulants: the label recommends avoiding XIAFLEX with concomitant anticoagulation other than low-dose aspirin (up to 150 mg/day), and safety after anticoagulant use within 7 days is unknown.[19] No sexual activity between the two injections, and none for at least 4 weeks after the second injection until pain and swelling resolve[19]
Usual exclusionsVentral curvature, isolated hourglass deformity, calcified plaque, and plaque causing curvature near the penile base were not evaluated in IMPRESS; inability to complete home modeling also limits use. The label contraindicates urethral-involving plaques and prior hypersensitivity to XIAFLEX or therapeutic collagenase.[4][19]

Office setup for injection and modeling. CCH is administered in an outpatient office setting, not the operating room. Before each treatment cycle, perform antiseptic skin preparation and induce an erection to locate and mark the plaque; a single intracavernosal injection of alprostadil 10 or 20 mcg may be used. Inject XIAFLEX into the marked plaque after detumescence, avoiding the urethra, nerves, blood vessels, and corpora cavernosa.[19] The label allows, but does not require, a suitable local anesthetic before the XIAFLEX injection itself and before the modeling procedure, at the treating clinician's discretion.[19]

Interferon α-2b has modest evidence for curvature reduction and pain relief: in the placebo-controlled trial summarized by the AUA, mean curvature fell 13.5° versus 4.5° with placebo (a net difference of about 9°). The 2015 AUA guideline allowed intralesional interferon α-2b , historically given as 5 million units every 2 weeks for six doses. Intron A is discontinued in the US, and EAU 2026 no longer recommends interferon for PD.[1][4][13][25][26]

Verapamil, a calcium channel blocker, has some evidence for plaque softening and pain in uncontrolled series but lacks strong RCT support.[13] The AUA gives intralesional verapamil a Conditional Recommendation (Grade C) and advises against electromotive verapamil .[4]

Other intralesional agents. EAU 2026 weakly recommends hyaluronic acid for pain and/or curvature during active PD, while emphasizing limited outcome data. Botulinum toxin, nicardipine, and corticosteroids lack established efficacy for routine use.[28]

Mechanical therapies​

Penile traction therapy (PTT). Traditional traction devices may require 2–8 hours daily; RestoreX was studied for 30–90 minutes daily.[14]

  • Evidence for modest curvature reduction and length preservation, especially in the acute phase and as adjunct to intralesional therapy
  • The best-studied device is RestoreX. In a randomized, single-blind trial (n = 110, randomized 3:1 to traction or no treatment; 30–90 minutes daily for 3 months), curvature changed by −11.7° with traction versus +1.3° in controls, and length by +1.5 cm versus 0 cm[14]
  • Adherence is the main limitation, because the devices require sustained daily use[2][14]

Vacuum erection device (VED). Adjunct evidence only, typically combined with traction or injection therapy.

Extracorporeal shock wave therapy (ESWT). ESWT has been reported to reduce pain in acute-phase PD but does not correct curvature. The AUA advises against ESWT for curvature or plaque size and allows it for pain .[1][4][11]

Combination protocols​

CCH plus traction and ESWT plus intralesional agents remain under study.[29] A 2024 meta-analysis of seven comparative CCH studies (532 participants) found better length and symptom scores with combination treatment, but no significant added curvature improvement versus CCH alone.[29]

Surgical Management​

Surgery is offered when stable deformity interferes with intercourse and the patient prefers operative correction.[4][24] The decision tree hinges on erectile function:

Erectile function statusSurgery of choice
Intact (including response to PDE5i, VED, ICI)Tunica plication for less-severe uncomplicated curvature or plaque incision/excision + grafting for severe or complex deformity; extra-tunical grafting has been described for selected indentation or hourglass deformity without tunical incision.[24]
ED refractory to medical therapy, or severe deformity with high risk of ED after graftingPenile prosthesis with adjunctive straightening as needed; discuss the option with high-risk graft candidates.[37]

Tunica Plication​

A commonly performed PD operation.[4][15] The tunica on the convex side is shortened, via plication, imbrication, or Nesbit-style wedge excision, to match the shorter concave side.

