How to cite: Loh-Doyle JC. Peyronie’s disease: from clinic to O.R. with tips for success. Grand Rounds in Urology. October 2025. Accessed January 2026. https://grandroundsinurology.com/peyronies-disease-from-clinic-to-o-r-with-tips-for-success/
Summary
This presentation provides a practical, experience-driven guide to the evaluation and management of Peyronie’s disease, spanning clinic-based therapies through operative intervention. Jeffrey C. Loh-Doyle, MD, Assistant Professor of Clinical Urology, University of Southern California, Los Angeles, California, emphasizes patient counseling, emphasizes patient counseling, expectation management, and stepwise escalation of care, recognizing both the physical and psychological burden of the disease.
Dr. Loh-Doyle begins the discussion by addressing epidemiology and pathophysiology, noting that Peyronie’s disease affects an estimated 10 percent of men and is driven by abnormal type III collagen deposition following microtrauma. Common clinical features include pain, curvature, narrowing, penile shortening, and palpable plaque, with a known association with Dupuytren’s contracture. More than 80 percent of patients experience significant emotional distress, positioning urologists as first-line psychological as well as medical providers.
Evaluation strategies are reviewed with emphasis on thorough history, physical examination, and in-office intracavernosal injection testing with or without duplex ultrasound to document curvature, plaque characteristics, and erectile function. The natural history of the active phase is discussed, demonstrating that most patients experience progression or stability rather than spontaneous improvement.
Medical management during the active phase is outlined. Nonsteroidal anti-inflammatory drugs are recommended for pain control, while vitamin E, tamoxifen, procarbazine, omega-3 fatty acids, and L-carnitine combinations are discouraged due to lack of efficacy and risk of delaying effective treatment. Daily phosphodiesterase type 5 inhibitors are highlighted for their favorable safety profile, potential antifibrotic effects, and benefits for pain and lower urinary tract symptoms. Penile traction therapy is presented as a practical option, with second-generation devices demonstrating meaningful curvature reduction and penile length preservation.
The stable phase is defined as the point at which invasive therapies may be considered. Intralesional collagenase is reviewed, including patient selection, dosing cycles, technique considerations, and the importance of combining therapy with traction to optimize outcomes. Risks, including corporal rupture, are discussed with emphasis on counseling and management rather than avoidance.
Surgical options for refractory disease include plication, plaque incision with grafting, lengthening maneuvers, and penile prosthesis placement. Dr. Loh-Doyle concludes that Peyronie’s disease is underrecognized but highly treatable when managed with structured evaluation, patient-centered counseling, and appropriate use of medical and surgical therapies.
About The 12th Urology Today Conference:
Presented by chair Ryan P. Terlecki, MD, FACS, the 12th Urology Today conference was designed to keep urologists, urologic oncologists, and other healthcare providers educated on the most pertinent issues in urology practices. Areas of focus included urologic oncology, men’s health and reconstruction, female urology, pediatric urology, kidney stones and related conditions, and methods of providing the best care amidst the required logistics of the business side of medicine.
ABOUT THE AUTHOR
Jeffrey Loh-Doyle, MD, is an assistant professor of clinical urology at the Keck School of Medicine at the University of Southern California (USC). He is a specialist in complex surgical reconstruction of the male urinary tract, male urinary incontinence, erectile dysfunction, sexual health, urethral stricture disease, and Peyronie’s disease. He joined the USC Institute of Urology after completing his medical degree, urology residency, and a fellowship training in male genitourinary reconstructive and prosthetic surgery at the Keck School of Medicine at USC.
Dr. Loh-Doyle’s areas of clinical and research interest include erectile dysfunction, male urinary incontinence, Peyronie’s disease, reconstruction of the urinary tract, and urologic oncology. In addition to urology, he also has a keen interest in health policy and quality improvement and participated in a two-year health care administration scholars program run by the Los Angeles County Department of Health. He was awarded a grant to improve the perioperative patient experience and is an active participant in several committees aimed at improving the delivery of sophisticated healthcare to the underserved.
