4 Most Common Causes of Peyronie’s Disease

Etiology Breakthroughs: The Four Most Common Penile Trauma Variations Causing Peyronie’s Disease

The Big Four Causes of Peyronie’s

Since we isolated the core etiology of Peyronie’s, we discovered that like most diseases, it mirrors the 80/20 rule: 80% of all cases are born from just 20% of causes.

Based on retrospective evaluations of our treated patient histories, the following are what we believe to be the four most common sources of penile trauma that trigger a Peyronies indication. There is also a list of clinical situations in which a patient is “predisposed” to Peyronie’s disease despite just minor microtrauma. These patients have connective tissue wound healing disorders, which are frequently inherited.

Finally, it’s worth noting that we encountered cases where these various trauma kinds occurred together. For example, a patient may have long-standing penile plaque from continuing microtraumas, but because they haven’t yet encountered a Peyronie’s accelerator, they may not be displaying Peyronie’s symptoms.

They may, however, later suffer a direct or acute penile injury, resulting in a substantial Peyronie’s indication. Because of the changes in related plaque shape and density, the overall picture of penile plaque in such a situation requires a distinct approach.

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Perpetual Penile Microtrauma

Years of microtrauma to the penis are the most typical source of fibrotic plaque that causes a Peyronie’s indication. According to studies, patients with Peyronie’s disease who have no clear memory of any specific episode account for approximately 75% of all cases.

In certain cases, we discovered that “the feather principal” – where only one further tiny penile trauma tips the scales into an easily validated Peyronie’s diagnosis – led to permanent penile microtrauma evolving into a full-fledged Peyronie’s diagnosis.

Peyronie’s plaque, which is formed by a series of penile microtraumas, most usually matched one of two patterns, according to our findings:

  1. A spiderweb design of plaque within the penile tissue.
  2. Tunica Thickened

We believe that the initial microtrauma(s) caused the penis to fibrose. As the body progressively realizes that “something is still wrong” in that region of the penis, it sends extra fibrotic material to fix any abnormalities left over from the first minor injury.

It is uncommon for the new fibrotic material to finish up exactly where the original sign did. Rather, it generally ends up nearby. Because of this, long established microtrauma penile plaque is braided and resembles a spider web.

Based on Tunica density differences, we believe that situations of similar patient histories where the Peyronie’s indication is predominantly rooted in a thickened Tunica are similarly slow and eternal in growth. Tunica thickening can be detected in the region’s size and density.

We hypothesize that most young, healthy patients can slow fibrosis progression early on. A verifiable Peyronie’s indication, on the other hand, becomes unavoidable as the same patient ages, their health deteriorates somewhat, and one or more of the ten “Peyronie’s accelerators” is finally triggered.

The precise causes of these penile microtraumas are as varied as human experience. We were able to determine this crucial origin of Peyronie’s illness by differences in the density and design of the microtrauma-based plaque, in conjunction with patient interviews. The differences in plaque density within the spiderweb-like plaque striations are a tell-tale sign that some of these microtraumas could probably be traced as far back as “missed ground balls” in Peewee baseball to hours of grinding against a female partner’s pelvic bone during teen years intimate exploration.

The introduction of one or more of the 10 Peyronie’s Accelerators can sometimes be the tipping point for a Peyronie’s indication from constant microtrauma. These accelerators impair the body’s processes to keep the formation of fibrosis at bay which often leads a Peyronie’s case to go from unnoticed to impeding sexual fulfillment from seemingly “thin air”.

These latter elements support the logic behind Peyronie’s being most common in older patients, as they’ve had a lifetime to accumulate penile microtraumas and are the most vulnerable to ending up with a Peyronie’s accelerator due to their compromised health.

During evaluation, we frequently see a combination of fibrosis, plaques, and tunica thickening, with the amount and severity of each differing by case.

