2018 Canadian Urological Association guideline for Peyronie's disease and congenital penile curvature
Open accessAbstract
Peyronie’s disease (PD) is a highly prevalent condition that affects the physical and psychosocial well-being and quality of life (QoL) for thousands of Canadian men. The specific etiology of PD remains poorly understood and there remains a paucity of randomized placebo-controlled trials evaluating treatment interventions.1-3 PD can be found in up to 8.9% of men, a remarkable increase in cited prevalence that is attributable to growing awareness (as historical data suggested a rate of less than 1%); the burden of disease is significant, and PD is often present in otherwise healthy men. The following guidelines were crafted by the committee with a full awareness of the limitations of the literature, and sought to provide actionable recommendations to guide PD care in the Canadian health system.
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The AUA and CUA emphasize low utility of extracorporeal shockwave therapy because natural progression of Peyronie's disease resolves pain in most patients.
“The AUA and CUA emphasize the low utility given that the natural progression of PD results in pain resolution for most patients.”
From Comparing and Contrasting Peyronie's Disease Guidelines: Points of Consensus and Deviation. (2021) · cites this paper as [26]
The guideline’s Natural history section says PD-related pain improves or resolves in most patients without treatment. But its Extracorporeal shockwave lithotripsy section supports ESWT for potential pain improvement while rejecting its use to reduce curvature or plaque size; it does not describe ESWT as having low utility because pain usually resolves naturally. The cited CUA guideline also does not establish what the AUA emphasizes. (LLM, conf=0.86)
Experimental — accuracy not yet measuredThe CUA and EAU panels discuss PDE5 inhibitors such as tadalafil to optimize concurrent erectile dysfunction in men with Peyronie's disease.
“CUA and EAU panels also discuss the potential role for phosphodiesterase-5 inhibitors (PDE5-I) such as tadalafil to optimize concurrent ED”
From Comparing and Contrasting Peyronie's Disease Guidelines: Points of Consensus and Deviation. (2021) · cites this paper as [26]
The Clinical principle section says that oral PDE5 inhibitors are used to treat erectile dysfunction concomitant with Peyronie’s disease. It mentions tadalafil specifically for possible effects on plaque progression, not specifically for optimizing erectile dysfunction. The copy cites an EAU guideline but does not establish what the EAU panel says about PDE5 inhibitors for concurrent erectile dysfunction; page numbers are unavailable. (LLM, conf=0.86)
Experimental — accuracy not yet measuredThere is limited animal and human data on potential benefits of PDE5 inhibitors for fibrosis in Peyronie's disease.
“noting there is also limited animal and human data regarding potential benefits with respect to fibrosis.”
From Comparing and Contrasting Peyronie's Disease Guidelines: Points of Consensus and Deviation. (2021) · cites this paper as [26]
The Clinical principle section says tadalafil, a PDE5 inhibitor, appears promising for modifying Peyronie’s plaque progression, but that evidence is limited to one published study. It does not identify animal data on PDE5 inhibitors or specifically describe an effect on fibrosis; its discussion of animal models concerns other proposed agents. (LLM, conf=0.82)
Experimental — accuracy not yet measuredThe AUA, CUA, and EAU do not recommend electromotive drug therapy (iontophoresis) because of insufficient evidence and burden of administration.
“Electromotive drug therapy (iontophoresis) is not recommended by the AUA, CUA, and EAU guideline panels based on lack of sufficient evidence and burden of administration.”
From Comparing and Contrasting Peyronie's Disease Guidelines: Points of Consensus and Deviation. (2021) · cites this paper as [26]
The section on topical electromotive therapy says iontophoresis is not recommended because convincing evidence of efficacy is absent and administration is burdensome. It says the CUA position is consistent with AUA and ICSM evaluations, but does not establish the claimed EAU position. (LLM, conf=0.88)
Experimental — accuracy not yet measuredThe AUA, CUA, and EAU recommend NSAIDs as first-line therapy for pain in the acute phase of Peyronie's disease.
“AUA, CUA, and EAU panels recommend NSAIDs as first line therapy for pain in the acute phase”
From Comparing and Contrasting Peyronie's Disease Guidelines: Points of Consensus and Deviation. (2021) · cites this paper as [26]
The Clinical principle section says oral NSAIDs may be used to control pain during the active phase of Peyronie’s disease. It does not call them first-line therapy or establish that the AUA and EAU panels make the same recommendation. No page number is available in our copy. (LLM, conf=0.87)
Experimental — accuracy not yet measured
The AUA, CUA, and EAU recommend against oral vitamin E with or without L-carnitine, tamoxifen, procarbazine, and omega-3 fatty acids because of clear lack of efficacy.
