Treatment of active-phase Peyronie’s disease (PD) “remains a challenge for urologists,” according to a recent review of medical studies.
Affecting an estimated 3% to 9% of men, Peyronie’s disease is a benign condition that causes plaques to form within the tunica albuginea of the penis. It’s exact cause is unknown. Symptoms of Peyronie’s disease include pain, penile deformity, curvature, erectile dysfunction (ED), and distress. Some men with Peyronie’s disease are unable to have intercourse.
Peyronie’s disease occurs in two phases. The first (active/acute) phase, when plaques form and pain is noticeable, typically lasts about five to seven months. The second (stable/chronic) phase follows. At this stage, pain is usually diminished, but the curvature is usually permanent.
Clinicians treat active-phase Peyronie’s disease in a variety of ways, including oral medications, extracorporeal shock wave therapy, intralesional therapy, and traction therapy. Men in the stable phase may undergo surgery, but this route is not recommended for men in the active phase.
For a recent Sexual Medicine Reviews article, researchers examined studies on conservative treatments for the active phase published between 2013 and April 2018.
The authors discussed several forms of oral therapy, noting that the International Society for Sexual Medicine (ISSM), the American Urological Association (AUA), and the European Association of Urology (EAU) “all do not support oral treatment for PD as efficacious.”
Studies of phosphodiesterase type 5 (PDE5) inhibitors [medications commonly prescribed to men with erectile dysfunction (ED)] suggested that men with active-phase PD could see some pain relief and improved erections. Nonsteroidal anti-inflammatory drugs (NSAIDs) could be helpful for pain relief. But other drugs and substances, such as vitamin E, pentoxifylline, and coenzyme Q were not recommended.
Two topical therapies – verapamil and emu oil – were discussed. Verapamil was not found to be beneficial. A small study suggested that emu oil might reduce pain and curvature.
The authors noted that extracorporeal shock wave therapy is “still unproven” and not supported for use in men with active-phase PD. They added that this view “might change in the future if robust positive data from well-designed multicenter studies become available.”
Some men with active-phase PD opt for intralesional therapy, which involves injecting medication directly into the plaques. Collagenase clostridium histolyticum (brand name Xiaflex) is the only intralesional therapy approved by the U.S. Food and Drug Administration (FDA) and the most popular, the authors said. Another product, IFN-α2b (interferon) could be effective as well and is recommended.
Finally, traction therapy – wearing a straightening device for several hours a day – may also be an effective “new approach for treating PD.”
“No option is absolute for every patient,” the authors concluded. They called for more clinical trials to validate the various therapies.
International Society for Sexual Medicine
“Traction Therapy for Peyronie’s Disease”
(September 17, 2012)
Sexual Medicine Reviews
Brimley, Scott C., BS, et al.
“Review of Management Options for Active-Phase Peyronie’s Disease”
(Full-text article in press. Published online: November 29, 2018)
Urology Care Foundation
“What is Peyronie’s Disease?”