Therapeutic advances in the treatment of Peyronie's disease

Abstract

SUMMARYPeyronie's disease (PD) is an under-diagnosed condition with prevalence in the male population as high as 9%. It is a localized connective tissue disorder of the penis characterized by scarring of the tunica albuginea. Its pathophysiology, however, remains incompletely elucidated. For the management of the acute phase of PD, there are currently numerous available oral drugs, but the scientific evidence for their use is weak. In terms of intralesional injections, collagenase clostridium histolyticum is currently the only Food and Drug Administration-approved drug for the management of patients with PD and a palpable plaque with dorsal or dorsolateral curvature >30°. Other available intralesional injectable drugs include verapamil and interferon-alpha-2B, however, their use is considered off-label. Iontophoresis, shockwave therapy, and radiation therapy have also been described with unconvincing results, and as such, their use is currently not recommended. Traction therapy, as part of a multimodal approach, is an underused additional tool for the prevention of PD-associated loss of penile length, but its efficacy is dependent on patient compliance. Surgical therapy remains the gold standard for patients in the chronic phase of the disease. In patients with adequate erectile function, tunical plication and/or incision/partial excision and grafting can be offered, depending on degree of curvature and/or presence of destabilizing deformity. In patients with erectile dysfunction non-responsive to oral therapy, insertion of an inflatable penile prosthesis with or without straightening procedures should be offered.

Efficacy and safety evaluation of pentoxifylline associated with other antioxidants in medical treatment of Peyronie's disease: a case-control study

“…Prevalence of this disease varies between 3.6% and 13% as reported by various epidemiological studies. 1 – 4 It is, therefore, not as rare a disease as is generally believed; in fact, PD prevalence is much higher than that of diabetes mellitus, which was 2.8% in 2000 (the estimated prevalence for 2030 is 4.4%). 5 …”

The Combination of Blueberry Juice and Probiotics Ameliorate Non-Alcoholic Steatohepatitis (NASH) by Affecting SREBP-1c/PNPLA-3 Pathway via PPAR-α

“…However, all these medicines have obvious side effects. Long-term consumption of vitamin E will cause nausea, vomiting, diarrhea, headache, dizziness, and cerebrovascular disorders, as well as increase the risk of cancers [16]. Pioglitazone belongs to PPAR-γ agonist thiazolidinedione and has many side effects [17], including weight gain, pedal edema, bone loss and heart failure [18].…”

Efficacy and safety of dorsal penile nerve block before collagenase of clostridium histolyticum injections in peyronie's disease patients: Results from a prospective pilot study

“…Historically, the gold standard of PD treatment was surgery (Yafi, Pinsky, Sangkum, & Hellstrom, 2015). Over the years, many drugs were proposed as nonsurgical treatment of PD, being administered orally, with intraplaque injections, or by iontophoresis, without showing a clear benefit over placebo in penile curvature correction (Levine, 2007(Levine, , 2013Russell, Steers, & McVary, 2007;Yafi et al, 2015).…”

“…Historically, the gold standard of PD treatment was surgery (Yafi, Pinsky, Sangkum, & Hellstrom, 2015). Over the years, many drugs were proposed as nonsurgical treatment of PD, being administered orally, with intraplaque injections, or by iontophoresis, without showing a clear benefit over placebo in penile curvature correction (Levine, 2007(Levine, , 2013Russell, Steers, & McVary, 2007;Yafi et al, 2015). In contrast, in 2013 the Food and Drug Administration (FDA) approved the use of collagenase from Clostridium Histolyticum (CCH; Xiapex®, Swedish Orphan Biovitrium AB), along with penile modelling, as a therapeutic alternative in patients with PD in stable phase, palpable noncalcified plaque and penile curvature of at least 30º; after it was demonstrated in the IMPRESS I and II trials that it was a safe and effective treatment in this setting (Gelbard et al, 2013).…”