A Modern Review of Penile Traction Monotherapy and Combination Therapy for the Treatment of Peyronie's Disease

Peyronie’s disease (PD) is a disorder of the tunica albuginea that causes penile deformity as well as pain and sexual dysfunction. While surgical procedures such as penile plication or incision and grafting are the gold standard for curvature correction, patients and providers are increasingly interested in non-invasive treatment options. This is particularly relevant for less severe curvature and penile shortening. Non-invasive treatments include the use of oral medications (which are not recommended by many authorities), penile traction therapy, and intralesional (plaque) injections.

Penile traction therapy (PTT) is an attractive, cost-effective option for men who are hesitant to undergo surgery, those who are in the acute phase of the disease process, and those who have concerns over penile length loss. However, an internet search for penile traction devices delivers multiple results from reputable companies as well as some dubious options. Therefore, it becomes increasingly important to examine the available evidence for PTT and understand the differences between the various devices.

We performed a rigorous database search to identify all studies pertaining to PTT for the treatment of PD through November 2019. We identified 17 trials that have explored the use of PTT as monotherapy or in combination with surgical or nonsurgical treatments for PD.

Five different devices were studied as PTT monotherapy. All devices were well-tolerated, although compliance and daily duration of use were highly variable depending on the study protocol. The average curvature improvement ranged between 4 to 38.4 degrees and the average stretched penile length improvement ranged between 0.8 to 4.1 cm. Although there was no direct comparison of devices, it is likely that treatment efficacy is affected by both type of device and duration of use.

Combination therapy has been studied with PTT and oral medications and intralesional injections. In general, the addition of PTT to any oral or intralesional therapy regimen appears to add more benefit in terms of stretched penile length, although the level of evidence is somewhat weak.
In summary, to date the available evidence shows that PTT results in variable improvements in stretched penile length and penile curvature, depending on study protocol, patient population, and device. However, it is a safe and well-tolerated treatment option for both acute and chronic phase PD patients and is the only non-surgical option that reliably treats penile shortening which is highly bothersome for many men with PD. Further studies are needed for head-to-head comparisons of popular commercial devices, to further describe device patient characteristics associated with treatment success, and to determine the optimal duration of use.

Written by: Raevti Bole, MD, Lindsay White, MD, Nikki Parikh, Sevann Helo, MD, Tobias Kohler, MD, MPH, and Matthew Ziegelmann, MD, Mayo Clinic, Rochester, MN, USA

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