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Purified clostridial collagenase was administered intralesionally in 31 men with Peyronie's disease. Within 4 weeks of treatment 20 patients showed an objective improvement. Pain was eliminated in 13 of 14 patients with this complaint at presentation within the same 4-week period. The ability to have intercourse was restored in 3 of 4 patients with this problem. Except for a small corporeal rupture at the site of injection in 1 patient, no significant untoward effects were noted. During the mean 9.8-month followup 1 recurrence of bending was noted.

A total of 20 patients with Peyronie's disease, including 15 with erectile failure and 5 with normal potency, underwent evaluation with dynamic xenon washout and infusion cavernosography. Abnormal drainage from the cavernous body was found in 13 of the 15 patients with erectile failure and in none of the 5 potent patients (p less than 0.01), indicating that this condition seems to be the underlying pathological mechanism leading to erectile impotence in patients with Peyronie's disease.

Of 62 hospitalized patients with Peyronie's disease 18 (29 per cent) had abnormal nocturnal penile tumescence studies that were characterized as indicating organic impotence. However, the majority of these patients had some underlying disease or factor other than the plaque itself to explain the altered nocturnal penile tumescence. In only 5 per cent of these patients could the abnormal nocturnal penile tumescence be attributable to the plaque itself. Primary excision of the plaque and dermal grafting improved erectile function in all except a minority of patients who required insertion of a penile prosthesis to alleviate continued erectile impotence. For this reason we do not recommend insertion of a penile prosthesis during plaque excision. The plaque of Peyronie's disease does not appear to impede vascular flow distal to the plaque. However, previous excision may result in altered hemodynamics that can result in erectile impotence.

A Dacron patch graft for surgical correction of Peyronie disease was used in 4 patients. Results were satisfactory as far as the correction of the penile deformity and resolution of the pain during erection were concerned. No change was found in the patients' potency except in 1 patient whose potency has improved postoperatively. A penile prosthesis was inserted subsequently in 1 patient with decreased potency preoperatively. We conclude that this is a useful and simple surgical treatment for Peyronie disease.

An unusual case of Peyronie's disease in a 22-year-old male is presented. The patient complained of sluggish erection of the pendulous portion of the penis. A fibrous plaque in the tunica albuginea at the base of the penis extended into the corpus cavernosum cross-sectionally. Histology was consistent with Peyronie's disease. Some improvement was obtained by partial excision of the plaque.