Management of Peyronie's disease - a review

Peyronie's disease is an uncommon condition involving middle-aged men and probably resulting from penile trauma. The injury causes an inflammation in the tunica and ultimately scarring and penile curvature develop. It may also occur due to nonspecific inflammation. The use of medications such as β-blockers can sometimes result in Peyronie's disease. In Peyronie's disease, the normal elastic tissue of the tunica is replaced by scar tissue. The penile plaque, or scar tissue in this condition, is not elastic but hard and will not stretch with erection. The side that does not stretch results in penile curvature to the side of the scar. One third of men with Peyronie's disease have painful erections. A low percentage of men with Peyronie's disease develop erectile dysfunction. Because inflammation is initially associated with the scar tissue, some amount of discomfort occurs during erection. Most patients with early stage Peyronie's disease can continue to function sexually with the curvature in the penis. Others with a severe penile deformity will have difficulty in sexual intercourse. Literature regarding the effectiveness of conservative therapy in the early phase with pain and inflammation is limited, with only modest and at times anecdotal benefits. The commonly used agents include 400 units of vitamin E (vitamin E promotes healing and prevents scarring), ibuprofen (anti-inflammatory) and Colchicine (useful for pain during erection). Fexofenadine is recently being used in the early phase of Peyronie's disease for its anti-inflammatory effect. Radiation and ultrasound are not usually very helpful. When the disease process stops, there is usually some residual distortion of the penis but the majority of patients are able to have satisfactory sexual intercourse. However, if there is severe penile distortion interfering with intercourse, surgery is indicated. Surgical techniques for Peyronie's disease include tightening or plication (Nesbit's tuck) of the penis opposite the curvature to produce straightening. This usually results in some small loss of length. The other type of surgery consists of incision of the plaque or scar tissue and patching with a vein (saphenous vein graft) or dermal graft. Laser therapy is occasionally used. A penile prosthesis is the treatment of choice in patients with Peyronie's disease and erectile dysfunction.