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. 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 phosphodiesterase type 5 (PDE-5) inhibitors for erectile dysfunction leading to improved general awareness among patients and clinicians.To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- Hauck EW, Weidner W. François de la Peyronie and the disease named after him. Lancet 2001; 357:2049.
- Lindsay MB, Schain DM, Grambsch P, et al. The incidence of Peyronie's disease in Rochester, Minnesota, 1950 through 1984. J Urol 1991; 146:1007.
- Greenfield JM, Levine LA. Peyronie's disease: etiology, epidemiology and medical treatment. Urol Clin North Am 2005; 32:469.
- Schwarzer U, Sommer F, Klotz T, et al. The prevalence of Peyronie's disease: results of a large survey. BJU Int 2001; 88:727.
- Kadioglu A, Oktar T, Kandirali E, et al. Incidentally diagnosed Peyronie's disease in men presenting with erectile dysfunction. Int J Impot Res 2004; 16:540.
- Mulhall JP, Creech SD, Boorjian SA, et al. Subjective and objective analysis of the prevalence of Peyronie's disease in a population of men presenting for prostate cancer screening. J Urol 2004; 171:2350.
- Lue TF. Peyronie's disease: an anatomically-based hypothesis and beyond. Int J Impot Res 2002; 14:411.
- Haag SM, Hauck EW, Szardening-Kirchner C, et al. Alterations in the transforming growth factor (TGF)-beta pathway as a potential factor in the pathogenesis of Peyronie's disease. Eur Urol 2007; 51:255.
- Bella AJ, Perelman MA, Brant WO, Lue TF. Peyronie's disease (CME). J Sex Med 2007; 4:1527.
- Carrieri MP, Serraino D, Palmiotto F, et al. A case-control study on risk factors for Peyronie's disease. J Clin Epidemiol 1998; 51:511.
- Qian A, Meals RA, Rajfer J, Gonzalez-Cadavid NF. Comparison of gene expression profiles between Peyronie's disease and Dupuytren's contracture. Urology 2004; 64:399.
- Gholami SS, Gonzalez-Cadavid NF, Lin CS, et al. Peyronie's disease: a review. J Urol 2003; 169:1234.
- Bjekic MD, Vlajinac HD, Sipetic SB, Marinkovic JM. Risk factors for Peyronie's disease: a case-control study. BJU Int 2006; 97:570.
- Usta MF, Bivalacqua TJ, Jabren GW, et al. Relationship between the severity of penile curvature and the presence of comorbidities in men with Peyronie's disease. J Urol 2004; 171:775.
- Zargooshi J. Trauma as the cause of Peyronie's disease: penile fracture as a model of trauma. J Urol 2004; 172:186.
- Mulhall JP, Schiff J, Guhring P. An analysis of the natural history of Peyronie's disease. J Urol 2006; 175:2115.
- Kadioglu A, Tefekli A, Erol B, et al. A retrospective review of 307 men with Peyronie's disease. J Urol 2002; 168:1075.
- Pryor JP, Ralph DJ. Clinical presentations of Peyronie's disease. Int J Impot Res 2002; 14:414.
- Bella AJ, Sener A, Foell K, Brock GB. Nonpalpable scarring of the penile septum as a cause of erectile dysfunction: an atypical form of Peyronie's disease. J Sex Med 2007; 4:226.
- Brant WO, Bella AJ, Garcia MM, et al. Isolated septal fibrosis or hematoma--atypical Peyronie's disease? J Urol 2007; 177:179.
- Andresen R, Wegner HE, Miller K, Banzer D. Imaging modalities in Peyronie's disease. An intrapersonal comparison of ultrasound sonography, X-ray in mammography technique, computerized tomography, and nuclear magnetic resonance in 20 patients. Eur Urol 1998; 34:128.
- Ung JO, Padera RF, O'Leary MP. Angiosarcoma of the penis masquerading as a Peyronie's plaque. J Urol 2002; 167:1785.
- Hauck EW, Schmelz HU, Diemer T, et al. Epithelioid sarcoma of the penis--a rare differential diagnosis of Peyronie's disease. Int J Impot Res 2003; 15:378.
- Nehra A, Alterowitz R, Culkin DJ, et al. Peyronie's Disease: AUA Guideline. J Urol 2015; 194:745.
- Hauck EW, Diemer T, Schmelz HU, Weidner W. A critical analysis of nonsurgical treatment of Peyronie's disease. Eur Urol 2006; 49:987.
- Ohebshalom M, Mulhall J, Guhring P, Parker M. Measurement of penile curvature in Peyronie's disease patients: comparison of three methods. J Sex Med 2007; 4:199.
- Hashimoto K, Hisasue S, Kato R, et al. Outcome analysis for conservative management of Peyronie's disease. Int J Urol 2006; 13:244.
