genitourinary disorders
Peyronie Disease
Treatment of Peyronie Disease
Oralvitamin Eand potassium para-aminobenzoate Surgical replacement of fibrosis with patch graft Local injections ofverapamil, high-potency corticosteroids, orcollagenaseClostridium histolyticum(collagenase) Ultrasound or radiation therapy Repeated use of external traction devices (to straighten the penis) Treatment results are unpredictable. Oralvitamin Eand potassium para-aminobenzoate have had varied success. Surgical removal of the fibrosis and replacement with a patch graft may be successful or may result in further scarring and exaggeration of the defect. Graft patches may be created using autografts (dermis, tunica vaginalis, or buccal mucosa), allografts (usually cadaveric pericardium), xenografts (bovine pericardium or intestinal submucosa), and synthetic grafts (Dacron and Gore-Tex). A series of local injections ofverapamilor high-potency corticosteroids into the plaque may be effective, but oral corticosteroids are not. For a penile curvature of > 30° accompanied by a palpable plaque, 1 to 4 treatment cycles (performed about 6 weeks apart) of injections ofcollagenaseclostridium histolyticum (collagenase) into the plaque followed by at-home manual penile remodeling may be used. Repeated injection ofcollagenasewith manipulation is provided by penile stretching and straightening exercises to break up the plaque. Ultrasound treatments can stimulate blood flow, which may prevent further scarring. Radiation therapy may decrease pain; however, radiation often worsens tissue damage. To assist penetration, a penile prosthesis may be implanted but may require a patch procedure to straighten the penis. Penile external traction to straighten the penis is often done in conjunction with medical therapies. Surgical penile plication may be used to treat Peyronie disease by using sutures to shorten the side opposite the plaque. It is generally successful at straightening the penis but usually results in mild shortening of the penis. 