| Treatment | Intralesional Injections for Peyronie’s Disease |
|---|---|
| Also known as | Peyronie’s disease injections, plaque injections, intralesional therapy |
| Used for | Penile curvature and plaque associated with Peyronie’s disease |
| How it works | Medication is injected directly into the Peyronie’s plaque to act locally on the abnormal scar tissue |
| Treatment options | May include collagenase (also known as Xiaflex) and other intralesional agents depending on clinical suitability, evidence and local availability |
| Procedure type | Minimally invasive, non-surgical treatment |
| Anaesthesia | Local anaesthesia may be used where required |
| Treatment setting | Outpatient clinic |
| Number of treatments | Varies according to the injectable agent, treatment protocol and individual response |
| Suitable for | Selected men with Peyronie’s disease who may benefit from non-surgical treatment |
What are Intralesional Injections?
Intralesional injections are a non-surgical treatment for Peyronie’s disease, a condition in which fibrous scar tissue, known as plaque, develops within the penis. The plaque can prevent the affected area from expanding normally during an erection, resulting in penile curvature, narrowing, indentation or other changes in shape.
Unlike oral medication, intralesional therapy delivers medication directly into the Peyronie’s plaque. Depending on the agent used, treatment may act on components of the scar tissue or influence processes involved in plaque formation and remodelling. The aim is to reduce the deformity sufficiently to improve penile function rather than necessarily restoring the penis to its exact shape before Peyronie’s disease developed.
Watch Dr Joe Lee explain what Peyronie’s disease is and how plaque formation can affect penile shape and curvature.
@drjollyurology Named after a French surgeon, but no romance here. 🇫🇷 Peyronie’s disease can cause pain, deformity, and performance problems. #urology #doctor #menshealth #fyp #PeyroniesDisease #menshealthawareness #doctorsoftiktok
♬ original sound - Dr Joe Lee | Urology - Dr Joe Lee | Urology
How Do Intralesional Injections Work?
The medication is injected directly into the Peyronie’s plaque rather than being given systemically. This allows treatment to be concentrated at the site of the abnormal scar tissue.
The mechanism depends on the medication used. Collagenase Clostridium histolyticum (CCH) also known as Xiaflex, enzymatically breaks down collagen, a major structural component of Peyronie’s plaque. Treatment is generally combined with penile modelling to help remodel the affected tissue and improve curvature. Other agents have also been investigated for intralesional treatment, although their evidence and recommended use differ.
Intralesional treatment usually involves a course of injections rather than a single procedure. The number and timing of injections depend on the medication and treatment protocol.
Who May Be Suitable for Intralesional Injections?
Suitability depends on the stage of Peyronie’s disease, degree and direction of curvature, plaque characteristics, erectile function and the specific injectable treatment being considered.
Intralesional treatment may be considered for selected men who:
- Have a clearly identifiable Peyronie’s plaque that can be assessed and targeted for treatment.
- Have penile curvature affecting sexual function but do not currently require or prefer surgical correction.
- Prefer a non-surgical approach after discussing its expected benefits and limitations.
- Have adequate erectile function, either naturally or with appropriate treatment.
- Have a pattern of curvature suitable for the particular injectable agent being considered.
- Understand that improvement is usually gradual and that injections may reduce rather than completely eliminate curvature.
For collagenase specifically, current EAU guidance recommends its use in men with Peyronie’s disease who have dorsal or lateral curvature greater than 30° and request non-surgical treatment. Patient selection nevertheless depends on the full clinical picture and local access to the treatment.
Types of Intralesional Injections
Several agents have been studied for injection directly into Peyronie’s plaques, but they should not be considered interchangeable because the quality of evidence differs.
Collagenase Clostridium Histolyticum (CCH - also known as Xiaflex)
Collagenase is an enzyme treatment designed to break down collagen within Peyronie’s plaque. Clinical studies have demonstrated reductions in penile curvature in appropriately selected patients, and treatment is typically combined with clinician- and patient-performed penile modelling.
Whether a particular collagenase product is available and appropriate for use depends on local regulatory status and clinical circumstances. In Singapore, therapeutic products require HSA registration before routine local supply, while specific access mechanisms exist for certain unregistered products. Our clinic is registered to treat patients with collagenase (also known as Xiaflex) in Singapore.
Interferon Alpha-2b
Intralesional interferon alpha-2b has been studied for Peyronie’s disease and may improve curvature, plaque characteristics and pain in some patients. The AUA guideline includes intralesional interferon alpha-2b as an option, while the EAU also reports evidence of potential improvement in curvature and plaque size.
Verapamil
Verapamil has also been used as an intralesional treatment for Peyronie’s disease. However, current evidence is inconsistent. The EAU notes that studies using verapamil and related calcium-channel blockers have produced contradictory results and have not demonstrated meaningful improvement in curvature compared with placebo.
For this reason, the choice of injectable therapy should be based on the available evidence, individual clinical findings and the availability of the treatment rather than assuming that all plaque injections provide equivalent results.
What to Expect During Intralesional Injection Treatment
Before Treatment
A detailed assessment is performed to determine the characteristics of Peyronie’s disease and whether intralesional treatment is appropriate.
- Medical and sexual history — Your symptoms, onset of Peyronie’s disease, pain, erectile function and effect on sexual activity are discussed.
- Assessment of penile curvature — The degree, direction and location of curvature are documented to establish the deformity before treatment.
- Plaque assessment — The plaque is examined to determine its location, size and characteristics.
- Evaluation of other deformities — Indentation, narrowing, hourglass deformity or hinge effects are assessed where present.
- Erectile function assessment — Your ability to achieve and maintain an erection is evaluated because erectile dysfunction may influence treatment selection.
