History of Peyronie's disease: from early descriptions to modern treatments

Peyronie's disease (PD) is a fibroproliferative disorder of the tunica albuginea characterized by localized plaque formation, penile curvature, and erectile dysfunction, most commonly affecting men between 40 and 70 years of age. Although François Gigot de La Peyronie is credited with the first formal description of the disease in 1743, depictions of penile curvature predate his description by millennia.

This review aims to provide a comprehensive understanding of the historical and contemporary evolution of therapeutic strategies for PD, highlighting the shift from anecdotal remedies to evidence-based approaches.

PubMed, Cochrane, and Embase databases were searched without restrictions on publication date, using keywords related to PD and its therapies. Key interventions, including oral and topical agents, intralesional injections, penile traction therapy (PTT), and surgical techniques, were analyzed in the context of clinical trial data and guideline recommendations.

Early therapeutic approaches focused on oral and topical agents, which failed to demonstrate consistent efficacy in randomized trials. Intralesional injection (ILI) therapy has emerged as a leading option for nonsurgical management, with collagenase Clostridium histolyticum (CCH) as the standard treatment supported by robust evidence of significant improvements in penile curvature. PTT has undergone considerable refinement, with second-generation devices yielding excellent outcomes, particularly when combined with CCH. Surgical intervention remains the gold standard for definitive treatment of severe or complex deformities. Technical modifications have developed, including the use of biologic grafts, inflatable prosthesis placement with manual modeling, and graftless techniques such as tunica expansion and auxetics.

A review of the historical progression of PD management demonstrates the shift from anecdotal claims of treatment efficacy to evidence-based practice. Current guidelines recommend ILI and PTT as first-line nonsurgical management, with surgery providing exceptional outcomes. Future progress aims to gain a greater molecular understanding of fibrosis and tissue remodeling to foster targeted therapies.