“recommend against oral therapy with vitamin E (+/− L-carnitine), tamoxifen, procarbazine, and omega-3 fatty acids due to a clear lack of efficacy.”
From Comparing and Contrasting Peyronie's Disease Guidelines: Points of Consensus and Deviation. (2021) · cites this paper as [26]
The Clinical principle section says the CUA does not recommend vitamin E, tamoxifen, procarbazine, or vitamin E/L-carnitine for standard Peyronie’s disease care in Canada, and specifically says vitamin E lacks evidence of efficacy. The passages do not establish the claimed recommendation by all three associations, include omega-3 fatty acids in that list, or establish a clear lack of efficacy for every listed agent. Page numbers were not available in our copy. (LLM, conf=0.87)
Experimental — accuracy not yet measuredThe CUA considers verapamil a second-line intralesional therapy along with interferon, and notes that injection protocols likely influence outcomes.
“The CUA considers verapamil to be a second line intralesional therapy (along with IFN), and notes that injection protocols (volume, frequency, concentration, treatment duration) likely influence outcomes.”
From Comparing and Contrasting Peyronie's Disease Guidelines: Points of Consensus and Deviation. (2021) · cites this paper as [26]
The Intralesional therapies section recommends intralesional verapamil, and the guideline also says intralesional interferon can be used. The discussion of verapamil states that injection volume, frequency, concentration and duration appear to affect outcomes. Our copy does not designate verapamil and interferon as second-line therapies; page numbers are unavailable in the indexed passages. (LLM, conf=0.85)
Experimental — accuracy not yet measuredCUA, EAU, and ISSM discourage MRI, CT, and plain-film X-ray because they lack proven efficacy and involve expense and radiation.
“Other imaging modalities including MRI, CT, and plain-film XRAY are discouraged by the CUA, EAU, and ISSM guideline panels given their lack of proven efficacy, expense, and radiation exposure.26, 28”
From Comparing and Contrasting Peyronie's Disease Guidelines: Points of Consensus and Deviation. (2021) · cites this paper as [26]
In §4, Investigations (page unavailable), the CUA guideline does not support routine MRI use and says CT and plain radiography have no role in routine Peyronie’s disease evaluation. It does not attribute those positions to expense or radiation exposure, or state the EAU and ISSM panels’ positions. It also calls MRI an excellent imaging modality, rather than saying it lacks proven efficacy. (LLM, conf=0.88)
Experimental — accuracy not yet measuredThe CUA, EAU, and ISSM suggest plaque incision with grafting be reserved for men with more severe penile deformity.
“The CUA, EAU, and ISSM guideline panels suggest that plaque incision with grafting be reserved for men with more severe penile deformity.”
From Comparing and Contrasting Peyronie's Disease Guidelines: Points of Consensus and Deviation. (2021) · cites this paper as [26]
The CUA guideline’s Grafting procedures section recommends grafting for men with severe or complex curvature and other substantial deformities, supporting the CUA portion of the claim. The passages do not establish what the EAU or ISSM guideline panels recommend. Page numbers are unavailable in our copy. (LLM, conf=0.85)
Experimental — accuracy not yet measuredThe EAU, CUA, and ISSM emphasize the concept of a functionally straight penis, within 20 degrees of straight rather than arrow straight.
“The EAU, CUA, and ISSM panels specifically emphasize the concept of a “functionally” straight penis (i.e. within 20o of straight as opposed to “arrow” straight).”
From Comparing and Contrasting Peyronie's Disease Guidelines: Points of Consensus and Deviation. (2021) · cites this paper as [26]
In the Overview section (page unavailable), the CUA guideline says patients should understand that “functionally straight” means penetration is not compromised and, in most cases, residual curvature is less than 20 degrees, rather than a completely straight penis. The cited paper supports the claim about the CUA, but the passages do not establish what the EAU or ISSM panels emphasize. (LLM, conf=0.87)
Experimental — accuracy not yet measuredThe CUA, EAU, and ISSM strongly recommend against synthetic grafts because of adverse outcomes including persistent or recurrent fibrosis and infection.
