Abstract
Peyronie’s disease (PD) is an acquired disorder of the tunica albuginea of the penis resulting in varying degrees of penile curvature and sexual dysfunction. The diagnosis of the disorder is usually straightforward after a detailed sexual history and focused physical exam. Although a wide range of medical treatments have been employed to treat the disorder, data from randomized trials support only a few. The administration of intralesional verapamil has provided generally consistent and positive results, while some evidence exists to support the use of colchicine, Potaba™, l-carnitine, and superoxide dismutase. Other promising therapies, but not yet verified by randomized trials, include penile extender devices and pentoxifylline.
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsReferences
Zargooshi, J. (2004). Trauma as the cause of Peyronie’s disease: penile fracture as a model of trauma. Journal d’Urologie, 172, 186–188.
Taylor, F. L., & Levine, L. A. (2007). Peyronie’s disease. The Urologic Clinics of North America, 34, 517–534.
Lindsay, M. B., Schain, D. M., Grambsch, P., Benson, R. C., Beard, C. M., & Kurland, L. T. (1991). The incidence of Peyronie’s disease in Rochester, Minnesota, 1950 through 1984. Journal d’Urologie, 146, 1007–1009.
Jordan, G. (2007). Peyronie’s disease. In L. Kavoussi, A. Novick, A. Partin, C. Peters, & A. Wein (Eds.), Campbell-Walsh Urology (Ninthth ed., pp. 818–838). Philadelphia: Saunders Elsevier.
Rhoden, E. L., Teloken, C., Ting, H. Y., & Lucas, M. L. (2001). Teodosio da Ros C, Ary Vargas Souto C. Prevalence of Peyronie’s disease in men over 50-y-old from Southern Brazil. International Journal of Impotence Research, 13, 291–293.
Mulhall, J. P., Creech, S. D., Boorjian, S. A., Ghaly, S., Kim, E. D., Moty, A., et al. (2004). Subjective and objective analysis of the prevalence of Peyronie’s disease in a population of men presenting for prostate cancer screening. Journal d’Urologie, 171, 2350–2353.
Schwarzer, U., Sommer, F., Klotz, T., Braun, M., Reifenrath, B., & Engelmann, U. (2001). The prevalence of Peyronie’s disease: results of a large survey. BJU International, 88, 727–730.
Kadioglu, A., Oktar, T., Kandirali, E., Kendirci, M., Sanli, O., & Ozsoy, C. (2004). Incidentally diagnosed Peyronie’s disease in men presenting with erectile dysfunction. International Journal of Impotence Research, 16, 540–543.
Mulhall, J. P., Schiff, J., & Guhring, P. (2006). An analysis of the natural history of Peyronie’s disease. Journal d’Urologie, 175, 2115–2118. Discussion 8.
Jordan, G. (2006) Peyronie’s disease. In: W. Campbell (Ed.), Campbell-Walsh Urology.
El-Sakka, A. I., Hassoba, H. M., Pillarisetty, R. J., Dahiya, R., & Lue, T. F. (1997). Peyronie’s disease is associated with an increase in transforming growth factor-beta protein expression. The Journal of Urology, 158, 1391–1394.
Smith, B. H. (1966). Peyronie’s disease. American Journal of Clinical Pathology, 45, 670–678.
Brock, G., Hsu, G. L., Nunes, L., von Heyden, B., & Lue, T. F. (1997). The anatomy of the tunica albuginea in the normal penis and Peyronie’s disease. The Journal of Urology, 157, 276–281.
Devine, C. J., Jr., & Horton, C. E. (1988). Peyronie’s disease. Clinics in Plastic Surgery, 15, 405–409.
Lue, T. F. (2002). Peyronie’s disease: an anatomically-based hypothesis and beyond. International Journal of Impotence Research, 14, 411–413.
Akkus, E., Carrier, S., Baba, K., Hsu, G. L., Padma-Nathan, H., Nunes, L., et al. (1997). Structural alterations in the tunica albuginea of the penis: impact of Peyronie’s disease, ageing and impotence. British Journal of Urology, 79, 47–53.
Smith, J. F., Conti, S. L., Shindel, A. W., Walsh, T. J., Eisenberg, M., Brant, W. O., et al. (2008) The incidence and prevalence of sonographic characteristics in men with Peyronie’s disease. Sexual Medicine of Society of North America Annual Meeting 2008; Abstract.
Iacono, F., Barra, S., De Rosa, G., Boscaino, A., & Lotti, T. (1993). Microstructural disorders of tunica albuginea in patients affected by Peyronie’s disease with or without erection dysfunction. The Journal of Urology, 150, 1806–1809.
