This treatment is often intended for men suffering from Peyronie’s disease who wish to improve a curvature that negatively affects the quality of their erection. The condition is generally considered problematic when the curvature exceeds 30 degrees. In some cases, penetration may become difficult or even painful for the patient or their partner. Some patients also report a loss of penile length following the onset of curvature due to Peyronie’s disease. This can be improved through the use of a vacuum erection device or a penile extender in conjunction with PRP treatment. Results may vary, with average improvements ranging from 10% to 20%. Not all patients are treated with the PRP protocol, as other treatments may be more appropriate. Some individuals may not be suitable candidates, particularly those with severe curvature or advanced-stage disease. Patients with multiple plaques may also not be ideal candidates for this procedure. It is evident that the older, thicker, and/or calcified the plaques are, the lower the chances of seeing an improvement in curvature.

Platelet-rich plasma (PRP) represents a major advancement in regenerative medicine. PRP is used across various fields of medicine, including sports medicine, to manage certain injuries. It is increasingly employed in procedures aimed at accelerating healing time. In aesthetic medicine, PRP is a valuable tool for treating old stretch marks by stimulating collagen production through fibroblast activation. Injecting PRP into the scalp improves graft anchoring and stimulates hair follicles in the treatment of alopecia. It is also used in facial rejuvenation therapies. The principle is relatively simple. A blood sample is taken from the arm, then processed using a Health Canada-approved centrifugation device to isolate the platelet-rich plasma from whole blood for autologous use. The blood separates into two phases: red blood cells at the bottom and serum at the top. The serum is the desired component, rich in platelets that release growth factors during centrifugation. These elements stimulate the body to heal, repair, or regenerate various tissues using platelets, growth factors, and other highly concentrated chemical markers. This is considered a regenerative injection therapy with powerful tissue-repairing capabilities. The color of the plasma may range from dark yellow to light yellow depending on its lipid content. Smokers tend to experience reduced results, as smoking negatively affects circulation.

This treatment is based on promising studies by Dr. Virag in France. Injecting PRP into a penile plaque appears to stimulate regeneration of the tunica albuginea, which surrounds the corpora cavernosa and erectile tissues of the penis. The hyaluronic acid gel provides greater stability over time for the growth factors at the injection site. Injecting PRP combined with hyaluronic acid gel into a penile plaque appears to activate tissue regeneration for a longer duration than PRP alone.

An initial consultation is required. Dr. Marois will assess the patient to determine whether they are a suitable candidate for this treatment. The patient will complete questionnaires on sexual function (IIEF-5) and testosterone deficiency (QADAM). A testosterone level test is often necessary to rule out any deficiency. Dr. Marois will then explain the procedure and inform the patient of any potential unexpected side effects. It is recommended to dry shave the base of the penis to facilitate the use of a vacuum erection device after the treatment.

The procedure causes little to no discomfort. Ativan may be offered to reduce anxiety, but the patient must be accompanied. The procedure is performed under local anesthesia using a penile nerve block. It is guided by ultrasound to locate the plaque. A minimum of four sessions is required, spaced four to six weeks apart. A penile extender or vacuum erection device is used to enhance results. Maintenance treatments may be necessary over several months until the disease stabilizes. The satisfaction rate is high, with approximately 75% of treated patients experiencing a 15% improvement in curvature. The procedure itself takes only about 5 minutes to perform. However, approximately 45 minutes should be allocated for the entire process, which includes signing the consent form, answering questions, applying anesthetic cream, performing the nerve block, drawing blood from the arm, centrifuging the sample, transferring the PRP into syringes, adding a physiological buffer to activate the PRP, mixing in the hyaluronic acid gel, performing the injections, applying a compression dressing, and finally explaining the use of a vacuum erection device versus a suction-based penile extender.

Penile PRP treatment does not interact with your medications or cardiovascular health. There are no absolute contraindications. For example, taking anticoagulants does not prevent you from receiving the treatment, although the risk of skin bruising may be slightly higher. Temporary skin reactions such as redness, mild discomfort, swelling, or bruising at the injection site may occur.

You may experience mild pain and slight bruising, but you can resume your usual activities. Many patients return to work or continue their regular exercise routines the same day. However, it is recommended to wait 24 to 48 hours before resuming sexual activity after the injection. Keep in mind that the penis has small wounds that need time to heal. You must use either a vacuum erection device or a penile extender throughout the treatment period to maintain improvement in curvature. These devices can be purchased in advance at the clinic, in stores, or online. Dr. Marois will explain the benefits of each. The vacuum device should be used for 10 to 15 minutes, ideally twice a day. The penile extender is more effective but must be worn for extended periods—three hours, twice a day. It is a more demanding option. The recommended extender is comfortable, as it features a suction system on the glans. You should also take 5 mg of Tadalafil at bedtime throughout the treatment period (four to six months) to stimulate nocturnal erections. We recommend being physically active daily to promote blood circulation. Engage in daily exercise or take a brisk 5-kilometer walk. A follow-up appointment is scheduled one month after the treatment. The sexual function questionnaire will be completed again to establish a comparison.

Although each man’s experience may vary, most report improvement in curvature after the second treatment. On average, patients undergo about four sessions. If there is little improvement after four sessions, another treatment option should be considered.

Collagenase injection therapy, which dissolves fibrous plaques, will be available in 2018. It will also require multiple sessions combined with mechanical penile extension. It is not yet known whether this treatment will be eligible for reimbursement under the RAMQ patient exemption program.