Kozub A. et al., 2023: Current trends in non-surgical management of Peyronie's disease-A narrative review

Tuesday, 06 February 2024

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IIIrd Department of Radiotherapy and Chemotherapy, Maria Sklodowska-Curie National Research Institute of Oncology (MSCNRIO), Gliwice, Poland.
Department of Urology, Jagiellonian University, Collegium Medicum, Krakow, Poland.
Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.
Department of Urology and Urooncology, City Hospital, Gliwice, Poland.
Department of Urology, University of Tours, Tours, France.
Department of Urology, Hospital Clínico San Carlos, Madrid, Spain.
Department of Urology, Medical University of Silesia, Zabrze, Poland.
Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.

Abstract

Peyronie's disease (PD) is a connective tissue disorder affecting the tunica albuginea. It can cause pain and penile deformation, and its prevalence increases with age. Although surgery is the gold standard for the chronic phase of the disease, there are several conservative treatment methods available, and the optimal management of the acute phase of the disease remains a matter of debate. In this article, we aim to summarize the recent trends in research on the subject of non-surgical treatment of PD. The search was performed in PubMed, Scopus, and Web of Science databases and included studies in English published between 2012 and 2022 investigating the clinical outcomes of non-surgical PD management in humans. We have identified 20 distinct conservative treatment strategies. Among the oral therapeutics, only the use of phosphodiesterase type 5 inhibitors is currently recommended for clinical use in patients with concomitant erectile dysfunction. The use of collagenase from Clostridium histolyticum is supported by the best quality evidence in terms of intralesional injections for patients suffering from significant penile curvature; however, interferon alpha-2b can also be an option in such patients. Among other non-invasive methods, extracorporeal shockwaves can be useful for pain reduction, and penile traction therapy can lead to a reduction in penile curvature and plaque size. Despite a wide range of non-surgical methods available for PD treatment, the majority are not supported by sufficient scientific evidence, and the treatment efficacy is underwhelming. Further research on the subject of non-surgical management of PD is highly warranted.
Andrology. 2023 Aug 18. doi: 10.1111/andr.13512. Online ahead of print. PMID: 37593783 Review.

Comments 1

Jens Rassweiler on Tuesday, 06 February 2024 09:50

The article explores non-surgical approaches for managing Peyronie’s disease (PD), a connective tissue disorder affecting the penis. While surgery is the gold standard for the chronic phase, the acute phase's optimal management remains debated. The authors conducted a review (2012-2022) identifying 20 non-surgical treatment strategies, emphasizing recent trends in research.
The review covers oral pharmacotherapy, including Vitamin E, whose efficacy lacks robust evidence, and Phosphodiesterase type 5 (PDE5) inhibitors, showing limited improvement in objective parameters but potential for alleviating erectile dysfunction. Pentoxifylline, a non-specific PDE5 inhibitor, did not significantly enhance outcomes in a study combining it with verapamil injections. Limited data on its efficacy were inconclusive. The article underscores the need for more research on non-surgical PD management due to insufficient scientific evidence for many available methods.
Moving beyond oral pharmacotherapy, the review discusses non-invasive methods such as extracorporeal shockwaves, which can reduce pain, and penile traction therapy (PTT), associated with a reduction in penile curvature and plaque size. While PTT shows promise, the majority of non-surgical methods lack sufficient scientific backing, and their efficacy remains underwhelming. The article emphasizes the imperative for further research to establish the effectiveness of non-surgical approaches for Peyronie’s disease, particularly during the acute phase, where optimal management remains a topic of debate.
Limited evidence suggests potential for pain relief and improvement in erectile function for iontophoresis or laser treatment n combination with verapamil injections. Further research is needed. The same applies to radiotherapy: a retrospective study indicates potential benefits in reducing curvature and pain, but further randomized studies are required
The article discusses various intralesional injection therapies for Peyronie's disease (PD), focusing on collagenase clostridium histolyticum (CCH). CCH, approved by regulatory agencies, dissolves fibrous plaques, showing effectiveness in reducing penile curvature and improving patient-reported outcomes (PROs). Studies indicate its potential in the acute phase, and shorter treatment protocols with mechanical therapies may be beneficial, reducing time and costs. However, CCH has been banned by EMA because of serious side effects.
The narrative also covers alternative therapies such as dexamethasone, methylprednisolone, hyaluronic acid (HA), iloprost, interferon alpha-2b, platelet-rich plasma (PRP), thiocolchicine, verapamil, and stem cells. Results vary across these treatments, with some showing promise, like HA injections, which improve penile curvature, pain, and erectile function. Interferon alpha-2b demonstrates potential, supported by meta-analysis, while PRP and stem cell therapies require further research for conclusive clinical value.