Somers, K. D., & Dawson, D. M. (1997). Fibrin deposition in Peyronie’s disease plaque. The Journal of Urology, 157, 311–315.
Brant, W. O., Bella, A. J., Garcia, M. M., Tantiwongse, K., Dean, R. C., & Lue, T. F. (2007). Isolated septal fibrosis or hematoma – atypical Peyronie’s disease? Journal d’Urologie, 177, 179–182. Discussion 83.
Hellstrom, W. J., & Bivalacqua, T. J. (2000). Peyronie’s disease: etiology, medical, and surgical therapy. Journal of Andrology, 21, 347–354.
El-Sakka, A. I., Hassoba, H. M., Chui, R. M., Bhatnagar, R. S., Dahiya, R., & Lue, T. F. (1997). An animal model of Peyronie’s-like condition associated with an increase of transforming growth factor beta mRNA and protein expression. The Journal of Urology, 158, 2284–2290.
Davila, H. H., Magee, T. R., Zuniga, F. I., Rajfer, J., & Gonzalez-Cadavid, N. F. (2005). Peyronie’s disease associated with increase in plasminogen activator inhibitor in fibrotic plaque. Urology, 65, 645–648.
Qian, A., Meals, R., & Rajfer, J. (2004). Comparison of Gene Expression Profiles between Peyronie’s disease and Dupuytren’s contracture. Urology, 64, 399–404.
Afsar, H., & Sozduyar, N. (1992). Urethral manipulation syndrome (Kelami syndrome): acquired ventral penile deviation. Archivio Italiano di Urologia, Nefrologia, Andrologia, 64, 349–351.
Kelami, A. (1984). Urethral manipulation syndrome. Description of a new syndrome. Urologia internationalis, 39, 352–354.
Merkle, W. (1990). Cause of deviation of the erectile penis after urethral manipulations (Kelami syndrome)–demonstration of ultrasound findings and case reports. Urologia Internationalis, 45, 183–185.
Lyles, K. W., Gold, D. T., Newton, R. A., Parekh, S., Shipp, K. M., Pieper, C. F., et al. (1997). Peyronie’s disease is associated with Paget’s disease of bone. Journal of Bone and Mineral Research, 12, 929–934.
Smith, J. F., Walsh, T. J., Conti, S. L., Turek, P., & Lue, T. (2008). Risk factors for emotional and relationship problems in Peyronie’s disease. The Journal of Sexual Medicine, 5, 2179–2184.
Jordan, G. H., & Angermeier, K. W. (1993). Preoperative evaluation of erectile function with dynamic infusion cavernosometry/cavernosography in patients undergoing surgery for Peyronie’s disease: correlation with postoperative results. Journal d’Urologie, 150, 1138–1142.
Ralph, D. J., Hughes, T., Lees, W. R., & Pryor, J. P. (1992). Pre-operative assessment of Peyronie’s disease using colour Doppler sonography. British Journal of Urology, 69, 629–632.
Jarow, J. P., & Lowe, F. C. (1997). Penile trauma: an etiologic factor in Peyronie’s disease and erectile dysfunction. Journal d’Urologie, 158, 1388–1390.
Deveci, S., Palese, M., Parker, M., Guhring, P., & Mulhall, J. P. (2006). Erectile function profiles in men with Peyronie’s disease. Journal d’Urologie, 175, 1807–1811. Discussion 11.
Kendirci, M., Trost, L., Sikka, S. C., & Hellstrom, W. J. (2007). Diabetes mellitus is associated with severe Peyronie’s disease. BJU International, 99, 383–386.
Rosen, R., Catania, J., Lue, T., Althof, S., Henne, J., Hellstrom, W., et al. (2008). Impact of Peyronie’s disease on sexual and psychosocial functioning: qualitative findings in patients and controls. The Journal of Sexual Medicine, 5, 1977–1984.
Nelson, C. J., Diblasio, C., Kendirci, M., Hellstrom, W., Guhring, P., & Mulhall, J. P. (2008). The chronology of depression and distress in men with Peyronie’s disease. The Journal of Sexual Medicine, 5, 1985–1990.
Levine, L. A., & Greenfield, J. M. (2003). Establishing a standardized evaluation of the man with Peyronie’s disease. International Journal of Impotence Research, 15(Suppl 5), S103–S112.
Ohebshalom, M., Mulhall, J., Guhring, P., & Parker, M. (2007). Measurement of penile curvature in Peyronie’s disease patients: comparison of three methods. The Journal of Sexual Medicine, 4, 199–203.
