- Vitamin E
- Colchicine and Vitamin
- Intra-lesional Verapamil (injected directly into the lesion)
All of the above medical therapies have side-effects and have never been demonstrated to be effective in good, randomized, placebo controlled studies. I have had good, anecdotal experience with Vitamin E.
Men with Peyronies should be evaluated with a good history, including sexual history, and physical examination. Often, the plaque is palpable. When curvature is not visible with the flaccid penis, I will ask the man to take a digital picture or Polaroid of the erect penis when he is at home and bring it to me on the next visit. This way, I can see the degree of the curvature. If he is unable to get an erection at home, I will give him an injection with caverject or trimix in the office and assess the curvature that way, and take a digital photograph. Men that opt for invasive forms of treatment, such as the incision and patch of the plaque, will need to undergo objective tests of erectile function, such as a penile doppler.
Men in the acute phase are offered Vitamin or Potaba, or if the curvature is mild or after informed consent, reassurance. Treatment in the chronic phase depends on the degree of curvature and the presence or absence of ED. Treatment options include:
- Tunica albuginea plication
- Incision and patch
- Penile implant insertion
Surgical intervention must not be performed during the acute phase, or failure will occur. Failure is defined as worsening or progressive curvature after the operation. ED after Peyronies surgery is uncommon and if it occurs, it typically means it was present pre-op. If ED is present pre-op, the treatment option of first choice is the penile implant.