- Smith JF, Shindel AW, Huang YC, et al. Pentoxifylline treatment and penile calcifications in men with Peyronie's disease. Asian J Androl 2011; 13:322.
- Valente EG, Vernet D, Ferrini MG, et al. L-arginine and phosphodiesterase (PDE) inhibitors counteract fibrosis in the Peyronie's fibrotic plaque and related fibroblast cultures. Nitric Oxide 2003; 9:229.
- Brant WO, Dean RC, Lue TF. Treatment of Peyronie's disease with oral pentoxifylline. Nat Clin Pract Urol 2006; 3:111.
- Garcia MM, Bella AJ, Lin GT, et al. The effect of pentoxyfylline on cultured human tunical fibroblasts harvested from patients with Peyronie's disease. Can J Urol 2006; 13:3099.
- Pryor JP, Farrell CR. Controlled clinical trial of vitamin E in Peyronie's disease. Prg Reprod Biol Med 1983; 9:41.
- Safarinejad MR, Hosseini SY, Kolahi AA. Comparison of vitamin E and propionyl-L-carnitine, separately or in combination, in patients with early chronic Peyronie's disease: a double-blind, placebo controlled, randomized study. J Urol 2007; 178:1398.
- Prieto Castro RM, Leva Vallejo ME, Regueiro Lopez JC, et al. Combined treatment with vitamin E and colchicine in the early stages of Peyronie's disease. BJU Int 2003; 91:522.
- Weidner W, Hauck EW, Schnitker J, Peyronie's Disease Study Group of Andrological Group of German Urologists. Potassium paraaminobenzoate (POTABA) in the treatment of Peyronie's disease: a prospective, placebo-controlled, randomized study. Eur Urol 2005; 47:530.
- Akkus E, Carrier S, Rehman J, et al. Is colchicine effective in Peyronie's disease? A pilot study. Urology 1994; 44:291.
- Kadioglu A, Tefekli A, Köksal T, et al. Treatment of Peyronie's disease with oral colchicine: long-term results and predictive parameters of successful outcome. Int J Impot Res 2000; 12:169.
- Safarinejad MR. Therapeutic effects of colchicine in the management of Peyronie's disease: a randomized double-blind, placebo-controlled study. Int J Impot Res 2004; 16:238.
- Teloken C, Rhoden EL, Grazziotin TM, et al. Tamoxifen versus placebo in the treatment of Peyronie's disease. J Urol 1999; 162:2003.
- Biagiotti G, Cavallini G. Acetyl-L-carnitine vs tamoxifen in the oral therapy of Peyronie's disease: a preliminary report. BJU Int 2001; 88:63.
- Cavallini G, Biagiotti G, Koverech A, Vitali G. Oral propionyl-l-carnitine and intraplaque verapamil in the therapy of advanced and resistant Peyronie's disease. BJU Int 2002; 89:895.
- Russell S, Steers W, McVary KT. Systematic evidence-based analysis of plaque injection therapy for Peyronie's disease. Eur Urol 2007; 51:640.
- Lee RC, Ping JA. Calcium antagonists retard extracellular matrix production in connective tissue equivalent. J Surg Res 1990; 49:463.
- Nicolai M, Cipollone G, Iantorno R, et al. Intralesional verapamil injection versus placebo in Peyronie's disease. J Urol 1998; 159:117.
- Steiger M, Ohlig W, Ludwig G. Verapamil versus placebo als injektionstherapie der induratio penis plastica: langzeitergebnisse einer doppel-blind-studie. Urologie A 1999; 38:S58.
- Rehman J, Benet A, Melman A. Use of intralesional verapamil to dissolve Peyronie's disease plaque: a long-term single-blind study. Urology 1998; 51:620.
- Wolff B, Peyronnet B, Cattarino S, et al. Intralesional Injections for Early Peyronie Disease: Standardized Assessment and Analysis of Predictive Factors for Treatment Response. Urology 2015; 86:57.
- Shirazi M, Haghpanah AR, Badiee M, et al. Effect of intralesional verapamil for treatment of Peyronie's disease: a randomized single-blind, placebo-controlled study. Int Urol Nephrol 2009; 41:467.
- Hellstrom WJ, Kendirci M, Matern R, et al. Single-blind, multicenter, placebo controlled, parallel study to assess the safety and efficacy of intralesional interferon alpha-2B for minimally invasive treatment for Peyronie's disease. J Urol 2006; 176:394.
- Stewart CA, Yafi FA, Knoedler M, et al. Intralesional Injection of Interferon-α2b Improves Penile Curvature in Men with Peyronie's Disease Independent of Plaque Location. J Urol 2015; 194:1704.
