Peyronie’s Disease Treatment: 8 Options Compared by Evidence in 2026

Peyronie’s disease treatment depends on four things: whether the condition is active or stable, whether erections remain strong enough for intercourse, the type and severity of the deformity, and how much it interferes with sexual function. Current options range from observation and penile traction to intralesional injections and surgery. No single treatment is best for every man, and several heavily marketed tablets, supplements and procedures have weak or insufficient evidence.

That is the most important point to understand before comparing treatments.

Peyronie’s disease is not one uniform condition.

One man may have:

• painful erections;

• a new 30-degree curve;

• and a plaque that has been changing for four months.

Another may have:

• a stable 70-degree curvature;

• significant shortening;

• good erection quality;

• and no pain for more than a year.

A third may have:

• moderate curvature;

• an hourglass deformity;

• and erectile dysfunction severe enough that tablets no longer produce a usable erection.

These three patients should not automatically receive the same Peyronie’s disease treatment.

The first may need conservative management while the disease is still active.

The second may be considering reconstructive surgery.

The third may be a better candidate for penile prosthesis surgery because straightening the penis without restoring rigidity would not solve his main functional problem.

The 2026 European Association of Urology guideline reflects exactly this treatment logic. Conservative therapies are primarily used during active disease or when surgery is not appropriate or desired. Surgery is generally reserved for stable disease that compromises sexual intercourse. The surgical choice then depends heavily on penile length, curvature complexity and erectile function.

A 2026 review comparing the major international Peyronie’s guidelines reached a similar conclusion: there is broad agreement about the importance of disease phase, careful counselling and matching surgical treatment to erectile function, while non-surgical treatments remain an area where evidence quality varies substantially.

So rather than asking:

“What is the best treatment for Peyronie’s disease?”

a better question is:

“Which treatment has evidence for the specific problem I have?”

This guide compares eight major treatment pathways using the strength of current evidence rather than marketing claims.

Peyronie’s Disease Treatment at a Glance

That table is the short answer.

The rest of the article explains what those ratings really mean.

Before Treatment: Is Your Peyronie’s Disease Active or Stable?

This decision comes before choosing a drug, injection or operation.

Active Peyronie’s disease

Active disease generally means the condition is still evolving.

Clues include:

recent onset;

painful erections;

increasing curvature;

new indentation;

progressive shortening;

or another recent change in penile shape.

The goal during this stage is often to:

control pain;

support erectile function;

document progression;

preserve length;

and consider selected conservative therapies.

Stable Peyronie’s disease

Stable disease means the deformity has stopped changing.

The EAU considers resolution of pain plus stable curvature for at least about three months supportive of stabilization. Reconstructive surgery is generally considered only after this point and usually when disease has been present for at least approximately nine to twelve months.

That is why the same operation that may be appropriate at month 18 can be premature at month four.

If you need the disease-stage explanation first, read the main [Peyronie’s disease guide](/en/conditions/peyronies-disease).

Option 1: Observation, Pain Control and Treatment of Erectile Dysfunction

Not every man with Peyronie’s disease needs immediate curvature treatment.

For mild disease, observation can be a legitimate medical strategy.

This is particularly true when:

curvature is modest;

intercourse remains possible;

pain is mild;

erections remain strong;

and the deformity is not creating substantial distress.

Observation does not mean doing nothing.

It means documenting the disease while avoiding unnecessary treatment.

Pain treatment

During active disease, pain can be one of the main symptoms.

Current EAU guidance gives a strong recommendation for non-steroidal anti-inflammatory drugs, or NSAIDs, to treat penile pain during the acute phase when medically appropriate.

Examples of this drug class include common anti-inflammatory medicines, but the specific drug should depend on the patient’s:

kidney function;

stomach history;

cardiovascular risk;

other medication;

and clinician advice.

Pain treatment is important because it improves comfort.

It does not mean the plaque has been treated or that curvature will straighten.

Treating associated erectile dysfunction

Peyronie’s disease frequently overlaps with erectile dysfunction.

If erection quality is poor, PDE5 inhibitors such as sildenafil or tadalafil may be appropriate.

The 2026 EAU guideline gives a weak recommendation for PDE5 inhibitors specifically to treat concomitant erectile dysfunction in men with Peyronie’s disease.

Some retrospective studies have also suggested that daily tadalafil during active disease may be associated with less curvature progression.