“The CUA, EAU, and ISSM panels recommend strongly against synthetic grafts as they have been associated with adverse outcomes including persistent/recurrent fibrosis and infection.”
From Comparing and Contrasting Peyronie's Disease Guidelines: Points of Consensus and Deviation. (2021) · cites this paper as [26]
The Grafting procedures section strongly recommends against synthetic grafts because of infection risk and graft inflammation causing tissue fibrosis. This is the CUA guideline’s recommendation; the passages do not establish that the EAU and ISSM panels make the same recommendation, or specifically describe the fibrosis as persistent or recurrent. No page number is available in our copy. (LLM, conf=0.88)
Experimental — accuracy not yet measuredThe CUA and ISSM consider isolated hourglass deformity and severe plaque calcification as exclusion criteria for collagenase clostridium histolyticum.
“The CUA and ISSM guideline panels consider isolated hourglass deformity and severe plaque calcification as exclusion criteria for CCH.”
From Comparing and Contrasting Peyronie's Disease Guidelines: Points of Consensus and Deviation. (2021) · cites this paper as [26]
The Collagenase (Xiaflex) section identifies optimal CCH candidates as having neither isolated hourglass deformity nor calcified plaque. It does not specifically call these formal exclusion criteria or attribute that position to an ISSM guideline panel; the Methods section says only that ISSM guidelines informed the CUA guideline. (LLM, conf=0.85)
Experimental — accuracy not yet measuredThe AUA and CUA suggest treatment inclusion criteria of non-calcified plaques with more than 30 degrees of curvature.
“Treatment inclusion criteria suggested by the AUA and CUA guidelines include non-calcified plaques with >30-degrees of curvature.”
From Comparing and Contrasting Peyronie's Disease Guidelines: Points of Consensus and Deviation. (2021) · cites this paper as [26]
The CUA guideline’s Collagenase (Xiaflex) section identifies patients with non-calcified plaques and curvature greater than 30° as candidates for that specific treatment. It also specifies curvature below 90°, stable disease, and other conditions. This source establishes the CUA criteria but does not establish what the AUA guideline suggests. (LLM, conf=0.82)
Experimental — accuracy not yet measuredInterferon is considered second-line intralesional therapy by the CUA but is rarely used in Canada because of cost and adverse events such as sinusitis and flu-like symptoms.
“while considered second line for intralesional therapy according to the CUA guideline panel, IFN is rarely used in Canada owing to cost and potential adverse events such as sinusitis and flu-like symptoms.”
From Comparing and Contrasting Peyronie's Disease Guidelines: Points of Consensus and Deviation. (2021) · cites this paper as [26]
The guideline’s interferon discussion says intralesional IFN is rarely used in Canada because of cost and adverse events, including sinusitis and flu-like symptoms. It says IFN can be used in selected men, but does not explicitly classify it as second-line intralesional therapy; the Intralesional therapies section instead recommends verapamil. The indexed passages provide no page numbers. (LLM, conf=0.85)
Experimental — accuracy not yet measuredThe PDQ is considered an adjunctive evaluation tool by the CUA and ISSM, and the EAU recommends it during initial assessment and follow-up to determine treatment efficacy beyond objective measurements.
“The PDQ is considered an adjunctive evaluation tool by the CUA and ISSM, and the EAU now recommends this tool during the initial assessment and subsequent follow-up to determine treatment efficacy beyond simple objective measurements.”
From Comparing and Contrasting Peyronie's Disease Guidelines: Points of Consensus and Deviation. (2021) · cites this paper as [26]
The Sexual function section of the CUA guideline (page not provided) presents the PDQ as an optional assessment tool and says it can track changes in symptoms and disease progression. The copy does not establish that the ISSM endorses the PDQ or that the EAU recommends it for initial assessment and follow-up to evaluate treatment efficacy beyond objective measurements. (LLM, conf=0.85)
Experimental — accuracy not yet measuredA careful history and physical examination is required and may be enough for diagnosis, according to expert opinion from AUA, CUA, and ISSM.
“A careful history and physical examination is mandated and may be all that is needed to make the diagnosis based on expert opinion from the AUA, CUA, and ISSM panels.1, 26, 28”
From Comparing and Contrasting Peyronie's Disease Guidelines: Points of Consensus and Deviation. (2021) · cites this paper as [26]
The CUA guideline stresses referral to subspecialized physicians, especially for surgery.
