Traditional management strategies for Peyronie's disease, largely monotherapeutic and stage-dependent, have produced inconsistent outcomes and rarely address the underlying biology of fibrosis. Based on existing knowledge, a multimodal novel concept, the 3Ts Protocol, is presented, involving Tadalafil daily, Tunneling with intralesional biologics, and daily Traction therapy. It introduces a comprehensive, regenerative strategy that integrates pharmacologic, biologic, and mechanical interventions in a single sequence. Daily low-dose tadalafil improves cavernosal oxygenation and arterial inflow, counteracting hypoxia-driven fibrosis. Tunneling injections of biologics deliver growth factors directly into and around the plaque, promoting regeneration and remodeling, while traction therapy provides continuous mechanotransductive stimulation for structural realignment. Together, these components act synergistically to modulate inflammation, restore microvascular perfusion, and induce tissue regeneration. Importantly, this work provides, to our knowledge, the first fully specified, step-by-step description of a Peyronie's disease management protocol, enabling reproducible clinical implementation and facilitating meaningful comparison across future studies employing different biologic agents. Prospective randomized studies examining the efficacy of the 3Ts Protocol are needed. If so, the 3Ts Protocol represents a paradigm shift from deformity correction to structural restoration, offering a novel pathway toward multimodal management of Peyronie's disease.

Residual penile curvature after inflatable penile prosthesis (IPP) placement is a recognized problem, which may require adjuvant procedures to achieve complete curvature correction. To evaluate the impact of extended corporal dilation (ECD) on the magnitude of intraoperative residual curvature and the need for adjuvant maneuvers during IPP placement in men with Peyronie's disease (PD). Men with PD who had a penile duplex Doppler ultrasound/curvature assessment and goniometer assessment of deformity magnitude who underwent penile implant surgery constituted the study population. Prior to 2016, corporal standard dilation (SD) with a Dilamezinsert dilator was conducted. Since then, we have incorporated ECD, adding the use of serial Hegar dilation ≥14mm. After device insertion and full inflation, repeat goniometer assessment of residual curvature was performed. If >20° of curvature remained, adjuvant maneuvers were performed. We compared residual curvature rates and the need for adjuvant intraoperative maneuvers between the SD and ECD groups. The primary outcome was the degree of residual intraoperative curvature and secondarily the need for performing adjuvant maneuvers. Two hundred eighty-four men metall criteria, with a mean age = 63 ± 22years. Two hundred eighteen (77%) patients underwent SD, while 66 (23%) had ECD. Baseline and residual curvature for the entire cohort was 62 ± 12° and 24 ± 22°, respectively. Despite similar baseline magnitude of penile curvature (P= .76), ECD resulted in less post-implant intraoperative residual curvature (P= .02) and less need for intraoperative adjuvant maneuvers (P< .01). One patient in each group had an intraoperative urethral perforation during manual modeling (SD < 1%, ECD 1.5%; P< .05). ECD provides a more effective strategy for reducing intraoperative curvature correction and the resulting need for adjuvant maneuvers during IPP placement in men with PD. Strengths include standardized preoperative and intraoperative curvature assessment and direct comparison of two dilation strategies; limitations include retrospective design, single-center data, and modest sample size for the ECD cohort. ECD during IPP surgery in PD reduces residual intraoperative curvature and the requirement for adjuvant maneuvers. While further evaluation is necessary, these preliminary data may support its eventual adoption as a technique.

Function over form: embracing curvature in Peyronie's disease treatment.

