Abstract
Peyronie's disease is a fibrotic disorder of the tunica albuginea of the penis resulting in varying degrees of penile curvature and sexual dysfunction. Diagnosis of the disorder is made by detailed sexual history and focused physical examination. A wide range of medical treatments has been employed to treat the disorder. Verapamil treatment administered by intraplaque injection is supported by generally consistent randomized controlled trials (RCT). Some RCT evidence exists to support the use of colchicine, potaba, L-carnitine and liposomal superoxide dismutase. Future studies of medical efficacy should focus on improving RCT design, implementation and results reporting to improve the quality of evidence generated by each study. The surgical treatment of Peyronie's disease is a viable and recommended alternative for men with compromised sexual function due to severe curvature or lesions causing penile instability. The choice of corrective procedure should be tailored to each patient after a detailed evaluation of disease severity and sexual function.
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References
Taylor FL, Levine LA . Peyronie's disease. Urol Clin North Am 2007; 34: 517.
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: 727.
Rhoden EL, Teloken C, Ting HY, Lucas ML, Teodosio da Ros C, Ary Vargas Souto C . Prevalence of Peyronie's disease in men over 50-y-old from Southern Brazil. Int J Impot Res 2001; 13: 291.
Mulhall JP, Creech SD, Boorjian SA, Ghaly S, Kim ED, Moty A et al. Subjective and objective analysis of the prevalence of Peyronie's disease in a population of men presenting for prostate cancer screening. J Urol 2004; 171: 2350.
Kadioglu A, Oktar T, Kandirali E, Kendirci M, Sanli O, Ozsoy C . Incidentally diagnosed Peyronie's disease in men presenting with erectile dysfunction. Int J Impot Res 2004; 16: 540.
Lindsay MB, Schain DM, Grambsch P, Benson RC, Beard CM, Kurland LT . The incidence of Peyronie's disease in Rochester, Minnesota, 1950 through 1984. J Urol 1991; 146: 1007.
Jordan G . Peyronie's disease. In: Kavoussi L, Novick A, Partin A, et al. (eds). Campbell-Walsh Urology, 9th edn., Vol 1. Saunders Elsevier: Philadelphia, 2007, pp 818–838.
Mulhall JP, Schiff J, Guhring P . An analysis of the natural history of Peyronie's disease. J Urol 2006; 175: 2115.
Jordan G . Peyronie's disease. In: Campbell M, Walsh P (eds). Campbell-Walsh Urology 2006.
Zargooshi J . Trauma as the cause of Peyronie's disease: penile fracture as a model of trauma. J Urol 2004; 172: 186.
Somers KD, Dawson DM . Fibrin deposition in Peyronie's disease plaque. J Urol 1997; 157: 311.
Afsar H, Sozduyar N . Urethral manipulation syndrome (Kelamy syndrome): acquired ventral penile deviation. Arch Ital Urol Nefrol Androl 1992; 64: 349.
Kelami A . Urethral manipulation syndrome. Description of a new syndrome. Urol Int 1984; 39: 352.
Merkle W . Cause of deviation of the erectile penis after urethral manipulations (Kelami syndrome)—demonstration of ultrasound findings and case reports. Urol Int 1990; 45: 183.
Lyles KW, Gold DT, Newton RA, Parekh S, Shipp KM, Pieper CF et al. Peyronie's disease is associated with Paget's disease of bone. J Bone Miner Res 1997; 12: 929.
Qian A, Meals R, Rajfer J . Comparison of gene expression profiles between Peyronie's disease and Dupuytren's contracture. Urology 2004; 64: 399.
Jordan GH, Angermeier KW . Preoperative evaluation of erectile function with dynamic infusion cavernosometry/cavernosography in patients undergoing surgery for Peyronie's disease: correlation with postoperative results. J Urol 1993; 150: 1138.
Ralph DJ, Hughes T, Lees WR, Pryor JP . Pre-operative assessment of Peyronie's disease using colour Doppler sonography. Br J Urol 1992; 69: 629.