Tunica thickening without fibrosis or plaques is also occasionally found, which is why we added “and/or tunica thickening” to our revised definition of Peyronie’s Disease. We believe tunica thickening will be an important factor in future studies on perennial penile microtrauma and Peyronie’s Disease.

Acute Penile Injury

A meaningful and unforgettable acute injury to the penis is the second most common cause of a Peyronie’s indication. Two common types of acute penile injury include sexual injuries produced by a partner being “on top” and lowering themselves at an unpleasant angle onto the penis, and sexual injuries caused by extremely violent thrusting during intercourse that results in pain from misalignment.

Non-sexual causes of acute penile injuries include groin injuries from sports and severe impact on the penis from unforeseen incidents. One of our patients lost his footing while trekking in the Yukon and plunged into waist-deep, freezing water, causing an acute penile injury resulting in Peyronie’s disease.

According to our observations, acute penile injury Peyronie’s plaque appears as a “big glob” of penile plaque as commonly referenced within Peyronie’s medical photos.

Healthcare Related Penile Injury

No aspect of healthcare is designed to hurt or injure a patient. However, our research reveals that the number of men ending up with a Peyronie’s diagnosis as a byproduct of a medical procedure is perhaps more common than many realize.

Medical procedures[23] that produce penile damage can result in a Peyronie’s diagnosis. This type of Peyronie’s Disease most commonly occurs when a urinary catheter or other bladder control treatment is utilized while under anesthesia. On rare occasions, a nurse may inadvertently inflate a catheter in the urethra rather than the bladder, resulting in injury. Furthermore, because they were born with a small urethra, certain patients are predisposed to experiencing penile injury from catheterization.

In certain patients, a catheter implanted to protect the penis while receiving particular cancer therapies developed Peyronie’s triggering plaque. Another common medical cause of penile injury is a prostatectomy. While a radical prostatectomy typically results in more harm, some patients who undergo a robotic prostatectomy experience a fibrotic reaction.

[23] Tal R, Heck M, Teloken P, et al. Peyronie’s disease following radical prostatectomy: incidence and predictors. J Sex Med 2010;7:1254-61

PGE Injections

We uncovered another less commonly recognized source of recurrent penile microtrauma within urology: long-term intravenous injection of Alprostadil (PGE) to treat erectile dysfunction.

Despite the fact that long-term PGE use is recommended as reasonably safe by standards of care, we continue to see patients with intracorporeal fibrosis caused by continuous needle injection of PGE medicine.

Intracorporeal plaque (Peyronie’s plaques within the corpora) is a relatively rare type of the disease unless the patient receives PGE injections.

Beginning in February 2018, all new erectile dysfunction patients who contacted our clinic for therapy and had a history of PGE injections were submitted to duplex Doppler ultrasonography tests. We identified intracorporeal fibrosis in 66.2% of ED patients who had PGE injections on a regular basis for more than two years using ultrasound analysis of the areas for injection sites.

Based on this discovery, we created a new protocol in which all PGE injection patients, new and old, receive a single ExoSurge® treatment each month. There is no evidence of fibrotic buildup in any of these patients after PGE injections.

Etiology Breakthroughs: Crucial Peyronie’s case insights

Peyronie’s Accelerators

How is it that a man awakens and notices his morning erection is now noticeably curved when it was perfectly straight the night before?

What causes a constant micro trauma case with no symptoms to suddenly develop into a full-blown Peyronie’s disease with palpable plaque and obvious curvature?

The scenario is set for an extended Peyronie’s case when a patient with a history of persistent microtrauma collides with one or more “Peyronie’s Accelerators” that practically every man eventually experiences with aging.

We discovered that a PD indication can suddenly become evident and problematic when one or more of these accelerators are introduced to a long-standing instance of constant microtrauma that has never previously displayed symptoms.

Peyronie’s Accelerators, as their name suggests, exacerbate a PD case. Peyronie’s accelerators make it harder to achieve meaningful plaque reduction even with our ground-breaking ExoSurge® technology if the patient doesn’t adhere to our instructions to make things better.

