Peyronie’s disease: current therapy

Peyronie’s disease is a connective tissue disorder affecting the tunica albuginea of the penis, causing a myriad of problems including penile pain, erectile dysfunction, penile deformity, and difficulty in performing coitus. Francois de la Peyronie first described this in 1743 while he was the surgeon for Louis XIV of France. Although the exact prevalence is unknown, it is relatively common with varying data quoting a prevalence of about 3.2-8.9% with more than 75% of cases occurring in men between 45 and 65 years of age. The incidence of PD following radical prostatectomy is reported to be as high as 15.9% and a recent study showed that penile curvature is a common finding (38.6%) at IPP implantation surgery for ED after prostate cancer treatment (1). The exact etiology is not known but many studies suggest an inciting event causes inflammation of the tunica albuginea with altered wound healing. Examples of inciting events include minor penile trauma during intercourse, history of other genital or perineal injuries, transurethral prostatectomy, and cystoscopy. Other proposed risk factors include diabetes, cigarette smoking, alcohol consumption, hypertension, autoimmune disease, malnutrition, and propranolol administration. There is also a correlation in patients with Dupuytren’s contractures. It has been proposed that Peyronie’s disease has 2 distinct stages: an early/acute inflammatory phase followed by a mature/quiescent stage. Surgery has long been the gold standard for treatment but with improved understanding of the pathophysiology of this disease, more conservative treatment modalities have been used with varying degrees of success. Oral therapy