Donatucci, C. F., & Lue, T. F. (1992). Correction of penile deformity assisted by intracavernous injection of papaverine. Journal d’Urologie, 147, 1108–1110.
Andresen, R., Wegner, H. E., Miller, K., & Banzer, D. (1998). Imaging modalities in Peyronie’s disease. An intrapersonal comparison of ultrasound sonography, X-ray in mammography technique, computerized tomography, and nuclear magnetic resonance in 20 patients. European Urology, 34, 128–134. Discussion 35.
Hauck, E. W., Hackstein, N., Vosshenrich, R., Diemer, T., Schmelz, H. U., Bschleipfer, T., et al. (2003). Diagnostic value of magnetic resonance imaging in Peyronie’s disease – a comparison both with palpation and ultrasound in the evaluation of plaque formation. European Urology, 43, 293–299. Discussion 9–300.
Aversa, A., & Sarteschi, L. M. (2007). The role of penile color-duplex ultrasound for the evaluation of erectile dysfunction. The Journal of Sexual Medicine, 4, 1437–1447.
Lee, R. C., & Ping, J. A. (1990). Calcium antagonists retard extracellular matrix production in connective tissue equivalent. The Journal of Surgical Research, 49, 463–466.
Rehman, J., Benet, A., & Melman, A. (1998). Use of intralesional verapamil to dissolve Peyronie’s disease plaque: a long-term single-blind study. Urology, 51, 620–626.
Cavallini, G., Biagiotti, G., Koverech, A., & Vitali, G. (2002). Oral propionyl-l-carnitine and intraplaque verapamil in the therapy of advanced and resistant Peyronie’s disease. BJU International, 89, 895–900.
Cavallini, G., Modenini, F., & Vitali, G. (2007). Open preliminary randomized prospective clinical trial of efficacy and safety of three different verapamil dilutions for intraplaque therapy of Peyronie’s disease. Urology, 69, 950–954.
Russell, S., Steers, W., & McVary, K. T. (2007). Systematic evidence-based analysis of plaque injection therapy for Peyronie’s disease. European Urology, 51, 640–647.
Jordan, G. H. (2008). The use of intralesional clostridial collagenase injection therapy for Peyronie’s disease: a prospective, single-center, non-placebo-controlled study. The Journal of Sexual Medicine, 5, 180–187.
Gelbard, M. K., Lindner, A., & Kaufman, J. J. (1985). The use of collagenase in the treatment of Peyronie’s disease. Journal d’Urologie, 134, 280–283.
Duncan, M. R., Hasan, A., & Berman, B. (1995). Pentoxifylline, pentifylline, and interferons decrease type I and III procollagen mRNA levels in dermal fibroblasts: evidence for mediation by nuclear factor 1 down-regulation. The Journal of Investigative Dermatology, 104, 282–286.
Duncan, M. R., Berman, B., & Nseyo, U. O. (1991). Regulation of the proliferation and biosynthetic activities of cultured human Peyronie’s disease fibroblasts by interferons-alpha, -beta and -gamma. Scandinavian Journal of Urology and Nephrology, 25, 89–94.
Inal, T., Tokatli, Z., Akand, M., Ozdiler, E., & Yaman, O. (2006). Effect of intralesional interferon-alpha 2b combined with oral vitamin E for treatment of early stage Peyronie’s disease: a randomized and prospective study. Urology, 67, 1038–1042.
Hellstrom, W. J., Kendirci, M., Matern, R., Cockerham, Y., Myers, L., Sikka, S. C., et al. (2006). Single-blind, multicenter, placebo controlled, parallel study to assess the safety and efficacy of intralesional interferon alpha-2B for minimally invasive treatment for Peyronie’s disease. Journal d’Urologie, 176, 394–398.
Bartsch, G., Menander-Huber, K. B., Huber, W., & Marberger, H. (1981). Orgotein, a new drug for the treatment of Peyronie’s disease. European Journal of Rheumatology and Inflammation, 4, 250–259.
Gustafson, H., Johansson, B., & Edsmyr, F. (1981). Peyronie’s disease: experience of local treatment with Orgotein. European Urology, 7, 346–348.
Montorsi, F., Salonia, A., Guazzoni, G., Barbieri, L., Colombo, R., Brausi, M., et al. (2000). Transdermal electromotive multi-drug administration for Peyronie’s disease: preliminary results. Journal of Andrology, 21, 85–90.
Riedl, C. R., Sternig, P., Galle, G., Langmann, F., Vcelar, B., Vorauer, K., et al. (2005). Liposomal recombinant human superoxide dismutase for the treatment of Peyronie’s disease: a randomized placebo-controlled double-blind prospective clinical study. European Urology, 48, 656–661.
