Peyronie's disease: update on medical management and surgical tips

Peyronie's disease is a scarring phenomenon of the penis causing various deformities; initially pain with erection, and in most patients is associated with some element of erectile dysfunction. Studies of the natural history of the disease show that Peyronie's disease is a self-limited condition. In its stable and quiescent phase, patients have stable deformity, and in some cases that deformity then requires surgery. For the most part, pharmacologic therapy is confined to the immature or active phase of the disease. Pharmacotherapy is aimed at trying to adjust or interfere with the scarring process, so that the resultant scar causes as little disability as possible to the patient. Most pharmacotherapy is thus useful only in the active/immature phase of disease. In the mature or quiescent phase of the disease, therapy is aimed at undoing the effects of the scarring lesion. Those therapies for the most part can be considered "scar revisions". There is no best surgical therapy, and unfortunately because the disease process generally evolves with the background of erectile dysfunction, often times with surgery there is progression of the erectile dysfunction. All patients should be counseled with regards to the option of continued watchful waiting. Patients who are operated on must be counseled with regards to realistic outcomes.