What are the treatment options for Peyronie’s disease?

This review looked at the varying treatments for Peyronie’s disease (PD) and their effectiveness in treating it. 

PD is a condition resulting from fibrous scar tissue that develops on the penis and causes curved, painful erections. This condition becomes more common with age. Sexual function can be affected. The mainstay of treatment is the surgical removal of the fibrous scar tissue. However, this cannot be carried out during the active phase of the disease. The active phase is when the plaques form and is very painful. 

Currently, there is no ideal management of PD. This analysis assessed varying treatment modalities to establish an optimal management for PD. 

The authors analyzed 92 articles for different treatment options for PD. 

Colchicine (Colcrys), an anti-inflammatory medication used in the treatment of gout has been shown to be effective in the early phase of PD.

There were several trials that assessed the use of verapamil (Isoptin) injections into PD lesions (plaques) may be beneficial, although data from large, randomized trials are lacking. Verapamil is a calcium channel blocker used for the treatment of high blood pressure, chest pain, and abnormal heart rhythm. Interferons (IFN), have also shown promising effectiveness compared to placebo when injected into lesions. IFNs are immune proteins that help the immune system react against foreign antigens. 

Collagenase clostridium histolyticum (CCH) injected into the lesions was approved for the treatment of PD. CCH involves an enzyme made by a bacteria that breaks collagen (a protein found in the plaques of PD). Previous larger studies have shown that CCH injections significantly improved the size of plaques as well as penis curvature compared to injected saline. However, it is more expensive than other treatments and it can cause pain and bruises. Its effectiveness in the active phase is yet to be demonstrated. 

Topical (local application) usage of hydrocortisone (Aquacort) and verapamil has been shown to beneficial reductions of pain, and the size of lesions, however further studies need to be carried out.

Extracorporeal shockwave therapy (ESWT) has been examined and was found to be effective and safe to reduce penile pain and lesion size in patients with PD. Radiotherapy, ultrasound, and laser therapy have also been studies. However, there is not enough evidence to support their use for the treatment of PD.

Vacuum therapy using a vacuum pump has shown satisfactory stretching of the penis and may be used before surgery. Penile traction therapy has been shown to improve penile curvature. Traction therapy requires patients to be highly-motivated. Patients must also comply with treatment. 

The authors reviewed the available management options for PD.