Recent Advances in the Treatment of Peyronie's Disease

Ryu, Ji Kan; Suh, Jun Kyu

Abstract

Peyronie's disease(PD) is an inflammatory condition characterized by the formation of fibrous, noncompliant nodules in the tunica albuginea leading to penile deformity and bending. Repetitive microtrauma of the penis during sexual intercourse is thought to incite a local autoimmune reaction in genetically susceptible individuals. The fibrotic plaques are most likely produced by tunical fibroblasts in response to cytokine stimulation, such as by transforming growth factor-beta1. In the acute inflammatory phase, pain during erection and penile deviation are the main symptom. In later stages, PD is often associated with erectile dysfunction(ED), distal flaccidity, or both. The causes of ED include psychological factors (performance anxiety), penile pain and deformity, flail penis, and vascular disease. Conservative treatment is useful during the early inflammatory stage. Despite myriad proposed medical therapies, including numerous oral agents and local injection regimens, there have been limited advances. Surgery is typically reserved for patients who fail to respond to conservative treatment and have had no disease progression for at least several months. Penile lengthening procedures with different grafting materials have, to a great extent, replaced conventional procedures with penile plication or its modifications. Prosthesis insertion is reserved for patients with severe ED that does not respond to medical management. As the molecular mechanism of inflammation and wound healing is elucidated, new approaches for medical intervention, such as modification of fibroblast function, growth factor activity, and cytokine action, will no doubt be available for therapy of PD.