Jarow JP, Lowe FC . Penile trauma: an etiologic factor in Peyronie's disease and erectile dysfunction. J Urol 1997; 158: 1388.
Deveci S, Palese M, Parker M, Guhring P, Mulhall JP . Erectile function profiles in men with Peyronie's disease. J Urol 2006; 175: 1807.
Kendirci M, Trost L, Sikka SC, Hellstrom WJ . Diabetes mellitus is associated with severe Peyronie's disease. BJU Int 2007; 99: 383.
Rosen R, Henne J, Catania J, Althof S . Patient-reported psychosocial impact of Peyronie's disease. J Sex Med 2008; 5 (Suppl 1):39.
Smith JF, Conti S, Walsh TJ, Garcia M, Turek PJ, Lue TF . Risk factors for emotional and relationship problems in Peyronie's disease. J Sex Med 2008; 5 (Suppl):40.
Levine LA, Greenfield JM . Establishing a standardized evaluation of the man with Peyronie's disease. Int J Impot Res 2003; 15 (Suppl 5): S103.
Ohebshalom M, Mulhall J, Guhring P, Parker M . Measurement of penile curvature in Peyronie's disease patients: comparison of three methods. J Sex Med 2007; 4: 199.
Aversa A, Sarteschi LM . The role of penile color-duplex ultrasound for the evaluation of erectile dysfunction. J Sex Med 2007; 4: 1437.
Andresen R, Wegner HE, Miller K, Banzer D . Imaging modalities in Peyronie's disease. An intrapersonal comparison of ultrasound sonography, X-ray in mammography technique, computerized tomography, and nuclear magnetic resonance in 20 patients. Eur Urol 1998; 34: 128.
Hauck EW, Hackstein N, Vosshenrich R, Diemer T, Schmelz HU, Bschleipfer T et al. Diagnostic value of magnetic resonance imaging in Peyronie's disease—a comparison both with palpation and ultrasound in the evaluation of plaque formation. Eur Urol 2003; 43: 293.
Brant WO, Bella AJ, Garcia MM, Tantiwongse K, Dean RC, Lue TF . Isolated septal fibrosis or hematoma—atypical Peyronie's disease? J Urol 2007; 177: 179.
Brock G, Hsu GL, Nunes L, von Heyden B, Lue TF . The anatomy of the tunica albuginea in the normal penis and Peyronie's disease. J Urol 1997; 157: 276.
Glasziou P . Levels of evidence. In: Centre for Evidence Based Medicine, ed. 2001, url: http://www.cebm.net/index.aspx?0=1025.
Rehman J, Benet A, Melman A . Use of intralesional verapamil to dissolve Peyronie's disease plaque: a long-term single-blind study. Urology 1998; 51: 620.
Cavallini G, Biagiotti G, Koverech A, Vitali G . Oral propionyl-l-carnitine and intraplaque verapamil in the therapy of advanced and resistant Peyronie's disease. BJU Int 2002; 89: 895.
Di Stasi SM, Giannantoni A, Stephen RL, Capelli G, Giurioli A, Jannini EA et al. A prospective, randomized study using transdermal electromotive administration of verapamil and dexamethasone for Peyronie's disease. J Urol 2004; 171: 1605.
Cavallini G, Modenini F, Vitali G . Open preliminary randomized prospective clinical trial of efficacy and safety of three different verapamil dilutions for intraplaque therapy of Peyronie's disease. Urology 2007; 69: 950.
Fitch III WP, Easterling WJ, Talbert RL, Bordovsky MJ, Mosier M . Topical verapamil HCl, topical trifluoperazine, and topical magnesium sulfate for the treatment of Peyronie's disease—a placebo-controlled pilot study. J Sex Med 2007; 4: 477.
Greenfield JM, Shah SJ, Levine LA . Verapamil versus saline in electromotive drug administration for Peyronie's disease: a double-blind, placebo controlled trial. J Urol 2007; 177: 972.