One observational study cited by the EAU found curvature progression at 12 weeks in:

25.9% of tadalafil-treated men

versus

39.7% of untreated controls.

Because this was not a randomized placebo-controlled trial, it cannot prove that tadalafil prevents Peyronie’s progression.

Therefore, tadalafil should be viewed primarily as an ED treatment.

Any possible disease-modifying effect remains less certain.

How strong is this option?

For pain control: strong guideline support.

For erectile dysfunction treatment: reasonable guideline support.

For straightening the penis: observation, NSAIDs and PDE5 inhibitors should not be presented as reliable curvature-correcting therapies.

Option 2: Oral Medicines and Supplements—Why Most Have Weak Evidence

This is one of the most important sections because Peyronie’s patients encounter an enormous number of tablets online.

Common examples include:

vitamin E;

omega-3 supplements;

tamoxifen;

L-carnitine;

pentoxifylline;

colchicine;

coenzyme Q10;

and herbal or antioxidant mixtures.

Many are attractive because they are:

cheap;

easy to take;

and avoid injections or surgery.

The problem is evidence.

What does the AUA say?

The American Urological Association specifically says clinicians should not offer oral therapy with:

vitamin E;

tamoxifen;

procarbazine;

omega-3 fatty acids;

or vitamin E combined with L-carnitine

for treating Peyronie’s disease.

The AUA explains why this matters.

Using ineffective therapies is not harmless simply because the pills themselves may have relatively few side effects.

They can cost money, consume months of time and delay treatments with stronger evidence.

What about pentoxifylline?

Pentoxifylline has been widely discussed in Peyronie’s medicine because of theoretical anti-fibrotic effects.

Evidence has remained inconsistent.

The 2026 EAU oral-treatment section no longer provides a routine recommendation for pentoxifylline as a proven curvature therapy. Instead, it focuses on NSAIDs for acute pain and PDE5 inhibitors for coexisting ED.

A 2023 network meta-analysis of 24 randomized trials and 1,643 men reached a similarly cautious conclusion.

In its Bayesian analysis, no evaluated medical therapy demonstrated statistically significant superiority to placebo for curvature, plaque size or erectile-function outcomes. Some agents appeared significant using other statistical methods, illustrating how unstable the evidence can become when trials are small and heterogeneous.

Does that mean every oral drug is useless?

No.

It means there is not enough consistent high-quality evidence to present traditional oral anti-fibrotic tablets as established curvature treatments.

Medicines still have legitimate roles for:

pain;

erectile dysfunction;

and other medical conditions.

The misleading claim is:

“Take this tablet and the Peyronie’s plaque will dissolve.”

Current evidence does not justify that promise.

Evidence rating

Curvature correction: weak/insufficient for most oral agents.

Pain and ED management: useful when targeted to those specific symptoms.

Option 3: Penile Traction Therapy and Vacuum Devices

Penile traction therapy is one of the more interesting non-surgical options because it uses mechanical force rather than medication.

A traction device applies controlled stretching to the penis for a set period each day.

The theory is that sustained mechanical tension can influence:

collagen organization;

myofibroblast activity;

and tissue remodeling.

What does the 2026 EAU say?

The EAU gives a weak recommendation to offer penile traction devices and vacuum devices to reduce deformity or as part of a multimodal treatment plan, while emphasizing that outcome data remain limited.

That is cautious support.

Not dismissal.

Not a guarantee.

The RestoreX randomized trial

One of the strongest traction studies randomized 110 men to:

30–90 minutes of daily traction

or

no traction

for three months.

The men had a mean baseline curvature of about 59 degrees.

At three months, the traction group had average changes of:

+1.5 cm penile length

versus

0 cm in controls

and

−11.7 degrees curvature

versus

+1.3 degrees in controls.

The device was generally well tolerated, with mainly mild and transient adverse effects.

Longer follow-up found additional gains among men who continued treatment.

What does the broader evidence say?

A 2023 meta-analysis included five studies and 419 men.

It found a statistically significant overall improvement in penile curvature but did not find statistically significant pooled improvement in penile length or erectile function.

That apparent disagreement with the RestoreX trial is a good example of why single-device studies and pooled traction literature should not be treated as identical.

Different devices require:

different forces;

different daily use;

different protocols;

and different patient adherence.

What about vacuum erection devices?

The biological rationale is plausible and VED may help maintain tissue expansion.

