Treatments — Andrology
Peyronie’s Disease — Assessment, Treatment & Surgery
Peyronie’s disease is a scarring condition of the penis causing a bend or deformity that can significantly affect sexual function and quality of life. Mr. Jesuraj provides specialist assessment, honest guidance on the natural course, and — when the time is right — surgical correction.
Understanding the Condition
What Is Peyronie’s Disease?
Peyronie’s disease is a benign but often distressing condition in which fibrous scar tissue (plaque) forms within the tunica albuginea — the tough, fibrous sheath that surrounds the erectile tissue of the penis. This plaque is inelastic and does not stretch normally during erection, causing the penis to curve, shorten, narrow, or develop an hourglass deformity on the side where the scar has formed.
The condition is caused by micro-trauma to the tunica albuginea — often during vigorous sexual activity — which triggers an abnormal healing response in which fibrous scar tissue forms instead of normal tissue. In some men, a genetic predisposition plays a role, and Peyronie’s disease is associated with Dupuytren’s contracture (a similar scarring condition of the hand).
It is important to understand that Peyronie’s disease is not a cancer, not contagious, and not caused by any STI. It is a wound-healing disorder — the body’s abnormal response to injury. Many men feel significant embarrassment or distress, but this is a recognised medical condition with effective treatment options.
How Peyronie’s Disease Affects Men
The most visible sign — a bend, curve or angulation on erection. Can be upward, downward, sideways or complex. Severe curvature makes intercourse painful or impossible.
As the plaque contracts it shortens the affected side of the penis — perceived shortening is one of the most common and distressing complaints alongside curvature.
Pain — particularly in the acute phase — is caused by the inflamed plaque being stretched during erection. This typically resolves as the condition stabilises but can be significant early on.
ED may accompany Peyronie’s disease — either due to the psychological impact of the deformity, or because the plaque impairs the vascular mechanics of erection. Assessment of erectile function is always part of the evaluation.
Associated Conditions
- Dupuytren’s contracture — fibrous scarring of the palm causing finger contracture. Found in up to 20% of men with Peyronie’s — suggests a shared genetic predisposition to abnormal fibrosis.
- Erectile dysfunction — may precede, accompany or follow Peyronie’s. Always assessed separately.
- Diabetes — increased risk of Peyronie’s and associated ED.
- Hypertension & cardiovascular disease — vascular risk factors impair healing and worsen erectile function.
When to Seek Assessment
- A new bend or change in shape of the erect penis
- Pain on erection — particularly new onset
- A palpable lump or thickening on the penis
- Difficulty with penetration due to deformity
- Penile shortening causing distress
- Erectile dysfunction associated with penile deformity
Natural History
The Natural Course — Understanding the Phases
Peyronie’s disease has a characteristic natural history in two phases. Understanding this is essential — it explains why timing of treatment matters greatly, and why waiting is not simply doing nothing.
The Acute (Active) Phase
Typically 6–18 months from onsetDuring the acute phase, the scar is actively forming and the condition is evolving. This phase is characterised by:
- Pain on erection — caused by the inflamed, stretching plaque
- Progressive change in the degree or direction of curvature
- The plaque may be tender to palpation
- Deformity may worsen over weeks and months
Surgery is not appropriate during the acute phase. Operating on an active, evolving scar risks worsening the outcome — the deformity may change further after surgery, and the results of surgical correction are unpredictable. Non-operative management, pain relief and patient support are the priorities during this phase.
The Chronic (Stable) Phase
After 12–18 months of stabilityThe chronic phase begins when the condition has fully stabilised — no further change in curvature for at least 3–6 months, and resolution of pain on erection. This is characterised by:
- No new change in the direction or degree of curvature
- Pain on erection has resolved or significantly improved
- The plaque is firm, well-defined and no longer tender
- The deformity is stable and predictable
Surgical correction is appropriate in the stable phase — once the deformity has been stable for at least 3–6 months and all pain has resolved. Operating on a stable, mature scar gives the most predictable and durable results. Mr. Jesuraj will confirm stability before recommending surgery.
What Happens Without Treatment?
Spontaneous improvement in curvature
Condition remains stable without significant change
Progressive worsening of deformity over time
These figures explain why watchful waiting alone — without specialist assessment and support — is not a satisfactory long-term plan for the majority of men with Peyronie’s disease.
Non-Operative Treatment
Conservative Management — Acute Phase & Beyond
During the acute phase, the priorities are pain control, patient support, slowing progression and preserving penile length. Several non-operative options have evidence to support their use.
Pain Management
Acute PhasePain on erection in the acute phase is caused by the inflamed, actively forming plaque being stretched during erection. Simple analgesia — non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen — can provide meaningful relief during this period.
Pain typically resolves spontaneously as the acute phase passes and the plaque matures. Persistent or severe pain warrants specialist assessment to exclude other pathology.
