madman
Super Moderator
A clinical pathway for the management of Peyronie’s disease: integrating clinical guidelines from the International Society of Sexual Medicine, American Urological Association and European Urological Association
Objective
To provide a clinical framework and key guideline statements to assist clinicians in the evidence-based management of Peyronie’s disease (PD).
Methods
We conducted a review of the published literature relevant to PD management, with an emphasis on published clinical guidelines. References used in the text have been assessed according to their level of evidence, and guideline recommendations have been graded based on the Oxford Centre for Evidence-based Medicine Levels of Evidence.
Results
The management of PD involves taking a detailed penile and sexual history, with a focused penile examination to identify plaque and hourglass deformity, and digital photographs of the erect curved (deformed) penis. Penile colour Duplex ultrasonography evaluates tunical plaque and underlying cavernosal smooth muscle and blood flow variables. The current therapy for PD can be divided into two main groups, namely, medical therapy and penile reconstructive surgery, and the patient should be counselled on the benefits and risks of each treatment option.
Conclusions
Peyronie’s disease remains a clinical challenge and presents a considerable therapeutic dilemma as the current therapy addresses existing penile curvature only and is not very effective in preventing future penile fibrosis and/or reversing underlying erectile dysfunction.
Key Messages
• Peyronie’s disease (PD) is a psychosexual condition characterized by the presence of penile pain, curvature and/ or deformity, with a potential palpable plaque and concomitant sexual dysfunction.
• Peyronie’s disease is largely a progressive disorder, with approximately half of affected men reporting disease progression if left untreated.
• Penile colour Duplex ultrasonography remains the imaging method of choice and provides useful information on the tunical plaque, underlying cavernosal smooth muscle and blood flow variables.
• The current therapy for PD can be divided into two groups: medical therapy and penile reconstructive surgery,
and the patient should be counselled on the benefits and risks of each treatment.
• Penile reconstructive surgery provides the fastest, most reliable and sustained outcomes for correction of penile deformity for stable PD. It is important to provide adequate preoperative counselling to set patients’ expectations as surgery is often associated with risks of penile length loss, persistent or recurrent curvature, altered penile sensation and erectile dysfunction.
In conclusion, despite significant advances over the last decade, there is a need for greater understanding of the molecular basis and search for more innovative treatment options in PD. To date, PD continues to pose a clinical challenge and therapeutic dilemma. Further collaborative clinical trials will need to be conducted with stricter methodology and meaningful objective outcome measures and be replicated and validated across multiple institutions and countries.
While the existing therapy addresses the penile curvature, it is not very effective in preventing future penile curvature. Hopefully, the increased knowledge and utility of translational research with the use of regenerative technology will address penile fibrosis and ultimately restore the penile size and erectile function in men with PD in the near future.
Objective
To provide a clinical framework and key guideline statements to assist clinicians in the evidence-based management of Peyronie’s disease (PD).
Methods
We conducted a review of the published literature relevant to PD management, with an emphasis on published clinical guidelines. References used in the text have been assessed according to their level of evidence, and guideline recommendations have been graded based on the Oxford Centre for Evidence-based Medicine Levels of Evidence.
Results
The management of PD involves taking a detailed penile and sexual history, with a focused penile examination to identify plaque and hourglass deformity, and digital photographs of the erect curved (deformed) penis. Penile colour Duplex ultrasonography evaluates tunical plaque and underlying cavernosal smooth muscle and blood flow variables. The current therapy for PD can be divided into two main groups, namely, medical therapy and penile reconstructive surgery, and the patient should be counselled on the benefits and risks of each treatment option.
Conclusions
Peyronie’s disease remains a clinical challenge and presents a considerable therapeutic dilemma as the current therapy addresses existing penile curvature only and is not very effective in preventing future penile fibrosis and/or reversing underlying erectile dysfunction.
Key Messages
• Peyronie’s disease (PD) is a psychosexual condition characterized by the presence of penile pain, curvature and/ or deformity, with a potential palpable plaque and concomitant sexual dysfunction.
• Peyronie’s disease is largely a progressive disorder, with approximately half of affected men reporting disease progression if left untreated.
• Penile colour Duplex ultrasonography remains the imaging method of choice and provides useful information on the tunical plaque, underlying cavernosal smooth muscle and blood flow variables.
• The current therapy for PD can be divided into two groups: medical therapy and penile reconstructive surgery,
and the patient should be counselled on the benefits and risks of each treatment.
• Penile reconstructive surgery provides the fastest, most reliable and sustained outcomes for correction of penile deformity for stable PD. It is important to provide adequate preoperative counselling to set patients’ expectations as surgery is often associated with risks of penile length loss, persistent or recurrent curvature, altered penile sensation and erectile dysfunction.
In conclusion, despite significant advances over the last decade, there is a need for greater understanding of the molecular basis and search for more innovative treatment options in PD. To date, PD continues to pose a clinical challenge and therapeutic dilemma. Further collaborative clinical trials will need to be conducted with stricter methodology and meaningful objective outcome measures and be replicated and validated across multiple institutions and countries.
While the existing therapy addresses the penile curvature, it is not very effective in preventing future penile curvature. Hopefully, the increased knowledge and utility of translational research with the use of regenerative technology will address penile fibrosis and ultimately restore the penile size and erectile function in men with PD in the near future.