Di Stasi, S. M., Giannantoni, A., Stephen, R. L., Capelli, G., Giurioli, A., Jannini, E. A., et al. (2004). A prospective, randomized study using transdermal electromotive administration of verapamil and dexamethasone for Peyronie’s disease. Journal d’Urologie, 171, 1605–1608.
Greenfield, J. M., Shah, S. J., & Levine, L. A. (2007). Verapamil versus saline in electromotive drug administration for Peyronie’s disease: a double-blind, placebo controlled trial. Journal d’Urologie, 177, 972–975.
Fitch, W. P., 3rd, Easterling, W. J., Talbert, R. L., Bordovsky, M. J., & Mosier, M. (2007). Topical verapamil HCl, topical trifluoperazine, and topical magnesium sulfate for the treatment of Peyronie’s disease–a placebo-controlled pilot study. The Journal of Sexual Medicine, 4, 477–484.
Martin, D. J., Badwan, K., Parker, M., & Mulhall, J. P. (2002). Transdermal application of verapamil gel to the penile shaft fails to infiltrate the tunica albuginea. Journal d’Urologie, 168, 2483–2485.
Bremer, J. (1983). Carnitine–metabolism and functions. Physiological Reviews, 63, 1420–1480.
Biagiotti, G., & Cavallini, G. (2001). Acetyl-l-carnitine vs tamoxifen in the oral therapy of Peyronie’s disease: a preliminary report. BJU International, 88, 63–67.
Safarinejad, M. R., Hosseini, S. Y., & Kolahi, A. A. (2007). Comparison of vitamin E and propionyl-l-carnitine, separately or in combination, in patients with early chronic Peyronie’s disease: a double-blind, placebo controlled, randomized study. Journal d’Urologie, 178, 1398–1403. Discussion 403.
Karlic, H., & Lohninger, A. (2004). Supplementation of l-carnitine in athletes: does it make sense? Nutrition, 20, 709–715. Burbank, Los Angeles County, Calif.
Wagenknecht, L. V. (1996). Differential therapies in various stages of penile induration. Archivos Españoles de Urología, 49, 285–292.
Carson, C. C. (1997). Potassium para-aminobenzoate for the treatment of Peyronie’s disease: is it effective? Techniques in Urology, 3, 135–139.
Weidner, W., Hauck, E. W., & Schnitker, J. (2005). Potassium paraaminobenzoate (POTABA) in the treatment of Peyronie’s disease: a prospective, placebo-controlled, randomized study. European Urology, 47, 530–535. Discussion 5–6.
McCarty, M. F. (1999). Interleukin-6 as a central mediator of cardiovascular risk associated with chronic inflammation, smoking, diabetes, and visceral obesity: down-regulation with essential fatty acids, ethanol and pentoxifylline. Medical Hypotheses, 52, 465–477.
Delanian, S., Porcher, R., Balla-Mekias, S., & Lefaix, J. L. (2003). Randomized, placebo-controlled trial of combined pentoxifylline and tocopherol for regression of superficial radiation-induced fibrosis. Journal of Clinical Oncology, 21, 2545–2550.
Tittelbach, J., Graefe, T., & Wollina, U. (2001). Painful ulcers in calciphylaxis – combined treatment with maggot therapy and oral pentoxyfillin. The Journal of Dermatological Treatment, 12, 211–214.
Boldt, J., Brosch, C., Lehmann, A., Haisch, G., Lang, J., & Isgro, F. (2001). Prophylactic use of pentoxifylline on inflammation in elderly cardiac surgery patients. The Annals of Thoracic Surgery, 71, 1524–1529.
Aygenc, E., Celikkanat, S., Kaymakci, M., Aksaray, F., & Ozdem, C. (2004). Prophylactic effect of pentoxifylline on radiotherapy complications: a clinical study. Otolaryngology: Head and Neck Surgery, 130, 351–356.
Boldt, J., Brosch, C., Piper, S. N., Suttner, S., Lehmann, A., & Werling, C. (2001). Influence of prophylactic use of pentoxifylline on postoperative organ function in elderly cardiac surgery patients. Critical Care Medicine, 29, 952–958.
Noel, C., Copin, M. C., Hazzan, M., Labalette, M., Susen, S., Lelievre, G., et al. (2000). Immunomodulatory effect of pentoxifylline during human allograft rejection: involvement of tumor necrosis factor-alpha and adhesion molecules. Transplantation, 69, 1102–1107.