However, the EAU notes that only a small number of retrospective studies have evaluated vacuum therapy as a stand-alone straightening treatment.

It is therefore more reasonable to consider VED as:

part of a broader mechanical or rehabilitation strategy

rather than a guaranteed curvature correction.

Who may consider traction?

Traction may appeal to men who:

want non-surgical treatment;

wish to preserve length;

have active or stable disease;

are willing to use the device consistently;

or want an adjunct to injection therapy.

Main disadvantage

Compliance.

A device does not work in the drawer.

The treatment has to be physically used according to the prescribed protocol for weeks or months.

For a dedicated explanation, see [penile traction therapy](/en/procedures/penile-traction-therapy).

Evidence rating

Moderate emerging evidence, with stronger data for some modern traction protocols than others.

EAU recommendation: weak, because the overall evidence base remains limited.

Option 4: Collagenase Clostridium Histolyticum Injections

Collagenase Clostridium histolyticum, abbreviated CCH, is the best-studied intralesional pharmacological treatment for Peyronie’s curvature.

In the United States, the product is marketed as XIAFLEX.

The FDA approved it for adult men with Peyronie’s disease who have:

a palpable plaque;

and curvature of at least 30 degrees at the start of therapy.

How does collagenase work?

The Peyronie’s plaque contains collagen.

CCH contains enzymes that break down collagen within the injected plaque.

Treatment is combined with penile modelling.

The traditional protocol can involve up to four cycles, each including two injections and a physician modelling procedure.

The IMPRESS trials

The strongest randomized evidence comes from IMPRESS I and II.

Together, these phase III trials enrolled more than 800 men.

At 52 weeks, average curvature improvement was:

34% with CCH

compared with:

18.2% with placebo.

The mean absolute change was roughly:

17 degrees with CCH

versus

9.3 degrees with placebo.

Patient-reported Peyronie’s bother also improved more in the CCH groups.

Why did the placebo group improve so much?

The placebo arm also underwent modelling.

That suggests mechanical treatment itself contributes to results.

The EAU specifically points out that the relatively large placebo/modelling improvement makes it difficult to separate every component of the treatment effect.

Who tends to respond best?

Post-hoc analyses suggest stronger responses among men with:

curvature around 30–60 degrees;

good erectile function;

little or no calcification;

and certain disease characteristics.

This does not mean men outside that profile never respond.

It means response is not uniform.

Side effects

Local effects are common.

The EAU cites rates including:

penile haematoma about 50.2%;

penile pain about 33.5%;

penile swelling about 28.9%;

and injection-site pain about 24.1%.

Most resolved spontaneously.

The more serious concern is corporal rupture.

In the original IMPRESS trials, three serious corporal ruptures were surgically repaired.

Is CCH available everywhere?

No.

The EAU notes that the product was withdrawn from the European market by its manufacturer, although the guideline retains the evidence and recommendation because the clinical data remain relevant.

It remains FDA-approved for Peyronie’s disease in the United States.

Availability therefore depends heavily on country.

What does the EAU recommend?

The 2026 EAU gives a strong recommendation to use intralesional CCH in men with dorsal or lateral curvature greater than 30 degrees who request non-surgical treatment.

Evidence rating

Among the strongest non-surgical curvature evidence.

Major limitation: access, cost, patient selection and risk of local complications.

Option 5: Other Intralesional Injections—HA, Interferon and Verapamil

Not every injection should be placed in the same evidence category.

Three commonly discussed alternatives are:

hyaluronic acid;

interferon alpha-2b;

and verapamil.

Their evidence differs substantially.

Hyaluronic Acid

Hyaluronic acid, or HA, has gained more attention in recent European guidance, particularly for active disease.

The 2026 EAU gives a weak recommendation for intralesional HA, alone or in combination, to reduce pain and/or curvature in active-phase Peyronie’s disease.

The guideline emphasizes that data are still limited.

A 2024 prospective randomized trial compared weekly HA with weekly verapamil in 42 men with acute disease.

Curvature improved from an average of:

34.1° to 24.7°

in the HA group

and from:

36.2° to 30.8°

with verapamil.

The HA group had the stronger reduction at 12 weeks.

This is promising.

It is not enough to claim HA is now equivalent to the more extensively studied CCH evidence base.

A 2025 systematic review of injection therapy during the acute phase included 20 studies and 1,291 patients but found substantial heterogeneity and generally low-to-intermediate evidence quality.