BackgroundThe association between Diabetes Mellitus (DM) and Peyronie’s disease (PD), as well as the impact of DM on PD phenotypes, remains not fully elucidated.AimTo investigate the association between PD and DM and to assess the impact of DM on the clinical phenotype of PD.MethodsThis case–control study retrospectively enrolled 136 PD patients from Department of Andrology, The First Affiliated Hospital of Henan University of Chinese Medicine (December 2019 to May 2025) as the case group. Two control groups were established concurrently: andrology patients without PD and healthy examinees. To control for confounding bias, propensity score matching (PSM) was used to balance baseline characteristics. Logistic regression analysis was employed to determine the independent association between DM and PD. Furthermore, clinical characteristics were compared between PD patients with and without DM.OutcomesThis study evaluate the correlation between DM and PD, as well as the clinical manifestations of their comorbidity.Results① The prevalence of DM and the proportion of related risk factors were significantly higher in the case group (P < .05). ② After PSM, logistic regression confirmed an independent association between DM and PD (Model 1: OR = 2.815, 95% CI: 1.376-5.989; Model 2: OR = 3.436, 95% CI: 1.823-6.709). ③ Compared to the non-DM subgroup, PD patients in the DM subgroup had a greater number of plaques, higher plaque elasticity, and a larger curvature angle, but reported lower pain scores (all P < .05).Clinical ImplicationsThis finding suggests that clinicians should be vigilant for occult yet structurally severe PD in diabetic patients and consider implementing multidisciplinary management strategies.Strengths and LimitationsThe strengths of this study lie in its relatively large sample size of PD patients within the field of andrological rare diseases, the dual-control design, and the robust PSM analysis conducted. Limitations include its retrospective, single-center design and the potential for residual confounding factors.ConclusionDM is independently associated with PD and is linked to a distinct clinical phenotype characterized by more severe fibrosis (more plaques, greater curvature) but diminished pain perception.

Three-piece inflatable penile prosthesis (IPP) implantation is the gold standard for refractory erectile dysfunction. This work provides apractical overview of indications, perioperative management, surgical techniques, and complication management. The article comprises anarrative review based on European Association of Urology (EAU) guidelines and relevant literature. An IPP is indicated after failure of conservative therapies and in Peyronie's disease, priapism, or after gender-affirming surgery. Apenoscrotal approach offers advantages. Modern implants and infection prevention reduce complications. Ectopic reservoir placement is safe, especially in pre-operated patients. Inflatable penile prosthesis implantation is safe, effective, and highly satisfactory when performed with standardized techniques and structured perioperative management.

Peyronie's disease (PD) impacts the penile albuginea, leading to deformity,pain, erectile dysfunction (ED), and an anxious-depressive state. Diagnosis of PD involves taking a detailed medical history;examining the penis by palpation; documenting any deformities; performing a dynamic Doppler ultrasound; and administeringquestionnaires to assess pain, erectile dysfunction (ED), and the patient's psychological status. The aim of this study wasto assess the symptoms of PD and their prevalence among patients in the active phase who were seen at our andrologyclinic. The inclusion criteria were: data must be available forpatients diagnosed with active PD, including a comprehensive medical history, blood test results, penile examination information, photographic evidence of the deformity, color Dopplerpenile ultrasound, and completed questionnaires, including visual analog scale (VAS) for pain assessment, International Index of Erectile Function (IIEF) for assessing erectile function,and psychometric test. Patients with PD who are in a stable phase or not having data requested for inclusion. Results: We detected penile curvature in 90.5%, penile pain in54%; ED in 39.3%, significative anxiety in 89.0%, significative depression in 57.6%, and bother in 93.6%. Our study revealed that a large number ofpatients with PD experience significant levels of anxiety and depression, with 38.3% of them experiencing severe anxiety.Psychotherapy should be included as part of the treatment plan for patients with PD to enhance their quality of life andadherence to treatment.

Peyronie's disease (PD) is a connective tissue disorder of the penis that causes pain, curvature, and erectile dysfunction. Methods: A prospective study was conducted on 112 patientstreated with ESWT. Each received three sessions of 3,000 shockwaves at 0.11-0.17 mJ/mm2. Pain, curvature, and erectile function were assessed. Pain relief occurred in 90% of patients (mean VASreduction: 3, p<0.00001); 57.1% had curvature improvement (mean 30°, p<0.001); 26.2% of ED patients improved ≥ 4 points in IIEF. ESWT appears safe and effective in improvingpain and curvature in PD patients.

