AB56. Current medical therapy for peyronie’s disease

Abstract: Peyronie disease (PD) is characterized as a fibrous, inelastic lesion of the tunica albuginea. It is thought to result from trauma or microtrauma to the erect penis in genetically susceptible individuals, though the mechanism of disease has not been fully elucidated. The lesion can be painful in some individuals, and can also result in erection deformities making intromission difficult or impossible. Treatment options are chosen based upon disease severity, patient preference, and surgeon’s training. Options include oral medications, intralesional injection therapy, plication procedures, incision and grafting, and placement of a penile prosthesis with or without manual modeling or other ancillary straightening techniques. Numerous nonsurgical treatment options have been utilized since PD was first descriptively named in 1743. Despite various reports in the literature of deformity stabilization and/or reduction outcomes, recent guidelines indicate that the available evidence shows generally no significant benefit from oral therapies for reducing penile deformity. However, the standard of care still involves an initial trial of either oral or intralesional treatment at first presentation. An accepted goal of medical therapy is to shorten the acute phase of PD in order to stabilize the plaque or diminish disease progression. Oral agents could be considered non-invasive relative to surgery, though for the purposes of this review we have considered them to be minimally invasive, since these agents do have effects subsequent to entering the body. Oral, systemic treatment agents include vitamin E, Potaba, tamoxifen, carnitine, colchicine, and phosphodiesterase (PDE) manipulators, such as pentoxifylline and PDE5 inhibitors. Iontophoresis, with application of verapamil or combined verapamil and dexamethasone, is believed to enhance transcutaneous absorption of the drugs through direct electrophoresis, electro-osmosis, or enhanced diffusion using surface-delivered heat or current. Current treatment with intralesional injections directly into the penile plaque includes verapamil, nicardipine, IFN α-2b, and Collagenase Clostridium histolyticum (CCH). CCH showed significant improvement in penile curvature and patient reported outcome symptom bother scores, suggesting that this may be a safe, nonsurgical alternative for PD. The molecular mechanism of action has not been defined in ESWT; however, shock waves are used to disrupt the dense tissue of the scar or plaque. Treatment occurs over weekly sessions and is well tolerated. Adverse effects include superficial bruising over the treatment site that required no analgesia.

Keywords: Current medical therapy; peyronie’s disease’ phosphodiesterase (PDE)