{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T09:55:48Z","timestamp":1790589348683,"version":"4.1.0"},"reference-count":54,"publisher":"PAGEPress Publications","issue":"3","license":[{"start":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T00:00:00Z","timestamp":1790553600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Arch Ital Urol Androl"],"abstract":"<jats:p>Background: Peyronie's disease is an acquired connective tissue disorder of the tunica albuginea of the corpus cavernosum, characterized by fibrotic plaque formation that impairs normal penile expansion during erection, potentially leading to shaft deformity and erectile dysfunction. Although diagnosis and follow-up are guided by well-established recommendations, significant variability persists in clinical practice regarding intralesional therapy, particularly following the recent introduction of a new hyaluronic acid device for Peyronie\u2019s disease treatment.\nMaterials and methods: An Italian panel of experts convened to discuss and identify the most appropriate technique for intralesional hyaluronic acid injection in patients with Peyronie\u2019s disease and to review the range of intralesional treatment approaches currently used in Peyronie\u2019s disease.\nResults: Both periplaque and intraplaque injection techniques are currently used in everyday clinical practice. Based on the on the panel\u2019s collective clinical experience, periplaque injection may be considered a safe and reproducible option, alongside intraplaque injection, with therapeutic choice depending on patient characteristics and physician expertise.\nConclusions: Hyaluronic acid represents one of the most promising non-surgical treatments for Peyronie\u2019s disease. Both periplaque and intraplaque injection procedures are currently employed in patient management, with periplaque injection emerging as a safe and reproducible approach supported by clinical experience. This work may represent the first systematic effort to describe and compare the different HA injection approaches, providing a valuable contribution toward harmonizing clinical practice and guiding future research.<\/jats:p>","DOI":"10.4081\/aiua.2026.14895","type":"journal-article","created":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T09:04:02Z","timestamp":1790586242000},"source":"Crossref","is-referenced-by-count":0,"title":["Hyaluronic acid in Peyronie\u2019s disease: focus on injection procedures and clinical practice"],"prefix":"10.4081","volume":"98","author":[{"given":"Tommaso","family":"Cai","sequence":"first","affiliation":[{"name":"Interdepartmental Centre of Medical Sciences (CISMed), University of Trento;\u00a0Urology Division, Santa Chiara Regional and Teaching Hospital, Provincial Health Care Agency (APSS), Trento"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Falcone","sequence":"additional","affiliation":[{"name":"Department of Neurourology - A.O.U. \"Citt\u00e0 della Salute e della Scienza\" - Unit\u00e0 Spinale Unipolare, Turin;\u00a0Department of Urology, University of Turin, Citt\u00e0 della Salute e della Scienza, Turin - Molinette Hospital, Turin; Department of Surgical Sciences, University of Turin"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicola","family":"Mondaini","sequence":"additional","affiliation":[{"name":"Department of Urology, University Magna Graecia, Catanzaro"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2549","published-online":{"date-parts":[[2026,9,28]]},"reference":[{"key":"253726","doi-asserted-by":"crossref","unstructured":"1. 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A 7-year analysis from a tertiary care men's health center. J Sex Med. 2025; 22:794-798. Erratum in: J Sex Med. 2025; 22:1534.","DOI":"10.1093\/jsxmed\/qdaf051"},{"key":"253760","doi-asserted-by":"crossref","unstructured":"33. Cocci A, Russo GI, Briganti A, et al. Predictors of treatment success after collagenase Clostridium histolyticum injection for Peyronie's disease: development of a nomogram from a multicentre single-arm, non-placebo controlled clinical study. BJU Int. 2018; 122:680-687.","DOI":"10.1111\/bju.14410"},{"key":"253761","doi-asserted-by":"crossref","unstructured":"34. Howell S, Green