Hyaluronic acid in Peyronie’s disease: focus on injection procedures and clinical practice

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's disease treatment. MATERIALS 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's disease and to review the range of intralesional treatment approaches currently used in Peyronie's disease. RESULTS: Both periplaque and intraplaque injection techniques are currently used in everyday clinical practice. Based on the on the panel's 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. CONCLUSIONS: Hyaluronic acid represents one of the most promising non-surgical treatments for Peyronie's 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.