Peyronie's disease is a connective tissue disorder of the penis characterized by the formation of fibrous plaques in the tunica albuginea, leading to penile curvature, possible erectile dysfunction, and significant physical and psychological distress. While surgical correction is effective, it is invasive and associated with potential complications. Conservative treatments such as penile traction therapy and oral phosphodiesterase-5 inhibitors are commonly used but often provide limited improvement when used alone.

This pilot, randomized, controlled, multicenter study was designed to evaluate the efficacy and safety of Fibrorestil®, an intralesional medical device combining hyaluronic acid with a proprietary enzymatic mixture, when used as an adjuvant to standard conservative treatment in men with stable-phase Peyronie's disease.

The primary objective of the study was to assess the change in penile curvature from baseline to week 28. Secondary objectives included evaluation of safety, changes in disease-related symptoms and quality of life, erectile function, and patient satisfaction. Safety was assessed through the monitoring and reporting of adverse events throughout the study period.

This study is a prospective, randomized, controlled, open-label, multicenter pilot clinical investigation designed to evaluate the efficacy and safety of intralesional Fibrorestil® as an adjuvant treatment to standard conservative therapy in patients with stable-phase Peyronie's disease.

Following the withdrawal of collagenase Clostridium histolyticum from the European market, there is a significant unmet need for effective, minimally invasive intralesional therapies. Fibrorestil® is a Class III medical device composed of hyaluronic acid combined with a proprietary enzymatic mixture intended to facilitate remodeling of fibrotic tissue while providing anti-inflammatory and antioxidant effects.

Eligible participants were adult men (≥18 years) with stable Peyronie's disease, defined as stable symptoms for at least three months, a palpable penile plaque, and penile curvature between 30 and 90 degrees. Patients with prior surgical treatment for Peyronie's disease or significant comorbid conditions affecting wound healing or safety were excluded.

A total of 38 patients were randomized in a 1:1 allocation to one of two parallel groups. The experimental group received three intralesional Fibrorestil® treatment sessions administered at four-week intervals using a percutaneous tunneling technique under local anesthesia, in addition to standard conservative treatment. The control group received standard conservative treatment alone. Standard treatment in both groups consisted of daily use of a penile traction device for a minimum of four hours and daily oral tadalafil at the maximum tolerated dose (up to 5 mg).

Penile curvature was assessed at baseline and at week 28 using standardized self-photography and goniometric measurement. When adequate rigidity could not be achieved naturally, intracavernosal alprostadil was administered according to the Kelami test protocol.

The primary outcome measure was the change in penile curvature from baseline to week 28, expressed in degrees and as a percentage change. Secondary outcome measures included safety and tolerability assessed by adverse event reporting, changes in erectile function measured by the International Index of Erectile Function erectile function domain (IIEF-EF), disease-specific quality of life assessed using the Peyronie's Disease Questionnaire (PDQ), and patient-reported treatment satisfaction.

This pilot study was designed to assess feasibility, safety, and preliminary efficacy, and to inform the design of future larger-scale controlled trials.

Inclusion Criteria:

• Male patients aged 18 years or older
• Diagnosis of Peyronie's disease with stable symptoms for at least 3 months
• Penile curvature between 30 and 90 degrees, assessed by standardized self-photography or Kelami test
• Presence of a palpable penile plaque consistent with Peyronie's disease
• No prior surgical treatment for Peyronie's disease
• Willingness and ability to comply with study procedures, including use of penile traction therapy and completion of questionnaires
• Ability to provide written informed consent

Exclusion Criteria:

• Prior surgical treatment for Peyronie's disease
• Known hypersensitivity or allergy to hyaluronic acid or any component of the investigational medical device
• Active oncological disease or oncological treatment within the previous 6 months
• Systemic immunosuppression
• Severe hepatic or renal disease
• Medical conditions affecting wound healing or tissue repair (e.g., scleroderma, systemic lupus erythematosus, dermatomyositis)
• Active infection or infected scar tissue in the treatment area
• Use of other treatments for Peyronie's disease during the study period, including surgery
• Any medical condition that, in the investigator's judgment, could increase risk to the participant or interfere with study participation or outcome assessment

This was an open-label study with no masking of participants, care providers, investigators, or outcome assessors.