Straightening out Peyronie's: a medical and surgical approach to the patient.

PURPOSE: Peyronie's disease is characterized by plaque formation within the tunica albuginea of the penile corpora cavernosa. The exact etiology of Peyronie's is uncertain at this time, and multiple treatment options exist. Following a literature review, a treatment algorithm has been developed to streamline decisions for both medical and surgical intervention.

METHODS: A review of the Medline literature published between 1940 and 2008 was performed looking at the history, pathophysiology, medical and surgical treatments for Peyronie's disease.

RESULTS: The current standard is to treat Peyronie's with expectant medical management or by adding oral, topical, or injected medicines to the plaque until the process is stabile for 12 to 18 months. Besides pain relief, few patients experience significant disease regression with these nonsurgical therapies. Although initially discouraging, recent studies of plaque being injected with verapamil, interferon, or collagenase show promising objective improvements. Patients with disabling curvature in the chronic disease phase respond best to surgical intervention. A review of the mechanisms, adverse effects, and supporting literature are provided.

CONCLUSION: The approach to concerns about Peyronie's disease should begin with understanding the patient's expectations and making the patient aware of associated successes and risks with each treatment option. Medical treatments provide a reasonable starting point, they: lessen pain in most, improve deformity in some, but completely resolve symptoms in only a few. Those who fail to experience adequate improvement with medical therapy, and those with stable yet significant deformity, should proceed to surgical intervention. The algorithm developed in this review provides an organized approach for making decisions about patient treatment.