Effectiveness of hyaluronic acid in the treatment of Peyronie's disease in the light of the European Urology Guidelines: the real-world experience

BACKGROUND: Peyronie's disease (PD) is a progressive fibrotic disorder of the tunica albuginea that impairs penile anatomy, sexual function, and quality of life. With no approved pharmacological treatments in Europe after the withdrawal of collagenase Clostridium histolyticum (CCH), intralesional hyaluronic acid (HA) has emerged as a potential option. This study aims to assess the clinical effectiveness of HA in PD, focusing on patient-reported outcomes via the Peyronie's Disease Questionnaire (PDQ). METHODS: This prospective observational study included patients treated with weekly intralesional HA injections for 8 weeks, combined with penile modeling and daily tadalafil. Inclusion required a penile curvature >30 degrees and at least one episode of penetrative intercourse within the past 3 months. Penile curvature, IIEF-5, and PDQ scores were assessed at baseline and after 3 months. RESULTS: Sixty-six patients were included. Total PDQ scores improved from 61.5 (50.0-67.0) to 40.0 (26.8-49.0; P<0.001), with a mean reduction of-19.9 +/- 9.7. Specifically, all three domains of the PDQ questionnaire (Penile Pain, Penile Deformity, and Symptom Bother) showed a significant improvement (P<0.001). No adverse events were recorded. CONCLUSIONS: Intralesional HA injections are safe and effective in improving patient's reported symptoms and subsequently quality of life in PD patients. This therapy may represent a valuable alternative in real-world clinical practice, especially in Europe where other pharmacological options are lacking.