Vacuum Erection Device (Penile Traction)
Acute & Stable PhaseVacuum erection devices (VEDs) and penile traction therapy (PTT) are currently the most widely supported non-surgical interventions for Peyronie’s disease. They work by applying controlled mechanical force to the plaque — promoting remodelling of the scar tissue and counteracting the shortening effect of the contracting plaque.
Evidence supports their use for:
- Reducing curvature — particularly in the acute phase when the plaque is still forming and more amenable to remodelling
- Preserving or recovering penile length — the most distressing functional loss for many men
- Pre-operatively — to maximise length recovery before surgical correction
- Post-operatively — to maintain the surgical correction and prevent recurrence
Traction therapy requires commitment — devices need to be used regularly for several hours per day over weeks to months. Results are modest but real, particularly for length preservation, and the treatment is safe with minimal risk of harm when used correctly.
Intralesional Injections
Acute & Early Stable PhaseIntralesional injection therapy involves injecting medication directly into the Peyronie’s plaque — aiming to break down or remodel the fibrous tissue. The most widely studied and used agent is collagenase clostridium histolyticum (Xiapex/Xiaflex), which enzymatically dissolves the collagen within the plaque.
This treatment has regulatory approval in some countries and has evidence from the IMPRESS trial showing modest but statistically significant reductions in curvature alongside penile modelling exercises. It requires multiple injection sessions and specialist administration.
Note: Mr. Jesuraj does not currently offer intralesional injection therapy at Tees Urology. For patients who would particularly like to explore this option, he will provide a full assessment and can arrange appropriate referral to a specialist centre where this treatment is available. The evidence supports its use in selected patients with moderate curvature in the acute or early stable phase.
Psychological Support & Counselling
All PhasesThe psychological impact of Peyronie’s disease is significant and frequently underestimated. Studies consistently show high rates of depression, anxiety, relationship difficulties and loss of sexual confidence in affected men. These effects can persist even after successful surgical correction.
Mr. Jesuraj takes the psychological dimension of Peyronie’s disease seriously. He ensures there is time for honest discussion about the impact on quality of life, and where appropriate will recommend referral to a psychosexual counsellor or therapist — for the patient and their partner.
When to Operate
Indications for Surgical Correction
Surgery for Peyronie’s disease is not appropriate for everyone — and timing is critical. The decision to operate requires all of the following to be satisfied:
No change in curvature for a minimum of 3–6 months. No pain on erection. Operating on an active, evolving deformity produces unpredictable results.
The condition should have been present for at least 12 months to allow the natural course to complete. Early surgery risks operating before the deformity has fully declared itself.
The curvature causes difficulty with penetration or makes intercourse painful or impossible for the patient or their partner. Mild curvature that does not impair function may not require surgery.
Sufficient natural erectile function to allow intercourse is necessary for most procedures. Where erectile dysfunction is significant, this must be addressed — either separately or as part of a combined surgical approach (penile prosthesis).
The patient understands that surgery straightens — but does not elongate — the penis. Some further shortening may result. Residual curvature of up to 20 degrees is generally considered a satisfactory outcome. Perfect geometry is not the goal — functional intercourse is.
Before Surgery Mr. Jesuraj Will Assess:
- Degree and direction of curvature — ideally with a photograph at home or duplex ultrasound with pharmacological erection
- Presence and size of the plaque — clinical examination
- Penile length — measured in the stretched flaccid state
- Erectile function — IIEF questionnaire and clinical assessment
- Duration of stability — confirmed history
- Co-morbidities affecting erectile function — cardiovascular risk, diabetes, medications
- Patient’s priorities — straightening vs length preservation vs sexual function
Surgical Treatments
Surgical Options — Matched to the Individual
Three categories of surgical correction exist — each with different indications, advantages, risks and trade-offs. The right operation depends on the degree of curvature, penile length, and erectile function.
Penile Plication — Nesbit & Modified Plication Procedures
Shortening the longer side of the penis to match the scarred shorter side — straightening by bringing both sides to equal length
How Plication Works
Plication procedures work on the principle of shortening the convex (longer) side of the penis to match the concave (scarred, shorter) side — effectively straightening the penis by making both sides equal. This is achieved by placing permanent sutures (or removing small ellipses of tunica albuginea) on the opposite side to the plaque, creating a counterbalancing tuck that neutralises the curvature.
The Nesbit procedure — the original and most established technique — involves excising small ellipses of tunica at the point of maximum curvature. The Sixteen-dot (16-dot) plication and other modified techniques use permanent sutures placed in a specific pattern to shorten the longer side without excising tissue, reducing the risk of haematoma formation.
Why Plication Is the Right Choice for Many Men
Technically straightforward — predictable results
Very low risk of postoperative erectile dysfunction
Day case procedure — rapid recovery
Durable — recurrence uncommon
Suitable for moderate curvature with good penile length
No grafting — no donor site morbidity
⚠️ Important Trade-off — Penile Shortening
Plication procedures shorten the penis — this is inherent to the technique and is not a complication, it is the mechanism. The degree of shortening depends on the degree of curvature corrected. Men with already significant plaque-related shortening should be counselled carefully, as plication will add further shortening on the opposite side. For men where penile length is the primary concern, incision and grafting may theoretically preserve more length — but comes with significantly higher risks (see below).
