How to cite: Patel D. Tips and Tricks: Peyronie’s Disease. Grand Rounds in Urology. November 13, 2025. Accessed Feb 2026. https://grandroundsinurology.com/tips-and-tricks-peyronies-disease/
Summary
In this practical, technique-focused presentation, Darshan P. Patel, MD, Associate Professor of Urology, University of California, San Diego, San Diego, California, shares real-world tips and operative pearls for treating Peyronie’s disease, organized around the core decision of whether to inject, plicate, or graft.
Dr. Patel begins with intralesional injection therapy, emphasizing that collagenase clostridium histolyticum remains the only FDA-approved nonsurgical treatment. He reviews key technical considerations, including precise plaque targeting, low injection volume, resistance during injection as confirmation of intraplaque placement, use of local anesthesia, and routine compressive wrapping to reduce hematoma risk.
Surgical correction is then reviewed, beginning with penile plication. Contemporary non-incisional techniques such as dot plication and tunica albuginea plication are described, along with guidance on incision selection, suture placement, and intraoperative erection testing to avoid undercorrection. Dr. Patel discusses trade-offs between curvature correction and penile shortening and highlights strategies to minimize recurrence.
Plaque excision and grafting is a highly selective option reserved for men with severe curvature exceeding 60 degrees, significant hinge effect, or cases in which plication would result in insufficient postoperative length. Strict preoperative requirements are outlined, including good baseline erectile function, with caution emphasized for ventral curvature due to a higher risk of postoperative erectile dysfunction. Dr. Patel addresses recovery expectations, postoperative traction therapy, and scenarios in which penile prosthesis placement may offer a more reliable and durable solution.
About the 32nd Annual Perspectives in Urology: Point Counterpoint conference: Presented by Program Chair and Grand Rounds in Urology Editor-in-Chief E. David Crawford, MD, this conference brought together leading experts in urology, medical oncology, and radiation oncology to discuss and debate the latest topics in genitourinary cancers, primarily prostate cancer and bladder cancer. This interactive conference offered topical lectures, pro/con debates, interesting-case presentations, interactive panel discussions, and interactive audience and faculty networking.
ABOUT THE AUTHOR
Darshan P. Patel, MD, is an Associate Professor of Urology at the University of California, San Diego. Dr. Patel specializes in men's urologic health, including male infertility, low testosterone, erectile dysfunction, Peyronie's disease, prosthetic urology, and cosmetic lower genitourinary reconstruction. He is an expert in microsurgical vasectomy reversal, varicocele repair, testicular sperm extraction, as well as medical treatments and advanced surgical reconstruction for complex Peyronie's disease and erectile dysfunction.