Evidence rating for HA

Promising but limited.

EAU: weak recommendation in acute disease.

Interferon Alpha-2b

Intralesional interferon has randomized clinical evidence.

A multicenter placebo-controlled study enrolled 117 men.

Interferon treatment produced significantly greater improvement in:

curvature;

plaque size;

plaque density;

and pain

than placebo.

The EAU summarizes mean curvature improvement around 13.5 degrees in the randomized evidence.

Side effects can include:

flu-like symptoms;

sinusitis;

and temporary swelling.

However, there is a major practical issue.

The EAU reports that interferon alpha-2b was withdrawn from the European and U.S. markets in 2021 and therefore is not currently recommended as a practical treatment option in its guideline.

Evidence rating for interferon

Historical randomized evidence exists.

Current availability substantially limits clinical relevance.

Verapamil

Verapamil has been used intralesionally for decades.

It is a calcium-channel blocker thought to influence collagen production and fibroblast biology.

Its clinical evidence is much less convincing than its long history might suggest.

The AUA states that clinicians may offer intralesional verapamil, but the recommendation is conditional and based on Grade C evidence.

The 2026 EAU is more skeptical.

It states that:

different dosing schedules;

contradictory study results;

and weak placebo comparisons

mean evidence is not strong enough to demonstrate a meaningful curvature benefit.

This difference between guidelines is useful.

It does not mean one society is “wrong.”

It shows that the evidence is weak enough for expert panels to interpret it differently.

Evidence rating for verapamil

Weak/inconsistent.

AUA: conditional option.

EAU 2026: evidence not strong enough to support routine use.

Where Does PRP Fit?

Platelet-rich plasma is frequently marketed for Peyronie’s disease.

The biological idea is attractive because PRP contains growth factors involved in tissue repair and inflammation.

But the clinical evidence remains immature.

The EAU gives a strong counselling recommendation that patients be told the available data for intralesional PRP are still limited.

A phase II randomized placebo-controlled crossover study has provided early safety information, but its preliminary analysis did not establish PRP as a standard curvature therapy.

Therefore PRP should not currently be presented as:

“proven to dissolve Peyronie’s plaque.”

That would overstate the evidence.

Where Does Shockwave Therapy Fit?

ESWT deserves a separate explanation because it is often advertised as a curvature treatment.

The evidence supports something narrower.

Multiple randomized studies show that shockwave therapy can improve pain.

They have not demonstrated consistent improvement in:

curvature;

or plaque size.

The EAU therefore gives a weak recommendation for ESWT to treat pain during active Peyronie’s disease but a strong recommendation against using ESWT to improve penile curvature.

The AUA takes essentially the same position: ESWT should not be used for curvature or plaque reduction, although it may be offered for pain.

So if a clinic says:

“Six shockwave sessions will straighten your Peyronie’s disease,”

that claim does not match current AUA/EAU guidance.

Option 6: Penile Plication Surgery

Once Peyronie’s disease is stable, surgery becomes relevant for men whose deformity prevents satisfactory intercourse.

Plication is usually the simplest of the three main surgical pathways.

It works by shortening the longer, convex side of the penis so that it better matches the shorter scarred side.

The plaque is not necessarily removed.

Who is a typical plication candidate?

Current EAU guidance describes an appropriate patient as someone with:

good erectile function;

adequate penile length;

less severe curvature;

and no major hourglass or hinge deformity.

The exact degree that counts as “less severe” is not absolute.

The overall geometry matters.

Advantages

Plication can offer:

high straightening rates;

a relatively predictable operation;

no need for a graft;

and lower risk to erectile function than more extensive tunical-lengthening surgery.

Main disadvantage: shortening

Because plication works by shortening the longer side, some loss of length is expected.

The clinical importance depends on:

preoperative penile length;

curvature severity;

and patient expectations.

This is why objective length measurement before surgery is important.

Does one plication technique win?

No.

Many variants exist.

Examples include:

Nesbit-type procedures;

incision or excision techniques;

and multiple suture-based plication methods.

The EAU states that no single shortening procedure has proven universal superiority, so surgeon and patient preference matter.

For the procedure itself, see [penile plication surgery](/en/procedures/penile-plication-surgery).

Evidence rating

Established surgical treatment for the right anatomy.

Best for stable disease with good erections and adequate penile length.

