Nonsurgical Treatment Options
- Vitamin E
- Phosphodiesterase Type 5 Inhibitors
Patients that have no pain or difficulty with intercourse may only require reassurance. Currently, no oral agent included in the list above has been shown in clinical trials to be better than a placebo to result in clinically meaningful improvement of penile deformity and curvature.
Topical Drug Application
Similarly, topical medication, shock wave and radiation therapy have not been shown to reduce penile deformity. Radiation could also increase the risk of ED.
Electromotive Drug Administration
Extracorporeal Shockwave Therapy
Vacuum therapy because of the short duration of the stretching forces on the penis does not benefit patients with PD.
Penile traction provides minimal improvement of penile curvature and penile length and for some patients, traction has been shown to be effective to recover lost length and reduce curvature if the device is applied to the penis for a minimum of 3 or more hours per day.
Injection of Plaque
- Clostridial Collagenase
Studies of injection of the plaque with Verapamil have not shown any favorable response. A Nicardipine injection was shown to be effective in some patients in only one study published in 2010. A study comparing the injection of interferon vs. placebo showed a small benefit of interferon over saline injection, but the side effects and cost of interferon did not justify it’s use. Clostridial Collagenase (Xiaflex) is the first FDA approved injection drug for the treatment of PD. Initial studies have shown improvement of the symptoms of PD including reduction of the pain and 35% improvement of the curvature. Further experience will help to determine which patients will benefit the most from Xiaflex injections. A recent study did not demonstrate any benefit for patients with severe curvatures and in patients with ED.
One study from 2012 using combination of daily pentoxifylline and L-arginine with Verapamil injections and penile traction showed the best result of correction of penile curvature, however the author did not specify how long traction was applied to the penis. More studies of combination therapy are needed to demonstrate efficacy.