Abstract Peyronie’s disease (PD) is characterised by fibrosis of the tunica albuginea and may cause penile pain, curvature, and erectile dysfunction. Current therapies are largely restricted to surgery or intralesional injection. We have previously shown that combining phosphodiesterase type 5 inhibitors (PDE5i; sildenafil, tadalafil) with selective oestrogen receptor modulators (SERMs; tamoxifen, raloxifene) exerts synergistic anti-fibrotic effects in experimental models of PD. Building on this, we compared tamoxifen plus a PDE5i with standard care in men with acute PD. Penile curvature and pain were assessed at baseline and after three months of treatment as part of a clinical audit. A total of 133 men with PD (mean disease duration 7.1 months) received an off-label regimen of tamoxifen (20 mg twice daily) combined with sildenafil (50 mg) or tadalafil (5 mg) daily for three months at a private hospital. In comparison, 26 men with PD (mean duration 7.8 months) received standard care (no treatment or vitamin E) for three months at a non-private hospital. Men who received combination therapy demonstrated significant improvement in penile curvature, while no meaningful change was observed with standard care. Pain improved in both groups but the reduction was greater in those treated with tamoxifen plus PDE5i. This is the first study to show that tamoxifen combined with a PDE5i may halt or reverse disease progression in men with acute PD.

Abstract Peyronie’s disease (PD) is a fibrotic disorder of the penis characterised by plaque formation and abnormal curvature. Evidence suggests that its incidence is higher in men after radical prostatectomy (RP). Postoperative hypoxia of the corpora cavernosa, secondary to nerve injury, has been implicated in the development of erectile dysfunction, and experimental studies demonstrate that hypoxia can promote fibrosis. We therefore hypothesised that penile hypoxia may underlie fibrotic changes and calcification observed after RP. In this pilot study, 24 men were assessed before and at 3 and 6 months after RP. Erectile function and PD-related symptoms were evaluated using the International Index of Erectile Function (IIEF), PD questionnaires, stretched penile length, and nocturnal penile tumescence. Fibrosis and calcification were assessed by ultrasonography, and penile tissue oxygenation was measured by oximetry. All patients developed fibrotic changes and calcifications detectable on ultrasonography, alongside a significant reduction in penile oxygen levels following RP. Erectile function scores declined significantly, although no participants reported curvature. Stretched penile length was reduced, and a significant correlation between oxygen levels and calcification was observed between 3 and 6 months. This study demonstrates for the first time a marked reduction in penile oxygenation after RP, accompanied by fibrosis and calcification. The correlation between hypoxia and calcification suggests that hypoxia-driven fibrosis may be a key mechanism in the progression of PD. Surgeons should consider informing patients that RP may predispose to penile fibrosis through hypoxia.

This case report presents the surgical management of a patient with complex Peyronie's disease involving a densely ossified plaque.The report highlights technical tips and tricks used to overcome intraoperative challenges, including dissection strategies and grafting techniques.Our experience emphasizes the importance of surgical expertise in achieving successful outcomes in such demanding cases.

Peyronie's disease (PD), also known as penile fibromatosis, predominantly impacts middle-aged males between the ages of 55 and 65 years, with an incidence of from 3.2% to 8.9%. This exploratory study evaluated short-term outcomes following surgical correction using collagen membrane transplantation in a small cohort of patients. We selected a bovine collagen membrane for its 'off-the-shelf' availability and guided tissue regeneration (GTR) properties to avoid donor-site morbidity. The GTR membrane acts as a barrier, mechanically preventing the rapid ingrowth of fibroblasts from the surrounding tissue, thereby favoring organized tunical repair. This study aimed to evaluate the feasibility, safety, and short-term outcomes of surgical correction using a bovine collagen membrane (BME-10X) for tunical repair in patients with PD. Twenty patients (mean age 55 years, range 42-66 years) diagnosed with PD underwent collagen membrane grafting. Outcomes were assessed preoperatively and at a 6-month postoperative follow-up using the International Index of Erectile Function-5 (IIEF-5), Rigiscan monitoring (mean glanular erection rigidity), Self-Rating Anxiety Scale (SAS), and Self-Rating Depression Scale (SDS). In this initial short-term evaluation of 20 patients, collagen membrane grafting suggested feasibility and was associated with improvements in penile deformity, IIEF-5 scores, glanular rigidity, SAS, and SDS scores compared to baseline. Key limitations include the small sample size (n=20) and short follow-up period (6 months), which preclude definitive conclusions regarding long-term efficacy, durability, recurrence risk, and broader applicability. This preliminary study suggests that collagen membrane transplantation may offer a potential surgical approach for the short-term management of penile curvature in PD, with associated improvements in erectile function and patient-reported anxiety and depression symptoms in this small cohort. However, these initial findings require rigorous validation in larger, long-term studies to confirm efficacy, safety profile, and sustained benefit.

