Peyronie's Disease: Current Medical Treatment and Future Perspectives

Ji-Kan Ryu; Jun-Kyu Suh

doi:10.4111/kju.2009.50.6.527

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Ryu and Suh: Peyronie's Disease: Current Medical Treatment and Future Perspectives

Review Article

Korean J Urol 2009;50(6):527-533.

Published online: 19 January 2009

DOI: https://doi.org/10.4111/kju.2009.50.6.527

Peyronie's Disease: Current Medical Treatment and Future Perspectives

Ji-Kan Ryu, Jun-Kyu Suh

From the Department of Urology and National Research Laboratory of Regenerative Sexual Medicine, Inha University School of Medicine, Incheon, Korea

Correspondence to: Jun-Kyu Suh Professor of Urology and National Research Laboratory of Regenerative Sexual Medicine, Inha University School of Medicine, 7-206, 3rd ST, Shinheung-dong, Jung-gu, Incheon 400-711, Korea TEL: 032-890-3441 FAX: 032-890-3097 E-mail: jksuh@inha.ac.kr

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose:

Because of our incomplete understanding of the pathogenesis of Peyronie's disease (PD), management of PD remains a therapeutic dilemma in the field of sexual medicine. Most currently available medical treatments have not demonstrated conclusive effects. The present review addresses the current status of nonsurgical treatment and emerging new therapeutic targets for PD.

Materials and Methods:

A systematic review of clinical or preclinical results of nonsurgical treatment for PD published as original articles in peer-reviewed journals is provided.

Results:

Although many studies regarding nonsurgical treatment of PD showed positive outcomes, the majority of these studies were not placebo-controlled approaches. Currently available randomized controlled trials on the use of oral, intralesional injection, and topical agents have not showed conclusive effects, with minor or little effect. However, the outcomes of recent preclinical studies targeting the TGF-β pathway or NO-cGMP pathway are promising.

Conclusions:

There is no viable therapeutic option for PD between watchful waiting and surgical manipulation. With further research into the pathologic cascade of cellular and molecular events and an increase in our understanding of the pathophysiology of PD using animal models, the development of novel and effective medical therapies will become a realistic objective.

Keywords: Penile induration, Fibrosis, Therapy, Transforming growth factor beta, TGF-beta type I receptor

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Table 1.

Oral therapy for Peyronie's disease: placebo-controlled, double-blind trials

Type of therapy	No. of patients	Mean follow-up	Pain improvement	Curvature improvement	Plaque size reduction
Potaba⁷	103	12 months	NSD	No	Yes
				Yes, on progression
				of curvature
Vitamine E⁸	59	NR	NSD	NSD	NR
Propoleum^9a	34	6 months	Yes	Yes	Yes
Tamoxifen¹⁰	25	7 months	NSD	NSD	NSD
Colchicine¹¹	84	16 months	NSD	NSD	NSD
Acetyl-_L-carnitine^12b	48	9 months	Yes	Yes (15.8^o→8.4^o)	NSD
Propionyl-_L-carnitine＋Vitamin	n E^13c 236	16 months	NSD	NSD	NSD
Omega-3¹⁴	224	6 months	NSD	NSD	NSD

NSD: no significant difference, NR: not recorded,

^a : not clinically relevant because available only in Cuba

^b : tamoxifen-controlled study,

^c : propionyl-L-carnitine and vitamin E were given separately or in combination

Table 2.

Intralesional injection therapy for Peyronie's disease: placebo-controlled trials

Type of therapy	No. of patients	Mean follow-up	Pain improvement	Curvature improvement	Plaque size reduction
Collagenase¹⁵	49	3 months	NR	Yes^a	NR
Verapamil¹⁶	14	3 months	NR	NSD	Yes
Interferone α-2b¹⁷	117	At least 4 weeks	Yes	Yes (49.9^o→36.4^o)	Yes
Verapamil²⁰	80	24 weeks	NSD	NSD	NSD
NR: not recorded, NSD (curvature improvemen	D: no significant differen t, 15^o to 20^o)	nce, ^a: thirty-six percent	t of the patients receiving	collagenase expericenced	a positive response

Table 3.

Topical or transdermal therapy for Peyronie's disease: placebo-controlled trials

Type of therapy	No. of patients	Mean follow-up	Pain improvement	Curvature improvement	Plaque size reduction
Verapamil＋Dexamethasone (EMDA)²⁴	73	6 weeks	Yes	Yes	Yes
Verapamil (EMDA)²⁵	42	3 months	NR	NSD	NR
lrhSOD²⁶	39	12 weeks	Yes	NSD	NSD

NR: not recorded, NSD: no significant difference, EMDA: electromotive drug administration, lrhSOD: liposomally encapsulated recombinant human superoxide dismutase

Table 4.

Future therapeutic targets for Peyronie's disease: preclinical studies

Inhibition of TGF-β signaling pathway
Small molecule inhibitor of TGF-β type I receptor
(ALK5 inhibitor)⁴⁵
Activation of NO-cGMP pathway
L-arginine (NOS substrate)⁴⁸
iNOS gene therapy⁴⁹
NO donor (S-nitroso-N-acetyl penicillamine, SNAP)⁵⁰
PDE5 inhibitor⁵¹
Inhibition of myostatin (growth and differentiation factor-8,
GDF-8)
Myostatin shRNA⁵⁶

TGF-β: transforming growth factor-β, ALK5: activin receptor-like kinase 5, NO: nitric oxide, cGMP: cyclic 3’,5’-guanosine monophosphate, iNOS: inducible nitric oxide synthase, PDE5: type 5 phosphodiesterase, shRNA: short hairpin RNA

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