Option 7: Plaque Incision and Grafting

Plaque incision and grafting is a more complex reconstructive operation.

Instead of shortening the long side, the surgeon works on the short, concave side.

An incision is made through the contracted tunica at the area of maximum deformity.

The resulting defect is then covered with graft material.

Why use grafting?

The main reason is to avoid excessive shortening from plication in men with:

severe curvature;

major penile shortening;

hourglass deformity;

hinge deformity;

or another complex geometry.

The EAU notes that a curvature greater than about 60 degrees is often used as a practical definition of “severe,” although that threshold has not been validated as an absolute rule.

Does grafting make the penis longer?

It is better described as a length-preserving or tunical-lengthening strategy than a guaranteed penile enlargement operation.

The EAU specifically notes that these procedures rarely produce reliable long-term penile length gain.

Their aim is mainly to avoid the additional shortening that would result from plication in a severe deformity.

Why does erectile function matter so much?

Opening the tunica and placing a graft is more disruptive to penile mechanics than plication.

Postoperative erectile dysfunction is therefore a major concern.

The 2026 EAU guideline advises men without preoperative ED that postoperative ED risk can be as high as 50% in some published series.

That does not mean every grafting technique produces a 50% rate.

The literature includes:

different techniques;

different grafts;

different patient populations;

and different follow-up.

But the risk is significant enough that erectile function must be evaluated carefully before surgery.

Which graft is best?

No graft has proven clearly superior.

Materials used historically include:

human pericardium;

bovine or porcine tissues;

vein;

buccal mucosa;

and several other biological materials.

The EAU states that available comparative evidence does not support one universal graft choice.

For a dedicated explanation, see [plaque incision and grafting](/en/procedures/plaque-incision-and-grafting).

Evidence rating

Established option for selected complex stable Peyronie’s disease.

More technically demanding and carries greater postoperative ED risk than plication.

Option 8: Penile Prosthesis With Peyronie’s Correction

This is the correct surgical pathway when curvature and severe erectile dysfunction coexist.

Suppose a man has a 60-degree Peyronie’s curve but cannot achieve a reliable erection even with medication.

Straightening the penis alone does not solve the problem.

He would still have erectile dysfunction.

For these patients, penile prosthesis implantation can address:

rigidity;

and

deformity.

What do guidelines say?

The 2026 EAU gives a strong recommendation for penile prosthesis implantation—with or without additional straightening procedures—in men with Peyronie’s disease and ED that does not respond adequately to pharmacotherapy.

This is one of the clearest surgical recommendations in the entire Peyronie’s treatment pathway.

Does the implant itself straighten the penis?

Sometimes substantially.

Insertion and inflation of the cylinders can correct part of the curvature.

If clinically significant curvature remains, additional techniques may include:

manual modelling;

plication;

tunical incision;

or incision/grafting.

A recent multicenter study examined 499 men with Peyronie’s disease receiving inflatable penile prostheses.

Only 17.6% underwent prosthesis placement alone.

Most required some form of adjunctive straightening, most commonly modelling.

Grafting was used primarily in more severe deformities and produced the greatest median correction in that retrospective cohort.

When is an implant not appropriate?

A penile prosthesis should not generally be chosen purely because a man wants the straightest possible penis while his natural erections remain strong.

Implantation permanently changes the erectile mechanism.

Its main role is when ED itself requires surgical treatment.

For the combined pathway, see [penile prosthesis with Peyronie’s correction](/en/procedures/penile-prosthesis-peyronies-correction).

Evidence rating

Strong established treatment for Peyronie’s disease plus medication-refractory ED.

What Do AUA and EAU Explicitly Say Not to Use?

This section matters because many weak treatments remain commercially popular.

Vitamin E

AUA: do not offer as Peyronie’s oral therapy.

Omega-3 fatty acids

AUA: do not offer as disease treatment.

Tamoxifen

AUA: do not offer for Peyronie’s disease.

Procarbazine

AUA: do not offer.

Vitamin E plus L-carnitine

AUA: do not offer.

Electromotive verapamil

AUA: clinicians should not offer electromotive administration of verapamil.

Shockwave therapy for curvature

Both AUA and EAU say do not use ESWT to improve curvature or plaque size.

Its evidence-supported role is pain relief.

Radiotherapy

AUA recommends against radiotherapy for Peyronie’s disease.