Named variants:

  • Nesbit. Transverse elliptical wedge excision of the tunica on the convex side, closed primarily
  • Yachia. Longitudinal incision with transverse closure on the convex side (Heineke-Mikulicz principle)
  • 16-dot (Gholami-Lue). Multiple small plication sutures, no excision; popular for its simplicity
  • Tunica albuginea plication (TAP; Levine technique). Partial-thickness tunical incisions followed by plication with a permanent suture, distinct from the Gholami–Lue 16-dot method.[2][31]

Indications:

  • Less-severe, uncomplicated curvature; the proposed 60° threshold for severe curvature has not been validated.[30]
  • No hinge / hourglass / complex deformity
  • Intact erectile function (with or without PDE5i adjunct)
  • Patient acceptance of expected shortening

Outcomes:

  • In the AUA plication review (which also included combined plication/grafting series), 42 of 54 study arms reported curvature improvement of 90% or higher[4]
  • Across published tunical-shortening series, 1–1.5 cm shortening was reported in 22–69% of patients. Patients may perceive greater loss than is measured, so counsel about shortening and document penile length before and after surgery (see the Tunica Plication page).[24]
  • Recurrence varies by series and follow-up; in a mixed congenital-curvature/PD 16-dot cohort, 15% of 124 evaluable patients reported recurrent curvature at a mean 2.6 years.[31]

Complications: measured or perceived shortening, palpable suture knots, sensory change (usually transient), and ED in a minority.[3][5]

Plaque Incision / Excision with Grafting​

For severe curvature (>60°), complex deformity (hinge, hourglass, biplanar), or short-penis patients where additional shortening is unacceptable.[4][15]

Technique principle: Incision or partial excision of the plaque on the concave side lengthens the short side; the resulting tunical defect is bridged with a graft.

Graft options:

GraftNotes
Acellular collagen matrix (Bard InteXen)Popular; consistent handling
Bovine pericardium (Veritas) and cadaveric (human) pericardium (Tutoplast)Widely used; reliable handling
Porcine SIS (Cook Biodesign)Remodels to host tissue
Dermal graft — autologousHistorical standard; meaningful donor-site morbidity
Saphenous vein — autologousRequires graft harvest[5]
Tunica vaginalis — autologousEasily harvested adjacent tissue

Outcomes:[4]

  • Curvature improvement 25–100% across observational series in the AUA review (64 of 72 study arms above 80%); AUA evidence is Grade C[4]
  • Aims to limit additional shortening compared with plication; long-term length gain is uncommon, and grafting can still shorten the penis.[24]
  • ED risk is higher than plication in some series (reported 10–25%); AUA-reviewed erectile outcomes were mixed. The EAU advises counseling patients without preoperative ED that postoperative ED after tunical lengthening can reach 50%; graft-related veno-occlusive dysfunction remains a concern.[4][5]
  • Persistent sensory change 0–25% in AUA-reviewed grafting series[4]

Indications:

  • Curvature >60° or complex deformity
  • Intact erectile function (or function responsive to oral medications / VED / ICI)
  • Patient willing to accept higher postoperative ED risk

Penile Prosthesis Implantation​

The operation of choice when PD coexists with ED refractory to medical therapy, or when severe deformity and ED make plication or grafting unlikely to produce a functional erection.[4][16][17]

Adjunctive straightening at implant is frequently required:

TechniqueFrequencyCurvature correction (median)
Manual modeling (Wilson "crack" maneuver): forceful reverse-direction bending against the inflated cylinders~75% of cases26° [IQR 20–39.5°][17]
Concurrent tunical plication over the implanted cylinders~5%40° [28–41°]
Plaque incision + grafting over the cylinders~2%55° [48–74°]; highest correction but most technically demanding

Prosthesis selection:

  • The AUA recommends an inflatable prosthesis for PD prosthetic surgery , because modeling is difficult with semi-rigid devices[4]
  • AMS 700 CX or Coloplast Titan OTR/Touch are routine choices
  • The AMS 700 LGX is often avoided in PD because longitudinal expansion can worsen a hinge deformity; the AMS 700 IFU itself cautions that LGX cylinders in Peyronie's disease may not give a satisfactory result[18]
  • The subcoronal approach is preferred when significant tunical work (grafting) is anticipated, because it exposes the entire shaft

See surgical approaches and preoperative evaluation in the penile implants subsection for the full operative framework.