Inal T, Tokatli Z, Akand M, Ozdiler E, Yaman O . Effect of intralesional interferon-alpha 2b combined with oral vitamin E for treatment of early stage Peyronie's disease: a randomized and prospective study. Urology 2006; 67: 1038.
Weidner W, Hauck EW, Schnitker J . Potassium paraaminobenzoate (POTABA) in the treatment of Peyronie's disease: a prospective, placebo-controlled, randomized study. Eur Urol 2005; 47: 530.
Prieto Castro RM, Leva Vallejo ME, Regueiro Lopez JC, Anglada Curado FJ, Alvarez Kindelan J, Requena Tapia MJ . Combined treatment with vitamin E and colchicine in the early stages of Peyronie's disease. BJU Int 2003; 91: 522.
Safarinejad MR, Hosseini SY, Kolahi AA . Comparison of vitamin E and propionyl-L-carnitine, separately or in combination, in patients with early chronic Peyronie's disease: a double-blind, placebo controlled, randomized study. J Urol 2007; 178: 1398.
Teloken C, Rhoden EL, Grazziotin TM, Ros CT, Sogari PR, Souto CA . Tamoxifen versus placebo in the treatment of Peyronie's disease. J Urol 1999; 162: 2003.
Biagiotti G, Cavallini G . Acetyl-L-carnitine vs tamoxifen in the oral therapy of Peyronie's disease: a preliminary report. BJU Int 2001; 88: 63.
Montorsi F, Salonia A, Guazzoni G, Barbieri L, Colombo R, Brausi M et al. Transdermal electromotive multi-drug administration for Peyronie's disease: preliminary results. J Androl 2000; 21: 85.
Riedl CR, Sternig P, Galle G, Langmann F, Vcelar B, Vorauer K et al. Liposomal recombinant human superoxide dismutase for the treatment of Peyronie's disease: a randomized placebo-controlled double-blind prospective clinical study. Eur Urol 2005; 48: 656.
Safarinejad MR . Therapeutic effects of colchicine in the management of Peyronie's disease: a randomized double-blind, placebo-controlled study. Int J Impot Res 2004; 16: 238.
Wagenknecht LV . Differential therapies in various stages of penile induration. Arch Esp Urol 1996; 49: 285.
Carson CC . Potassium para-aminobenzoate for the treatment of Peyronie's disease: is it effective? Tech Urol 1997; 3: 135.
Bremer J . Carnitine—metabolism and functions. Physiol Rev 1983; 63: 1420.
Karlic H, Lohninger A . Supplementation of L-carnitine in athletes: does it make sense? Nutrition 2004; 20: 709.
Trost LW, Gur S, Hellstrom WJ . Pharmacological management of Peyronie's disease. Drugs 2007; 67: 527.
Azzi A . Molecular mechanism of alpha-tocopherol action. Free Radic Biol Med 2007; 43: 16.
Diegelmann RF, Peterkofsky B . Inhibition of collagen secretion from bone and cultured fibroblasts by microtubular disruptive drugs. Proc Natl Acad Sci USA 1972; 69: 892.
Cannella AC, Mikuls TR . Understanding treatments for gout. Am J Manag Care 2005; 11: S451.
Colletta AA, Wakefield LM, Howell FV, van Roozendaal KE, Danielpour D, Ebbs SR et al. Anti-oestrogens induce the secretion of active transforming growth factor beta from human fetal fibroblasts. Br J Cancer 1990; 62: 405.
Hauck EW, Diemer T, Schmelz HU, Weidner W . A critical analysis of nonsurgical treatment of Peyronie's disease. Eur Urol 2006; 49: 987.
Delanian S, Porcher R, Balla-Mekias S, Lefaix JL . Randomized, placebo-controlled trial of combined pentoxifylline and tocopherol for regression of superficial radiation-induced fibrosis. J Clin Oncol 2003; 21: 2545.
Tittelbach J, Graefe T, Wollina U . Painful ulcers in calciphylaxis—combined treatment with maggot therapy and oral pentoxyfillin. J Dermatolog Treat 2001; 12: 211.
