Guideline of guidelines: Peyronie's disease

To compare major Peyronie's disease (PD) guidelines, highlight key similarities and differences among panel recommendations, and identify areas requiring further research.

An extensive review was conducted to analyse and compare diagnostic and treatment recommendations from publicly available guidelines published by the American Urological Association, European Association of Urology, Canadian Urological Association, and the International Society of Sexual Medicine. Key similarities and differences regarding PD definition, evaluation, non-surgical treatments, and surgical management were systematically compared.

Areas of general consensus across guidelines include the importance of comprehensive history-taking for PD diagnosis and the role of intracavernosal injection as the 'gold standard' for assessing penile deformity prior to invasive intervention. Shared decision-making and thorough patient counselling are universally emphasised. Plication or incision and grafting surgery is generally reserved for patients with preserved erectile function, whereas penile prosthesis implantation is the preferred surgical option for those with erectile dysfunction unresponsive to medical therapy. Non-surgical treatments remain an area of controversy due to limited evidence of efficacy; however, intralesional injections are recognised by all panels as a potential treatment option, especially in the acute phase. Further research into PD pathophysiology and rigorous outcomes studies are needed to inform novel treatments and refine surgical management strategies.

While major urological societies demonstrate substantial consensus on several aspects of PD evaluation and management, key areas of divergence remain, underscoring the need for further research to guide evidence-based care.