(694) Effect of Penile Traction Monotherapy on Penile Curvature in Men with Peyronie’s Disease: A Systematic Review and Meta Analysis

Introduction Peyronie’s disease (PD) is an acquired, benign penile disorder characterised by fibrous plaque formation within the tunica albuginea, leading to penile curvature, deformity, pain, and often erectile dysfunction. The condition affects approximately 3-9% of adult men, most commonly between the ages of 50-59. Non-surgical treatments such as penile traction therapy (PTT) aim to reduce curvature and restore penile length by applying sustained mechanical stretching. While previous reviews have investigated PTT in combination with other interventions, the efficacy of PTT as a standalone (monotherapy) treatment remains unclear. This systematic review and meta-analysis evaluates the impact of PTT monotherapy on penile curvature in men with PD. Objective To assess the effectiveness and safety of penile traction therapy used as monotherapy in reducing penile curvature among men diagnosed with Peyronie’s disease. Methods This systematic review and meta-analysis adhered to PRISMA guidelines and was registered in PROSPERO (CRD42024605873). A comprehensive search of PubMed, SCOPUS, and Web of Science identified English-language studies published up to March 2025 using predefined search terms relating to “Peyronie’s disease” and “Penile Traction Therapy.” Eligible studies included adult men with PD treated exclusively with PTT and reporting changes in penile curvature. Excluded were studies involving combination therapies, non-PD indications, or non-original research. Data extraction and quality assessment were performed independently by two reviewers using the Revised Cochrane Risk of Bias Tool (RoB 2) for randomised controlled trials (RCTs) and the Newcastle-Ottawa Scale (NOS) for cohort studies. Random-effects meta-analyses were performed in R Studio using the “meta” package, with heterogeneity assessed via Higgins’ I2 and Cochrane’s Q test. Results From 181 screened studies, six met inclusion criteria, comprising three RCTs and three prospective cohort studies with a total of 324 participants. Treatment durations ranged from 3-6 months, with daily PTT application between 30 minutes and 8 hours, depending on device and protocol. At 3 months, pooled analysis of three studies showed a statistically significant mean reduction in penile curvature of 16.97° (95% CI: 1.15-32.80; p < 0.0001; I2 = 97.8%). At 6 months, pooled data from four studies demonstrated a mean reduction of 13.04° (95% CI: 4.20-21.89; p < 0.0001; I2 = 94.0%). The greatest improvement (31.2°) was achieved with intensive use (3-8 hours/day), suggesting a potential dose-response relationship. Adverse events were generally mild and self-limiting, including penile erythema, discomfort, and transient sensory changes. No serious complications or therapy discontinuations were reported. Risk of bias among RCTs was low-to-moderate, with moderate quality observed in cohort studies (NOS 6-8/9). Conclusions PTT monotherapy results in modest yet statistically significant reductions in penile curvature at 3 and 6 months, supporting its role as a safe, non-invasive therapeutic option for PD. Evidence remains limited by small sample sizes, heterogeneous protocols, and inconsistent compliance reporting. The absence of a validated minimal clinically important difference for curvature reduction further limits the interpretation of clinical significance. Future research should prioritise adequately powered, standardised RCTs that incorporate compliance monitoring, longer follow-up, and patient-centred outcomes to establish robust evidence for the standalone clinical utility of penile traction therapy in Peyronie’s disease. Disclosure No