Outcomes: the AUA review found that curvature improvement after plaque incision or excision with grafting generally ranged from 25% to 100% across observational study arms, with a majority above 80% (Grade C).[4] The multicenter series cited above is retrospective, and its adjunct groups differed in baseline curvature.[4][17]

Treatment Algorithm​

Active phase (until deformity stabilizes)​

  1. Counsel on disease trajectory and realistic expectations
  2. Non-surgical therapy. Consider traction. The AUA CCH recommendation applies to stable PD with >30° and <90° curvature and intact erectile function with or without medication ; EAU 2026 strongly recommends CCH for dorsal or lateral curvature >30° in patients seeking nonsurgical treatment and calls active-phase data preliminary; its manufacturer withdrew CCH from the European market, where the recommendation is retained for completeness.[4][33]
  3. Pain-directed therapy. Use oral NSAIDs for active-phase pain . Consider ESWT if pain remains inadequately controlled ; it does not improve curvature.[4][24]
  4. Deferred surgery. The AUA advises assessing surgical candidacy based on stable disease ; surgical outcomes in active disease are unknown.[4]

Stable phase (usually after 12–18 months; symptoms unchanged for at least 3 months; pain may persist)​

  • Deformity interferes with intercourse; rigidity is adequate. Choose plication or grafting by available length, curvature severity, hinge/hourglass deformity, and patient preference; 60° is an unvalidated heuristic.[24]
  • Deformity + ED refractory to medical therapy → penile prosthesis with intraoperative modeling, plication, or grafting as needed
  • Deformity not interfering with coitus → shared decision; ongoing monitoring

Shared decision-making​

The PD conversation is unusually values-laden. Patients weigh:

  • Curvature correction, length, sensation, and treatment burden. Comparative surgical rankings are uncertain; in a 38-patient randomized trial at 3 months, surgery plus traction and sildenafil corrected curvature more than CCH plus traction and sildenafil, while the CCH group preserved more length.[5][32]
  • Baseline erectile function and the risk of new or worsened ED after plication or grafting; discuss prosthesis separately when ED is refractory to medical therapy.[4][5]
  • Recovery time and technical complexity
  • Ability to stop treatment: later CCH injection cycles can be omitted, but corporal rupture or other injection injury may have lasting effects; surgery also has lasting effects.[19]

No single answer is "correct" for all patients. The surgeon's job is to present the trade-off honestly.

Counseling Essentials​

  • Recovery to pre-disease state is unlikely. Treatments, medical and surgical, reduce deformity.
  • Length outcomes vary by operation. Plication can reduce measured or perceived length; grafting aims to limit further shortening but can also shorten, and prosthesis implantation restores rigidity rather than prior length.[5][27]
  • ED is a recognized risk of grafting and, to a lesser extent, plication. Full discussion of this is part of informed consent.
  • Psychological impact is real and underappreciated. Referral for mental-health support is part of complete care in many patients.
  • Partner counseling. In a cross-sectional study of 44 men with PD and their female partners, the partners reported lower sexual function and satisfaction than population norms; offer partner involvement with the patient's consent.[38]

Special Scenarios​

Post-prostatectomy PD​

PD develops or progresses in some men after radical prostatectomy; altered penile hemodynamics and nocturnal tumescence have been proposed as mechanisms. When post-prostatectomy ED remains refractory to medical therapy, IPP with intraoperative straightening is an option; otherwise select treatment according to erectile response and deformity.[4][5]

Congenital curvature vs. PD​

Congenital penile curvature is present from puberty, lacks a plaque, is painless, and is managed by plication in adulthood if it interferes with coitus. Distinguishing PD from congenital curvature is a matter of history and examination.

Isolated penile torsion is a related but distinct congenital anomaly: rotation of the corporal bodies or glans around the penile long axis, usually counterclockwise (left; 79% in one neonatal series), rather than the dorsal/ventral or lateral bending of congenital curvature or PD.[22] Bhat et al. cite earlier isolated-torsion incidence estimates of 1.7–27% and severe torsion of 0.7%; in their own 5,018-neonate cohort, isolated torsion occurred in 99 (1.97%) and rotation >90° in one (0.02%).[22] Most children are asymptomatic, correction is primarily cosmetic, and torsion of the penis rarely provokes a complaint in adults; in one andrology-clinic series, only 2.2% of men found to have congenital torsion were bothered by it.[23]

Concurrent Dupuytren contracture​

Patients with both PD and Dupuytren contracture have the "fibrosing diathesis." There is some evidence these men respond less well to all therapies and are at higher risk of recurrence.