- Additional investigations — An induced-erection assessment or penile Doppler ultrasound may be used in selected cases to document deformity and evaluate penile blood flow.
- Treatment discussion — The expected degree of improvement, number of treatment sessions, potential adverse effects and alternative options are discussed before proceeding.
During Treatment
Intralesional therapy is generally performed as an outpatient procedure.
- Identification of the plaque — The treatment area is carefully located before the injection.
- Local anaesthesia if required — Anaesthetic may be used depending on the treatment and individual comfort.
- Injection into the plaque — The selected medication is carefully delivered directly into the targeted Peyronie’s plaque.
- Penile modelling where indicated — Certain treatment protocols, particularly collagenase therapy, incorporate controlled modelling to help remodel the plaque and improve curvature.
- Repeated treatment sessions — Additional injections may be administered according to the prescribed protocol and response to treatment.
- Monitoring after injection — The penis is checked for immediate swelling, bruising or other reactions before the patient leaves the clinic.
After Treatment
Post-treatment instructions depend on the injectable agent used and the individual response.
- Temporary swelling and bruising — Local swelling, tenderness, bruising or a small haematoma may occur around the injection site.
- Activity precautions — Instructions are provided regarding sexual activity and other activities that could place stress on the penis during the early post-injection period.
- Home modelling where prescribed — Patients receiving certain treatments may be taught specific penile modelling exercises to perform between treatment sessions.
- Monitoring for complications — Patients are advised which symptoms are expected and which require prompt medical assessment.
- Follow-up assessment — Changes in curvature, plaque, erectile function and symptoms are reviewed during subsequent appointments.
- Further treatment planning — Additional injections or another treatment approach may be considered according to the response.
Intralesional Injections vs Surgery
Intralesional injections and penile surgery have different roles in the management of Peyronie’s disease. Injection therapy is minimally invasive and aims to produce a meaningful reduction in curvature without an operation, but the degree of correction is generally more limited than can be achieved surgically.
Surgery may be considered when Peyronie’s disease is stable and the deformity is severe enough to prevent satisfactory sexual intercourse, particularly when greater correction is required than non-surgical treatment is likely to provide. Surgical options can include penile plication, penile grafting or penile prosthesis surgery, depending on the deformity, penile length and erectile function.
Watch Dr Joe Lee explain when it may be time to consider surgery for Peyronie’s disease.
@drjollyurology When is surgery for Peyronie’s worth it? 📏 If the bend makes s*x painful or impossible, it may be time to straighten things out. 🩺 #urology #doctor #menshealth #fyp #PeyroniesDisease #menshealthawareness #doctorsoftiktok
♬ original sound - Dr Joe Lee | Urology - Dr Joe Lee | Urology
Benefits of Intralesional Injections
For appropriately selected patients, potential benefits include:
- Non-surgical treatment — Treatment is performed without an incision or reconstructive operation.
- Direct treatment of the plaque — Medication is delivered to the affected tissue rather than relying on systemic treatment.
- Potential reduction in penile curvature — Certain intralesional therapies can produce measurable improvement in curvature.
- Outpatient treatment — Injections are generally performed in the clinic without hospital admission.
- Shorter recovery than surgery — Most patients can return to routine non-sexual activities relatively quickly, subject to their doctor’s instructions.
- May delay or avoid surgery in selected patients — Sufficient improvement may allow some men to manage the condition without reconstructive surgery.
The amount of improvement varies, and intralesional therapy should not be presented as providing the same degree of straightening as surgical correction.
Risks and Limitations
The risks depend partly on the medication used, but patients should understand the general limitations of intralesional therapy before treatment.
- Pain or tenderness — Temporary discomfort can occur at the injection site.
- Swelling and bruising — These are common local reactions after some intralesional treatments.
- Penile haematoma — Bleeding beneath the skin can result in more substantial bruising or swelling.
- Incomplete correction — Curvature may improve without disappearing completely.
- Variable response — Some patients experience greater improvement than others.
- Multiple treatment sessions — A course of treatment may be required rather than a single injection.
- Erectile dysfunction may require separate treatment — Intralesional therapy primarily addresses Peyronie’s plaque and deformity rather than treating underlying erectile dysfunction.
- Rare serious injury — With collagenase treatment, corporal rupture or serious penile haematoma has been reported and requires prompt medical attention.
- Evidence differs between injectable agents — Some commonly discussed injections have substantially weaker evidence than others.
Results of Intralesional Injections
Results depend on the type of injection, initial curvature, plaque characteristics, stage of disease and individual response. The goal is generally to achieve a clinically meaningful reduction in curvature and improved penile function, rather than guaranteeing complete straightening.
Improvement occurs gradually over a treatment course. Some patients may obtain sufficient correction to improve sexual function, while others may continue to have significant curvature despite treatment.
If the deformity remains functionally limiting after non-surgical treatment, surgical correction may subsequently be considered once the disease is stable. The decision should take into account the remaining curvature, penile length, erectile function and the patient’s treatment priorities.
Summary
Intralesional injections offer a non-surgical treatment option for selected men with Peyronie’s disease by delivering medication directly into the penile plaque. Depending on the agent used, treatment may help remodel scar tissue and reduce penile curvature.
Treatment usually involves multiple sessions, and results vary according to the type of injection and individual characteristics of the disease. Intralesional therapy may improve curvature without surgery, but it does not guarantee complete straightening and may not provide sufficient correction for severe or complex deformities.
If Peyronie’s disease is causing bothersome penile curvature or affecting sexual function, consider scheduling a consultation with Dr Joe Lee to discuss whether intralesional injections or another treatment approach may be suitable for you.