PRP as a proven curvature treatment

The EAU does not say PRP can never be used, but it specifically says patients should be counselled that evidence remains limited.

That is different from marketing PRP as an established plaque-removal treatment.

Which Peyronie’s Disease Treatment Has the Strongest Evidence?

There is no single winner because the treatments solve different problems.

For pain during active disease, NSAIDs have a clear guideline role.

For erectile dysfunction, PDE5 inhibitors may help the erection but are not proven straightening therapy.

For a non-invasive mechanical option, traction has meaningful clinical evidence but overall studies remain heterogeneous.

For a non-surgical curvature injection, CCH has the strongest randomized trial evidence and strong EAU support in suitable patients, but availability varies.

For stable curvature with strong erections, plication or grafting can provide definitive correction depending on anatomy.

For Peyronie’s plus severe ED, penile prosthesis surgery becomes the most logical reconstructive option.

So the evidence hierarchy cannot be separated from the clinical goal.

Does More Aggressive Treatment Mean Better Results?

No.

A man with a mild 25-degree curvature and comfortable intercourse does not necessarily benefit from an operation simply because surgery can produce more straightening.

Likewise, a man with:

a 90-degree curve;

severe hourglass deformity;

and stable disease

may reasonably find months of weak oral therapy inadequate.

Treatment intensity should match:

functional impairment;

disease stage;

erectile quality;

and patient goals.

Why “Percentage Straightening” Can Be Misleading

Treatment studies often report percentage curvature improvement.

Suppose a man has:

60° curvature.

A 30% improvement brings him to approximately:

42°.

That is meaningful.

But it is not a straight penis.

Another patient may start at:

35°.

A 30% improvement brings him to about:

25°.

That may be enough for comfortable intercourse.

This is why a percentage alone cannot tell you whether a treatment will produce a satisfactory functional result.

What Is the Goal of Peyronie’s Disease Treatment?

The goal depends on the patient.

Possible goals include:

reducing pain;

preventing progression;

preserving length;

improving curvature;

restoring penetration;

improving erection quality;

or restoring sexual confidence.

Surgery has a particularly important expectation to understand.

The 2026 EAU guideline states:

“The main objective of surgery is to achieve a ‘functionally straight’ penis.”

That phrase is excellent patient counselling.

The aim is functional sexual anatomy.

Not mathematical perfection.

What if the Penis Is Curved but Sex Is Still Possible?

Treatment is optional.

A visible deformity alone does not force a man to undergo injections or surgery.

Observation may be reasonable when:

erections are strong;

penetration is possible;

pain has resolved;

and the patient is not significantly bothered.

The man’s priorities matter.

What if the Disease Is Still Changing?

Be cautious about irreversible reconstructive surgery.

If curvature is actively progressing, operating too early can mean the disease changes after the reconstruction.

Conservative options are therefore more relevant during this period.

That may include:

monitoring;

pain control;

ED treatment;

traction;

or selected intralesional therapies.

The key step is proving whether the deformity has truly stabilized.

What if the Main Problem Is Penile Shortening?

This changes the treatment conversation.

Plication can straighten the penis but does so by shortening the longer side.

A patient already distressed by major length loss may therefore prefer to discuss:

traction;

or, once stable and anatomically appropriate,

a length-preserving grafting strategy.

But grafting brings a different risk profile, especially postoperative erectile dysfunction.

There is no technique that reliably restores every centimetre lost to Peyronie’s disease without trade-offs.

What if the Main Problem Is an Hourglass or Hinge Deformity?

Degree of curvature may underestimate severity.

A penis may have only moderate curvature but severe circumferential narrowing.

This can create a hinge point that buckles during intercourse.

Simple plication may not correct the underlying instability.

Complex deformities are one reason specialist reconstructive assessment matters.

The EAU specifically identifies:

hourglass deformity;

hinge narrowing;

multiplanar curvature;

and severe shortening

as features affecting surgical selection.

What if Erectile Function Is Borderline?

This is one of the most difficult treatment decisions.

Imagine a man who can sometimes achieve erections with tadalafil but not reliably.

He also has a severe Peyronie’s curve.

If he undergoes grafting and his erectile function worsens, he may later require a penile implant anyway.

On the other hand, implanting a prosthesis immediately may feel too aggressive if erections are still usable.

This is why penile Doppler evaluation and a careful assessment of response to ED medication can be useful before reconstructive surgery.

