Image-Guided Injection Therapy for Penile Curvature
Intralesional therapy involves injecting a therapeutic agent directly into the Peyronie’s plaque, the area of scar tissue responsible for penile curvature, indentation or narrowing. Delivering treatment into the plaque allows a high concentration at the target tissue and offers a non-surgical option for suitable men.
In Australia, collagenase (Xiaflex) is not available, which has created a need for alternative non-surgical treatments before considering surgery. Dr Ross Calopedos offers ultrasound-guided intralesional therapy using hyaluronic acid or verapamil, often combined with traction, for deformity optimisation.
Comprehensive Assessment First
Before any treatment, a thorough evaluation confirms the diagnosis and assesses suitability. This usually includes a specialist consultation and a penile duplex ultrasound, typically performed with a pharmacologically induced erection, to characterise the plaque (location, density, calcification), assess vascular function, and establish a baseline of curvature and deformity. This ensures treatment is appropriate and planned to your individual anatomy.
Treatment Options
Hyaluronic acid (HA): a naturally occurring component of the body’s connective tissue. In Peyronie’s disease it acts as both a biological modulator (anti-fibrotic and anti-inflammatory effects) and a mechanical one, helping hydrate tissue, improve elasticity and, through careful micro-distribution within the plaque, improve tissue compliance and the response to traction.
Verapamil: a medication used off-label in Peyronie’s disease that may reduce fibroblast activity and collagen production. It acts primarily as a biological anti-fibrotic agent, with less mechanical effect than HA.
The choice between them is individualised, based on disease phase and plaque characteristics. Both are off-label / experimental uses, and Dr Ross will explain what is and is not known before you proceed.
Why This Technique Is Different
Image-guided, ultrasound assists precise placement within the plaque and helps avoid non-target injection
Tissue-specific technique, micro-aliquot distribution designed for dense fibrotic tissue
Integrated approach, injection combined with modelling and traction
Specialist-led, performed by a urological surgeon with a focus on functional outcomes, not a cosmetic filler approach
What the Evidence Shows
The evidence base is still developing and results vary between individuals. Published data suggest a mean curvature reduction of around 12.4° (approximately 23%) following a short course of HA injections in stable disease, with about 80% of patients reporting subjective improvement. However, around 10 to 15% may see no measurable improvement, and high-quality comparative trials are ongoing.
What it is not designed to do: fully straighten the penis, reverse established shortening, correct complex deformities (such as hinge or hourglass narrowing), or replace surgery in advanced disease.
Treatment protocol & safety
Treatment is usually delivered as a series of injections (commonly 3 to 6 sessions, around every 2 weeks) under local anaesthesia, often combined with daily traction therapy. Common side effects include swelling, bruising, mild pain and temporary firmness. Less commonly, a localised lump, haematoma or infection can occur. Rare risks include injury to nearby nerves or blood vessels; ultrasound guidance is used to reduce this risk. Worsening deformity does not necessarily indicate treatment failure, it can reflect the underlying progression of the disease itself.
Speak with Dr Ross
Considering Your Options?
A consultation with Dr Ross is the best place to understand whether this treatment is right for you, what it involves, and the results you can realistically expect.
He takes the time to listen, examine and explain your options clearly, so you can make an informed decision at your own pace, with expert, confidential advice tailored to your situation.
Ask Dr Ross.
If you are not ready to make an appointment but would like more information, we are here to help.
Frequently Asked Questions (FAQ)
Is Intralesional Therapy a Cure for Peyronie’s Disease?
No. It is a non-surgical option that aims to reduce curvature and improve tissue quality and comfort in suitable men. It is not designed to fully straighten the penis or reverse established shortening, and results vary. Surgery, including penile implant surgery, remains the more definitive option in advanced disease or where ED coexists.
Why Is Xiaflex Not Used in Australia?
Collagenase (Xiaflex) is not available in Australia. This has created a need for alternative non-surgical treatments, such as ultrasound-guided hyaluronic acid or verapamil injections, for men who wish to explore options before considering surgery.
How Many Sessions Will I Need?
Treatment is usually given as a course of around 3 to 6 injection sessions, roughly every 2 weeks, often combined with daily traction therapy. Your individual plan is tailored following assessment, including penile duplex ultrasound.
Visit Dr Ross at one of our convenient Sydney locations
Kalix Healthcare Specialists - Bella Vista
Suite 5.14 The Bond
8 Elizabeth Macarthur Drive, Bella Vista 2153
Kalix Healthcare Specialists - Kingsford
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