Boldt J, Brosch C, Lehmann A, Haisch G, Lang J, Isgro F . Prophylactic use of pentoxifylline on inflammation in elderly cardiac surgery patients. Ann Thorac Surg 2001; 71: 1524.
Aygenc E, Celikkanat S, Kaymakci M, Aksaray F, Ozdem C . Prophylactic effect of pentoxifylline on radiotherapy complications: a clinical study. Otolaryngol Head Neck Surg 2004; 130: 351.
Boldt J, Brosch C, Piper SN, Suttner S, Lehmann A, Werling C . Influence of prophylactic use of pentoxifylline on postoperative organ function in elderly cardiac surgery patients. Crit Care Med 2001; 29: 952.
Noel C, Copin MC, Hazzan M, Labalette M, Susen S, Lelievre G et al. Immunomodulatory effect of pentoxifylline during human allograft rejection: involvement of tumor necrosis factor-alpha and adhesion molecules. Transplantation 2000; 69: 1102.
McCarty MF . Interleukin-6 as a central mediator of cardiovascular risk associated with chronic inflammation, smoking, diabetes, and visceral obesity: down-regulation with essential fatty acids, ethanol and pentoxifylline. Med Hypotheses 1999; 52: 465.
Valente EG, Vernet D, Ferrini MG, Qian A, Rajfer J, Gonzalez-Cadavid NF . -arginine and phosphodiesterase (PDE) inhibitors counteract fibrosis in the Peyronie's fibrotic plaque and related fibroblast cultures. Nitric Oxide 2003; 9: 229.
Takami M, Cho ES, Lee SY, Kamijo R, Yim M . Phosphodiesterase inhibitors stimulate osteoclast formation via TRANCE/RANKL expression in osteoblasts: possible involvement of ERK and p38 MAPK pathways. FEBS Lett 2005; 579: 832.
Rajfer J, Gore JL, Kaufman J, Gonzalez-Cadavid N . Case report: avoidance of palpable corporal fibrosis due to priapism with upregulators of nitric oxide. J Sex Med 2006; 3: 173.
Brant WO, Dean RC, Lue TF . Treatment of Peyronie's disease with oral pentoxifylline. Nat Clin Pract Urol 2006; 3: 111.
Micromedex, Pentoxifylline: Adverse Effects. Thomson, 2008.
Morgan RJ, Pryor JP . Procarbazine (Natulan) in the treatment of Peyronie's disease. Br J Urol 1978; 50: 111.
Bystrom J . Induration penis plastica. Experience of treatment with procarbazine Natulan. Scand J Urol Nephrol 1976; 10: 21.
Oosterlinck W, Renders G . Treatment of Peyronie's disease with procarbazine. Br J Urol 1975; 47: 219.
Martin DJ, Badwan K, Parker M, Mulhall JP . Transdermal application of verapamil gel to the penile shaft fails to infiltrate the tunica albuginea. J Urol 2002; 168: 2483.
Bartsch G, Menander-Huber KB, Huber W, Marberger H . Orgotein, a new drug for the treatment of Peyronie's disease. Eur J Rheumatol Inflamm 1981; 4: 250.
Gustafson H, Johansson B, Edsmyr F . Peyronie's disease: experience of local treatment with Orgotein. Eur Urol 1981; 7: 346.
Duncan MR, Hasan A, Berman B . Pentoxifylline, pentifylline, and interferons decrease type I and III procollagen mRNA levels in dermal fibroblasts: evidence for mediation by nuclear factor 1 down-regulation. J Invest Dermatol 1995; 104: 282.
Duncan MR, Berman B, Nseyo UO . Regulation of the proliferation and biosynthetic activities of cultured human Peyronie's disease fibroblasts by interferons-alpha, -beta and -gamma. Scand J Urol Nephrol 1991; 25: 89.
