Peyronie's disease: Diagnosis and medical management
- William O Brant, MD, FACS, FECSM
William O Brant, MD, FACS, FECSM
- Veterans Affairs Medical Center, Salt Lake City, UT
- Anthony J Bella, MD, FRCSC
Anthony J Bella, MD, FRCSC
- Assistant Professor of Urology and Associate Scientist, Neuroscience
- Endowed Chair in Men's Health Research
- Greta and John Hansen Chair in Men's Health Research
- University of Ottawa
- Tom F Lue, MD, ScD (Hon), FACS
Tom F Lue, MD, ScD (Hon), FACS
- Professor and Vice Chair
- Emil Tanagho Endowed Chair in Clinical Urology
- Department of Urology
- University of California, San Francisco
Peyronie's disease (PD) is an acquired, localized fibrotic disorder of the tunica albuginea resulting in penile deformity, mass, pain, and in some men, erectile dysfunction (ED). The disorder is named after Francois Gigot de la Peyronie, surgeon to King Louis XIV, who in 1743 described "rosary beads" of scar tissue extending the full length of the dorsal penis in a treatise on ejaculatory failure .
PD can resolve spontaneously in a minority of cases while others have stable disease. However, nearly half of patients will have worsening within one year. PD can be a psychologically and physically disabling disorder, leading to a lower quality of life. Diagnosis is generally straightforward, based on history and physical examination. Ultrasound can also be used to confirm fibrotic plaque.
The efficacy of medical management for PD is limited. Treatment options typically include oral or intralesional drug therapy. In most cases, medical management should be initiated once the diagnosis of PD is made. Surgical management may be considered for patients who have penile deformity compromising sexual function and whose PD has persisted for more than 12 months, regardless of previous medical therapy.
The diagnosis and medical management of PD will be reviewed here. Surgical management of PD and general issues relating to male sexual dysfunction are discussed separately. (See "Surgical management of Peyronie's disease" and "Overview of male sexual dysfunction".)
Many clinicians, including urologists, have the misconception that Peyronie's disease (PD) is a rare condition, based on previous case reports documenting prevalence of ≤1 percent [2,3]. Contemporary estimates are several-fold higher, perhaps partly due to the introduction of PDE-5 inhibitors for erectile dysfunction leading to improved general awareness among patients and clinicians.
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- Risk factors
- Natural history
- CLINICAL MANIFESTATIONS
- DIAGNOSIS AND ASSESSMENT
- Differential diagnosis
- INDICATIONS FOR UROLOGY REFERRAL
- MEDICAL MANAGEMENT
- Oral therapy
- - Pentoxifylline
- - Vitamin E
- - Potassium para-aminobenzoate
- - Colchicine
- - Tamoxifen
- - Carnitine
- Intralesional drug therapy
- - Verapamil
- - Interferon alpha-2b
- - Collagenase
- Topical therapy
- OTHER TREATMENTS
- Penile traction therapy
- Extracorporeal shock wave therapy
- Radiation therapy
- SUMMARY AND RECOMMENDATIONS