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Medical management of Peyronie's disease.
J Androl. 2009 Jul-Aug; 30(4):397-405.JA

Abstract

Peyronie's disease (PD) is a wound-healing disorder in which a fibrotic plaque forms in the tunica albuginea layer of the penis. It clinically presents as any combination of penile pain, angulation, and erectile dysfunction. Recent studies indicate that PD has a prevalence of 3%-9% in adult men. Although the exact etiology has not been established, PD likely results from a predisposing genetic susceptibility combined with an inciting event such as microtrauma during intercourse. During the initial acute phase (6-18 months), the condition may progress, stabilize, or regress. For this reason authorities recommend a more conservative treatment approach, with a trial of oral and/or intralesional pharmacotherapy, before surgical reconstruction is considered. Oral therapies most commonly employed include tocopherol (vitamin E) and paraaminobenzoate (Potaba), with colchicine, tamoxifen, propoleum, and acetyl-L-carnitine being used less often. There are a limited number of long-term placebo-controlled studies with these oral agents, and for the most part, studies have failed to show a consistent beneficial effect. Intralesional injection therapy for PD is more commonly used as a first-line therapy. The current standard of care includes injection with interferon-alpha-2b, verapamil, or collagenase. Interferon-alpha-2b, in particular, has been documented in a large, multicenter, placebo-controlled study to show significant benefit over placebo in decreasing penile curvature, plaque size, penile pain, and plaque density. However, intralesional interferon is associated with posttreatment flu-like symptoms unless patients are premedicated with a nonsteroid anti-inflammatory agent. Other available therapies that have not consistently shown efficacy in placebo-controlled studies include corticosteroids, orgotein, radiation, and extracorporeal shockwave therapy. Surgery is considered when men with PD do not respond to conservative or medical therapy for approximately 1 year and cannot perform satisfactory sexual intercourse. Ongoing basic research in PD will likely identify future targets for medical exploitation.

Authors+Show Affiliations

Tulane University School of Medicine, Department of Urology, 1430 Tulane Ave, New Orleans, LA 70112-2699, USA. whellst@tulane.edu

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

18974422

Citation

Hellstrom, Wayne J G.. "Medical Management of Peyronie's Disease." Journal of Andrology, vol. 30, no. 4, 2009, pp. 397-405.
Hellstrom WJ. Medical management of Peyronie's disease. J Androl. 2009;30(4):397-405.
Hellstrom, W. J. (2009). Medical management of Peyronie's disease. Journal of Andrology, 30(4), 397-405. https://doi.org/10.2164/jandrol.108.006221
Hellstrom WJ. Medical Management of Peyronie's Disease. J Androl. 2009 Jul-Aug;30(4):397-405. PubMed PMID: 18974422.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Medical management of Peyronie's disease. A1 - Hellstrom,Wayne J G, Y1 - 2008/10/30/ PY - 2008/11/1/pubmed PY - 2009/10/27/medline PY - 2008/11/1/entrez SP - 397 EP - 405 JF - Journal of andrology JO - J Androl VL - 30 IS - 4 N2 - Peyronie's disease (PD) is a wound-healing disorder in which a fibrotic plaque forms in the tunica albuginea layer of the penis. It clinically presents as any combination of penile pain, angulation, and erectile dysfunction. Recent studies indicate that PD has a prevalence of 3%-9% in adult men. Although the exact etiology has not been established, PD likely results from a predisposing genetic susceptibility combined with an inciting event such as microtrauma during intercourse. During the initial acute phase (6-18 months), the condition may progress, stabilize, or regress. For this reason authorities recommend a more conservative treatment approach, with a trial of oral and/or intralesional pharmacotherapy, before surgical reconstruction is considered. Oral therapies most commonly employed include tocopherol (vitamin E) and paraaminobenzoate (Potaba), with colchicine, tamoxifen, propoleum, and acetyl-L-carnitine being used less often. There are a limited number of long-term placebo-controlled studies with these oral agents, and for the most part, studies have failed to show a consistent beneficial effect. Intralesional injection therapy for PD is more commonly used as a first-line therapy. The current standard of care includes injection with interferon-alpha-2b, verapamil, or collagenase. Interferon-alpha-2b, in particular, has been documented in a large, multicenter, placebo-controlled study to show significant benefit over placebo in decreasing penile curvature, plaque size, penile pain, and plaque density. However, intralesional interferon is associated with posttreatment flu-like symptoms unless patients are premedicated with a nonsteroid anti-inflammatory agent. Other available therapies that have not consistently shown efficacy in placebo-controlled studies include corticosteroids, orgotein, radiation, and extracorporeal shockwave therapy. Surgery is considered when men with PD do not respond to conservative or medical therapy for approximately 1 year and cannot perform satisfactory sexual intercourse. Ongoing basic research in PD will likely identify future targets for medical exploitation. SN - 1939-4640 UR - https://wwww.unboundmedicine.com/medline/citation/18974422/Medical_management_of_Peyronie's_disease_ L2 - https://doi.org/10.2164/jandrol.108.006221 DB - PRIME DP - Unbound Medicine ER -