Konstantinos Douroumis et al., 2024: Acute Phase Peyronie's Disease: Where Do We Stand ?

Tuesday, 10 December 2024

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Konstantinos Douroumis, Konstantinos Kotrotsios , Panagiotis Katsikatsos, Napoleon Moulavasilis, Evangelos Fragkiadis, Dionysios Mitropoulos, Ioannis Adamakis
Department of Urology, National and Kapodistrian University of Athens, Athens, GRC.

Abstract

Peyronie's disease (PD) is a common benign condition characterized by superficial fibrosis and scar formation at the tunica albuginea of the penis, eventually leading to penile curvature. It is believed that penile micro-traumas during intercourse and subsequent activation of inflammatory processes constitute the pathogenetic basis of the disease. Routinely, PD is divided into acute and chronic phases, with pain during erection or flaccid state being the hallmark of the former. Surgical intervention should be avoided during the acute phase, as the risk of recurrence or progression of penile deformity during this stage might affect the optimal outcomes of the procedure. During this stage, many conservative treatment options have been suggested, including oral, topical, and intralesional therapies, extracorporeal shock wave therapy (ESWT), and penile traction therapy (PTT). Currently, the optimal treatment consists of a combined treatment strategy with phosphodiesterase type 5 inhibitors (PDE5Is), ESWT for pain management, PTT, and intralesional therapies. Large, well-designed randomized controlled trials (RCTs) are necessary to further elucidate the most efficient treatment option for acute phase PD.

Cureus. 2024 Aug 17;16(8):e67054. doi: 10.7759/cureus.67054. eCollection 2024 Aug.
PMID: 39286663 PMCID: PMC11403542

Comments 1

Jens Rassweiler on Tuesday, 10 December 2024 10:00

This is a review article focusing on all aspects of treatment of acute phase Peyronie`s Disease.

Overview: Peyronie’s disease (PD) is a benign condition characterized by fibrosis and scar formation in the tunica albuginea of the penis, leading to curvature and deformities. It occurs due to microtraumas during intercourse and subsequent inflammation. PD progresses through an acute phase, marked by pain, and a chronic phase. Management of the acute phase focuses on non-surgical treatments, as surgery during this stage may worsen outcomes.

Pathophysiology: Peyronie’s disease is primarily a wound-healing disorder affecting the tunica albuginea, the fibrous envelope surrounding the penile corpora cavernosa. The pathophysiology is complex, involving mechanical trauma, inflammation, and fibrotic remodeling. Peyronie’s disease is a multifactorial condition rooted in an abnormal wound-healing response to penile trauma. The interplay of inflammation, fibroblast activation, and fibrosis underpins disease progression. Understanding these mechanisms is essential for developing targeted treatments, particularly during the acute phase when interventions may prevent chronic deformity.

There is one problem, that such a microtrauma is denied by most of PD-patients, respectively acute phase PD developed also in sexually inactive men.

Treatment Approaches for Acute Phase PD: The following therapies have been tested and proved some effcicacy

1. Oral Therapies:
o Colchicine: Initially promising but inconsistent results; recent studies show limited benefits compared to placebo.
o Potassium para-aminobenzoate (Potaba): Reduces plaque size but does not significantly improve curvature or pain.
o Vitamin E: Lacks efficacy as monotherapy but may be useful in combination therapies.
o Phosphodiesterase Type 5 Inhibitors (PDE5Is): Show improvement in erectile function and curvature stabilization with minimal side effects.

Basically, among all oral options, only PDE5-Inhibitors are promising. It is hypothesized that through the inhibition of TGF-β1, they promote the reduction of collagen deposition. Clinically, they are useful to reduce pain and work very well in combination with ESWT, particularly in the acute phase of PD.

2. Intralesional Therapy:
o Collagenase Clostridium histolyticum (CCh): Effective and safe in reducing curvature and improving symptoms in both acute and stable phases. Studies report consistent improvements with minimal complications.

It has to be mentioned that CCh is not approved by the EMA, due to side effects like rupture of the tunica albuginea.

3. Extracorporeal Shock Wave Therapy (ESWT):
o Demonstrates analgesic effects and improvements in erectile function. However, it has limited impact on curvature or plaque size.

Unfortunatetly, until now, there are no prospective studies on the management of acute phase PD with ESWT. Such studies, probably in combination with 5 mg Taldalafil could be promising.

4. Penile Traction Therapy (PTT):
o Recommended as part of a combination therapy for curvature correction and plaque remodeling.

Challenges and Future Directions: Current treatments lack standardized protocols. Combination therapies involving PDE5Is and ESWT are promising. Large, well-designed randomized controlled trials (RCTs) are needed to identify the optimal treatment approach. Advances in understanding PD’s pathophysiology may lead to new therapeutic options.

Jens Rassweiler

This is a review article focusing on all aspects of treatment of acute phase Peyronie`s Disease.

Overview: Peyronie’s disease (PD) is a benign condition characterized by fibrosis and scar formation in the tunica albuginea of the penis, leading to curvature and deformities. It occurs due to microtraumas during intercourse and subsequent inflammation. PD progresses through an acute phase, marked by pain, and a chronic phase. Management of the acute phase focuses on non-surgical treatments, as surgery during this stage may worsen outcomes.

