Antonio Minore et al., 2024: Intralesional and topical treatments for Peyronie's disease: a narrative review of current knowledge

Friday, 06 December 2024

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Antonio Minore 1, Loris Cacciatore 1, Fabrizio Presicce 2, Andrea Iannuzzi 1, Antonio Testa 1, Gianluigi Raso 1, Rocco Papalia 1, Marco Martini 2, Roberto Mario Scarpa 1, Francesco Esperto 1
1Department of Urology, Campus Bio-Medico, University of Rome, Rome 00128, Italy.
2Department of Urology, San Filippo Neri Hospital, Rome 00135, Italy.

Abstract

Peyronie's disease (PD) presents a multifaceted challenge in contemporary urological practice, marked by penile deformity, pain, and the potential for erectile dysfunction. We meticulously explored the existing literature of intralesional/topical interventions, aiming to provide clinicians with a nuanced understanding of available options for comprehensive PD management. To conduct this review, we performed a systematic search using the PubMed, Scopus, and ScienceDirect databases, including the keywords of combination of the "Peyronie's disease/plastic induration of the penis (PIP) and intralesional/topical treatments". The study selection was based on adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, resulting in the inclusion of 16 articles. We delve into the effectiveness and safety profiles of collagenase Clostridium histolyticum (CCH), interferon, platelet-rich plasma (PRP), hyaluronic acid, botulinum toxin, stem cell, extracorporeal shock wave therapy (ESWT), and traction therapy, assessing their impact on penile curvature, length improvement, and patient-reported symptoms and outcomes. The best options evaluated are intralesional injections of CCH and penile traction devices, alone or in combination. Despite PD remains a challenge for urologists, the objective of this review is to contribute to the evolving landscape of PD management, fostering informed decision-making, and personalized care for individuals grappling with this challenging condition.

Asian J Androl. 2024 Aug 23. doi: 10.4103/aja202460. Online ahead of print. PMID: 39177048
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Comments 1

Jens Rassweiler on Friday, 06 December 2024 10:00

Introduction: Peyronie's disease (PD) is characterized by fibrous plaques in the tunica albuginea (TA) of the penis, leading to deformities such as curvature and shortening. The condition progresses through two phases:

• Acute Phase: Lasting up to 18 months, with pain, inflammation, and rapid plaque growth.
• Chronic Phase: Stabilized plaques with persistent curvature and reduced pain.

PD can have significant physical and psychological impacts, including erectile dysfunction. While surgical options exist for severe cases, conservative treatments for mild-to-moderate PD have mixed results.

Current Treatments: The review highlights several intralesional and topical treatments:

1. Collagenase Clostridium Histolyticum (CCH):
o The only FDA-approved noninvasive treatment for PD.
o Administered in cycles, primarily during the chronic phase.
o Studies show improvements in penile curvature and patient satisfaction, though outcomes vary with plaque characteristics (e.g., calcification).
o Combination therapies, such as CCH with sildenafil or penile traction, enhance results.
o However, CCH is not approved by EMA

2. Interferon α-2b (IFN-α2b):
o Reduces collagen production and plaque size.
o Promising results in preliminary studies but requires further research.

3. Penile Traction Devices (PTDs):
o Stretch the penis to reduce curvature and improve length.
o Devices like RestoreX show higher patient compliance and better outcomes compared to traditional PTDs.

4. Shock Wave Therapy (SWT):
o Reduces pain and supports tissue repair.
o Effective for symptom management but not recommended as a standalone treatment for curvature.
o For reduction of curvature, higher shock wave energy necessary

5. Laser Therapy (LT):
o Uses advanced lasers to inhibit fibroblast activity and reduce scarring.
o Limited adoption due to varying protocols, but recent studies show positive long-term outcomes.

6. Platelet-Rich Plasma (PRP):
o Promotes tissue repair through growth factors.
o Shows promise in reducing deformities and improving erectile function when combined with other therapies.

Challenges and Limitations: There is a lack of consensus on a gold-standard treatment for PD. There are only limited comparative studies and variability in treatment protocols. The need for more robust, randomized trials to establish efficacy.

Conclusions: CCH remains the most extensively studied treatment, demonstrating efficacy in both acute and chronic phases of PD. However, its benefits are enhanced with multimodal approaches involving traction devices or combination drug therapies. Alternative treatments like IFN-α2b, PRP, SWT, and LT show potential but require more research. Developing standardized treatment guidelines will be critical for improving PD management

Jens Rassweiler

•	Acute Phase: Lasting up to 18 months, with pain, inflammation, and rapid plaque growth.
•	Chronic Phase: Stabilized plaques with persistent curvature and reduced pain.

