Guidelines for Peyronie’s disease – an update

This study provided 7 new recommendations for the management of Peyronie's disease (PD) based on recent evidence.

Peyronie's disease (PD) is a condition in which scar tissue, called plaque, develops along the shaft of the penis. These plaques cause the penis to curve, particularly during erections, which can be painful and can lead to erectile dysfunction. PD is likely caused by minor injury to the penis and poor wound healing. Most researchers believe PD also has genetic causes. There is currently no international standard on the evaluation of PD and its treatment outcomes.

The International Society for Sexual Medicine provided 7 new recommendations for the management of PD.

PD is typically diagnosed based on medical history and penile examination. A detailed history should be recorded that includes disease onset, duration, pain, deformity, and erectile status. Sexual function should also be assessed. This should focus on penile sensation, erectile and ejaculatory function, and concerns of penile length and girth. A psychological referral should also be offered, if necessary.

The Peyronie’s Disease Questionnaire (PDQ) is a 15-question self-reported survey that measures the impact and severity of PD symptoms. There is moderate evidence that supports the reliability of the PDQ. However, it has not yet been widely adopted or validated across different cultures and countries.

Physical examination should include genital examination, such as circumcision status, plaque size and location, and assessment of the degree of penile deformity. Most patients have well-defined plaque that can be felt during a physical examination. It is most commonly located on the underside of the penis. Digital home photographs of the erect penis could be sufficient for monitoring disease progression.

Based on expert opinion, the assessment of the curvature of the erection is best performed after an injection that helps dilute the blood vessels. Such an injection is also advisable before an invasive procedure to treat PD. Some patients may report changes in penile sensation with disease progression. In such cases, a test that uses vibration to test sensations, called biothesiometry, is recommended before undergoing an invasive procedure.

Recent evidence has largely failed to find a benefit of low-intensity shock wave therapy to treat penile curvature. However, there is some moderate-quality evidence suggesting that it may be effective in younger patients. In combination with other treatment options, some improvements in erectile function and quality of life were observed. The current literature supports the use of low-intensity shock wave therapy in PD for lowering penile pain and disease stabilization.

Surgery remains the fastest and most reliable treatment option with the longest lasting results. However, surgery should only be considered under certain conditions. These include that PD must be stable for at least 6 months. There must also be severe penile deformity causing difficult intercourse. Other less invasive treatment options must have failed, or the patient may seek the most reliable results. A penile prosthesis may be a suitable alternative for some patients.

Patients should have realistic outcome expectations. Surgery is associated with a number of risks. These can include recurrent curvature, loss of penile length, erectile dysfunction, and reduced sexual sensation. These should be adequately discussed with the patient before surgery.

This study provided 7 new recommendations for the management of PD based on recent evidence.

Additional treatment options for PD were covered in the Fourth International Consultation on Sexual Medicine guidelines on PD.  These include oral therapy with supplements (such as vitamin E and potassium), antioxidants, anti-swelling agents (such as colchicine [Colcrys]), and hormone therapy (such as tamoxifen [Nolvadex]) as well as penile injections with steroids and collagenase (enzymes that break down connective tissue).