Contemporary Review of Peyronie’s Disease Treatment
- 28 Downloads
To analyze the literature on the current treatment options for Peyronie’s disease (PD).
Intracavernosal injection therapy using collagenase clostridium histolyticum (CCH) has been widely adopted since its FDA approval in 2013. Based on the current evidence, it appears to be moderately efficacious for men with mild curvatures. Although a recent study has shown similar outcomes using a modified protocol requiring fewer injections, CCH remains an expensive medication. Surgery provides the most definitive treatment. The most common adverse effect following surgery is perceived loss of length. Length restoration procedures have recently been developed to address this with promising results reported in small series.
There are a variety of medical treatment options for PD, with CCH getting the most attention for being the first drug to be FDA approved for PD treatment. It is the authors’ opinion that the non-surgical therapy most likely to provide meaningful results is combination therapy utilizing oral, intralesional, and external traction therapy. Surgery remains the gold standard for definitive treatment.
KeywordsInfertility Andrology Peyronie’s disease Treatment Intracavernosal injection therapy
Compliance with Ethical Standards
Conflict of Interest
Edward Capoccia declares no potential conflicts of interest.
Laurence A. Levine reports consultant and speaker fees from Boston Scientific and Coloplast.
Human and Animal Rights
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance
- 1.De la Peyronie F. Sur quelques obstacles quis opposent a l ejaculation naturelle de la semence. Mem Acad Roy Chir. 1743;1:423–34.Google Scholar
- 4.• Schwarzer U, Sommer F, Klotz T, Braun M, Reifenrath B, Engelmann U. The prevalence of Peyronie’s disease: results of a large survey. BJU Int. 2001;88(7):727–30. This was the first large cross-sectional study evaluating the prevalence of PD. The results helped demonstrate how PD is more widespread than previously thought. CrossRefPubMedGoogle Scholar
- 10.• Nehra A, Alterowitz R, Culkin DJ, et al. Peyronie's Disease: AUA Guideline. J Urol. 2015;194(3):745–53. A systematic review of the literature regarding the diagnosis and treatment of PD. Based on the review, guideline statements were created to help Urologists make evidence based decisions when treating patients with PD. CrossRefPubMedPubMedCentralGoogle Scholar
- 33.Palmieri A, Imbimbo C, Creta M, Verze P, Fusco F, Mirone V. Tadalafil once daily and extracorporeal shock wave therapy in the management of patients with Peyronie's disease and erectile dysfunction: results from a prospective randomized trial. Int J Androl. 2012;35(2):190–5.CrossRefPubMedGoogle Scholar
- 55.• Abdel raheem A, Johnson M, Abdel-raheem T, Capece M, Ralph D. Collagenase Clostridium histolyticum in the Treatment of Peyronie's Disease-A Review of the Literature and a New Modified Protocol. Sex Med Rev. 2017;5(4):529–35. Prospective study of 53 men with PD treatment with CCH using a modified protocol. The results showed the new shortened protocol to provide similar results compared to standard protocol with a significant decrease in cost and time commitment. CrossRefPubMedGoogle Scholar
- 56.• Cordon BH, Hofer MD, Hutchinson RC, Broderick GA, Lotan Y, Morey AF. Superior cost effectiveness of penile plication vs intralesional collagenase injection for treatment of Peyronie’s disease deformities. Urol Pract. 2017;4(2):118–25. A cost analysis was performed comparing CCH and penile plication. The average cost of plication surgery was $3,039 compared to $25,856 for a treatment course of CCH. CrossRefGoogle Scholar
- 65.• Martinez-Salamanca JI, Equi A, Moncada I, et al. Acute phase Peyronie’s disease management with traction device: a nonrandomized prospective controlled trial with ultrasound correlation. J Sex Med. 2014;11:506–15. 55 men underwent 6 months of PTT and were compared to 41 men who underwent no treatment. All men were in the active phase. Men who underwent PTT had a significant improvement in their curvature and erectile function when compared to the control group. CrossRefPubMedGoogle Scholar
- 68.Ostrowski KA, Gannon JA, Walsh TJA. Review of the epidemiology and treatment of Peyronie’s disease. Res Rep Urol. 2016;29:61–70.Google Scholar
- 74.Levine LA. Penile straightening with tunica albuginea plication procedure: TAP procedure. In: Levine LA, editor. Peyronie’s disease: a guide to clinical management Totowa, NJ; Humana; 2006. p. 151–60.Google Scholar
- 81.Rybak J, Papagiannopoulos D, Levine L. A retrospective comparative study of traction therapy vs. no traction following tunica albuginea plication or partial excision and grafting for Peyronie’s disease: measured lengths and patient perceptions. J Sex Med. 2012;9:2396–403.CrossRefPubMedGoogle Scholar
- 86.Rolle L, Ceruti C, Timpano M, Sedigh O, Destefanis P, Galletto E, et al. A new, innovative, lengthening surgical procedure for Peyronie’s disease by penile prosthesis implantation with double dorsal-ventral patch graft: the “sliding technique”. J Sex Med. 2012;9(9):2389–95.CrossRefPubMedGoogle Scholar
- 87.• Morey AF. Re: Penile lengthening and widening without grafting according to a modified ‘sliding’ technique. J Urol. 2016;195(6):1822–3. A modified sliding technique was performed on 143 patients to determine the feasibility and safety of this length and girth restoring procedure. The authors reported a mean length gain of 3.1 cm. Google Scholar
- 88.• Wilson SK, Mora-estaves C, Egydio P, et al. Glans necrosis following penile prosthesis implantation: prevention and treatment suggestions. Urology. 2017;107:144–8. Examined 21 patients who had glans necrosis following penile prosthesis implantation to better determine the etiology. Risk factors for glans necrosis include cardiovascular disease, diabetes, using sliding technique, and subcoronal incision. CrossRefPubMedGoogle Scholar