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Super Moderator
Peyronie’s Disease (2022)
Fabrizio Palumbo, Francesco Sebastiani, Alessandro Procacci, Nicola D’Altilia, Anna Ricapito, and Luigi Cormio
6.1 Introduction
Peyronie’s disease (PD), also known as induration penis plastica (IPP), is a clinical condition characterized by the formation of fibrotic plaques onto the tunica albuginea of the penis, which may result in abnormal penile curvature and deformity, erectile dysfunction (ED), and loss of penile length. The combination of these events may result in the impossibility of performing penetrative intercourse [1].
PD is thought to be a form of connective tissue disease deriving from excessive scarring of the tunica albuginea or of the septum of the corpora cavernosa as a reaction to penile trauma; nevertheless, not all patients recall such episodes when reporting their clinical history [2]. Patients suffering from PD most commonly present with diabetes, hypertension, hyperlipidemia as comorbidities and smoking, sexually transmitted diseases, and genital tract surgery as risk factors [3].
PD is not rare even though its occurrence is probably underreported. Indeed, its prevalence has been reported to range between 0.4% and 7% [4] and up to 16% in the subset of patients undergone radical prostatectomy [5]. PD may be an incidental finding in asymptomatic patients or diagnosed in patients with acquired penile curvature or/and ED, taking a complete medical and andrological history and a focused physical examination of the penile shaft. The correct assessment of the entity of the penile curvature and deformity, as well as of erectile function, especially prior to a planned surgical treatment, requires the evaluation of the penis during erection. So, intracavernous injection and penile Doppler ultrasonography (PDUS) [6] represent the gold-standard diagnostic evaluation.
6.2 Pathophysiology
6.3 Epidemiology
6.4 Clinical Presentation and Medical Evaluation
6.5 Non-surgical Treatment for Peyronie’s Disease
The main objective of conservative treatment is to prevent disease progression and relieve pain in patients in the early stage or in patients who decline other treatments during the active phase.
Non-surgical treatments are as follows: oral medications, topical medications, traction therapy, extracorporeal shock wave therapy, electromotive drugs, intralesional injections, and vacuum erection device. There are several studies on conservative treatments and often their results are contradictory, not allowing to provide recommendations in real life
6.5.1 Oral Medications
6.5.1.1 Phosphodiesterase Type 5 Inhibitors (PDE5is)
6.5.1.2 Nonsteroidal Anti-inflammatory Drugs (NSAIDs)
6.5.1.3 Coenzyme Q10
6.5.1.4 Vitamin E
6.5.1.5 Colchicine
6.5.1.6 Para-aminobenzoacidic Potassium (POTABA)
6.5.1.7 Carnitine
6.5.1.8 Tamoxifen
6.5.2 Topical Medications
6.5.3 Extracorporeal Shock Wave Therapy (ESWT)
6.5.4 Mechanical Devices
6.5.4.1 Penile Traction Therapy
6.5.4.2 Vacuum Erection Device
6.5.5 Intraplaque Injection
6.5.5.1 Collagenase Clostridium Histolyticum (CCH)
6.5.5.2 Interferon Alpha
6.5.5.3 Calcium Channel Blockers (Verapamil, Nicardipine)
6.6 Surgical Treatment for Peyronie’s Disease
6.6.1 Tunical Shortening Procedure
6.6.2 Tunical Lengthening Procedure
6.6.3 Penile Prosthesis Implant
Fabrizio Palumbo, Francesco Sebastiani, Alessandro Procacci, Nicola D’Altilia, Anna Ricapito, and Luigi Cormio
6.1 Introduction
Peyronie’s disease (PD), also known as induration penis plastica (IPP), is a clinical condition characterized by the formation of fibrotic plaques onto the tunica albuginea of the penis, which may result in abnormal penile curvature and deformity, erectile dysfunction (ED), and loss of penile length. The combination of these events may result in the impossibility of performing penetrative intercourse [1].
PD is thought to be a form of connective tissue disease deriving from excessive scarring of the tunica albuginea or of the septum of the corpora cavernosa as a reaction to penile trauma; nevertheless, not all patients recall such episodes when reporting their clinical history [2]. Patients suffering from PD most commonly present with diabetes, hypertension, hyperlipidemia as comorbidities and smoking, sexually transmitted diseases, and genital tract surgery as risk factors [3].
PD is not rare even though its occurrence is probably underreported. Indeed, its prevalence has been reported to range between 0.4% and 7% [4] and up to 16% in the subset of patients undergone radical prostatectomy [5]. PD may be an incidental finding in asymptomatic patients or diagnosed in patients with acquired penile curvature or/and ED, taking a complete medical and andrological history and a focused physical examination of the penile shaft. The correct assessment of the entity of the penile curvature and deformity, as well as of erectile function, especially prior to a planned surgical treatment, requires the evaluation of the penis during erection. So, intracavernous injection and penile Doppler ultrasonography (PDUS) [6] represent the gold-standard diagnostic evaluation.
6.2 Pathophysiology
6.3 Epidemiology
6.4 Clinical Presentation and Medical Evaluation
6.5 Non-surgical Treatment for Peyronie’s Disease
The main objective of conservative treatment is to prevent disease progression and relieve pain in patients in the early stage or in patients who decline other treatments during the active phase.
Non-surgical treatments are as follows: oral medications, topical medications, traction therapy, extracorporeal shock wave therapy, electromotive drugs, intralesional injections, and vacuum erection device. There are several studies on conservative treatments and often their results are contradictory, not allowing to provide recommendations in real life
6.5.1 Oral Medications
6.5.1.1 Phosphodiesterase Type 5 Inhibitors (PDE5is)
6.5.1.2 Nonsteroidal Anti-inflammatory Drugs (NSAIDs)
6.5.1.3 Coenzyme Q10
6.5.1.4 Vitamin E
6.5.1.5 Colchicine
6.5.1.6 Para-aminobenzoacidic Potassium (POTABA)
6.5.1.7 Carnitine
6.5.1.8 Tamoxifen
6.5.2 Topical Medications
6.5.3 Extracorporeal Shock Wave Therapy (ESWT)
6.5.4 Mechanical Devices
6.5.4.1 Penile Traction Therapy
6.5.4.2 Vacuum Erection Device
6.5.5 Intraplaque Injection
6.5.5.1 Collagenase Clostridium Histolyticum (CCH)
6.5.5.2 Interferon Alpha
6.5.5.3 Calcium Channel Blockers (Verapamil, Nicardipine)
6.6 Surgical Treatment for Peyronie’s Disease
6.6.1 Tunical Shortening Procedure
6.6.2 Tunical Lengthening Procedure
6.6.3 Penile Prosthesis Implant
