Understanding the phases and treatment options for Peyronie’s disease

The review article titled"Current insights and future directions in Peyronie's disease management: A narrative review", was published on November 12, 2024 in UroPrecision.

PD is an inflammatory and fibrotic condition characterized by the formation of fibrous plaques in the tunica albuginea, leading to penile curvature, pain, and significant psychological distress. Affecting up to one in nine men in the United States and between 0.3% and 13.1% globally, PD progresses through two distinct phases: an acute phase marked by pain and plaque formation, and a chronic or stable phase where pain subsides, and the deformity stabilizes. Despite ongoing research, the precise etiology of PD remains unclear, though microtrauma during intercourse, genetic predisposition, and systemic inflammatory conditions are thought to play significant roles.

Diagnosis of PD relies primarily on a thorough history and physical examination, with induced erection and ultrasonography being key diagnostic tools. Imaging beyond ultrasound is not routinely recommended, as it rarely provides additional actionable information. Current management strategies are tailored to the disease phase. In the acute phase, the focus is on pain control and slowing disease progression, often using nonsteroidal anti-inflammatory drugs and, in some cases, extracorporeal shockwave therapy. In the stable phase, treatment shifts to correcting bothersome curvature, with options ranging from non-surgical interventions like traction therapy and intralesional injections to surgical procedures such as tunical plication or penile prosthesis implantation.

Non-surgical treatments, while widely used, are often poorly supported by robust evidence. Exceptions include traction therapy, which has shown promise in reducing curvature and preserving penile length, and intralesional injections of collagenase Clostridium histolyticum or interferon alpha-2b, which have demonstrated efficacy in specific patient populations. Surgical intervention is reserved for stable disease and is highly individualized, depending on the severity of curvature and the presence of erectile dysfunction. Techniques such as tunical shortening or lengthening, plaque incision or excision with grafting, and inflatable penile prosthesis placement are commonly employed, each with its own set of benefits and risks.

Future directions in PD management are focused on improving diagnostic accuracy, understanding the underlying biological mechanisms, and developing targeted therapies. Advances in imaging, such as contrast-enhanced MRI and nuclear scintigraphy, may help better distinguish between active and stable disease. Regenerative therapies, including stem cells and platelet-rich plasma, hold promise for addressing both fibrosis and erectile dysfunction. Additionally, ongoing clinical trials are exploring novel treatments, including combination therapies and new surgical techniques, which may further refine the management of PD.

In conclusion, while significant progress has been made in understanding and managing PD, many questions remain unanswered. As diagnostic tools and therapeutic options continue to evolve, the management of PD will become increasingly personalized, offering hope for improved outcomes and quality of life for affected men. This review highlights the current state of knowledge and outlines promising avenues for future research and clinical practice.