The EAU recommends assessing erectile function—including response to pharmacotherapy—before selecting shortening, lengthening or prosthesis surgery.

Can Treatments Be Combined?

Yes, and multimodal therapy is increasingly studied.

Examples include:

traction plus CCH;

vacuum therapy plus injection treatment;

PDE5 inhibitors plus mechanical therapy;

or traction after surgery.

However, combining treatments does not automatically mean better outcomes.

The EAU notes conflicting evidence for traction as an adjunct to injections.

A meta-analysis cited by the guideline found approximately:

1 cm greater stretched penile length

with adjunctive traction

but no significant curvature difference between groups.

Another meta-analysis of CCH with VED or traction found only small additional average effects.

Combination therapy can be reasonable.

It should not be marketed as:

“three treatments together therefore three times more effective.”

Is There a Cure for Peyronie’s Disease?

“Cure” is not the most useful word.

A plaque may remain palpable after successful treatment.

Curvature may improve without disappearing entirely.

Surgery can correct deformity but does not erase a history of Peyronie’s biology.

A more realistic goal is:

adequate shape and rigidity for comfortable sexual function with acceptable risk and patient satisfaction.

How Long Does Peyronie’s Treatment Take?

It depends on the approach.

Observation may last months while the disease stabilizes.

Traction usually requires repeated daily use over several months.

CCH protocols may extend over multiple treatment cycles.

Some other injection programs involve weekly or biweekly appointments.

Surgery provides immediate anatomical correction but requires postoperative healing.

The fastest procedure is not automatically the best treatment.

Can Peyronie’s Disease Return After Treatment?

Residual or recurrent deformity can occur.

The risk depends on:

treatment;

disease stability;

baseline anatomy;

and follow-up.

This is another reason surgery is generally delayed until stability.

A patient should understand the difference between:

significant successful correction

and

guaranteed lifelong zero-degree curvature.

How Should You Choose Among the 8 Options?

A practical decision framework is:

Active disease + pain, minimal functional problem

Start with observation and symptom management.

Active disease + concern about length or progression

Discuss traction and selected conservative strategies.

Wants non-surgical curvature reduction and is suitable for injections

Discuss evidence-based intralesional options according to local availability.

Stable disease + good erections + adequate length + simpler curve

Plication may be appropriate.

Stable disease + good erections + severe/complex deformity or significant shortening

Discuss incision/grafting.

Stable disease + ED not responding adequately to medication

Discuss penile prosthesis with straightening as needed.

That is much more useful than choosing whichever treatment is advertised most aggressively online.

Peyronie’s Disease Treatment Abroad

International treatment can provide access to:

specialized reconstructive surgeons;

different injection availability;

penile prosthesis expertise;

or different treatment costs.

But the diagnosis should come before the package.

A high-quality assessment should establish:

active versus stable disease;

curvature degree;

deformity pattern;

penile length;

erectile function;

response to ED medication;

plaque characteristics;

and previous treatment.

A clinic that jumps directly from one photograph to:

“You need surgery”

without discussing disease stability or erectile function may be missing critical information.

For definitive surgical options, see [Peyronie’s disease surgery](/en/procedures/peyronies-disease-surgery).

For plication, see [penile plication surgery](/en/procedures/penile-plication-surgery).

For complex length-preserving reconstruction, see [plaque incision and grafting](/en/procedures/plaque-incision-and-grafting).

15 Questions to Ask Before Choosing Peyronie’s Disease Treatment

1. Is my disease still active or clearly stable?

2. What is my measured curvature?

3. Do I have hourglass or hinge deformity?

4. Has my penile length changed?

5. Is my erectile function objectively adequate?

6. Is the proposed treatment intended to reduce pain, curvature or both?

7. What is the strongest evidence supporting it?

8. What do current EAU and AUA guidelines say about it?

9. What percentage improvement is realistic for my starting curvature?

10. Does treatment preserve or risk penile length?

11. Could it worsen erectile function?

12. What happens if it does not work?

13. Would waiting change my future surgical options?

14. How many cases like mine does the surgeon treat?

15. If surgery is recommended, why is plication, grafting or prosthesis the best fit for my anatomy?

A specialist should be able to answer these without overselling certainty.

The Bottom Line on Peyronie’s Disease Treatment

Peyronie’s disease treatment should be selected according to disease phase, erectile function, deformity complexity and how much the condition interferes with sexual life—not simply by the degree of curvature.