Pediatric / adolescent PD​

Rare; usually post-traumatic rather than idiopathic. Referral to high-volume pediatric urology centers.

See Also​

References​

1. Rosenberg JE, Ergun O, Hwang EC, et al. Non-surgical therapies for Peyronie's disease. Cochrane Database Syst Rev. 2023;7:CD012206. doi:10.1002/14651858.CD012206.pub2

2. Ziegelmann MJ, Bajic P, Levine LA. Peyronie's disease: contemporary evaluation and management. Int J Urol. 2020;27(6):504–516. doi:10.1111/iju.14230

3. Tsambarlis P, Levine LA. Nonsurgical management of Peyronie's disease. Nat Rev Urol. 2019;16(3):172–186. doi:10.1038/s41585-018-0117-7

4. Nehra A, Alterowitz R, Culkin DJ, et al. Peyronie's disease: AUA guideline. J Urol. 2015;194(3):745–753. doi:10.1016/j.juro.2015.05.098

5. Salonia A, Capogrosso P, Boeri L, et al. European Association of Urology guidelines on male sexual and reproductive health: 2025 update on male hypogonadism, erectile dysfunction, premature ejaculation, and Peyronie's disease. Eur Urol. 2025;88(1):76–102. doi:10.1016/j.eururo.2025.04.010

6. Chierigo F, Fallara G, Tozzi M, et al. Guideline of guidelines: Peyronie's disease. BJU Int. 2026;137(5):770–782. doi:10.1111/bju.70201

7. Patel DP, Christensen MB, Hotaling JM, Pastuszak AW. A review of inflammation and fibrosis: implications for the pathogenesis of Peyronie's disease. World J Urol. 2020;38(2):253–261. doi:10.1007/s00345-019-02815-6

8. Şahin A, Babayev H, Cirigliano L, et al. Unveiling the molecular hallmarks of Peyronie's disease: a comprehensive narrative review. Int J Impot Res. 2024;36(8):801–808. doi:10.1038/s41443-024-00845-2

9. Swislocki ALM, Eisenberg ML. Peyronie disease as a marker of inflammation — is there hope on the horizon? Am J Med. 2021;134(10):1218–1223. doi:10.1016/j.amjmed.2021.06.015

10. Chung E, Gillman M, Tuckey J, La Bianca S, Love C. A clinical pathway for the management of Peyronie's disease: integrating clinical guidelines from the International Society of Sexual Medicine, American Urological Association and European Urological Association. BJU Int. 2020;126 Suppl 1:12–17. doi:10.1111/bju.15057

11. Russo GI, Milenkovic U, Hellstrom W, et al. Clinical efficacy of injection and mechanical therapy for Peyronie's disease: a systematic review of the literature. Eur Urol. 2018;74(6):767–781. doi:10.1016/j.eururo.2018.07.005

12. Minore A, Cacciatore L, Presicce F, et al. Intralesional and topical treatments for Peyronie's disease: a narrative review of current knowledge. Asian J Androl. 2025;27(2):156–165. doi:10.4103/aja202460

13. Hayat S, Brunckhorst O, Alnajjar HM, et al. A systematic review of non-surgical management in Peyronie's disease. Int J Impot Res. 2023;35(6):523–532. doi:10.1038/s41443-022-00633-w

14. Ziegelmann M, Savage J, Toussi A, et al. Outcomes of a novel penile traction device in men with Peyronie's disease: a randomized, single-blind, controlled trial. J Urol. 2019;202(3):599–610. doi:10.1097/JU.0000000000000245

15. Levine LA, Lenting EL. A surgical algorithm for the treatment of Peyronie's disease. J Urol. 1997;158(6):2149–52. doi:10.1016/s0022-5347(01)68184-9

16. Chung E, Blecher G. Perspective: residual penile curvature correction during penile prosthesis implantation by plication in Peyronie's patients. Int J Impot Res. 2023;35(7):643–646. doi:10.1038/s41443-023-00774-6

17. Hammad MAM, Barham DW, Simhan J, et al. A multicenter evaluation of penile curvature correction in men with Peyronie's disease undergoing inflatable penile prosthesis placement. J Sex Med. 2025;22(2):349–355. doi:10.1093/jsxmed/qdae192

18. Boston Scientific. AMS 700 Inflatable Penile Prosthesis with TENACIO Pump: Instructions for Use. 51558342-01A (US English). Precautions: LGX cylinders in Peyronie's disease.