Procedure Details
Incision / Excision & Grafting
Incising the plaque and filling the defect with a graft — corrects curvature with less shortening but carries significant risks to erectile function
How Incision and Grafting Works
Rather than shortening the opposite side (as in plication), incision and grafting involves making incisions through the plaque itself — releasing the tethering effect and correcting the curvature — then filling the resulting defect with a graft material to maintain the correction. The graft can be autologous (taken from the patient’s own body — vein, dermis, buccal mucosa) or synthetic (pericardium, SIS, Tutoplast).
Theoretically this approach preserves more penile length compared to plication — because it corrects from the short side rather than shortening the long side. However, this theoretical advantage comes at a significant cost.
⚠️ Critical Risk — Erectile Dysfunction
Incision and grafting procedures carry a significantly higher risk of postoperative erectile dysfunction — reported rates range from 15–30% in published series, with some studies reporting higher. This risk arises because the operation involves dissection on or near the neurovascular bundles of the penis, and because the graft disrupts the normal biomechanics of the tunica albuginea which is critical to the hydraulic mechanism of erection.
This risk must be considered very carefully. A procedure that corrects the curvature but causes significant erectile dysfunction may defeat its own purpose — a straighter penis that cannot achieve a functional erection does not restore sexual function. Pre-operative erectile function is therefore a critical factor in deciding whether grafting is appropriate.
For this reason, grafting procedures are generally reserved for men with very severe curvature (typically over 60–70 degrees), significant ventral (downward) curvature where plication is technically difficult, or complex deformities (hourglass, hinge effect) where plication alone is insufficient — and only when pre-operative erectile function is excellent and the patient fully understands and accepts the ED risk.
Mr. Jesuraj does not routinely perform incision and grafting procedures. Patients for whom this approach may be most appropriate will be given a full assessment and honest discussion, and will be referred to a specialist centre with dedicated expertise in complex Peyronie’s surgery.
Procedure Details
Penile Prosthesis (Implant)
Placement of an inflatable penile implant — treating both erectile dysfunction and Peyronie’s curvature simultaneously
When a Penile Prosthesis Is the Right Answer
A penile prosthesis (inflatable penile implant) is the most appropriate surgical option when Peyronie’s disease is accompanied by significant erectile dysfunction that has not responded to medical treatment (PDE5 inhibitors such as Viagra/Cialis). In this situation, the prosthesis addresses both problems simultaneously — restoring erectile function through the implant while straightening the penis during implantation.
During prosthesis placement, the erectile cylinders are inserted into the corpora cavernosa. The mechanical straightening effect of the cylinders within the corpora often significantly corrects the curvature without additional procedures. If residual curvature remains after cylinder inflation, additional manoeuvres — manual modelling, incision over the prosthesis, or plication sutures — are performed at the same time.
Indications for Penile Prosthesis in Peyronie’s Disease
- Peyronie’s disease with concurrent significant erectile dysfunction not responding to oral therapy
- Peyronie’s disease where planned incision and grafting would place erectile function at unacceptable risk
- Severe Peyronie’s disease with complex deformity and poor pre-operative erectile function
- Previously failed Peyronie’s surgery with associated ED
The three-piece inflatable penile prosthesis is the gold standard device — the pump is placed in the scrotum, the reservoir in the pelvis, and the cylinders within the corpora. It provides a reliable, concealed erection when needed and a flaccid appearance at rest. Patient satisfaction rates are high — provided expectations are fully discussed beforehand.
Mr. Jesuraj does not currently perform penile prosthesis implantation. He will arrange referral to a specialist andrological surgeon for patients where this is the most appropriate option, following a thorough assessment and discussion of all alternatives.
Procedure Details
Quick Reference
Which Operation — At a Glance
| Curvature | Erectile Function | Best Surgical Option | Available at Tees Urology |
|---|---|---|---|
| Mild–moderate (<60°) | Good | ★ Plication (Nesbit / 16-dot) | Yes — Mr. Jesuraj |
| Severe (>60–70°) or complex | Excellent pre-op | Incision & grafting | Referral arranged |
| Any degree | Significant ED + Peyronie’s | Penile prosthesis ± correction | Referral arranged |
| Acute / evolving | Any | Non-operative — wait for stability | Full support provided |
All patients for whom referral is arranged will have a full assessment and discussion with Mr. Jesuraj first — with a clear explanation of why a particular approach is recommended and what to expect from the referral pathway.
You Don’t Have to Manage This Alone
Appointments at Best Life Clinic, Stockton-on-Tees — Monday, Thursday and Friday. Most patients seen within 7 days. Complete discretion. No GP referral required.