We’ve identified ten distinct Peyronie’s accelerators at this point in the development of our technology. We’re not able to share the details of these conditions and at what levels they must be optimized to repair a Peyronie’s case as they’re still a hidden aspect of our intellectual property.

Earlier Peyronie’s fibrosis that never truly “went away”

How many men have heard this: do nothing after a penile injury since it goes away on its own in 13% of cases. We believed this common precept for years as a building block of our curative solution.

We now strongly believe this presumption might not be entirely true. To put it another way, we think some healthy boys can occasionally overcome the symptoms of a Peyronie’s diagnosis, but we doubt that the injury that caused the symptoms would fully recover during that process.

Three patients who were under our care had previously experienced a penile injury, and they remembered experiencing palpable fibrosis and an erect penile curvature before the problem resolved on its own. Take a step forward more than 20 years despite deteriorating health inputs. The bending and tangible stiffness came back. We can only speculate as to whether that is what happens because no urologist has undertaken duplex Doppler testing to obtain images of the area where the plaque “went away.”

We think it’s feasible that the fibrosis gets better, but the underlying issue from the initial damage still exists and frequently gets worse if Peyronie’s accelerators start working as a result of aging, etc.

The present AUA standards of care for PD recommend a “hands off” approach to an early stage Peyronie’s indication as it might simply “go away” on its own. We theorize that assumption might not be 100% correct. In other words, we believe the symptoms of a Peyronie’s diagnosis can sometimes be overcome be overcome by select healthy males, however we question whether the injury that triggered the symptoms completely heals during that process.

We noted three patients under our care that suffered an earlier penile injury, recalled having palpable fibrosis and erect penile curvature and the condition went away on its own. Fast forward over twenty years in the face of declining health inputs. The curvature and palpable firmness returned. In the absence of a urologist having performed duplex Doppler testing to gather imagery of the area where the plaque “went away” we can only theorize about if that is what occurs.

We believe it’s possible the fibrosis improves but the core basis from the original injury remains and often becomes worse once one or more “Peyronie’s accelerators” kick-in over time.

Hereditary predisposition for Peyronie’s Disease

Select “predisposed for Peyronie’s” characteristics virtually invariably result in a PD diagnosis for a patient. Such predispositions turn what for the ordinary male would be a little microtrauma into a full-blown penile injury case with an accompanying severe fibrotic plaque response.

Most are tied to hereditary diagnosis related to wound healing disorders. We sometimes compare men that fall into these categories are the “hemophiliacs of Peyronie’s because even routine sex and manual masturbation are sometimes enough to trigger the formation of penile fibrosis.

Examples of Peyronie’s predisposition conditions include Dupuytren’s contractures, tympanosclerosis, connective tissue disorders, and Marfan syndrome.

Although they cannot develop Peyronie’s as quickly as men with the symptoms mentioned above, males with a congenital curvature can be also categorized as a subpopulation of men who are predisposed to the disease.

According to our estimates, a man with a congenital curvature has about twice the risk of getting hurt during sexual activity.

The 10 Variations in Peyronie’s Penile Plaque

Historically, Peyronie’s plaque was categorized into two states: calcified and uncalcified. Our research unearthed basic ten distinctive forms of penile fibrosis and plaque linked with Peyronie’s disease; each demands a unique method to penile plaque removal. It’s worth noting that in many cases, a patient will have more than one of these major forms of plaque at the same time.

After all our intellectual property projects are completed, we will publish more details about these unique Peyronie’s plaque variances and how each is best treated. It’s one of the most exciting aspects of our discoveries with the etiology of Peyronie’s Disease.

Issues and Complications: ExoSurge and Peyronie’s Disease

What are the negative aspects of ExoSurge® treatments for Peyronie’s disease?

There have been no negative side effects associated with our ExoSurge® technology treatments aside from mild swelling and tenderness following care. Those outcomes are temporary are minimal for most patients.