“CUA also emphasizes the appropriateness of referral to subspecialized physicians particularly for surgical management26”
From Comparing and Contrasting Peyronie's Disease Guidelines: Points of Consensus and Deviation. (2021) · cites this paper as [26]
Guidelines differ on how many months after symptom onset define stable disease, from six months in CUA and ISSM to more than 12 months in AUA.
“In contrast, there is discrepancy regarding the number of months since symptom onset that defines stable disease, ranging from six-months (CUA, ISSM) to greater than 12-months (AUA).1, 26, 28”
From Comparing and Contrasting Peyronie's Disease Guidelines: Points of Consensus and Deviation. (2021) · cites this paper as [26]
The AUA, ISSM, CUA, and EAU each issued a PD clinical guideline in the five years before this review.
“Within the last five years clinical guidelines were published by the American Urological Association (AUA), International Society for Sexual Medicine (ISSM), Canadian Urological Association (CUA), and the European Association of Urology (EAU).26–29”
From Comparing and Contrasting Peyronie's Disease Guidelines: Points of Consensus and Deviation. (2021) · cites this paper as [26]
All panels acknowledge these psychosocial concerns and stress assessing psychological burden with subjective and objective measures, including the PDQ symptom-bother domain.
“These concerns are acknowledged by all guideline panels with emphasis placed on assessing psychological burden through subjective and objective measures, including the PDQ which has a specific domain pertaining to symptom bother.1, 26, 28, 29”
From Comparing and Contrasting Peyronie's Disease Guidelines: Points of Consensus and Deviation. (2021) · cites this paper as [26]
AUA, CUA, and EAU include treatment algorithms to help clinicians with diagnosis and treatment choices.
“Treatment algorithms are included within the AUA, CUA, and EAU guidelines to assist clinicians with diagnosis and treatment options.1, 26, 29”
From Comparing and Contrasting Peyronie's Disease Guidelines: Points of Consensus and Deviation. (2021) · cites this paper as [26]
The CUA recommends penile traction therapy but emphasizes lack of defined protocols including device type and duration of use.
“The CUA also recommends PTT but emphasizes the lack of defined treatment protocols including type of device and duration of use.”
From Comparing and Contrasting Peyronie's Disease Guidelines: Points of Consensus and Deviation. (2021) · cites this paper as [26]
The CUA highlights penile traction therapy after plication to optimize outcomes including length, though studies of efficacy are limited.
“Interestingly, the CUA highlights the utility of PTT post-plication to optimize outcomes including length, albeit with limited studies regarding efficacy at this time.”
From Comparing and Contrasting Peyronie's Disease Guidelines: Points of Consensus and Deviation. (2021) · cites this paper as [26]
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Technological Advancements for Treating Erectile Dysfunction and Peyronie's Disease
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Current insights and future directions in Peyronie's disease management: A narrative review
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- Authors
- Bella, A. J., Lee, J. C., Grober, E. D., Carrier, S., Benard, F., & Brock, G. B.
- Affiliations
- University of Ottawa (CA)
- University of Toronto (CA)
- Université de Montréal (CA)
- Western University (CA)
- Venue
- Canadian Urological Association Journal
- Published
- 2018-02-22
- Volume
- 12
- Issue
- 5
- Pages
- E197-209
- ISSN
- 1911-6470 (ISSN-L)
- 1920-1214
- PMC
- PMC5966931
- OpenAlex
- W2790919173
- Semantic Scholar
- 1863be4cd5329a80e7f52edb7d33f313c3877fdc
- Cited by
- 68
- References
- 121
- Citations by year
- 2026: 6 · 2025: 5 · 2024: 15 · 2023: 9 · 2022: 5 · 2021: 8 · 2020: 12 · 2019: 7 · 2017: 1
- FWCI
- 5.31
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Locations
- Canadian Urological Association Journal (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Sexual function and dysfunction studies
- Health Sciences › Medicine › Urology › Urological Disorders and Treatments
- Health Sciences › Medicine › Rheumatology › Dupuytren's Contracture and Treatments
- Keywords
- Peyronie's disease, congenital penile curvature, penile curvature, quality of life, prevalence, treatment guidelines, etiology, psychosocial impact
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