Peyronie’s disease is a wound-healing disorder in which fibrous plaque forms in the tunica albuginea of the penis, causing curvature, shortening, an hourglass deformity, pain, and often erectile dysfunction. Treatment depends on whether the disease is still active, how severe the bend is, and whether erections are still adequate.
Also referred to as: penile curvature, induratio penis plastica, bent penis correction, penil eğrilik, penile plaque surgery.
What is happening inside the penis
The erectile bodies are wrapped in a tough elastic sheath called the tunica albuginea. In Peyronie’s disease, an area of that sheath is replaced by inelastic scar — a plaque. When the penis fills with blood, the healthy tunica stretches and the plaque does not, so the shaft bends toward the plaque, narrows at the level of the plaque, or both. The plaque is not a tumour and it is not cancer.
It usually begins after an unnoticed injury: a bend during intercourse, a straddle injury, or repeated micro-trauma. Some men have a genetic predisposition to abnormal wound healing, which is why Peyronie’s runs alongside Dupuytren’s contracture of the hand and plantar fascia disease in the same families. Diabetes, smoking and low testosterone increase the risk. Around one man in twenty is affected, and the true figure is almost certainly higher because so many never present.
The distinction that governs everything else is the phase of the disease. In the active phase — typically the first six to eighteen months — the plaque is still forming, the curve is still changing, and erections are often painful. In the stable phase the plaque has matured, pain has resolved, and the curvature has not changed for at least three months. Surgery belongs to the stable phase; operating on an active plaque invites recurrence.
How the deformity is assessed
Accurate correction depends on accurate measurement. A photograph of a partial erection is not enough to plan surgery on.
- History: date of onset, whether the curve is still changing, presence of pain, and the effect on penetration
- Validated questionnaires — IIEF-5 for erectile function and the PDQ for bother and symptom severity
- Examination of the flaccid penis to map plaque position, size and any calcification
- An induced erection using an intracavernosal injection, so the curvature can be measured with a goniometer in degrees rather than estimated
- Doppler ultrasound during the same injection to assess arterial inflow, venous leak and plaque calcification
- Stretched penile length, documented before any decision is made — because every straightening operation trades a little length for a straight shaft
Non-surgical treatment in the active phase
If the disease is still evolving, the aim is to control pain, limit the final deformity and buy time until the plaque matures. Nothing reliably dissolves an established plaque, and any clinic promising otherwise is overselling.
Penile traction therapy
The only conservative measure with consistent evidence for both curvature reduction and length preservation. It requires genuine commitment — several hours a day over three to six months — and we set that expectation openly rather than handing over a device and hoping.
Intralesional collagenase
Collagenase clostridium histolyticum injected directly into the plaque can reduce curvature by roughly 30–35% in selected patients with a bend between 30° and 90° and no calcification. Availability varies by country and it is not a substitute for surgery in severe deformity.
Intralesional verapamil
A lower-cost injectable option with more modest and less consistent evidence, sometimes combined with traction. Reasonable where collagenase is unavailable and the patient wants to try a conservative course first.
Shockwave therapy for pain
Low-intensity extracorporeal shockwave treatment reduces the pain of the active phase in many men. It does not straighten the penis, and we say so before anyone pays for a course of it.
Choosing the right operation
Three surgical strategies exist, and the choice is dictated by the degree of curvature, the quality of erections, and penile length. Getting that choice right matters more than the technical polish of any individual technique.
| Technique | Indicated when | What it involves | Trade-off |
|---|---|---|---|
| Plication (Nesbit, Yachia, 16-dot) | Curvature under about 60°, good rigidity, no hourglass narrowing, adequate length | Shortening the longer, healthy side of the tunica with sutures so the shaft straightens. The plaque itself is left alone. | Loses roughly 1–2 cm of length. Simplest operation, lowest risk to erectile function, sutures may be palpable. |
| Plaque incision or partial excision with grafting | Curvature over 60°, hourglass or hinge deformity, but erections still good without medication | The plaque is cut to release the tethering, and the resulting tunical defect is patched with a graft such as bovine or processed pericardium. | Preserves length. Carries a 10–25% risk of worsened erectile function, so it is reserved for men with genuinely strong erections. |
| Penile implant with straightening | Curvature of any degree combined with erectile dysfunction that no longer responds to medication | An inflatable prosthesis is placed, and the shaft is straightened over it by manual modelling, plaque incision or grafting as required. | Solves curvature and erectile dysfunction in one operation. Irreversible, as with any implant. |
A residual curve of up to 20° is functionally irrelevant and is accepted in all three techniques rather than chased with additional risk.
Recovery after straightening surgery
- Day 0–1 One night in hospital with a light compressive dressing. Pain is moderate and controlled with oral analgesia. The catheter, where used, is removed the following morning.
- Days 2–7 Swelling and bruising of the shaft are expected and can be dramatic in appearance without being significant. Wound review before you fly home.
- Weeks 2–4 Bruising resolves. Desk work resumes within seven to ten days. Nocturnal erections may be uncomfortable initially; this settles.
- Weeks 4–8 Where a graft has been used, we start a gentle stretching or vacuum protocol at around four weeks to keep the graft supple and preserve length.
- From week 6–8 Intercourse resumes after review. Final cosmetic result is judged at three months, once all swelling has settled.
Questions we are asked about peyronie’s disease
Will Peyronie’s disease go away on its own?
Rarely. Spontaneous improvement occurs in roughly one man in eight; in most the curvature stabilises and persists, and in a minority it worsens. Pain, in contrast, resolves by itself in the great majority of cases within twelve to eighteen months.
Will surgery make my penis shorter?
Plication deliberately shortens the longer side, so it costs roughly one to two centimetres. Grafting is designed to preserve length and sometimes restores a little of what the plaque took. We measure and document stretched length at consultation so the conversation is based on numbers rather than impressions.
Can the curvature come back after surgery?
Recurrence is uncommon when surgery is performed in the stable phase, which is precisely why we insist on stability first. Operating on an active plaque significantly increases the chance of the deformity re-forming.
Can Peyronie’s disease be treated without surgery?
In the active phase, yes — traction therapy, intralesional injections and pain management can limit the final deformity. Once the plaque is mature and the bend prevents intercourse, surgery is the only treatment that reliably straightens the penis.
I have both curvature and erectile dysfunction. What then?
That combination is common and is usually best treated with an inflatable implant plus straightening in a single operation. Correcting only the curve in a man who cannot achieve a rigid erection leaves him with a straight penis he still cannot use.
Does Peyronie’s disease increase the risk of cancer?
No. The plaque is scar tissue in the tunica albuginea. It has no malignant potential and does not develop into cancer.
Clinically reviewed by the Santa Urology surgical team. This page describes typical outcomes reported in the surgical literature and in our own practice; individual results vary and nothing here is a substitute for a personal consultation. See our medical disclaimer.