PD can have significant physical and psychological impacts, including erectile dysfunction. While surgical options exist for severe cases, conservative treatments for mild-to-moderate PD have mixed results.

Current Treatments: The review highlights several intralesional and topical treatments:

1.	Collagenase Clostridium Histolyticum (CCH):
o	The only FDA-approved noninvasive treatment for PD.
o	Administered in cycles, primarily during the chronic phase.
o	Studies show improvements in penile curvature and patient satisfaction, though outcomes vary with plaque characteristics (e.g., calcification).
o	Combination therapies, such as CCH with sildenafil or penile traction, enhance results.
o	However, CCH is not approved by EMA

2.	Interferon α-2b (IFN-α2b):
o	Reduces collagen production and plaque size.
o	Promising results in preliminary studies but requires further research.

3.	Penile Traction Devices (PTDs):
o	Stretch the penis to reduce curvature and improve length.
o	Devices like RestoreX show higher patient compliance and better outcomes compared to traditional PTDs.

4.	Shock Wave Therapy (SWT):
o	Reduces pain and supports tissue repair.
o	Effective for symptom management but not recommended as a standalone treatment for curvature.
o	For reduction of curvature, higher shock wave energy necessary

5.	Laser Therapy (LT):
o	Uses advanced lasers to inhibit fibroblast activity and reduce scarring.
o	Limited adoption due to varying protocols, but recent studies show positive long-term outcomes.

6.	Platelet-Rich Plasma (PRP):
o	Promotes tissue repair through growth factors.
o	Shows promise in reducing deformities and improving erectile function when combined with other therapies.

Challenges and Limitations: There is a lack of consensus on a gold-standard treatment for PD. There are only limited comparative studies and variability in treatment protocols. The need for more robust, randomized trials to establish efficacy.

Conclusions: CCH remains the most extensively studied treatment, demonstrating efficacy in both acute and chronic phases of PD. However, its benefits are enhanced with multimodal approaches involving traction devices or combination drug therapies. Alternative treatments like IFN-α2b, PRP, SWT, and LT show potential but require more research. Developing standardized treatment guidelines will be critical for improving PD management

Jens Rassweiler

Introduction: Peyronie's disease (PD) is characterized by fibrous plaques in the tunica albuginea (TA) of the penis, leading to deformities such as curvature and shortening. The condition progresses through two phases: • Acute Phase: Lasting up to 18 months, with pain, inflammation, and rapid plaque growth. • Chronic Phase: Stabilized plaques with persistent curvature and reduced pain. PD can have significant physical and psychological impacts, including erectile dysfunction. While surgical options exist for severe cases, conservative treatments for mild-to-moderate PD have mixed results. Current Treatments: The review highlights several intralesional and topical treatments: 1. Collagenase Clostridium Histolyticum (CCH): o The only FDA-approved noninvasive treatment for PD. o Administered in cycles, primarily during the chronic phase. o Studies show improvements in penile curvature and patient satisfaction, though outcomes vary with plaque characteristics (e.g., calcification). o Combination therapies, such as CCH with sildenafil or penile traction, enhance results. o However, CCH is not approved by EMA 2. Interferon α-2b (IFN-α2b): o Reduces collagen production and plaque size. o Promising results in preliminary studies but requires further research. 3. Penile Traction Devices (PTDs): o Stretch the penis to reduce curvature and improve length. o Devices like RestoreX show higher patient compliance and better outcomes compared to traditional PTDs. 4. Shock Wave Therapy (SWT): o Reduces pain and supports tissue repair. o Effective for symptom management but not recommended as a standalone treatment for curvature. o For reduction of curvature, higher shock wave energy necessary 5. Laser Therapy (LT): o Uses advanced lasers to inhibit fibroblast activity and reduce scarring. o Limited adoption due to varying protocols, but recent studies show positive long-term outcomes. 6. Platelet-Rich Plasma (PRP): o Promotes tissue repair through growth factors. o Shows promise in reducing deformities and improving erectile function when combined with other therapies. Challenges and Limitations: There is a lack of consensus on a gold-standard treatment for PD. There are only limited comparative studies and variability in treatment protocols. The need for more robust, randomized trials to establish efficacy. Conclusions: CCH remains the most extensively studied treatment, demonstrating efficacy in both acute and chronic phases of PD. However, its benefits are enhanced with multimodal approaches involving traction devices or combination drug therapies. Alternative treatments like IFN-α2b, PRP, SWT, and LT show potential but require more research. Developing standardized treatment guidelines will be critical for improving PD management Jens Rassweiler

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