The biggest problems associated with the ExoSurge® treatment platform are time, investment, and patient compliance.

Time Investment

Depending upon the size, nature, density, and location of plaque within your penis and the number and severity of Peyronie’s accelerators we must modulate, treatments can take anywhere between four and fifty-two weeks to completely remove the plaque and fibrosis.

A thorough analysis of your individual case will allow us to offer a realistic estimate of the time that will be required to heal your penis. The good news is that ongoing results are measurable: this isn’t a “wait until the end” guessing game.

We are willing to customize your approach based upon your personal circumstances.

Peyronie’s Treatment Costs

Depending upon all the related underlying diagnosis and your exact type of health insurance, some parts of your treatment are often covered by insurance. However, the breakthrough technology itself will not be covered until the technology is approved by the FDA. We only charge $60 per treatment for that aspect of care at this juncture in order to make this technology to as many men as possible.

At this point the drug injections are only insurance covered once every 14 days since that’s what’s recommended under the old method of just using Verapamil injections. (That will all change after FDA approval). For local patients, this works out fine. However, for patients coming from of town, traveling to Atlanta doesn’t make economic sense for a singular, insurance covered therapies. Additional treatments cost $370 per visit and patients can only get one session per day for safety’s sake.

Compliance: Peyronie’s Treatment Time Requirement

Because of the cost and time investments associated with our treatment process, some patients are unable to complete the process. Additionally, a few have attempted to start self-adjusting their prescribed protocol with things like P-shots which only hinders progress.

We are able and willing to create a custom regimen to support whatever specific circumstances whenever possible. The optimal and fastest result includes whatever complete process is prescribed, but we understand not everyone is in a position to achieve that situation.


One frustrating aspect of healing we’ve discovered from our patients with severe, long-established Peyronie’s conditions is that the curvature is all they’re fixated upon. Unfortunately, in such cases – the most notable reduction to curvature often occurs happens in the final phases because of the spider web nature of most plaque designs. We first must eliminate the largest plaques that are triggering the symptoms. Additionally, we sometimes have to enhance aspects of your underlying health or progress becomes much slower. These circumstances in cases with lots of dense plaque make resolution especially challenging when a patient refuses to be compliant. Severe Peyronie’s plaque almost always didn’t occur in one day. We can’t safely remove quick, either.

Free Initial Consultation

Do you want to know if ExoSurge is right for you? We provide a free initial case consultation over the phone to evaluate your current condition and determine if ExoSurge treatment is appropriate for you in the future. Most insurance plans (including Medicare) usually cover the costs of the extensive testing required to develop an accurate treatment plan for your Peyronie’s disease. However, there will be out-of-pocket expenses for care, which can be costly if you travel from out of state and must include travel costs, lodging, and meals.

Studies on ExoSurge

Status of Published Studies

Our lawyers have not yet allowed us to share any details of our studies because the information contained therein includes details for upcoming patents. This is a frustrating to us as it is to many of our patients and future clinical partners.

Our most recent retrospective study showed a 79% reduction in the penile plaque and fibrosis that cause Peyronie’s (confirmed through verifiable changes in imagery from duplex Doppler sonographic imagery). More recent results appear to be even better.

We can now share some imagery you won’t find anywhere else in the world.

First, are a handful of “before and after” ultrasonic images of reduction in calcified plaque from ExoSurge technology. Fibrotic plaque appears in “movie” type images that require motion to measure, making them impossible to compare frame to frame.

Before and After Peyronie’s Calcification Reduction Images

Patients with Peyronie’s disease, in which calcification accumulates atop fibrotic plaque, face the most challenging and time-consuming treatment options. Our current technology is effective at removing calcified and fibrotic plaques, but due to calcification’s density, it takes significantly longer.

We have recently developed a promising new technique for the removal of calcified Peyronie’s plaque. We hope to share additional details about this discovery in the near future.