Pathophysiology: Peyronie’s disease is primarily a wound-healing disorder affecting the tunica albuginea, the fibrous envelope surrounding the penile corpora cavernosa. The pathophysiology is complex, involving mechanical trauma, inflammation, and fibrotic remodeling. Peyronie’s disease is a multifactorial condition rooted in an abnormal wound-healing response to penile trauma. The interplay of inflammation, fibroblast activation, and fibrosis underpins disease progression. Understanding these mechanisms is essential for developing targeted treatments, particularly during the acute phase when interventions may prevent chronic deformity.

There is one problem, that such a microtrauma is denied by most of PD-patients, respectively acute phase PD developed also in sexually inactive men.

Treatment Approaches for Acute Phase PD: The following therapies have been tested and proved some effcicacy

1.	Oral Therapies:
o	Colchicine: Initially promising but inconsistent results; recent studies show limited benefits compared to placebo.
o	Potassium para-aminobenzoate (Potaba): Reduces plaque size but does not significantly improve curvature or pain.
o	Vitamin E: Lacks efficacy as monotherapy but may be useful in combination therapies.
o	Phosphodiesterase Type 5 Inhibitors (PDE5Is): Show improvement in erectile function and curvature stabilization with minimal side effects.

Basically, among all oral options, only PDE5-Inhibitors are promising. It is hypothesized that through the inhibition of TGF-β1, they promote the reduction of collagen deposition. Clinically, they are useful to reduce pain and work very well in combination with ESWT, particularly in the acute phase of PD.

2.	Intralesional Therapy:
o	Collagenase Clostridium histolyticum (CCh): Effective and safe in reducing curvature and improving symptoms in both acute and stable phases. Studies report consistent improvements with minimal complications.

It has to be mentioned that CCh is not approved by the EMA, due to side effects like rupture of the tunica albuginea.

3.	Extracorporeal Shock Wave Therapy (ESWT):
o	Demonstrates analgesic effects and improvements in erectile function. However, it has limited impact on curvature or plaque size.

Unfortunatetly, until now, there are no prospective studies on the management of acute phase PD with ESWT. Such studies, probably in combination with 5 mg Taldalafil could be promising.

4.	Penile Traction Therapy (PTT):
o	Recommended as part of a combination therapy for curvature correction and plaque remodeling.

Challenges and Future Directions: Current treatments lack standardized protocols. Combination therapies involving PDE5Is and ESWT are promising. Large, well-designed randomized controlled trials (RCTs) are needed to identify the optimal treatment approach. Advances in understanding PD’s pathophysiology may lead to new therapeutic options.

Jens Rassweiler

This is a review article focusing on all aspects of treatment of acute phase Peyronie`s Disease. Overview: Peyronie’s disease (PD) is a benign condition characterized by fibrosis and scar formation in the tunica albuginea of the penis, leading to curvature and deformities. It occurs due to microtraumas during intercourse and subsequent inflammation. PD progresses through an acute phase, marked by pain, and a chronic phase. Management of the acute phase focuses on non-surgical treatments, as surgery during this stage may worsen outcomes. Pathophysiology: Peyronie’s disease is primarily a wound-healing disorder affecting the tunica albuginea, the fibrous envelope surrounding the penile corpora cavernosa. The pathophysiology is complex, involving mechanical trauma, inflammation, and fibrotic remodeling. Peyronie’s disease is a multifactorial condition rooted in an abnormal wound-healing response to penile trauma. The interplay of inflammation, fibroblast activation, and fibrosis underpins disease progression. Understanding these mechanisms is essential for developing targeted treatments, particularly during the acute phase when interventions may prevent chronic deformity. There is one problem, that such a microtrauma is denied by most of PD-patients, respectively acute phase PD developed also in sexually inactive men. Treatment Approaches for Acute Phase PD: The following therapies have been tested and proved some effcicacy 1. Oral Therapies: o Colchicine: Initially promising but inconsistent results; recent studies show limited benefits compared to placebo. o Potassium para-aminobenzoate (Potaba): Reduces plaque size but does not significantly improve curvature or pain. o Vitamin E: Lacks efficacy as monotherapy but may be useful in combination therapies. o Phosphodiesterase Type 5 Inhibitors (PDE5Is): Show improvement in erectile function and curvature stabilization with minimal side effects. Basically, among all oral options, only PDE5-Inhibitors are promising. It is hypothesized that through the inhibition of TGF-β1, they promote the reduction of collagen deposition. Clinically, they are useful to reduce pain and work very well in combination with ESWT, particularly in the acute phase of PD. 2. Intralesional Therapy: o Collagenase Clostridium histolyticum (CCh): Effective and safe in reducing curvature and improving symptoms in both acute and stable phases. Studies report consistent improvements with minimal complications. It has to be mentioned that CCh is not approved by the EMA, due to side effects like rupture of the tunica albuginea. 3. Extracorporeal Shock Wave Therapy (ESWT): o Demonstrates analgesic effects and improvements in erectile function. However, it has limited impact on curvature or plaque size. Unfortunatetly, until now, there are no prospective studies on the management of acute phase PD with ESWT. Such studies, probably in combination with 5 mg Taldalafil could be promising. 4. Penile Traction Therapy (PTT): o Recommended as part of a combination therapy for curvature correction and plaque remodeling. Challenges and Future Directions: Current treatments lack standardized protocols. Combination therapies involving PDE5Is and ESWT are promising. Large, well-designed randomized controlled trials (RCTs) are needed to identify the optimal treatment approach. Advances in understanding PD’s pathophysiology may lead to new therapeutic options. Jens Rassweiler

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