Targeting the acute phase of Peyronie's disease: preliminary experience with Perovial®, a novel hyaluronic acid formulation.

Peyronie's disease (PD) continues to represent one of the most challenging conditions in sexual medicine, particularly in its acute phase, where pain, progressive curvature, and psychological distress converge to disrupt patients' lives. For decades, clinicians have been limited to watchful waiting or off-label therapies, with collagenase Clostridium histolyticum (CCH) emerging as the most rigorously studied intralesional option in the chronic phase. Yet, the acute phase has largely remained an uncharted therapeutic territory. In this perspective, we present our preliminary clinical experience with Perovial® (IBSA, Italy), a novel intraplaque therapy administered in 10 weekly sessions, combined with daily vacuum therapy and penile modeling. Among 16 acute-phase patients with a median baseline curvature of 43° (IQR 30-62), we observed a median curvature reduction of 15° (IQR 7.5-19), significant pain relief, and no complications. These results, although preliminary, raise provocative questions: could Perovial® not only mirror but even surpass the benefits of CCH in acute disease? And more importantly, should the field of sexual medicine embrace earlier, mechanism-driven interventions rather than waiting for the disease to stabilize? We propose a possible game changer for acute PD.