The images listed below are a selection of “before and after” duplex Doppler sonographic images of calcified plaque changes induced by our standard ExoSurge and intralesional drug injections.

No other Peyronie’s treatment technology has ever demonstrated a verifiable reduction in the calcification of Peyronie’s disease.

Before and After Peyronie’s Penile Photos

Following that is an example of something that cannot be found elsewhere on the Internet. Real photographic images of Peyronie’s disease before and after treatment, with curve measurement change devices confirming improvement.

Don’t believe us?

Just Google “Before and After Peyronie’s Pictures.”

Let us know what you discover.

What’s the biggest problem facing our new ExoSurge® Technology?

Any new Peyronies treatment or technology is met with skepticism. This disease has been medically identified since the middle ages. The best any existing technology has achieved is to improve symptoms f the disease in a select number of patients. Acknowledging ExoSurge is a curative pathway, only broadens doubt.

That’s only fair. We understand that this cynicism will take time to overcome. Our patent legal issues further complicate matters. We can’t even share a tenth of what we’ve discovered yet. We have nearly two decades of effort and a lot of money invested in the development of this technology.

Right now, our hands are tied. Much of this, we’re told, will change by the end of 2023 or in 2024.

We can’t wait to tell everyone about our discoveries.

Xiaflex®  and ExoSurge®

Can you combine Xiaflex® and ExoSurge®?

One of the most frequently asked questions we receive is whether we use Xiaflex (CCH intralesional injections) or whether ExoSurge® is compatible with Xiaflex®. ExoSurge® and Xiaflex® are generally perfect complements and we’ve even had cases where patients who had received CCH injections from another urologist before arriving at our clinic have also been successfully treated and repaired. In the coming year, we plan to publish a five-patient study of men who previously failed with Xiaflex injections but succeeded with ExoSurge®.

CCH (Xiaflex®) consists of C. histolyticum-derived enzymes that have been purified. The inventors believed Collagen types I and III targeted by CCH are the most abundant fibers found in Peyronie’s plaques. Thus, the treatment concept was that when CCH is administered intralesionally, “it would synergistically cleave type I and type III collagens”

Unfortunately, we discovered that although Peyronie’s fibrosis frequently begins as collagen types I and III, it quickly becomes more dense with time, to the point where collagen formed more than 18 months prior to CCH injections is typically too dense for CCH to soften in any manner  where the penis can be manually straightened afterwards.

Moreover, even in cases where CCH dissolved a portion of the Peyronie’s plaque, it almost always left enough of it that the body’s healing mechanism signals the body to send more fibrotics over time, resulting in a solution that is at best temporary.

We sometimes use CCH collagenase clostridium histolyticum (Xiaflex®) in the treatment of penile fibrosis, but only after reducing the amount of penile fibrosis to a predetermined level.

The US Food and Drug Administration (FDA) approved only CCH in 2013 for the treatment of Peyronie’s Disease (PD) in men with dorsal or lateral penile curvature greater than 30 degrees. Notably, in the initial clinical trials for FDA approval of CCH, patients with calcified plaque (other than tiny, loose “stipple” calcified plaque) were excluded from all studies, and Xiaflex was not recommended for patients with detectable calcified plaques at the time. Following the 2015 hostile takeover of Auxilium by Endo Pharmaceuticals, this advisory was removed from the drug’s prescribing protocols. Nonetheless, a 2018 study24 confirms that CCH is unable to effectively penetrate calcified PD penile plaque.

Based on patients who presented to our clinic after failing multiple rounds of CCH injections at other clinics, our research indicates that CCH is also unsuitable for dense, noncalcified, long-standing plaques. In addition, 56% of Peyronie’s cases are caused by chronic micro trauma, indicating that their plaque fits the definition of long-standing dense fibrosis.

We believe that these are two of the primary reasons why Xiaflex has received such negative reviews on the two most prominent online drug review sites: Drugs.com and WebMD.com.

