Peyronie’s Disease: Lights and Shadows

Abstract

Peyronie’s disease (PD) is characterized by the onset of fibrous plaque inside the tunica albuginea of the penile corpora cavernosa that can cause pain and bending during the erection, making intercourse difficult or impossible. Evidence of the literature supports the autoimmune etiology of PD and suggests genetic and familiar conditions, penile traumatisms, and a history of genital tract diseases as risk factors, but no definitive conclusions arise about the pathogenesis of the disease. Few randomized trials demonstrated that medical therapies, such as vitamin E, colchicine, potassium aminobenzoate, tamoxifen, and injection therapy with verapamil, can stabilize the acute phase of the disease. Extracorporeal shock wave therapy and iontophoresis cannot be considered first-line or gold standard therapies. Satisfactory results have been published with the Nesbit operation in large series with low-stage disease, whereas plication procedures have shown significant relapse rates. A high incidence of long-term penile retractions has been reported in high-stage disease treated with plaque incision and simple graft insertion. Malleable, soft, or inflatable prostheses combined with graft implantation have given the best results in terms of penile straightening and lengthening and patient satisfaction. In conclusion, the etiopathogenesis of PD is not yet clearly understood, no medical therapy is fully effective, and surgery remains the gold standard in patients with severe deformity and/or erectile dysfunction.

An overview on therapeutic potential and various applications of microbial collagenases

“…This was proved to be successful with the use of injectable C. histolyticum collagenase [102][103][104][105][106][107][108]. Collagenase from C. histolyticum, lyses collagen and leads to disruption of contracted cords [109], was thought as new, minimally invasive, nonsurgical, investigational option for the treatment of advanced Dupuytren's disease. However, this treatment does not require anesthesia.…”

A Reappraisal of Saphenous Vein Grafting

“…The penile deep dorsal vein, inferior tibial vein, and saphenous vein are the grafts of choice in the surgical treatment of shortened penis caused by Peyronie disease 111. The plaque incision with saphenous vein grafting, known as a Lue procedure is now the standard operation for treating penile shortening due to Peyronie disease 112.…”

The emerging role of <em>Clostridium histolyticum</em> collagenase in the treatment of Dupuytren disease

“…It is commonly bilateral, with a pathological transformation of the fascial tissues into thickened fibrous nodules and cords which, on progression to the advanced stage of the disease, result in irreversible flexion contractures of the involved digits 19. DD can be associated with extra-palmar ectopic fibrosis over the knuckle pads, known as Garrod nodes;20 in the sole of the foot, known as Lederhose disease or plantar fibromatosis;21 formation of fibrotic plaques within the corpora cavernosal tunica albuginea, resulting in penile bending during erections, known as Peyronie disease (PD);22 and, uncommonly, with involvement of the wrist20 or with nodular fasciitis in the popliteal space 19…”