Editing Peyronie's Disease (2015) (section)

== Management ==

* Only clinicians with expertise in Peyronie’s disease should treat affected patients
* '''Treatment depends on whether the patient’s symptoms are active (dynamic) vs. stable'''

=== Active phase ===
* '''Oral non-steroidal anti-inflammatory medications can be used for pain'''

=== Stable phase ===

==== Recommended ====
* '''Intralesional options (3):'''
*# '''Intralesional collagenase clostridium histolyticum and modeling''' by the physician and patient
*#* '''Used to reduce penile curvature; does NOT treat pain or ED'''
*#* '''Appropriate in patients with curvature >30° and <90° and intact erectile function (with or without the use of medications)'''
*#** '''To-date, clinical trials have not evaluated the use of collagenase in patients with hourglass deformity, ventral curvature, calcified plaque, or plaque located proximal to the base of the penis'''
*#** '''The magnitude of treatment effect beyond placebo is modest'''
*#* '''Potential adverse effects: penile bruising, pain, swelling, and corporal rupture'''
*# '''Intralesional Interferon α-2b'''
*#* '''Used to reduce curvature, plaque size, pain, and improve some vascular outcomes'''
*#* '''Appropriate in patients with curvature > 30° and without calcified plaque'''
*#** '''The magnitude of treatment effect beyond placebo is modest'''
*#* '''Potential adverse effects: sinusitis, flu-like symptoms, and minor penile swelling'''
*# '''Intralesional verapamil'''
*#* Evidence for the use of intralesional verapamil is weak
*#* '''Potential adverse effects: penile bruising, pain, dizziness, and nausea'''

==== Conditional ====
* '''Extracorporeal shock wave therapy (ESWT)'''
** '''Can be used for penile pain'''
*** Recommendation is Conditional because the broader PD literature indicates that pain is the PD symptom that is most likely to resolve over time without intervention, the patient burden involved in obtaining ESWT treatment to treat pain may be substantial, and other treatments may be equally effective at alleviating pain. Further, ESWT is associated with frequent adverse events.
** '''SHOULD NOT be used for the reduction of penile curvature or plaque size'''

==== Not recommended (3): ====
# '''Oral therapies (vitamin E, tamoxifen, procarbazine, omega-3 fatty acids, or a combination of vitamin E with L-carnitine)'''
# '''Electromotive therapy with verapamil'''
# '''Radiotherapy'''

==== Surgical reconstruction ====
* '''Patients who are considering surgical reconstruction should have chronic, stable disease, i.e. the presence of Peyronie’s disease symptoms ≥12 months and stable curvature for 3-6 months'''
** The surgical literature focuses almost entirely on patients with stable disease; outcomes for patients with active disease are not known.
* '''Options:'''
** '''Treatment is based on baseline erectile function'''; because tunical plication or plaque incision/excision with or without grafting are not treatments for ED and because the consequences of these procedures with regard to erectile function remain unclear, the most appropriate candidates for surgery are patients with intact erectile function or with ED responsive to oral medications or vacuum pump therapy
** '''For patients with capable erectile function''' '''(with or without adjunct therapy''' (oral medications, vacuum pump therapy, or intracavernosal injections)) '''and lack of deformity adequate for intercourse, options include (2):'''
**# '''Tunical plication surgery to improve penile curvature'''
**# '''Plaque incision or excision and/or grafting to improve penile curvature'''
** '''For patients with erectile dysfunction (ED) and/or penile deformity sufficient to impair coitus despite adjunct therapy'''
*** '''Inflatable penile prosthesis'''
**** Can perform adjunctive intra-operative procedures, such as modeling, plication or incision/grafting, when significant penile deformity persists after insertion of the penile prosthesis