Penile Traction Therapy for Peyronie's Disease: A Contemporary Narrative Review of Clinical Evidence and Evolving Trends.

Peyronie's disease (PD) is a connective tissue disorder of the penile tunica albuginea that leads to curvature, deformity, and erectile dysfunction, resulting in significant psychosocial distress. Surgical interventions remain effective but are often reserved for severe deformities. Over the past decade, penile traction therapy (PTT) has gained recognition as a non-invasive alternative based on the principle of mechanotransduction, offering the potential to remodel fibrotic tissue, reduce curvature, and restore length. A structured narrative review was performed using PubMed, ScienceDirect, and Wiley Online Library databases covering publications from 2009 to 2025. Search terms included 'Peyronie's disease', 'penile traction therapy', 'traction device', and 'RestoreX'. Eligible studies comprised randomised controlled trials (RCTs), prospective cohorts, meta-analyses, and systematic or narrative reviews investigating PTT as monotherapy or in combination with adjunctive treatments. Extracted data included sample size, device used, treatment protocol, outcomes such as curvature reduction, length gain, erectile function, satisfaction, and adverse events. A total of 15 major studies, including over 1,000 patients, were reviewed. Modern devices such as RestoreX and Penimaster PRO achieved mean curvature reductions of 20-30% and penile length gains averaging 1.5-2.3 cm with high adherence exceeding 85%. Short-duration protocols of 30-90 minutes daily showed similar or improved efficacy compared to older devices requiring prolonged wear. Adjunctive use of PTT with collagenase Clostridium histolyticum (CCH) enhanced curvature correction by an additional 5-10% compared to CCH alone. Improvements in the International Index of Erectile Function (IIEF-5) and Peyronie's Disease Questionnaire (PDQ) scores confirmed both functional and psychological benefits. Adverse effects were mild, transient, and self-limited, primarily erythema and glans numbness. Overall, PTT offers a safe, effective, and patient-centred non-surgical approach for managing PD. Consistent evidence demonstrates clinically meaningful reductions in curvature, penile length restoration, and improved erectile function with minimal side effects. When combined with pharmacological or injection therapies, PTT provides synergistic benefits and may delay or prevent surgical intervention. Continued multicentre research is essential to standardise protocols, evaluate long-term durability, and incorporate psychosocial outcomes into treatment assessment.