Marco Cosentino et al., 2024: Conservative treatment of Peyronie's disease: a guide
Marco Cosentino 1 , Michele Di Nauta 2 , Luca Boeri 3 , Giordana Ferraioli 4 , Gianpaolo Lucignani 3 , Anna Ricapito 2 , Franco Gadda 3 , Massimo Iafrate 4 , Mariangela Mancini 4 , Fabrizio Dal Moro 4 , Eduard Ruiz-Castañe 5 , Carlo Bettocchi 2 , Emanuele Montanari 3 , Nikolaos Sofikitis 6
1Uro-Andrology Department, Casa di Cura Villa Maria, Via delle Melette 22, 35138, Padua, Italy.
2Department of Urology and Organ Transplantation, Università di Foggia, Foggia, Italy.
3Department of Urology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.
4Urology Clinic, Department of Surgical, Oncological and Gastroenterological Sciences, Padova University, Padua, Italy.
5Andrology Department, Fundacio Puigvert, Universitat Autonoma de Barcelona, Barcelona, Spain.
6Department of Urology, Ioannina University School of Medicine, Ioannina, Greece.
Abstract
Purpose: To review the literature on the topic, to suggest a common line of treatment applicable across a wide community of specialists, and to contribute in maintaining the high level of interest in this disease.
Methods: A comprehensive and exhaustive review of the literature was performed, identifying hundreds of articles on the topic.
Results: Peyronie's disease is a condition that has been recognized, studied, and treated for centuries; despite this, if one excludes surgery in cases in which the deformity is stable, no clear treatment (or line of treatment) is available for complete relief of signs and symptoms. Treatment options were divided into local, oral, and injection therapy, and a wide variety of drugs, remedies, and options were identified.
Conclusions: Low-intensity extracorporeal shock wave therapy, vacuum therapy, penile traction therapy, phosphodiesterase type 5 inhibitors, hyaluronic acid, and collagenase of Clostridium histolyticum may be recommended only in specific contexts. Further studies on individual options or potential combinations are required.
World J Urol. 2024 May 13;42(1):317. doi: 10.1007/s00345-024-04975-6. PMID: 38740620
Comments 1
Peyronie’s Disease (PD) is a condition characterized by the formation of fibrous plaques in the tunica albuginea of the penis, leading to penile curvature and other symptoms. Treatment options vary widely, and while surgery is often considered for advanced cases with stable deformities, conservative treatments are a focal point for managing early and moderate disease. This guide reviews the current literature on conservative treatments and provides recommendations based on available evidence.
Treatment Categories are as follows (i) local therapies, (ii) oral medications, and (iii) injection Therapies
1. Local Therapies
Effective have been:
Extracorporeal Shock Wave Therapy (ESWT): Some benefit in pain reduction but no significant change in curvature or plaque volume. Recommended mainly for pain relief. Unfortunately, the recent paper of Rassweiler et al in the World J Urol was not cited, which showed an effect on curvature when applying high-energy shock waves.
Liposomal Encapsulated Recombinant Human Superoxide Dismutase (lrhSOD): Shown to reduce penile pain but with minimal impact on plaque size or curvature.H-100 Gel: Contains nicardipine and superoxide dismutase. Significant improvements in penile curvature and pain have been observed, but further studies are needed due to small sample sizes.
Vacuum Therapy: Can be beneficial in stabilizing or improving curvature, especially when used regularly. Guidelines suggest it as part of multimodal therapy.
Penile Traction Therapy: Some evidence of increased penile length and minimal curvature improvement; further studies needed.
No efficacy has been documented for
Verapamil Gel: Limited evidence of efficacy; studies show no significant benefit in plaque reduction.
Electromotive Drug Administration (EMDA): Ineffective based on current evidence.
Radiotherapy: Associated with unacceptable side effects and is not recommended.
2. Oral Medications
Effective have been
Phosphodiesterase Type 5 Inhibitors (PDE5i): May reduce pain but lack evidence for improving curvature or plaque size. It may have also an effect on collagenase cycle.
Pentoxifylline: Some evidence of benefit, but more research is needed.
No efficacy has been documented for
Colchicine: No significant improvement in penile curvature or plaque size; notable side effects
.
Coenzyme Q10: Promising results in small studies, but further validation is required.
L-Carnitine: Mixed results; no significant benefit observed in larger trials.
Potaba: Potential benefits in early curvature cases, but overall evidence is insufficient. This is an important statement, since it was used frequently in Central Europe.
Procarbazine: Outdated with no recent evidence.
Tamoxifen: Initial promise but no significant benefit found in recent studies.
Vitamin E: Commonly recommended but lacks evidence for efficacy.
Omega-3 Fatty Acids: No significant benefit observed.
3. Injection Therapies
Mixed results have been found for
Calcium Channel Blockers (e.g., Verapamil): Mixed results; further research needed.
Interferon: Effective in reducing curvature and pain, though results are mixed and require further study.
Hyaluronic Acid: Positive outcomes observed, especially in reducing curvature and improving sexual function, but more reliable studies are needed.
Platelet-Rich Plasma (PRP): Mixed results; further robust trials needed.
Collagenase of Clostridium histolyticum (CCH): Effective for moderate curvature but not available in Europe; suitable candidates should be carefully selected. Moreover rupture of the corpus cavernosum has been reported.
No efficacy has been documented for
Botulinum Toxin: Limited evidence; not recommended.
Corticosteroids: No benefit over placebo; not recommended.
Conclusion
Conservative treatment options for Peyronie’s Disease include various local, oral, and injection therapies. Current evidence supports specific uses for some treatments such as low-intensity ESWT for pain relief, vacuum therapy, and penile traction therapy for curvature improvement. It makes sense to combine ESWT with Tadalafil particularly in the acute pahes of Peyroie`s disease.
CCH is effective for certain cases but has limitations and is not universally available. Most treatments require further validation through larger, well-designed studies to establish their efficacy and safety.
A multimodal approach tailored to individual patient needs and disease progression is often the most effective strategy
Jens Rassweiler