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There is no single best treatment for Peyronie’s disease (PD). The choice depends on whether the condition is still changing or has stabilized, how much the curvature or other deformity affects sex, erectile function, treatment risks and burdens, local availability, and the patient’s goals. Injections and traction are nonsurgical options for selected patients; surgery is generally considered for stable deformity that interferes with intercourse.
How do the main treatment options compare?
These treatments are not interchangeable: they address different problems, suit different patients, and have different evidence and burdens. The table is a starting point, not a ranking.
| Option | Main aim | When it may be considered | Main trade-off |
|---|---|---|---|
| Collagenase injections | Reduce curvature by acting on plaque tissue | Selected men with stable disease and a suitable curvature pattern who prefer a nonsurgical approach | Modest average benefit over placebo in the cited trials; repeated clinical treatment and risks including bruising, pain, swelling, and rare serious injury |
| Penile traction therapy | Apply sustained stretch, with potential goals of reducing curvature and recovering length | A nonsurgical option to discuss with a urologist, including as part of a treatment plan | Reported protocols demand substantial daily device time; studies are small and heterogeneous |
| Surgery | Correct function-limiting curvature or deformity | Usually stable disease when deformity compromises intercourse; procedure depends on erectile function, anatomy, and goals | Involves an operation and procedure-specific trade-offs, including possible changes in length or erectile function |
The comparison reflects the European Association of Urology (EAU) guideline chapter, accessed in 2026, and the American Urological Association (AUA) guideline, published in 2015. The AUA guideline is older; its trial figures below are identified as such rather than presented as newer evidence.
Why does disease phase matter?
PD may be active, with symptoms or curvature still changing, or stable, with the deformity no longer progressing. Conservative approaches are commonly considered earlier. Surgery is generally reserved for stable disease when deformity causes functional impairment or compromises intercourse. A treatment that targets curvature also may not relieve pain or improve erections, so it matters which problem needs attention.
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The AUA guideline says disease often becomes stable 12–18 months after symptoms begin. Surgical studies commonly required at least 12 months of symptoms and 3–6 months of stable curvature. Those are typical study criteria, not a fixed waiting period or eligibility rule for every person. A urologist should assess the individual course and impact.
What can collagenase injections do, and what are the trade-offs?
Collagenase clostridium histolyticum (CCH) is injected into plaque tissue as a nonsurgical treatment intended to reduce curvature. The EAU recommends considering it for men with stable PD, dorsal or lateral curvature greater than 30 degrees, who request nonsurgical treatment. The AUA guideline describes candidates as having stable disease, curvature greater than 30 and less than 90 degrees, and intact erectile function, with or without medication. These criteria come from different guidelines and should not be treated as a universal approval or access rule.
How much curvature improvement was reported?
- The EAU’s current online chapter, accessed in 2026, reports an average curvature improvement of 34% with CCH versus 18.2% with placebo. Improvement in the placebo group is important context when interpreting the treatment effect.
- The AUA’s 2015 summary of the IMPRESS trials reports mean curvature reduction at one year of 17 degrees with collagenase and 9.3 degrees with placebo, a 7.7-degree difference between groups. These trial averages do not predict an individual result.
These figures use different measures and source analyses; they are not directly comparable. Neither means that a particular patient will achieve that degree of correction.
What are the risks and practical requirements?
In the AUA’s 2015 summary, 84.2% of patients in the collagenase group and 36.3% in the placebo group had at least one adverse event after up to four cycles. The guideline describes most events as mild or moderate and resolving without intervention. The EAU reports penile hematoma in 50.2%, pain in 33.5%, swelling in 28.9%, and injection-site pain in 24.1%; it says most local events resolved spontaneously within 14 days. The EAU reports serious treatment-emergent adverse events, including hematoma and corporal rupture requiring surgery, at 0.9%. The sources describe results from their respective study summaries, not a guaranteed rate for every clinic or patient.
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Patients should be counselled about bruising, swelling, pain, and the possibility of corporal rupture. The EAU advises avoiding intercourse for four weeks after injection to help prevent serious adverse events; follow the treating clinician’s specific instructions. CCH addresses curvature, not penile pain or erectile dysfunction, according to the AUA guideline.
Does availability depend on where you live?
Yes. The EAU says the manufacturer officially withdrew CCH from the European market, while retaining its discussion of the evidence. That statement does not establish availability in the United States or any other country. Ask a local urologist or relevant health service whether it is currently available and appropriate in your jurisdiction.
