madman
Super Moderator
Abstract
Purpose of Review To analyze the literature on current conservative treatment options for Peyronie’s disease (PD).
Recent Findings Conservative therapy with intralesional collagenase clostridium histolyticum (CCH) is safe and efficacious in either the acute or chronic phases of PD. Combination treatment with penile traction therapy (PTT) can produce even better results. While most PTT devices require extended periods of therapy up to 8 h per day, the RestoreX® device can be effective at 30–90 min per day.
Summary A variety of conservative therapies are available for the treatment of PD. The available literature does not reveal any treatment benefit of oral therapies. Intralesional therapy is the mainstay conservative treatment of PD. Intralesional CCH therapy is the first Food and Drug Administration-approved intralesional therapy and represents the authors’ preference for medical therapy. The most effective conservative management of PD likely requires a combination of therapies.
Introduction
Peyronie’s disease (PD) is a connective tissue disorder characterized by the formation of fibrotic plaque in the tunica albuginea of the corpus cavernosa. The definitive etiology of the disease remains elusive. The most accepted theory involves repetitive microtrauma of the tunica albuginea with delamination of this layer, followed by hematoma formation and initiation of an inflammatory cascade [1]. PD is mostly diagnosed in men in the fifth decade of life; however, patients younger than 40 accounts for 10% of PD cases [2]. Though there is concern that PD is likely underreported, as patients may be hesitant to seek treatment, the reported prevalence of PD is 0.5‑20% [3–5].
Clinical presentation is variable and may include erectile dysfunction (ED), pain, penile shortening, deformity, curvature, and penile plaque formation [2]. Clinically, two phases of PD are recognized: the acute phase and the chronic phase [6]. In the acute phase, which typically lasts up to 12 months, patients complain of painful erection, progressive penile curvature, and palpable plaque(s). In the chronic phase, the plaque(s) solidifies, the pain subsides, and penile curvature stabilizes. Patients suffering from PD may suffer from psychological distress in addition to affected sexual function.
Oral Therapy
*Potassium Aminobenzoate (Potaba)
*Vitamin E
*Pentoxifylline
*Phosphodiesterase-5 Inhibitors
*Other
Topical Treatment
*Verapamil
*H-100
*Electromotive Drug Administration
Intralesional Injections
*Verapamil
*Interferons
*Collagenase
Mechanical Therapy
*Penile Traction Therapy
*Vacuum Device
*Extracorporeal Shock Wave Therapy
*Radiotherapy
Conclusion
Many studies have been conducted in order to establish a strategy founded on evidence-based medicine to treat PD. Conservative treatment may still be an attractive choice for many patients who wish to avoid surgical treatment. Both oral and topical treatments have not demonstrated therapeutic efficacy in the majority of studies, either due to small sample size, lack of control arm, or unreproducible results. Intralesional injections have demonstrated more meaningful results, especially when combined with other modalities of treatment. CCH is the first FDA-approved intralesional treatment in PD, with proven efficacy based on randomized, double-blind, placebo-controlled studies. Most of the studies recommend LiSWT to relieve penile pain, but with no effect on penile curvature or plaque size. As per the SMSNA position statement, it is considered experimental and should be not be used in clinical practice. Effective conservative management of PD likely requires a combination of the therapies described here. Overall, prospective randomized trials are needed to better understand the mechanism of PD and to evaluate response to different conservative therapeutic options.
Purpose of Review To analyze the literature on current conservative treatment options for Peyronie’s disease (PD).
Recent Findings Conservative therapy with intralesional collagenase clostridium histolyticum (CCH) is safe and efficacious in either the acute or chronic phases of PD. Combination treatment with penile traction therapy (PTT) can produce even better results. While most PTT devices require extended periods of therapy up to 8 h per day, the RestoreX® device can be effective at 30–90 min per day.
Summary A variety of conservative therapies are available for the treatment of PD. The available literature does not reveal any treatment benefit of oral therapies. Intralesional therapy is the mainstay conservative treatment of PD. Intralesional CCH therapy is the first Food and Drug Administration-approved intralesional therapy and represents the authors’ preference for medical therapy. The most effective conservative management of PD likely requires a combination of therapies.
Introduction
Peyronie’s disease (PD) is a connective tissue disorder characterized by the formation of fibrotic plaque in the tunica albuginea of the corpus cavernosa. The definitive etiology of the disease remains elusive. The most accepted theory involves repetitive microtrauma of the tunica albuginea with delamination of this layer, followed by hematoma formation and initiation of an inflammatory cascade [1]. PD is mostly diagnosed in men in the fifth decade of life; however, patients younger than 40 accounts for 10% of PD cases [2]. Though there is concern that PD is likely underreported, as patients may be hesitant to seek treatment, the reported prevalence of PD is 0.5‑20% [3–5].
Clinical presentation is variable and may include erectile dysfunction (ED), pain, penile shortening, deformity, curvature, and penile plaque formation [2]. Clinically, two phases of PD are recognized: the acute phase and the chronic phase [6]. In the acute phase, which typically lasts up to 12 months, patients complain of painful erection, progressive penile curvature, and palpable plaque(s). In the chronic phase, the plaque(s) solidifies, the pain subsides, and penile curvature stabilizes. Patients suffering from PD may suffer from psychological distress in addition to affected sexual function.
Oral Therapy
*Potassium Aminobenzoate (Potaba)
*Vitamin E
*Pentoxifylline
*Phosphodiesterase-5 Inhibitors
*Other
Topical Treatment
*Verapamil
*H-100
*Electromotive Drug Administration
Intralesional Injections
*Verapamil
*Interferons
*Collagenase
Mechanical Therapy
*Penile Traction Therapy
*Vacuum Device
*Extracorporeal Shock Wave Therapy
*Radiotherapy
Conclusion
Many studies have been conducted in order to establish a strategy founded on evidence-based medicine to treat PD. Conservative treatment may still be an attractive choice for many patients who wish to avoid surgical treatment. Both oral and topical treatments have not demonstrated therapeutic efficacy in the majority of studies, either due to small sample size, lack of control arm, or unreproducible results. Intralesional injections have demonstrated more meaningful results, especially when combined with other modalities of treatment. CCH is the first FDA-approved intralesional treatment in PD, with proven efficacy based on randomized, double-blind, placebo-controlled studies. Most of the studies recommend LiSWT to relieve penile pain, but with no effect on penile curvature or plaque size. As per the SMSNA position statement, it is considered experimental and should be not be used in clinical practice. Effective conservative management of PD likely requires a combination of the therapies described here. Overall, prospective randomized trials are needed to better understand the mechanism of PD and to evaluate response to different conservative therapeutic options.
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