Peyronie’s Disease: An Outcomes-Based Guide to Non-Surgical and Novel Treatment Modalities

Abstract

The clinical landscape of Peyronie’s disease is everchanging. There has been growing interest in non-invasive therapeutic options that could assist patients with achieving a meaningful reduction in penile curvature without surgical intervention. These therapies are wide-ranging in terms of their mechanisms of action, efficacies, and short- and long-term safety profiles. Recently, an abundance of outcomes literature on longstanding and novel non-surgical treatment modalities has been published. For sexual medicine providers hoping to offer patients the most up-to-date and evidence-based treatments for the management of Peyronie’s disease, it can be challenging to gain a thorough understanding of this body of literature. In this clinical management review, the workup and current theories on the pathophysiology of Peyronie’s disease are reviewed, and the most recent outcomes data on the currently available non-surgical treatment modalities are presented. With an accurate understanding of the current landscape of Peyronie’s disease treatment, sexual health providers will be able to better evaluate and engage in evidence-based shared decision-making with their patients.

A combination of phosphodiesterase type 5 inhibitor and tamoxifen for acute Peyronie’s disease: the first clinical signals

“…PD has been reported to affect 0.3% to 13.1% of men in the general population, and the prevalence has been reported to increase with age, diabetes, hypertension, hyperlipidemia, Dupuytren's contracture, smoking, alcohol consumption, postradical prostatectomy, and erectile dysfunction. 1 While the exact pathophysiology of PD remains unclear, it is believed that microvascular trauma, or repetitive minor trauma, leads to inflammation in TA, which triggers the release of profibrotic cytokines such as transforming growth factor β1. Increased concentrations of transforming growth factor β1 for prolonged periods due to unresolved wound healing ultimately leads to transformation of resident fibroblasts to profibrotic myofibroblasts.…”

“…In the chronic phase, which follows the acute phase, the pain typically subsides, and the plaque becomes more organized and stable and eventually stops growing. 1 While limited clinical evidence exists for therapies that demonstrate consistent efficacy in the acute phase of PD, the options for chronic PD are limited to collagenase injection and surgery. Unfortunately, collagenase has been withdrawn from the UK and European Union market and is currently available in only the US market.…”