19. Endo USA. XIAFLEX (collagenase clostridium histolyticum): US prescribing information. Label revised 04/2026; sections 1, 2.2, 4, 5.2, 5.3 and boxed warning, and patient counseling text, checked against the FDA label September 26, 2026.

20. Moreno SA, Morgentaler A. Testosterone deficiency and Peyronie's disease: pilot data suggesting a significant relationship. J Sex Med. 2009;6(6):1729-1735. doi:10.1111/j.1743-6109.2009.01250.x

21. Mulhall JP, Matsushita K, Nelson CJ. Testosterone Levels Are Not Associated With Magnitude of Deformity in Men With Peyronie's Disease. J Sex Med. 2019;16(8):1283-1289. doi:10.1016/j.jsxm.2019.05.021

22. Bhat A, Bhat M, Kumar V, Goyal S, Bhat A, Patni M. The incidence of isolated penile torsion in North India: a study of 5,018 male neonates. J Pediatr Urol. 2017;13(5):491.e1-491.e6. doi:10.1016/j.jpurol.2016.12.031

23. Shaeer O. Torsion of the penis in adults: prevalence and surgical correction. J Sex Med. 2008;5(3):735-739. doi:10.1111/j.1743-6109.2007.00709.x

24. European Association of Urology. EAU Guidelines on Sexual and Reproductive Health. Limited update March 2026, §8.2 Penile Curvature. Guideline.

25. US Food and Drug Administration. Purple Book: Intron A (interferon alfa-2b), BLA 103132. Marketing status: discontinued. Product record.

26. European Association of Urology. EAU Guidelines on Sexual and Reproductive Health. Limited update March 2026, §8.2 Penile Curvature. Guideline.

27. European Association of Urology. EAU Guidelines on Sexual and Reproductive Health. Limited update March 2026, §8.2 Penile Curvature. Guideline.

28. European Association of Urology. EAU Guidelines on Sexual and Reproductive Health. Limited update March 2026, §8.2 Penile Curvature. Guideline.

29. Guo Y, et al. "Efficacy of collagenase Clostridium histolyticum combination therapies for Peyronie's disease: a systematic review and meta-analysis." Sex Med Rev. 2024;12(3):497–504. doi:10.1093/sxmrev/qeae025.

30. European Association of Urology. EAU Guidelines on Sexual and Reproductive Health. Limited update March 2026, §8.2 Penile Curvature. Guideline.

31. Gholami SS, Lue TF. "Correction of penile curvature using the 16-dot plication technique: a review of 132 patients." J Urol. 2002;167(5):2066–2069. doi:10.1016/S0022-5347(05)65085-9

32. Green B, Flores A, Warner J, et al. "Comparison of Collagenase Clostridium histolyticum to Surgery for the Management of Peyronie's Disease: A Randomized Trial." J Urol. 2023;210(5):791–802. doi:10.1097/JU.0000000000003634.

33. European Association of Urology. EAU Guidelines on Sexual and Reproductive Health. Limited update March 2026, §8.2 Penile Curvature. Guideline.

34. Lindsay MB, et al. "The incidence of Peyronie's disease in Rochester, Minnesota, 1950 through 1984." J Urol. 1991;146(4):1007-1009. doi:10.1016/S0022-5347(17)37988-0

35. Levine LA, et al. "Peyronie Disease in Younger Men: Characteristics and Treatment Results." J Androl. 2003;24(1):27-32. doi:10.1002/j.1939-4640.2003.tb02634.x

36. Mulhall JP, et al. "An analysis of the natural history of Peyronie's disease." J Urol. 2006;175(6):2115-2118. doi:10.1016/S0022-5347(06)00270-9

37. Chung E, Ziegelmann M, Lin HC, et al. "Management of Peyronie's disease: recommendations from the Fifth International Consultation on Sexual Medicine (ICSM 2024)." Sex Med Rev. 2026;14(1):qeaf068. doi:10.1093/sxmrev/qeaf068

38. Davis SNP, Ferrar S, Sadikaj G, Gerard M, Binik YM, Carrier S. "Female partners of men with Peyronie's disease have impaired sexual function, satisfaction, and mood, while degree of sexual interference is associated with worse outcomes." J Sex Med. 2016;13(7):1095–1103. doi:10.1016/j.jsxm.2016.04.074