Treatment of Peyronie’s Disease: 2012 Update

Abstract

Peyronie's disease (PD) is the occurrence of a fibrous inelastic scar of the tunica albuginea of the penis. It is a relatively common disorder among men, with a reported prevalence of 3% to 8%. It is often associated with penile pain, anatomical deformities in the erect state, and difficulty with intromission. Because the exact pathophysiology of PD remains unknown and standards for evaluating or reporting treatment outcomes are unclear, research on effective therapies has been limited. The benefits of nonsurgical treatment options are conflicting and further controlled studies are required before any therapy can be fully recommended. The success of surgery has been well documented; however, surgery is invasive and costly and carries potential side effects. Patients who report stable disease that has been present for longer than 12 months and who experience penile deformity preventing satisfactory sexual intercourse are best suited for surgery. Additionally, failed conservative management and a patient's preference for definitive correction are important additional indications for surgical treatment.

Peyronie’s Disease: Still a Surgical Disease

“…Those with complex deformities such as hourglass deformities, lateral indentations, or curvatures >60–70° may not be appropriately treated with this technique [2]. …”

“…The majority of patients will experience maintenance or worsening of the defect. Once the disease has been stable for approximately 6 months, this is considered the stable (chronic) phase, at which time surgical treatment is appropriate [2, 3]. …”

Recent surgical advances in Peyronie’s Disease

“…It is believed it is probably due to disruption of the neurovascular bundle and cavernosal integrity. 23 A less invasive technique was developed by Essed and Schroeder in 1985, consisting in placing tight non-reabsorbable sutures on the convex side of the tunica albuginea to effectively plicate and straighten the penis, not requiring excision or incision of the tunica or mobilization of the neurovascular bundle ( Fig. 2) with cosmetic and functional satisfaction rates ranging 81% to 95%.…”

The Non-Surgical Treatment of Peyronie Disease: 2013 Update

“…Subsequent trials, however, failed to reproduce these positive findings, and unfavorable side effects (including local tissue atrophy and fibrosis) made any subsequent surgical interventions more difficult [4]. For these reasons, steroid injections are no longer recommended in the treatment of PD.…”

“…Aiming to build on the 2012 updates by Schaeffer and Burnett [3], and Serefoglu and Hellstrom [4], we placed emphasis on the most recent randomized controlled trials (RCTs) in order to provide the most accurate, scientifically based knowledge to guide clinical practice. See Table 1 [5-17] for a summary of recent studies, both RCTs and others, involving non-surgical treatments.…”