Conclusions
• Limited evidence supports oral therapies, except for PDE5 inhibitors for associated erectile dysfunction.
• Collagenase clostridium histolyticum (CCH) is well-researched and supported for clinical application, but banned by EMA due to serious side-effects.
• Extracorporeal shockwave therapy (ESWT) may alleviate pain but has limited efficacy in reducing curvature or plaque size. However, has no side effects
• Penile traction therapy (PTT) shows promising outcomes in reducing penile curvature or plaque size.
• Overall, conservative management for Peyronie's Disease lacks sufficient scientific evidence, and further research is crucial for more efficient non-surgical modalities.

Jens Rassweiler

The article explores non-surgical approaches for managing Peyronie’s disease (PD), a connective tissue disorder affecting the penis. While surgery is the gold standard for the chronic phase, the acute phase's optimal management remains debated. The authors conducted a review (2012-2022) identifying 20 non-surgical treatment strategies, emphasizing recent trends in research.
The review covers oral pharmacotherapy, including Vitamin E, whose efficacy lacks robust evidence, and Phosphodiesterase type 5 (PDE5) inhibitors, showing limited improvement in objective parameters but potential for alleviating erectile dysfunction. Pentoxifylline, a non-specific PDE5 inhibitor, did not significantly enhance outcomes in a study combining it with verapamil injections. Limited data on its efficacy were inconclusive. The article underscores the need for more research on non-surgical PD management due to insufficient scientific evidence for many available methods. 
Moving beyond oral pharmacotherapy, the review discusses non-invasive methods such as extracorporeal shockwaves, which can reduce pain, and penile traction therapy (PTT), associated with a reduction in penile curvature and plaque size. While PTT shows promise, the majority of non-surgical methods lack sufficient scientific backing, and their efficacy remains underwhelming. The article emphasizes the imperative for further research to establish the effectiveness of non-surgical approaches for Peyronie’s disease, particularly during the acute phase, where optimal management remains a topic of debate.
Limited evidence suggests potential for pain relief and improvement in erectile function for iontophoresis or laser treatment n combination with verapamil injections. Further research is needed. The same applies to radiotherapy: a retrospective study indicates potential benefits in reducing curvature and pain, but further randomized studies are required
The article discusses various intralesional injection therapies for Peyronie's disease (PD), focusing on collagenase clostridium histolyticum (CCH). CCH, approved by regulatory agencies, dissolves fibrous plaques, showing effectiveness in reducing penile curvature and improving patient-reported outcomes (PROs). Studies indicate its potential in the acute phase, and shorter treatment protocols with mechanical therapies may be beneficial, reducing time and costs. However, CCH has been banned by EMA because of serious side effects.
The narrative also covers alternative therapies such as dexamethasone, methylprednisolone, hyaluronic acid (HA), iloprost, interferon alpha-2b, platelet-rich plasma (PRP), thiocolchicine, verapamil, and stem cells. Results vary across these treatments, with some showing promise, like HA injections, which improve penile curvature, pain, and erectile function. Interferon alpha-2b demonstrates potential, supported by meta-analysis, while PRP and stem cell therapies require further research for conclusive clinical value.

