Peyronie’s disease (PD) can be difficult to treat, but new research on nonsurgical approaches is encouraging, according to a recent review.
Estimated to affect between 3% and 9% of older men, PD is characterized by plaques that form just beneath the skin of the penis. Many experts believe the condition is caused by an injury that does not heal properly. Men with PD develop a distinct curvature of the penis, which can make intercourse impossible. Many experience pain, erectile dysfunction (ED), and emotional distress.
Peyronie’s disease can be treated surgically, but less-invasive nonsurgical options are also available. In 2015, the American Urological Association issued clinical guidelines on these approaches, and a recent review published in the World Journal of Men’s Health discussed these guidelines along with new research on the topic over the past three years.
Oral therapies, including vitamin E, Tamoxifen, potassium para-aminobenzoate, and phosphodiesterase type 5 inhibitors, “serve a very limited role in the treatment of PD,” the authors wrote. Efficacy can be limited and side effects may make them difficult for patients to tolerate. For example, one study reported that about two-thirds of men taking potassium para-aminobenzoate dropped out, mostly because of gastrointestinal side effects.
Intralesional therapies, which involve injections to the penis, may be a “reasonable alternative” to surgery, the authors said. Currently, intralesional collagenase clostridium histolyticum (CCh – Xiaflex) is the only nonsurgical PD treatment to be approved by the U.S. Food and Drug Administration (FDA). Intralesional interferon α 2 β could be an alternative to CCh, but more study is needed. Other intralesional therapies, such as verapamil, hyaluronic acid, and botulinum toxin also need more research.
The authors discussed other nonsurgical treatments as well:
• Penile traction therapy does not appear to be effective on its own, they explained, but it could be useful in combination with other treatments and may address concerns about penile length.
• Topical therapies could be easy for patients to use, but do not seem to be effective, they said.
• Extracorporeal shock wave treatment might relieve pain, but probably won’t help with curvature.
• Stem cell research has had some encouraging results in rat models, but study is still in the very early stages.
“Overall, PD remains a challenging disease to treat, but the abundance of recent trials and experiments suggest a promising future for the nonsurgical treatment of PD,” the authors wrote.
The World Journal of Men’s Health
Joice, Gregory A. and Arthur L. Burnett
“Nonsurgical Interventions for Peyronie's Disease: Update as of 2016”
(Full-text. Published online: August 23, 2016)