Trends in Medicare utilization of intralesional collagenase injection and surgery for Peyronie's disease, 2013-2023.

To compare major Peyronie's disease (PD) guidelines, highlight key similarities and differences among panel recommendations, and identify areas requiring further research. An extensive review was conducted to analyse and compare diagnostic and treatment recommendations from publicly available guidelines published by the American Urological Association, European Association of Urology, Canadian Urological Association, and the International Society of Sexual Medicine. Key similarities and differences regarding PD definition, evaluation, non-surgical treatments, and surgical management were systematically compared. Areas of general consensus across guidelines include the importance of comprehensive history-taking for PD diagnosis and the role of intracavernosal injection as the 'gold standard' for assessing penile deformity prior to invasive intervention. Shared decision-making and thorough patient counselling are universally emphasised. Plication or incision and grafting surgery is generally reserved for patients with preserved erectile function, whereas penile prosthesis implantation is the preferred surgical option for those with erectile dysfunction unresponsive to medical therapy. Non-surgical treatments remain an area of controversy due to limited evidence of efficacy; however, intralesional injections are recognised by all panels as a potential treatment option, especially in the acute phase. Further research into PD pathophysiology and rigorous outcomes studies are needed to inform novel treatments and refine surgical management strategies. While major urological societies demonstrate substantial consensus on several aspects of PD evaluation and management, key areas of divergence remain, underscoring the need for further research to guide evidence-based care.

P0193 3D documentation of complex penile deformities in Peyronie's disease – an expertimental analysis of 2 devices.

Neurovascular bundle mobilization (NVBm) requires experience to avoid injury of the dorsal nerves and arteries of the penis. This work described Shaeer's Hydro-Inflation Technique for Neurovascular Bundle Mobilization (S-NVBm), whereby infiltration of the neurovascular bundle with saline is performed to increase safety and speed of NVBm. S-NVBm was performed in 50 cases: 21 cases of corporal rotation for congenital curvature, and 29 cases of penile prosthesis implantation with slitting of the tunica albuginea for correction of Peyronie's disease deformity (S-NVBm group). A matching group was operated upon with "classic" NVBm, without hydro-inflation (C-NVBm group, n = 32). In S-NVBm cases, hydro-inflation of Buck's fascia was performed prior to NVBm using 80% saline and 20% xylocaine (without adrenaline). The mixture was injected into Buck's fascia with the blunt nozzle of a 20 ml syringe, superficially applied to the surface. Average duration for NVBm in the S-NVBm group was 3.5 min ± 1.4 (range 1.2-7), compared to a duration of 7.3 ± 2 (range 4-11.2) in the C-NVBm group (p < 0.001); a 51.8% difference. No arterial injury was witnessed with S-NVBm group, compared to 1 case of minor unilateral arterial injury in the C-NVBm group. Sensitivity score was 10.2% higher in the S-NVBm group (mean 4.7 ± 0.5, range 3-5) compared to a mean of 4.3 ± 1 (range 2-5) in the C-NVBm group (p < 0.001). Biosthesiometry detected a mild sensory deficit in 1/50 cases of the S-NVBm group (2%) compared to 3/32 in the C-NVBm group (9.4%). Average post-operative pain score was 46% lower (2.5 ± 1.4, range 1-6) in the S-NVBm group compared to 4.6 ± 1.3 (range 2-7) in the C-NVBm group(p < 0.001). The findings herein demonstrate that Hydro-Inflation technique allows mobilization of the neurovascular bundle in a shorter time, with less post-operative pain, and with a lower risk for sensory deficit.