  1. On Drugs.com, 69% of patients rated the drug as “1” on a scale from 1 to 10.
  2. According to WebMD.com, 73% of patients rated the drug as “1” on a scale from 1 to 10. (25% of 34 total reviews)

Before considering administration of CCH, we advise all new patients to thoroughly review these public data.

[24] Wymer, Kevin et al, Plaque Calcification: An Important Predictor of Collagenase Clostridium Histolyticum Treatment Outcomes for Men With Peyronie’s Disease, Journal of Urology, 2018 September, 119; 119-114

How does ExoSurge® work with Xiaflex®?

Yes – Xiaflex can be an ideal complement to ExoSurge, if indicated for the patient’s condition.

The reason these two therapies complement each other so well is due to the underlying effect of each: Xiaflex (CCH) is a potent enzymatic (Collagenase Clostridium Histolyticum) that has been demonstrated to be effective in softening Peyronie’s fibrosis to the point where the penis can be manually “straightened” in what are known as “shaping sessions” with a treating urologist.

In almost every instance, however, the plaque and fibrosis that serve as the basis for the diagnosis remain within the penis. CCH is not inherently curative. Sometimes, it softens plaque to the point where it can be manually reshaped. CCH is a recognized treatment for one of the most common symptoms of Peyronie’s disease (erect curvature) and is covered by insurance when erect curvature is at least 30 degrees. Having adequate health insurance is crucial when using Xiaflex, as the total cost of the protocol is approximately $23,000.

ExoSurge, on the other hand, breaks up and permanently removes Peyronie’s plaque and fibrosis, but improvement in erect curvature takes longer because we cannot initially determine which specific plaque characteristics are most influential in erect curvature. ExoSurge technology is curative, as it permanently eliminates the disease’s cause as opposed to treating its symptoms.

After sufficient plaque and fibrosis have been removed to expedite a case, we’ve discovered that CCH injections are an excellent option. In addition, we have developed a protocol to optimize these outcomes that is significantly superior to what Xiaflex recommends. To maximize success with our new tandem, ExoSurge-Xiaflex patients must be willing to ignore repeated reminders from Xiaflex support that “it’s time for your next treatment.”

Getting ExoSurge Locally

Can my local Urologist provide ExoSurge® Peyronie’s Treatment Technology?

ExoSurge is a new, patented technology that employs a combination of gas injections that have been clinically proven to enhance the efficacy of generic intralesional Peyronie’s disease medications and eliminate penile plaques, scar tissue, and fibrosis permanently. 

We have spent twenty years and a substantial amount of money creating it. In the years to come, we plan to license and expand this new healing platform globally once we have completed a comprehensive clinical analysis demonstrating the positive patient outcomes we are now observing. 

Several patients have recently traveled to Atlanta for ExoSurge treatments and then returned home to their preferred urologist for Xiaflex injections: this can be an ideal approach for certain individuals. We are delighted to collaborate with your preferred vendors and within your comfort zone to maximize your success.


All About Peyronie’s: with Breakthrough ExoSurge Commentary

As the world’s only clinic to measurably and permanently reduce penile plaque associated with Peyronie’s disease amongst every compliant patient, we learned the realities behind the cause, effects, and proper care of a Peyronie’s diagnosis.

New ExoSurge® Peyronie’s Insight

You’ll discover an enclosed box with a different typestyle throughout this content where we share novel insights gleaned from ExoSurge’s success healing over 1,000 Peyronie’s Disease cases.

We strongly advise all prospective new patients to read this information before visiting Morganstern Health.

Throughout their Peyronie’s journey, the majority of patients have been bombarded with disinformation. A lot of what they heard was false. Furthermore, some have been duped by treatments that have been proven to be utterly unsuccessful in the treatment of penile fibrosis, such as low intensity shockwave therapy and PRP shots.

We sympathize with people who have been misled or mistreated, and we hope that this information will help you embark on the road to recovery.

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