FREE DAILY AND WEEKLY NEWSLETTERS OFFERED BY CONTENT OF INTEREST
Did you find this article relevant? Subscribe to UroToday-GUOncToday!
The fields of GU Oncology and Urology are advancing rapidly including new treatments, enrolling clinical trials, screening and surveillance recommendations along with updated guidelines. Join us as one of our subscribers who rely on UroToday as their must-read source for the latest news and data on drugs. Sign up today for blogs, video conversations, conference highlights and abstracts from peer-review publications by disease and condition delivered to your inbox and read on the go.
Surgery remains the gold standard for PD treatment in the stable phase. The goal is to provide the patient with a functionally straight penis, which has been defined as 20 degrees or less5. There are a variety of surgical procedures that have been described and an algorithm was developed to aid in determining the ideal procedure for each individual patient6,7. Men who have adequate rigidity for intercourse with or without the use of pharmacotherapy are good candidates for either tunica albuginea plication (TAP) or plaque excision and grafting (PEG). TAP is ideal for men with less severe curvatures (<60-70 degrees), no hourglass or hinge, and adequate penile length. PEG is more ideal for men with curves of >60-70 degrees, the presence of hinge or hourglass deformity, extensive plaque calcification, and strong preoperative erections. Placement of a penile prosthesis with straightening maneuvers is indicated in PD patients with erectile dysfunction not responsive to oral pharmacotherapy6,7. The most common adverse effect following surgery is perceived loss of length. Length restoration procedures have recently been developed to address this with promising results reported in small series. 8,9
It is the authors' opinion that the non-surgical therapy most likely to provide meaningful results is combination therapy utilizing oral, intralesional, and external traction therapy. Surgery remains the gold standard for definitive treatment.
Written by: Edward Capoccia, MD, Rush Urology
- Watt AJ, Hentz VR. Collagenase clostridium histolyticum: a novel nonoperative treatment for Dupuytren’s disease. Int J Clin Rhematol. 2011;6:123-133.
- Gelbard M, Goldstein I, Hellstrom WJ, et al. Clinical efficacy, safety and tolerability of collagenase clostridium histolyticum for the treatment of peyronie disease in 2 large double-blind, randomized, placebo controlled phase 3 studies. J Urol. 2013;190:199-207.
- Lipshultz L, Goldstein I, Seftel A, et al. Clinical efficacy of collagenase clostridium histolyticum in the treatment of Peyronie’s disease by subgroups: results from two large, double-blind, randomized, placebo-controlled, phase 3 studies. BJU Int. 2015;116:650-656.
- Cordon, B. H., Hofer, M. D., Hutchinson, R. C., Broderick, G. A., Lotan, Y., & Morey, A. F. (2017). Superior Cost Effectiveness of Penile Plication vs Intralesional Collagenase Injection for Treatment of Peyronie's Disease Deformities. Urology Practice, 4(2), 118-125.
- Martinez-Salamanca JI, Equi A, Moncada I, et al. Acute phase Peyronie’s disease management with traction device: a nonrandomized prospective controlled trial with ultrasound correlation. J Sex Med. 2014;11:506-515.
- Levine LA, Lenting EL. A surgical algorithm for the treatment of Peyronie’s disease. J Urol. 1997;158(6):2149-52.
- Levine, L. A., and R. J. Dimitriou. A surgical algorithm for penile prosthesis placement in men with erectile failure and Peyronie's disease. International journal of impotence research 12.3 (2000): 147-151.
- Wilson SK, Delk JR. A new treatment for Peyronie's disease: modeling the penis over an inflatable penile prosthesis. J Urol 1994; 152: 1121.
- Morey AF. Re: Penile Lengthening and Widening without Grafting According to a Modified 'Sliding' Technique. J Urol. 2016;195(6):1822-3.