Hellstrom WJ, Kendirci M, Matern R, Cockerham Y, Myers L, Sikka SC et al. Single-blind, multicenter, placebo controlled, parallel study to assess the safety and efficacy of intralesional interferon alpha-2B for minimally invasive treatment for Peyronie's disease. J Urol 2006; 176: 394.
Jordan GH . The use of intralesional clostridial collagenase injection therapy for Peyronie's disease: a prospective, single-center, non-placebo-controlled study. J Sex Med 2008; 5: 180.
Gelbard MK, Lindner A, Kaufman JJ . The use of collagenase in the treatment of Peyronie's disease. J Urol 1985; 134: 280.
Lee RC, Ping JA . Calcium antagonists retard extracellular matrix production in connective tissue equivalent. J Surg Res 1990; 49: 463.
Begg C, Cho M, Eastwood S, Horton R, Moher D, Olkin I et al. Improving the quality of reporting of randomized controlled trials. The CONSORT statement. JAMA 1996; 276: 637.
Moher D, Schulz KF, Altman D . The CONSORT statement: revised recommendations for improving the quality of reports of parallel-group randomized trials. JAMA 2001; 285: 1987.
Claro JA, Passerotti CC, Figueiredo Neto AC, Nardozza Jr A, Ortiz V, Srougi M . An alternative non-invasive treatment for Peyronie's disease. Int Braz J Urol 2004; 30: 199.
Abdel-Salam Y, Budair Z, Renner C, Frede T, Rassweiler J, El-Annany F et al. Treatment of Peyronie's disease by extracorporeal shockwave therapy: evaluation of our preliminary results. J Endourol 1999; 13: 549.
Skolarikos A, Alargof E, Rigas A, Deliveliotis C, Konstantinidis E . Shockwave therapy as first-line treatment for Peyronie's disease: a prospective study. J Endourol 2005; 19: 11.
Hauck EW, Mueller UO, Bschleipfer T, Schmelz HU, Diemer T, Weidner W . Extracorporeal shock wave therapy for Peyronie's disease: exploratory meta-analysis of clinical trials. J Urol 2004; 171: 740.
Abern M, Levine L . Intralesional verapamil injections with and without penile traction and oral therapies for management of Peyronie's disease. Abstract AUA National Meeting 2008.
Gontero P, Di Marco M, Giubilei G, Tizzani A, Fontana F, Bartoletti N . Penile extender device in the treatment of penile curvature due to Peyronie's disease. Results of a phase II prospective study. Abstract AUA National Meeting 2008.
Furlow WL, Swenson Jr HE, Lee RE . Peyronie's disease: a study of its natural history and treatment with orthovoltage radiotherapy. J Urol 1975; 114: 69.
Mulhall J, Ahmed A, Anderson M . Penile prosthetic surgery for Peyronie's disease: defining the need for intraoperative adjuvant maneuvers. J Sex Med 2004; 1: 318.
Nesbit RM . Congenital curvature of the phallus: report of three cases with description of corrective operation. J Urol 1965; 93: 230.
Yachia D . Modified corporoplasty for the treatment of penile curvature. J Urol 1990; 143: 80.
Savoca G, Scieri F, Pietropaolo F, Garaffa G, Belgrano E . Straightening corporoplasty for Peyronie's disease: a review of 218 patients with median follow-up of 89 months. Eur Urol 2004; 46: 610.
Rehman J, Benet A, Minsky LS, Melman A . Results of surgical treatment for abnormal penile curvature: Peyronie's disease and congenital deviation by modified Nesbit plication (tunical shaving and plication). J Urol 1997; 157: 1288.
Donatucci CF, Lue TF . Correction of penile deformity assisted by intracavernous injection of papaverine. J Urol 1992; 147: 1108.
Gholami SS, Lue TF . Correction of penile curvature using the 16-dot plication technique: a review of 132 patients. J Urol 2002; 167: 2066.
Kadioglu A, Akman T, Sanli O, Gurkan L, Cakan M, Celtik M . Surgical treatment of Peyronie's disease: a critical analysis. Eur Urol 2006; 50: 235.