Conclusions
•	Limited evidence supports oral therapies, except for PDE5 inhibitors for associated erectile dysfunction.
•	Collagenase clostridium histolyticum (CCH) is well-researched and supported for clinical application, but banned by EMA due to serious side-effects.
•	Extracorporeal shockwave therapy (ESWT) may alleviate pain but has limited efficacy in reducing curvature or plaque size. However, has no side effects
•	Penile traction therapy (PTT) shows promising outcomes in reducing penile curvature or plaque size.
•	Overall, conservative management for Peyronie's Disease lacks sufficient scientific evidence, and further research is crucial for more efficient non-surgical modalities.

Jens Rassweiler

The article explores non-surgical approaches for managing Peyronie’s disease (PD), a connective tissue disorder affecting the penis. While surgery is the gold standard for the chronic phase, the acute phase's optimal management remains debated. The authors conducted a review (2012-2022) identifying 20 non-surgical treatment strategies, emphasizing recent trends in research. The review covers oral pharmacotherapy, including Vitamin E, whose efficacy lacks robust evidence, and Phosphodiesterase type 5 (PDE5) inhibitors, showing limited improvement in objective parameters but potential for alleviating erectile dysfunction. Pentoxifylline, a non-specific PDE5 inhibitor, did not significantly enhance outcomes in a study combining it with verapamil injections. Limited data on its efficacy were inconclusive. The article underscores the need for more research on non-surgical PD management due to insufficient scientific evidence for many available methods. Moving beyond oral pharmacotherapy, the review discusses non-invasive methods such as extracorporeal shockwaves, which can reduce pain, and penile traction therapy (PTT), associated with a reduction in penile curvature and plaque size. While PTT shows promise, the majority of non-surgical methods lack sufficient scientific backing, and their efficacy remains underwhelming. The article emphasizes the imperative for further research to establish the effectiveness of non-surgical approaches for Peyronie’s disease, particularly during the acute phase, where optimal management remains a topic of debate. Limited evidence suggests potential for pain relief and improvement in erectile function for iontophoresis or laser treatment n combination with verapamil injections. Further research is needed. The same applies to radiotherapy: a retrospective study indicates potential benefits in reducing curvature and pain, but further randomized studies are required The article discusses various intralesional injection therapies for Peyronie's disease (PD), focusing on collagenase clostridium histolyticum (CCH). CCH, approved by regulatory agencies, dissolves fibrous plaques, showing effectiveness in reducing penile curvature and improving patient-reported outcomes (PROs). Studies indicate its potential in the acute phase, and shorter treatment protocols with mechanical therapies may be beneficial, reducing time and costs. However, CCH has been banned by EMA because of serious side effects. The narrative also covers alternative therapies such as dexamethasone, methylprednisolone, hyaluronic acid (HA), iloprost, interferon alpha-2b, platelet-rich plasma (PRP), thiocolchicine, verapamil, and stem cells. Results vary across these treatments, with some showing promise, like HA injections, which improve penile curvature, pain, and erectile function. Interferon alpha-2b demonstrates potential, supported by meta-analysis, while PRP and stem cell therapies require further research for conclusive clinical value. Conclusions • Limited evidence supports oral therapies, except for PDE5 inhibitors for associated erectile dysfunction. • Collagenase clostridium histolyticum (CCH) is well-researched and supported for clinical application, but banned by EMA due to serious side-effects. • Extracorporeal shockwave therapy (ESWT) may alleviate pain but has limited efficacy in reducing curvature or plaque size. However, has no side effects • Penile traction therapy (PTT) shows promising outcomes in reducing penile curvature or plaque size. • Overall, conservative management for Peyronie's Disease lacks sufficient scientific evidence, and further research is crucial for more efficient non-surgical modalities. Jens Rassweiler

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