Review literature: (Gholami et al, 2003) (Hauck et al, 2006) (Tunuguntla, 2001).
Photo-documentation of the penile deviation is recommended before surgical treatment after self-stimulation or after intracavernosal injection of prostaglandin.
Penile plaques can be seen using a high-resolution linear transducer. The plaques should be limited to the tunica albuginea (exclusion of a sarcoma). Documentation of the calcifications.
Vascular testing is indicated for patients with erectile dysfunction. The most common cause of erectile dysfunction is a veno-occlusive dysfunction.
Cavernosography is seldom indicated in Peyronie's disease. Cavernosography can proof veno-occlusive dysfunction, localize the venous leakage and confirm the Doppler ultrasound findings.
Potassium Aminobenzoate (Potaba) is an antifibrotic drug. Potaba achieved in a randomized study a reduction of the plaque size and prevented worsening of the penile deviation. An existing deviation could not be improved, as the effect on pain was not significant (Weidner et al, 2005). The dosage of Potaba is 4 × 3 g p.o.
Significant reduction of pain and improvement of the deviation was reported with Carnitine. The dosage of Carnitine is 2 g / day p.o.
Intralesional injections are used to increase the drug dose in the plaques and to avoid systemic side effects.
Verapamil has an inhibitory effect on fibroblasts and increases the production of collagenases. The efficacy of verapamil on Peyronie's disease is controversial. In several uncontrolled studies and in a randomized study, the efficacy of verapamil infiltration was demonstrated. Two other randomized studies found no efficiency.
Dosage of verapamil infiltrations: local infiltration of 10 mg verapamil diluted in 10 ml every two weeks, to a total of 12 injections.
Interferon inhibits fibroblasts and increases the production of collagenases. In particular, high-dose interferon treatment (5-10 MU interferon-α 2b) demonstrated in several controlled trials (without a long follow-up) effectiveness in pain reduction, improvement of sexual function and penile deviation.
Local injections of collagenase were effective in a randomized study, improvement of penile deviation was not pronounced.
Despite its relatively frequent use, cortisone injections are probably not effective (one controlled study without effectiveness).
Electromotive treatment uses the help of a weak electric current to bring ionized substances in high concentrations to penile plaques. Systemic side effects can be avoided. Agents used are verapamil, dexamethasone and lidocaine. Controlled studies are lacking.
Several sessions of ESWT with e.g. 2000 shock waves on the plaques of Peyronie's disease lead to the alleviation of pain. Some of the plaques are reduced in size, an improvement of the deviation is not very likely (Hauck et al, 2006).
After evaluation of conservative treatment alternatives and only for patients with stable stage of disease (at least 1 year of consistent deviation), surgery may be a treatment alternative depending on the extent of the deviation and erectile function.
With a low-grade deviation and preserved erectile function, the Nesbit operation or plication techniques are suitable. With high-grade deviation and preserved erectile function, plaque incisision/excision and grafting is recommended. In the absence of erectile function despite of cavernosal injection treatment, a penile prosthesis is the surgical treatment alternative.
During Nesbit operation, an elliptical excision of the tunica albuginea on the convex side and closure enables to straighten the penile deviation (Nesbit, 1965). Modified technique: longitudinal incision of the tunica albuginea and horizontal closure (Yachia, 1990).
.Advantage of the Nesbit technique: no mechanical weakening of the penile shaft by grafting. Disadvantage of the Nesbit technique: strong deviations can only be straightened with a loss in penile length. For technique and complications of the Nesbit procedure, please refer to Section Urologic Surgery.
The excision of the tunica albuginea (Nesbit procedure) is omitted. Reduction stitches with nonabsorbable sutures shorten the tunica albuginea on the convex side and straighten the penile deviation. For technique and complications of the Nesbit procedure, please refer to Section Urologic Surgery.
After the incision/excision of the penile plaque on the concave side, the penis can be straightened. The corporatomy creates a defect in the corpus cavernous. This defect must be covered with endogenous or exogenous materials (skin, vein, allogene material). Penile straightening is possible without shortening of the penis. For technique and complications, please refer to Section Urologic Surgery.
In patients with Peyronie's disease with severe erectile dysfunction despite treatment, erectile function after plaque inzision and grafting cannot be expected. These patients should be offered a penile prosthesis as a surgical treatment option.
| Peyronie's disease (1/2) | Index | Premature ejaculation |
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Hauck, E. W. u. a. (2006). A critical analysis of nonsurgical treatment of Peyronie’s disease. In: Eur Urol 49, S. 987–997.
Weidner, W. u. a. (2005). Potassium paraaminobenzoate (POTABA) in the treatment of Peyronie’s disease: a prospective, placebo-controlled, randomized study. In: Eur Urol 47, 530–5; discussion 535–6.
Deutsche Version: Therapie der Induratio penis plastica (Morbus Peyronie)
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Dr. med. Dirk Manski
man...@urologielehrbuch.de