P0191 Exploring depression among men with Peyronie's Disease: A binational cohort from Australia and Denmark

P0189 Quality and reliability of TikTok videos on Peyronie's disease: A cross-sectional study

V030 Inflatable penile prosthesis placement &amp; modified Egydio Tunica Expansion Procedure (TEP) for the treatment of severe curvature in Peyronie's disease with concomitant erectile dysfunction

Sexual medicine is still a dynamic, developing approach. Similar to the progress witnessed in other urological domains, the field of sexual medicine continues to evolve, probably at an even more rapid steps than certain other areas of medicine. Although many new concepts continue to evolve, confusion often challenges many physicians. This specific issue of UroPrecision, aims to update the interested physicians on the latest and most discussed “Hot Topics” in the field. Additionally, according to the recent literature, in this special issue, the authors have provided current information associated with these specific topics. Hereby, I would like to state that, in the present specific issue of UroPrecision, at least practically it was impossible to comprehensively provide all the latest developments in every specific topic. However, as mentioned before in this issue, we aimed to address conditions, which are still discussable and are not widely defined. This editorial summarizes the contents of the included articles which are written by internationally recognized authors in their respective sexual medicine disciplines. İbiş et al. evaluated the erectile and ejaculatory outcomes after holmium laser enucleation of the prostate (HoLEP). Actually, in recent years HoLEP has emerged as a worldwide used surgical technique for the management of benign prostatic hyperplasia (BPH), regardless of prostate size. However, the impact of this technique on male sexual function such as erectile and ejaculatory function remains a subject of debate. In this review article, the authors have searched robust data from the literature and showed that HoLEP has a moderate favorable effect on erectile function (EF). In contrast, it has been reported that retrograde ejaculation is a frequent and expected outcome, with incidence rates typically ranging from 74% to 78%. The authors concluded that while HoLEP is an effective and durable treatment for BPH, there is a high likelihood of ejaculatory dysfunction[1]. Albayrak and Usta in their manuscript tried to answer the question if or not penile traction therapy (PTT) can be added to the armamentarium as a minimally invasive option for penile rehabilitation after radical pelvic surgery. PTT has been reported as a non-invasive intervention which stimulates tissue remodeling, preserves length, and reduces fibrosis. Although this treatment was developed for Peyronie's disease, PTT is recently considered for penile rehabilitation following pelvic surgery. The results of this manuscript basically showed that, while PTT use remains off-label in this context, it represents a promising method for multimodal penile rehabilitation strategies[2]. Zhang et al. have evaluated the effect of various treatment options including oral phosphodiesterase type 5 inhibitors, intracavernosal injections, and vacuum erection devices, used alone or in combination on EF for penile rehabilitation after radical pelvic surgery. Furthermore, the possible efficacy of novel investigational approaches such as low-intensity shockwave therapy, stem cell therapy, platelet-rich plasma therapy and nerve grafting was also evaluated in this paper. More importantly, the authors have discussed the evidence-based issue and rationality of these options from a scientific point of view[3]. Degirmenci et al. have provided “Tips and Tricks” for preserving the neurovascular bundle during radical robotic prostatectomy. In this manuscript, the authors have reviewed the details of different “nerve sparing techniques” according to their experiences and the recent literature as well. The authors reported that nerve-sparing techniques play a crucial role in preserving postoperative EF and urinary continence. However, the authors revealed that postoperative success rates are associated with careful patient selection and precise intraoperative decision-making[4]. Mahdi et al. have assessed the efficacy of current surgical strategies for a not commonly seen clinical entity, namely supersonic transporter (SST) deformity or Floppy Glans syndrome. While this condition is a rarely seen complication, it causes to high rates of unsatisfaction in men after inflatable penile prosthesis implantation. The authors have reported both the results of conservative treatment options and surgical glanulopexy technique in their valuable paper. This paper will be really helpful for “high volume” physicians, who are dealing with inflatable penile prosthesis surgery[5]. I strongly believe that this specific issue of UroPrecision will be very helpful for the readers and sexual medicine providers. All the manuscripts are written under the guidance of the recent literature. In this issue, we preferred to discuss the not very well-defined conditions rather than the widely accepted topics. I am thankful to the authors who contributed to this special issue. They are to be congratulated. Mustafa Faruk Usta is solely responsible for the design and drafting of this editorial. The author declares no conflicts of interest. Not applicable.

P0128 Cord blood platelet-rich plasma (CB-PRP) plus penile traction therapy versus penile traction alone in patients with Peyronie's disease: A randomized clinical trial (CBPRP-TRAC1)