The Natural History of Peyronie’s Disease

Abstract

The natural history of Peyronie's disease was evaluated in 97 men by means of a questionnaire. Disease duration ranged from 3 months to 8 years. Questions addressed pain, bending, ability for intercourse, over-all effect of the disease, psychological effects, treatments received and degree of disease progression. Approximately 40% of the patients found pain, bending, ability for intercourse and over-all effects to be unchanged during the course of the disease. Bending and ability for relations worsened in 40% of the patients during the same interval, while only 6% had worsening of pain. Of the patients 77% reported psychological effects due to Peyronie's disease, which improved in 28%, did not change in 36% and worsened in 36%. Over-all, 13% of the patients believed the disease to be one of gradual resolution, 47% believed there had been little or no change and 40% believed that the disease pattern was one of gradual progression. We found no statistically significant association between disease duration and spontaneous improvement in penile bending. A similar lack of statistical significance was found when improvement in a variety of categories was compared in patients who received no therapy versus those who received a variety of conventional medical therapies.

Factors Associated With Erectile Dysfunction and the Peyronie's Disease Questionnaire in Patients With Peyronie Disease

“…30 suggesting that nonvascular factors may be responsible for the occurrence of ED in patients with PD. Such factors may include pain 10,21 and other comorbid conditions (eg, hypercholesterolemia), 8 which are prevalent among patients with PD. However, in a retrospective study of men with complaints of penile curvature and shortening who underwent penile duplex Doppler ultrasonography, demographic and baseline disease characteristics (eg, age, diabetes, smoking, hyperlipidemia, hypertension) were similar in patients with PD alone and in those with PD and ED.…”

“…Factors underlying this connection remain unknown, 13 but both conditions have been associated with increased age, 2,14-16 comorbid disorders (eg, diabetes, 2,8,16 cardiovascular events, 17,18 radical prostatectomy 19,20 ), psychological symptoms, [9][10][11]15,21,22 and altered blood flow. 13 In addition, ED has been associated with depression, 22 which, similar to PD, may influence a patient's assessment of physical and psychological functioning.…”

Review of non-surgical treatment options for Peyronie's Disease

“…Patients had received two or more previous treatments for PD, including potassium aminobenzoate, tamoxifen, colchicine, systemic steroids and intralesional verapamil. Gelbard et al 12 compared vitamin E therapy to the natural history of PD in 97 patients with disease duration ranging from 3 months to 8 years; no significant differences were found between the two groups in terms of curvature, pain or the ability to have intercourse. To date, no placebo-controlled trials using vitamin E have demonstrated any clinical benefit in the treatment of PD, and there is some evidence that vitamin E may also increase the risk of cerebrovascular events.…”

“…This group of investigators previously reported that 48% of patients had curvature progression in a no-treatment natural history observation study. 47 The first randomized, single-blind trial of intralesional verapamil was published in 1998 by Rehman et al 48 Significant improvements were noted in terms of erection [6][7][8][9][10][11][12][13][14][15][16][17][18], and all patients were treatmentnaive before entry into the study. Curvature was measured during duplex ultrasound of a pharmacologically induced erection.…”

“…PD data outcomes are difficult to interpret without a validated questionnaire, and this is further complicated by a reported spontaneous improvement rate of 13-39%. [10][11][12][13] The purpose of this article is to review the contemporary literature on non-surgical therapies for PD, and where possible, focus on randomized, placebo-controlled trials. The recently published guidelines on PD treatment by the International Consultation on Sexual Medicine (ICSM) are noted.…”