Brant WO, Bella AJ, Garcia MM, Tantiwongse K, Lue TF . Surgical Atlas. Correction of Peyronie's disease: plaque incision and grafting. BJU Int 2006; 97: 1353.
El-Sakka AI, Rashwan HM, Lue TF . Venous patch graft for Peyronie's disease. Part II: outcome analysis. J Urol 1998; 160: 2050.
Kadioglu A, Sanli O, Akman T, Ersay A, Guven S, Mammadov F . Graft materials in Peyronie's disease surgery: a comprehensive review. J Sex Med 2007; 4: 581.
Knoll LD . Use of small intestinal submucosa graft for the surgical management of Peyronie's disease. J Urol 2007; 178: 2474.
Breyer BN, Brant WO, Garcia MM, Bella AJ, Lue TF . Complications of porcine small intestine submucosa graft for Peyronie's disease. J Urol 2007; 177: 589.
Kalsi JS, Christopher N, Ralph DJ, Minhas S . Plaque incision and fascia lata grafting in the surgical management of Peyronie's disease. BJU Int 2006; 98: 110.
Krishnamurti S . Penile dermal flap for defect reconstruction in Peyronie's disease: operative technique and four years' experience in 17 patients. Int J Impot Res 1995; 7: 195.
Hatzichristou DG, Hatzimouratidis K, Apostolidis A, Tzortzis V, Bekos A, Ioannidis E . Corporoplasty using tunica albuginea free grafts for penile curvature: surgical technique and long-term results. J Urol 2002; 167: 1367.
Teloken C, Grazziotin T, Rhoden E, Da Ros C, Fornari A, Soares FC et al. Penile straightening with crural graft of the corpus cavernosum. J Urol 2000; 164: 107.
Schwarzer JU, Muhlen B, Schukai O . Penile corporoplasty using tunica albuginea free graft from proximal corpus cavernosum: a new technique for treatment of penile curvature in Peyronie's disease. Eur Urol 2003; 44: 720.
Montorsi F, Salonia A, Maga T, Bua L, Guazzoni G, Barbieri L et al. Evidence based assessment of long-term results of plaque incision and vein grafting for Peyronie's disease. J Urol 2000; 163: 1704.
Hellstrom WJ, Usta MF . Surgical approaches for advanced Peyronie's disease patients. Int J Impot Res 2003; 15 (Suppl 5): S121.
Mulcahy JJ, Wilson SK . Management of Peyronie's disease with penile prostheses. Int J Impot Res 2002; 14: 384.
Wilson SK, Delk II JR . A new treatment for Peyronie's disease: modeling the penis over an inflatable penile prosthesis. J Urol 1994; 152: 1121.
Akin-Olugbade O, Parker M, Guhring P, Mulhall J . Determinants of patient satisfaction following penile prosthesis surgery. J Sex Med 2006; 3: 743.
Wilson SK, Delk II JR, Salem E . Long-term survival of inflatable penile prostheses: single surgical group experience with 2384 first-time implants spanning two decades. J Sex Med 2007; 4: 1074.
Ghanem HM, Fahmy I, el-Meliegy A . Malleable penile implants without plaque surgery in the treatment of Peyronie's disease. Int J Impot Res 1998; 10: 171.
Carson CC . Penile prosthesis implantation in the treatment of Peyronie's disease. Int J Impot Res 1998; 10: 125.
Carson CC . Penile prosthesis implantation in the treatment of Peyronie's disease and erectile dysfunction. Int J Impot Res 2000; 12 (Suppl 4): S122.
Carson CC, Mulcahy JJ, Govier FE . Efficacy, safety and patient satisfaction outcomes of the AMS 700CX inflatable penile prosthesis: results of a long-term multicenter study. AMS 700CX Study Group. J Urol 2000; 164: 376.
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Smith, J., Walsh, T. & Lue, T. Peyronie's disease: a critical appraisal of current diagnosis and treatment. Int J Impot Res 20, 445–459 (2008). https://doi.org/10.1038/ijir.2008.30
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