Hourglass Peyronie’s Disease | Treatment | Best Surgical Techniques

Hourglass Peyronie's Disease

Hourglass Peyronie’s Disease

Hourglass deformity is a particularly bothersome morphologic deformity that occurs in a percentage of men with Peyronie’s disease (PD). This deformity can impair the ability to perform intercourse and can be associated with significant psychosocial morbidity.

We conducted a literature review to evaluate the current understanding, management, and outcomes following surgery for men with PD and hourglass deformities.

PD has been associated with a number of systemic disorders including Dupuytren’s contracture, Ledderhose disease, and lichen planus. The disorder is named after French surgeon Francois Gigot de la Peyronie who reported its occurrence in 1743. PD is a relatively rare disease affecting up to 5% of men. It occurs predominantly in white men over the age of 40 years.

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Surgical Techniques for Hourglass Peyronie’s Disease

Multiple surgical techniques have been described in the literature to correct hourglass deformities, including Inverted-V incision, U-shaped incision, V-shaped incision, T-incisions with plication, multiple inverted V-Y incisions with grafting, multiple inverted V-Y incisions with plication plus grafting, plaque incision and grafting, plaque excision and grafting, and plaque excision with a VY advancement flap. No standardized technique has emerged at this time.

Hourglass Peyronie's Disease

Most series report high rates of satisfaction after surgery for men with hourglass deformities from Peyronie’s disease. However, studies are limited by small sample sizes, non standardized outcome measures, and lack of control groups. Additional surgical techniques are needed to address this challenging deformity.

Besides a curvature deformity, other morphologic changes can occur in men with PD. In this article, we describe a series of men with PD who have an hourglass deformity and discuss the surgical strategies for correction of this deformity.


Treatment for Hourglass Peyronie’s Disease

Most treatments for mild hourglass peyronie’s disease can be done at home. More severe cases of hourglass peyronie’s disease may require surgery or other treatments.

Treatments include:

1. Vitamin E: A small study found that vitamin E supplements may help lessen pain and improve function in people with hourglass peyronie’s disease. The supplement also appeared to reduce plaque size, but more research is needed to confirm this effect.

2. Potassium para-aminobenzoate (Potaba)

This medication has been studied for use in men with hourglass peyronie’s disease. It appears to reduce penile curvature, but the drug may have serious side effects, such as gastrointestinal problems, fatigue and loss of appetite. More research is needed to determine whether the benefits outweigh the risks.

3. Colchicine

Colchicine helps prevent attacks of gout and inflammation associated with other diseases, such as familial Mediterranean fever (FMF).

Peyronie’s Disease (PD) and CCH

Peyronie’s Disease (PD) is an acquired condition that affects up to 1.5% of the population and leads to penile curvature, pain and sexual dysfunction.

Collagenase Clostridium histolyticum (CCH), a single-use, injectable enzyme, has been approved for the treatment of PD. However, consensus in the literature regarding the best candidates for CCH remains unclear.

We conducted a retrospective analysis of patients treated with CCH in a single-center practice over 2 years, identifying a total of 150 injections for PD across 31 patients.

These injections were administered in average doses ranging from 0.45 to 0.9 mg per injection, with a median dose of 0.6 mg per injection session.

We found that larger doses were associated with greater curvature correction at week 24 post-injection compared to smaller doses (p=0.03).

This effect remained significant at week 48 post-injection (p<0.001).


To determine the characteristics of patients with Peyronie’s disease (PD) who were treated with collagenase Clostridium histolyticum (CCH).


Data from IMPRESS I and II were analyzed, pooling patients in the CCH (0.58mg, n = 208) and placebo (n = 204) groups. Patient characteristics at baseline, including demographics, duration of PD and PD-related symptoms, were assessed. Outcomes included International Index of Erectile Function – Erectile Function domain (IIEF-EF) score, penile curvature deformity and PD bother score.


Mean age was 52 years. Mean PD duration was 37 months. Mean baseline IIEF-EF score was 20.4 for CCH vs 17.1 for placebo (P< .001); mean baseline penile curvature deformity was 54° for CCH vs 55° for placebo (P = .12); mean PD bother score was 51 for CCH vs 46 for placebo (P< .001).


The purpose of this study was to evaluate the relationship between baseline hourglass deformity and functional outcomes in women treated with collagen-coated hyaluronic acid (CCH).

We used data from a multicenter, randomized, double-blinded trial that compared CCH with placebo for the treatment of FSD and female sexual arousal disorder (FSAD) (ClinicalTrials.gov Identifier: NCT01060761). Women were randomly assigned to receive either 2 or 4 mL of CCH injected into the vagina at baseline, week 6, and week 12 postbaseline.


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