The treatment ladder begins conservatively.

Pain during active disease can be treated with NSAIDs when appropriate.

Associated ED can be treated with PDE5 inhibitors.

Neither should be marketed as a guaranteed plaque-dissolving therapy.

Traditional oral supplements are even more limited.

The AUA specifically advises clinicians not to offer:

vitamin E;

tamoxifen;

procarbazine;

omega-3;

or vitamin E plus L-carnitine

as Peyronie’s disease therapies.

Penile traction represents a more credible conservative option.

In a randomized trial, 30–90 minutes of daily traction produced an average 11.7-degree curvature reduction and 1.5 cm length gain after three months, while controls showed no comparable improvement.

The overall traction literature remains more heterogeneous, which is why the EAU recommendation remains weak rather than strong.

For intralesional therapy, collagenase has the strongest established randomized evidence.

The landmark IMPRESS trials demonstrated an average curvature improvement of 34% with CCH versus 18.2% with placebo/modelling.

The 2026 EAU guideline gives CCH a strong recommendation for selected men with dorsal or lateral curvature over 30 degrees who want non-surgical treatment, although European availability remains limited because the manufacturer withdrew it from that market.

Other injections are more complicated.

Hyaluronic acid now has a weak EAU recommendation during active disease, reflecting promising but still limited evidence.

Interferon has historical randomized evidence but poor current availability.

Verapamil remains controversial: the AUA permits it conditionally, while the current EAU guideline states that evidence does not demonstrate meaningful curvature improvement versus placebo.

Shockwave therapy belongs in a different category entirely.

It may help penile pain.

It should not be sold as an evidence-based curvature-straightening treatment. Both AUA and EAU guidance are clear on that point.

PRP remains investigational from an evidence standpoint.

Patients should be told that available clinical data are still limited.

Once Peyronie’s disease becomes stable, surgical treatment becomes more relevant.

Plication is generally suited to men with:

good erections;

adequate length;

less complex deformity;

and a willingness to accept some shortening.

Plaque incision and grafting is more appropriate in selected men with:

strong erectile function;

severe curvature;

significant shortening;

or complex hourglass or hinge deformity.

It is a more complex operation and carries a greater postoperative ED risk.

Finally, penile prosthesis surgery becomes the preferred reconstructive pathway when the man also has significant erectile dysfunction that does not respond adequately to medication.

In those patients, the prosthesis restores rigidity while:

modelling;

plication;

incision;

or grafting

can be added when residual curvature requires correction.

The treatment decision therefore becomes much clearer once you answer four questions:

Is the disease active or stable?

Are erections strong enough for intercourse?

Is the deformity simple or complex?

What outcome matters most to the patient—pain relief, straightening, length preservation or restoration of rigidity?

That is the evidence-based way to approach Peyronie’s disease treatment.

For the disease itself, start with [Peyronie’s disease](/en/conditions/peyronies-disease).

For stable disease requiring surgery, see [Peyronie’s disease surgery](/en/procedures/peyronies-disease-surgery).

For shorter-side correction, review [penile plication surgery](/en/procedures/penile-plication-surgery).

For complex length-preserving reconstruction, see [plaque incision and grafting](/en/procedures/plaque-incision-and-grafting).

And if you need your disease phase, curvature and erectile function reviewed before choosing a treatment pathway, [contact Andrology Abroad](/en/contact).

The strongest treatment is not always the most aggressive one.

It is the one that solves the patient's actual problem with the best balance of evidence, benefit and risk.

Hero Image

For this article, I would use an evidence-comparison treatment ladder rather than another plaque-only image.

Create a sophisticated, realistic medical consultation scene in which a urologist and mature male patient are looking at a large transparent clinical display.

The display should show a non-explicit abstract cross-section of the penile tunica with a fibrotic plaque in the center, surrounded by eight visual treatment symbols arranged as a pathway:

observation;

medication;

traction;

injection;

another injection pathway;

plication;

grafting;

and penile prosthesis.

Use visual hierarchy to move from conservative treatment on one side toward surgical treatment on the other.

Do not include readable text inside the image.

Use Andrology Abroad colors:

periwinkle blue, teal, mint green and soft lavender.

Keep the style premium, modern and medically realistic.

No explicit genital skin.
No nudity.
No before-and-after photography.
No unrealistic “plaque disappearing” effect.
No manufacturer logos.