- Gelbard M, Goldstein I, Hellstrom WJ, et al. Clinical efficacy, safety and tolerability of collagenase clostridium histolyticum for the treatment of peyronie disease in 2 large double-blind, randomized, placebo controlled phase 3 studies. J Urol 2013; 190:199.
- Gelbard M, Lipshultz LI, Tursi J, et al. Phase 2b study of the clinical efficacy and safety of collagenase Clostridium histolyticum in patients with Peyronie disease. J Urol 2012; 187:2268.
- Fitch WP 3rd, Easterling WJ, Talbert RL, et al. Topical verapamil HCl, topical trifluoperazine, and topical magnesium sulfate for the treatment of Peyronie's disease--a placebo-controlled pilot study. J Sex Med 2007; 4:477.
- Martin DJ, Badwan K, Parker M, Mulhall JP. Transdermal application of verapamil gel to the penile shaft fails to infiltrate the tunica albuginea. J Urol 2002; 168:2483.
- Riedl CR, Sternig P, Gallé G, et al. Liposomal recombinant human superoxide dismutase for the treatment of Peyronie's disease: a randomized placebo-controlled double-blind prospective clinical study. Eur Urol 2005; 48:656.
- Levine LA, Newell M, Taylor FL. Penile traction therapy for treatment of Peyronie's disease: a single-center pilot study. J Sex Med 2008; 5:1468.
- Levine LA, Newell MM. FastSize Medical Extender for the treatment of Peyronie's disease. Expert Rev Med Devices 2008; 5:305.
- Gontero P, Di Marco M, Giubilei G, et al. Use of penile extender device in the treatment of penile curvature as a result of Peyronie's disease. Results of a phase II prospective study. J Sex Med 2009; 6:558.
- Abern MR, Larsen S, Levine LA. Combination of penile traction, intralesional verapamil, and oral therapies for Peyronie's disease. J Sex Med 2012; 9:288.
- Yafi FA, Pinsky MR, Stewart C, et al. The Effect of Duration of Penile Traction Therapy in Patients Undergoing Intralesional Injection Therapy for Peyronie's Disease. J Urol 2015; 194:754.
- Ziegelmann MJ, Viers BR, Montgomery BD, et al. Clinical Experience With Penile Traction Therapy Among Men Undergoing Collagenase Clostridium histolyticum for Peyronie Disease. Urology 2017; 104:102.
- Rybak J, Papagiannopoulos D, Levine L. A retrospective comparative study of traction therapy vs. no traction following tunica albuginea plication or partial excision and grafting for Peyronie's disease: measured lengths and patient perceptions. J Sex Med 2012; 9:2396.
- Levine LA, Estrada CR, Shou W, Cole A. Tunica albuginea tissue analysis after electromotive drug administration. J Urol 2003; 169:1775.
- Di Stasi SM, Giannantoni A, Stephen RL, et al. A prospective, randomized study using transdermal electromotive administration of verapamil and dexamethasone for Peyronie's disease. J Urol 2004; 171:1605.
- Greenfield JM, Shah SJ, Levine LA. Verapamil versus saline in electromotive drug administration for Peyronie's disease: a double-blind, placebo controlled trial. J Urol 2007; 177:972.
- Ojingwa JC, Isseroff RR. Electrical stimulation of wound healing. J Invest Dermatol 2003; 121:1.
- Müller A, Akin-Olugbade Y, Deveci S, et al. The impact of shock wave therapy at varied energy and dose levels on functional and structural changes in erectile tissue. Eur Urol 2008; 53:635.
- Hauck EW, Mueller UO, Bschleipfer T, et al. Extracorporeal shock wave therapy for Peyronie's disease: exploratory meta-analysis of clinical trials. J Urol 2004; 171:740.
- Hatzichristodoulou G, Meisner C, Liske P, et al. Efficacy of extracorporeal shock wave therapy (ESWT) in patients with Peyronie's disease (PD)-first results of a prospective, randomized, placebo-controlled, single-blind study. J Urol 2006; 175(Suppl 4):320.
- Palmieri A, Imbimbo C, Longo N, et al. A first prospective, randomized, double-blind, placebo-controlled clinical trial evaluating extracorporeal shock wave therapy for the treatment of Peyronie's disease. Eur Urol 2009; 56:363.
- Incrocci L, Hop WC, Slob AK. Current sexual functioning in 106 patients with Peyronie's disease treated with radiotherapy 9 years earlier. Urology 2000; 56:1030.
- Niewald M, Wenzlawowicz KV, Fleckenstein J, et al. Results of radiotherapy for Peyronie's disease. Int J Radiat Oncol Biol Phys 2006; 64:258.
- 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 alfa-2b
- - Collagenase
- Topical therapy
- OTHER TREATMENTS
- Penile traction therapy
- Extracorporeal shockwave therapy
- Radiation therapy
- SUMMARY AND RECOMMENDATIONS