State of the art: medical treatment of Peyronie's disease

Abstract

Introduction: Peyronie's disease (PD) is a wound-healing disorder of the penis and is estimated to affect 3 – 9% of men. Once believed to be a spontaneously resolving condition, it is now established that most cases of PD progress. The pathophysiology of PD involves the formation of collagenous plaques within the tunica albuginea with subsequent development of penile curvature or indentations of the penis. This may evolve into pain with erection and difficulty with intromission. PD follows a predictable natural history consisting of an acute phase characterized by progressive plaque formation with sometimes painful erections and a chronic phase in which plaques stabilize. Men with PD are hypothesized to have a genetic predisposition that causes abnormal wound healing, and some antecedent penile (micro) trauma, usually precipitated by sexual intercourse.

Areas covered: In this review, the pathophysiology, epidemiology and medical therapeutic options in the treatment of PD will be covered. Newly evolving treatments will also be reviewed.

Expert opinion: While surgical intervention is the gold standard of treatment in the chronic phase of PD, currently, there is a general trend toward minimally invasive treatments using verapamil, interferon and collagenase intralesional injections. Oral therapies such as pentoxifylline, acetyl-l-carnitine and colchicine may also have a role in plaque stabilization. No long-term well-designed placebo-controlled trials using standardized methods for evaluation have been performed. Hence, oral therapies are considered experimental at best. Intralesional therapy, however, has developed a strong foothold in the treatment of PD and has demonstrated efficacy over oral therapies.

Keywords::

• erectile dysfunction
• oral therapies
• Peyronie's disease
• sexual dysfunction

Declaration of interest

Hellstrom has the following disclosures: i) American Medical Systems – Consultant or Advisor; ii) Andromedical – Consultant or Advisor; iii) Auxilium – Meeting Participant or Lecturer, Consultant or Advisor, Investigator; iv) Allergan – Consultant or Advisor, Scientific Study or Trial; v) Coloplast – Consultant or Advisor, Investigator; vi) Cook – Consultant or Advisor, Investigator; vii) Endo – Consultant or Advisor, Investigator, Lecturer; viii) Johnson & Johnson – Consultant or Advisor, Meeting Participant or Lecturer, Investigator; ix) Lilly, USA – Consultant or Advisor, Lecturer; x) NIH – Board Member, Officer, Trustee; xi) Slate – Pharmaceutical – Lecturer, Advisor, and Investigator; xii) Theralogix – Board Member, Officer, Trustee; xiii) VIVUS – Advisor/Consultant, Investigator, Lecturer.

Notes

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