T, Khalafalla K. Current insights and future directions in Peyronie's disease management: A narrative review. UroPrecision, 2025, 3:3-16.","DOI":"10.1002\/uro2.104"},{"key":"253762","doi-asserted-by":"crossref","unstructured":"35. Gelbard M, Goldstein I, Hellstrom WJ, et al. Clinical efficacy, safety and tolerability of collagenase clostridium histolyticum for the treatment of peyronie disease in 2 large double-blind, randomized, placebo-controlled phase 3 studies. J Urol. 2013; 190:199-207.","DOI":"10.1016\/j.juro.2013.01.087"},{"key":"253763","doi-asserted-by":"crossref","unstructured":"36. Wymer K, Kohler T, Trost L. Comparative cost-effectiveness of surgery, collagenase Clostridium histolyticum, and penile traction therapy in men with Peyronie\u2019s disease in an era of effective clinical treatment. J Sex Med. 2019; 16:1421-1432.","DOI":"10.1016\/j.jsxm.2019.06.010"},{"key":"253764","doi-asserted-by":"crossref","unstructured":"37. Lehner K, Byrne E, Roshandel MR, et al. The discontinuation rate with collagenase Clostridium histolyticum for Peyronie\u2019s disease in a high-volume practice is unexpectedly high: identifying opportunities for patient care improvement. Urology. 2024; 183:121-126.","DOI":"10.1016\/j.urology.2023.10.022"},{"key":"253765","doi-asserted-by":"crossref","unstructured":"38. Ahn ST, Moon DG. Collagenase clostridium hystolyticum in the management of Peyronie's disease. Transl Androl Urol. 2017; 6:305-307.","DOI":"10.21037\/tau.2017.01.15"},{"key":"253766","doi-asserted-by":"crossref","unstructured":"39. Abdel Raheem A, Johnson M, Abdel-Raheem T, et al. Collagenase clostridium histolyticum in the treatment of Peyronie\u2019s disease-a review of the literature and a new modified protocol. Sex Med Rev 2017; 5:529-35.","DOI":"10.1016\/j.sxmr.2017.07.005"},{"key":"253767","doi-asserted-by":"crossref","unstructured":"40. Cocci A, Di Mauro M, Kluth L, et al. Long-Term Outcomes (2 Years) After Hyaluronic Acid Therapy for Peyronie\u2019s Disease. Front. Urol. 2022; 2:929367.","DOI":"10.3389\/fruro.2022.929367"},{"key":"253768","unstructured":"41. Perovial Package Leaflet Last revision: January 2025."},{"key":"253769","doi-asserted-by":"crossref","unstructured":"42. Favilla V, Russo GI, Zucchi A, et al. Evaluation of intralesional injection of HA compared with verapamil in Peyronie\u2019s disease: preliminary results from a prospective, double-blinded, randomized study. Andrology. 2017; 5:771-775.","DOI":"10.1111\/andr.12368"},{"key":"253770","doi-asserted-by":"crossref","unstructured":"43. Jiang D, Liang J, Noble PW. Hyaluronan as an immune regulator in human diseases. Physiol Rev 2011; 91:221-64.","DOI":"10.1152\/physrev.00052.2009"},{"key":"253771","doi-asserted-by":"crossref","unstructured":"44. Califano G, Arcaniolo D, Ruvolo CC, et al. Glans penis augmentation: when, how, and why? Int J Impot Res 2022; 34:343-6.","DOI":"10.1038\/s41443-021-00464-1"},{"key":"253772","doi-asserted-by":"crossref","unstructured":"45. Romero-Otero J, Manfredi C, Ralph D, et al. Non-invasive and surgical penile enhancement interventions for aesthetic or therapeutic purposes: a systematic review. BJU Int 2021; 127:269-91.","DOI":"10.1111\/bju.15145"},{"key":"253773","doi-asserted-by":"crossref","unstructured":"46. Vetrano M, Ranieri D, Nanni M, et al. Hyaluronic Acid (HA), Platelet-Rich Plasm and Extracorporeal Shock Wave Therapy (ESWT) promote human chondrocyte regeneration in vitro and ESWT-mediated increase of CD44 expression enhances their susceptibility to HA treatment. PLoS One. 2019; 14:e0218740.","DOI":"10.1371\/journal.pone.0218740"},{"key":"253774","unstructured":"47. Cocci A, Di Maida F, Cito G, et al. Comparison of intralesional hyaluronic acid vs. Verapamil for the treatment of acute phase peyronie\u2019s"},{"key":"253775","doi-asserted-by":"crossref","unstructured":"disease: a prospective, open-label non-randomized clinical study. 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Cilio S, Rocca R, Celentano G, et al.; YAU Working Group Sexual and Reproductive Health. Intraplaque injections of hyaluronic acid for the treatment of stable-phase Peyronie's disease: a retrospective single-center experience. 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