Painful penile curvature

Specialty: Nephrology and urology.

• deviation of the erect penis
• symptomatic Peyronie's disease
• penile curvature

Why it occurs

• Peyronie's disease (chronic inflammatory process that culminates in the formation of an inelastic fibrous plaque in the tunica albuginea, pulling the penis during erection)
• Acute penile trauma during intercourse or previous poorly consolidated penile fracture
• Congenital curvature of the penis (generally painless, but may manifest pain due to ligamentous tension or coital friction)
• Post-priapism fibrosis or post-repeated intracavernosal injections for erectile dysfunction

Initial workup

Detailed physical palpation of the flaccid penis shaft to locate fibrous plaques; High-resolution Doppler ultrasound of the penis after pharmacological induction of erection (by injecting alprostadil) to precisely measure the angle of curvature, location and calcification of the plaque, and evaluate arterial and venous hemodynamics.

Standard management

• Collagenase from Clostridium histolyticum — direct intralesional injection into the fibrous plaque, indicated in the stable phase of Peyronie's disease with curvature >30 degrees, administered by an accredited urologist due to the risk of rupture of the corpus cavernosum
• Pentoxifylline — 400 mg every 8 hours orally, used in the active/initial inflammatory phase for its antifibrotic and collagen synthesis inhibitory properties
• Ibuprofen (600 mg every 8-12 hours orally to mitigate pain in the initial inflammatory phase).