Peyronie’s disease: pharmacological treatments and limitations

ABSTRACT

Introduction: Peyronie’s disease (PD) is a disorder of the tunica albuginea from disordered and excessive deposition of collagen resulting in a palpable scar, pain, erect penile deformity and erectile dysfunction that significantly impacts patients both physically and emotionally.

Areas Covered: Several treatment options have been described for PD, including shockwave therapy, traction therapy, both oral and intralesional pharmacological options, and surgery. This review seeks to examine the data for different types of non-surgical treatments for PD. We review how various treatment modalities impact several relevant clinical endpoints for Peyronie’s disease, including effects on pain, penile curvature, plaque formation, and erectile function. We performed a literature search using PubMed and SCOPUS while referencing AUA, EAU, and CUA guidelines for management of Peyronie’s Disease for studies published 1980–2020.

Expert opinion: Intralesional collagenase injections have the strongest evidence and are the only FDA approved intralesional treatment for PD. Penile traction therapy (PTT) is low risk and may be beneficial in patients willing to invest significant time using the devices. Furthermore, oral combination therapy with other modalities may provide some benefit. Further investigation is required to better understand pathophysiology of PD and clarify the therapeutic utility of existing treatments, potentially with a multimodal strategy.

KEYWORDS:

• Peyronie’s disease
• medical management
• oral
• intralesional
• traction
• topical

Article highlights

• Intralesional collagenase has the strongest evidence for treatment of PD among intralesional treatments and is the only intralesional treatment approved by the FDA. Intralesional verapamil and interferon α-2b remain off label treatments for PD with weaker evidence.

• The evidence on extracorporeal shockwave therapy (ESWT) in the treatment of PD is conflicting. There is no evidence that ESWT reduces erect penile deformity. ESWT is currently recommended only for the treatment of penile pain in PD patients.

• PTT is suggested to improve penile length, decrease curvature, and increase penile girth when worn daily for 3-4 months, although larger cohorts in well-designed randomized control trials are required to further characterize benefits of traction therapy. While traditional traction devices required patients to wear the device daily for more than 3 hours, the newer Restorex® device has shown improvement with shorter periods of daily use.

• Topical therapies are not currently recommended for treatment of PD by the AUA. The EAU currently only recommends topical verapamil.

• The AUA and EAU do not currently recommend oral therapy for treatment of PD for disease modifying intent due to lack of evidence demonstrating benefit of monotherapy. The agents are prescribed due to the potential benefit in the absence of risks.

• Future research should extend our insights behind the mechanisms leading to PD and uncover the therapeutic value of already existing treatment options. Well-designed, placebo-controlled randomized clinical trials are necessary to refine our current understanding of non-surgical treatments.

Declaration of interest

L. Levine has declared consultancy for Boston Scientific, Coloplast, Absorption Pharmaceuticals, and Gesiva Medical. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.