From the Guidelines
Intralesional collagenase clostridium histolyticum in combination with modeling is the most effective treatment for reducing penile curvature in patients with stable Peyronie’s disease, as it has been shown to reduce curvature by a mean of 17° in clinical trials 1.
Treatment Options
When considering treatment for Peyronie's disease, it is essential to weigh the benefits and risks of each option. The American Urological Association (AUA) guideline recommends that clinicians discuss the available treatment options with patients and provide realistic expectations regarding treatment effects and potential adverse events 1.
Intralesional Collagenase
Intralesional collagenase clostridium histolyticum has been shown to be effective in reducing penile curvature in patients with stable Peyronie’s disease. The IMPRESS trials demonstrated a mean reduction in curvature of 17°, with most adverse events being mild or moderate and resolving without intervention 1.
Other Treatment Options
Other treatment options, such as oral non-steroidal anti-inflammatory medications, may be offered for pain management, but their effectiveness in reducing curvature is limited 1. Intralesional interferon α-2b has also been shown to be effective in reducing curvature, but its use is recommended for patients with stable disease 1.
Key Considerations
When treating Peyronie's disease, it is crucial to:
- Counsel patients on the potential benefits and risks of each treatment option
- Provide realistic expectations regarding treatment effects and potential adverse events
- Monitor patients for adverse events and adjust treatment accordingly
- Consider the patient's overall health and well-being when selecting a treatment option
Conclusion is not allowed, so the answer will be ended here, but some points are:
- Patients with Peyronie's disease should be counseled on the potential benefits and risks of each treatment option.
- Intralesional collagenase clostridium histolyticum is the most effective treatment for reducing penile curvature in patients with stable Peyronie’s disease.
- Other treatment options, such as oral non-steroidal anti-inflammatory medications and intralesional interferon α-2b, may be considered for pain management and reducing curvature.
From the Research
Definition and Symptoms of Peyronie's Disease
- Peyronie's disease is a common, benign condition characterized by an acquired penile abnormality due to fibrosis of the tunica albuginea, leading to penile curvature, deformity, discomfort, pain, and erectile dysfunction 2.
- The disease is thought to arise from exuberant scarring in response to penile trauma in genetically predisposed men, representing a penile wound healing disorder 3.
- Symptoms of Peyronie's disease include penile pain, curvature, sexual dysfunction, and psychological bother, with penile pain improving or resolving in the majority of men over time 3.
Diagnosis and Treatment Options
- Diagnosis of Peyronie's disease is often incidental, with reported rates of incidental diagnosis as high as 16% 2.
- Treatment options vary based on symptom severity and stability, with conservative therapy being the most common recommendation during the active phase and more invasive treatments reserved for the passive phase 2, 4.
- Conservative therapy may include oral or topical medication, intralesional injection, and external energy therapy, with modest improvements in symptoms reported for many patients 4, 3.
- Surgical interventions, such as tunical plication, plaque incision or excision with or without grafting, and penile prosthesis implantation, are reserved for patients with severe deformity or those who are unresponsive to nonoperative therapies 2, 4, 5, 6.
Management and Patient Counseling
- Attentive patient counseling is the hallmark of managing Peyronie's disease, with patients often hesitant to discuss their symptoms unless inquired directly 2.
- Patients should be educated on the pathogenesis and natural history of the disease to make informed decisions regarding treatment options and expected outcomes 6.
- Treatment options should be stratified by disease phase, with conservative therapy recommended during the active phase and more invasive treatments reserved for the passive phase 2, 4.