Review of Current Non-Invasive Peyronie's Disease Management: A Changing Reality

In recent years, Clostridium Histolyticum collagenase (CCH) has emerged as the most promising non-invasive option for the treatment of Peyronie’s disease (PD). With consistent clinical results in reducing penile curvature and improving penile length, many specialized centers were beginning to consider it a key tool, reducing the need for surgery or allowing for less invasive surgical interventions.

However, its recent withdrawal from the market in Europe and Canada has created a significant therapeutic gap, forcing us to reconsider our approach to this condition, which affects a substantial number of adult men and can have a considerable psychological impact. For this reason, our Andrology Unit at the Hospital of Mérida undertook this review.
This context led us to systematically analyze the available evidence on non-invasive treatments for PD, ranging from oral therapy to intralesional injections and penile traction therapy (PTT). Following this review, we confirmed that the timing of intervention is critical: the active phase of the disease represents a key window for therapeutic action. Accordingly, we have adapted our clinical practice to focus on this early stage, aiming to contain the progression of fibrosis and deformity.

Currently, in our practice, we employ a combined approach that includes intralesional verapamil, penile traction therapy (PTT), and daily tadalafil 5 mg. In our experience, this strategy has yielded favorable clinical outcomes with minimal adverse effects. Intervening during the active phase allows us to control disease progression and, if necessary, offer less invasive corrective surgical interventions at later stages, while acknowledging that scientific evidence regarding the treatment of PD remains limited.

Regarding emerging alternatives, platelet-rich plasma (PRP) may represent a promising therapeutic tool, with the advantage of being easily obtainable in most hospital settings. However, a standardized and clear protocol has not yet been established, and its clinical use requires caution and individualized evaluation for each patient.

The withdrawal of CCH highlights the importance of maintaining a flexible and multidimensional approach. While awaiting new pharmacological alternatives and clinical trials introducing innovative treatments, the combination of available therapies and early diagnosis remains our most effective strategy.

In conclusion, managing PD requires a long-term vision: early intervention, careful selection of non-invasive treatments, and strategic planning of potential surgical procedures. Our experience suggests that a proactive approach during the active phase may help contain disease progression and facilitate less invasive surgical interventions, ultimately improving the overall patient experience

Written by: Jaime Garre-Hernanz, MD, FEBU Urologist, Department of Urology, Hospital de Mérida, Mérida, Spain

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