Peyronie's Disease: Evaluation and Review of Nonsurgical Therapy

Abstract

The purpose of our study was to outline the evaluation of the Peyronie's disease (PD) patient and review the available nonsurgical treatments. A review of the literature on oral, intralesional, external energy, iontophoresis, and mechanical therapies for PD was performed. PubMed was utilized to find all published articles, and several meeting abstracts were reviewed for data ahead of publication. Our medical evaluation of the PD patient is described. The published results of available treatment options are reviewed, with recommendation by the authors for appropriate nonsurgical management of PD. There are no available validated questionnaires for PD, but a thorough history and focused physical examination, including measurement of erect penile deformity, will help the clinician make the diagnosis and guide treatment options. Although there are many published reports that show efficacy of nonsurgical therapies for PD, there is a lack of large-scale, multicenter, controlled clinical trials, which makes treatment recommendations difficult. Careful review of the literature does suggest that there are treatment options that make scientific sense and appear to stabilize the disease process, reduce deformity, and improve function. Offering no treatment at all will encourage our patients to pursue alternative treatments that may do harm, and misses the opportunity to do some good. Clearly, further work is necessary to develop safe and effective nonsurgical treatments for PD.

A Population-Based Study of Peyronie's Disease: Prevalence and Treatment Patterns in the United States

“…Therefore, physicians have to base treatment recommendations for nonsurgical options on limited placebo-controlled clinical trial support [ 9 , 36 , 37 ]. This may lead some physicians to offer expectant management as opposed to potentially ineffective nonsurgical therapies [ 38 ]. Penile operations and injection treatments were uncommon among PD patients.…”

Safety and tolerability of local treatment with iloprost, a prostacyclin analogue, in patients with Peyronie's disease: a phase I study

“…The completion of phase I requires a further study on a larger scale which should also contemplate the use of concentrations higher of 400 ng and/or more frequent sessions. Regarding the efficacy, the need to use measurable parameters (in addition to AHP) to clearly define the progress of therapy led us to use a subjective questionnaire that takes into account the whole spectrum of symptoms and their modifications [26–29]. Owing to the small sample size of the present study, and the fact that it was not randomized and had no placebo control group, evaluation of efficacy is limited, but the present data warrant future investigation to obtain a more significant improvement of the disease.…”