What is known about penile traction therapy?
Traction devices apply sustained mechanical stretch. The EAU describes possible aims that include reducing curvature and recovering length. Its summary of the literature says traction alone or in a multimodal approach may reduce curvature and increase length, but stresses that studies are small, heterogeneous, and use nonstandardized criteria.
A meta-analysis of five randomized and nonrandomized controlled studies was associated with approximately 15 degrees of curvature improvement, as reported in the EAU’s current online chapter accessed in 2026. This pooled result is not a guaranteed response, does not show that every device works similarly, and is not a direct comparison with surgery.
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In the cited literature, device use was reported at two to eight hours daily. The EAU reports no serious adverse events in those studies, but that time commitment can be inconvenient or uncomfortable. Effects have not been systematically studied for all deformities, including calcified plaques, hourglass deformity, and hinge deformity. Evidence for studied protocols does not establish that an ordinary retail device is equivalent to a device used in a clinical study; discuss device choice and use with a urologist.
When might surgery be considered, and how do procedures differ?
Guidelines generally place surgery in stable disease when deformity interferes with intercourse or otherwise causes functional impairment. The EAU advises considering penile length, erectile function and response to medication, curvature severity, complex deformity, and the patient’s expectations. The suitable procedure depends on those findings and on what trade-offs the patient is willing to accept.
Tunical plication
Plication corrects curvature by shortening the longer side of the penis. The AUA says it may be offered when rigidity is adequate for intercourse, including when medication or a vacuum erection device helps. It is a curvature-correction procedure, not a treatment for erectile dysfunction; discuss possible length trade-offs with the surgeon.
Plaque incision or excision with grafting
This approach addresses plaque-related deformity through incision or excision and grafting, a lengthening approach compared with plication. The AUA says it may be offered when rigidity is adequate for intercourse. Erection quality and possible erectile-function consequences are important to discuss when weighing whether it suits the patient.
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Penile prosthesis
The AUA says a penile prosthesis may be offered when erectile dysfunction and/or deformity prevents intercourse despite medication and/or vacuum-device treatment. If significant deformity remains after placement, adjunctive modeling, plication, or incision and grafting may be used.
For all three approaches, surgical candidacy is individualized. The AUA’s 2015 guideline states: “Clinicians should assess patients as candidates for surgical reconstruction based on the presence of stable disease.”
Independent reader supportYour contribution helps us test, update, and keep practical guides available for everyone.Which other treatments should be approached cautiously?
Shockwave therapy
The AUA advises against using shockwave therapy to reduce curvature or plaque size, though it may be offered for pain. The EAU likewise reports pain relief but no effect on curvature or plaque size. Pain relief should not be represented as proven straightening.
Verapamil injections
The AUA describes the evidence for intralesional verapamil as weak and advises careful consideration. The EAU reports contradictory evidence that does not support meaningful curvature improvement versus placebo.
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Interferon alfa-2b
The EAU reports that interferon alfa-2b was withdrawn from European and US markets in 2021 and does not recommend it. This does not establish the status of every jurisdiction or compounded treatment.
Oral supplements
The AUA advises against vitamin E and several other oral therapies it reviewed because convincing evidence of efficacy is lacking. The EAU’s current guidance also advises against several oral agents. Supplements should not be presented as established curvature treatments.
What should a urologist assess before treatment?
Evaluation should establish the deformity and its effect, the disease phase, erectile function, and the patient’s priorities. The EAU chapter describes assessment of plaques, stretched or erect length, curvature, and associated conditions; erection photographs or an induced-erection assessment may be appropriate. The AUA says clinicians should discuss each option’s known benefits, risks, and burdens, and recommends assessment and treatment by clinicians with appropriate experience and diagnostic tools.
Useful questions to bring to the appointment include:
Quick Recap
- Is the curvature or deformity still changing, or is the disease stable?
- Which problem is the treatment intended to address: curvature, pain, erectile dysfunction, intercourse function, or length?
- How do erection quality, curvature pattern, plaque location, and any complex deformity affect eligibility?
- What benefit is supported by evidence for this option, and what remains uncertain?
- What visits, daily device use, recovery time, follow-up, and risks would the treatment involve?
- Is the treatment available locally, and what alternatives fit the same goals?
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