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What are the treatment options for Peyronie’s disease?
A urologist may treat Peyronie’s disease with
nonsurgical treatments or surgery.
The goal of treatment is to reduce pain and restore and
maintain the ability to have intercourse. Men with small
plaques, minimal penile curvature, no pain, and
satisfactory sexual function may not need treatment
until symptoms get worse. Peyronie’s disease may
resolve on its own without treatment.
A urologist may recommend changes in a man’s lifestyle
to reduce the risk of ED associated with Peyronie’s
disease.
Non-surgical treatments
Nonsurgical treatments include medications and
medical therapies.
Medications and remedies used “off label” . A Urologist
may prescribe medications aimed at decreasing a man’s
penile curvature, plaque size, and inflammation. A man
may take prescribed medications to treat Peyronie’s
disease orally––by mouth––or a urologist may inject
medications directly into the plaque.
VITAMIN E
this antioxidant has been widely used in the
treatment of Peyronie’s disease since 1948, though
scientific evidence on its effect is lacking.
POTABA
or potassium para aminobenzoate is related to
B complex vitamins and theoretically can help the supply
of oxygen to inflamed tissues.
COLCHICINE
is a medication used for many years in the
treatment of Gout. It acts against inflammation, and
interferes with collagen (scar) synthesis. There is weak
evidence for its effects against Peyronie’s in clinical trials.
It can cause diarrhea, and should not be used in patients
who are on statins (cholesterol-lowering drugs) due to
the risk of muscle inflammation.
TAMOXIFEN
is a non-steroid antiestrogen that may
inhibit scar-producing cells. Clinical evidence for use in
Peyronie’s disease is weak .
ACETYL CARNETINE
appears to reduce cellular damage
due to inflammation. Clinical trials in Peyronie’s patients
have shown minimal effects.
L-ARGENINE
is an amino acid supplement that is a
precursor to a nitric oxide, a neurotransmitter critical for
erection, and is thought to inhibit fibrosis or scarring
PENTOXYFILLINE
improves red blood cell circulation in
vascular disorders, and may help to locally reduce
scarring following inflammation.
Injections.
Medications injected directly into plaques may include
VERAPAMIL
blocks the delivery of scar tissue precursors
into an area of wound healing. Injection directly into the
plaques has shown varying degrees of success.
ALPHA INTERFERON
is a signaling protein that plays a
role in human immune responses, by inhibiting the
proliferation of cells. It was the first anti-Peyronie’s
disease drug to be tested in a multi-institutional clinical
trial, where comparison to placebo showed a small effect
on curvature reduction. It has a tendency to produce
systemic flu-like symptoms.
STEROIDS
especially in case of durable pain.
Collagenase (Xiaflex) with FDA approval(not available in
Europ)
Xiaflex is a proprietary combination of two enzymes
found in cell-free filtrates from cultures of the bacterium
Clostridium Histolyticum. This mix of powerful enzymes
is highly specific for collagen, the molecular constituent
of scar tissue. It is capable of dissolving this scar tissue at
normal body temperature and pH, reducing the curving
or distorting effect scar creates in the erectile bodies
(corpora cavernosa) of the penis. It has been FDA
approved for use in the hand (treating Dupuytren’s
contractures) since 2011, and in December 2013 for use
in Peyronie’s disease. Results are encouraging.
Local therapies.
A urologist may use medical therapies to break up scar
tissue and decrease plaque size and curvature.
Therapies to break up scar tissue may include
shockwave therapy
- focused, low-intensity
electroshock waves directed at the plaque
Iontophoresis
- painless, low-level electric current that
delivers medications through the skin over the
plaque to decrease plaque size and curvature.
mechanical traction and vacuum devices aimed at
stretching or bending the penis to reduce curvature.