Valente, E. G., Vernet, D., Ferrini, M. G., Qian, A., Rajfer, J., & Gonzalez-Cadavid, N. F. (2003). l-Arginine and phosphodiesterase (PDE) inhibitors counteract fibrosis in the Peyronie’s fibrotic plaque and related fibroblast cultures. Nitric Oxide, 9, 229–244.
Takami, M., Cho, E. S., Lee, S. Y., Kamijo, R., & Yim, M. (2005). Phosphodiesterase inhibitors stimulate osteoclast formation via TRANCE/RANKL expression in osteoblasts: possible involvement of ERK and p38 MAPK pathways. FEBS Letters, 579, 832–838.
Rajfer, J., Gore, J. L., Kaufman, J., & Gonzalez-Cadavid, N. (2006). Case report: Avoidance of palpable corporal fibrosis due to priapism with upregulators of nitric oxide. The Journal of Sexual Medicine, 3, 173–176.
Brant, W. O., Dean, R. C., & Lue, T. F. (2006). Treatment of Peyronie’s disease with oral pentoxifylline. Nature Clinical Practice Urology, 3, 111–115. quiz 6.
Pentoxifylline: Adverse Effects. Thomson. (2008). Retrieved March 15, 2008 from http://www.ucsf.som.edu/micromedex.
Trost, L. W., Gur, S., & Hellstrom, W. J. (2007). Pharmacological management of Peyronie’s disease. Drugs, 67, 527–545.
Azzi, A. (2007). Molecular mechanism of alpha-tocopherol action. Free Radical Biology and Medicine, 43, 16–21.
Prieto Castro, R. M., Leva Vallejo, M. E., Regueiro Lopez, J. C., Anglada Curado, F. J., Alvarez Kindelan, J., & Requena Tapia, M. J. (2003). Combined treatment with vitamin E and colchicine in the early stages of Peyronie’s disease. BJU International, 91, 522–524.
Brigelius-Flohe, R. (2007). Adverse effects of vitamin E by induction of drug metabolism. Genes and Nutrition, 2, 249–256.
Colletta, A. A., Wakefield, L. M., Howell, F. V., van Roozendaal, K. E., Danielpour, D., Ebbs, S. R., et al. (1990). Anti-oestrogens induce the secretion of active transforming growth factor beta from human fetal fibroblasts. British Journal of Cancer, 62, 405–409.
Hauck, E. W., Diemer, T., Schmelz, H. U., & Weidner, W. (2006). A critical analysis of nonsurgical treatment of Peyronie’s disease. European Urology, 49, 987–997.
Teloken, C., Rhoden, E. L., Grazziotin, T. M., Ros, C. T., Sogari, P. R., & Souto, C. A. (1999). Tamoxifen versus placebo in the treatment of Peyronie’s disease. Journal d’Urologie, 162, 2003–2005.
Diegelmann, R. F., & Peterkofsky, B. (1972). Inhibition of collagen secretion from bone and cultured fibroblasts by microtubular disruptive drugs. Proceedings of the National Academy of Sciences of the United States of America, 69, 892–896.
Cannella, A. C., & Mikuls, T. R. (2005). Understanding treatments for gout. The American Journal of Managed Care, 11, S451–S458. quiz S65-8.
Safarinejad, M. R. (2004). Therapeutic effects of colchicine in the management of Peyronie’s disease: a randomized double-blind, placebo-controlled study. International Journal of Impotence Research, 16, 238–243.
Gontero, P., Di Marco, M., Giubilei, G., Tizzani, A., Fontana, F., & Bartoletti, N. (2009). Use of penile extender device in the treatment of penile curvature due to Peyronie’s disease. Results of a phase II prospective study. The Journal of Sexual Medicine, 6, 558–6.
Levine, L. A., Newell, M., & Taylor, F. L. (2008). Penile traction therapy for treatment of Peyronie’s disease: a single-center pilot study. The Journal of Sexual Medicine, 5, 1468–1473.
Claro, J. A., Passerotti, C. C., Figueiredo Neto, A. C., Nardozza, A., Jr., Ortiz, V., & Srougi, M. (2004). An alternative non-invasive treatment for Peyronie’s disease. International Brazilian Journal of Urology, 30, 199–204. Discussion.
Abdel-Salam, Y., Budair, Z., Renner, C., Frede, T., Rassweiler, J., El-Annany, F., et al. (1999). Treatment of Peyronie’s disease by extracorporeal shockwave therapy: evaluation of our preliminary results. Journal of endourology/Endourological Society, 13, 549–552.
Skolarikos, A., Alargof, E., Rigas, A., Deliveliotis, C., & Konstantinidis, E. (2005). Shockwave therapy as first-line treatment for Peyronie’s disease: a prospective study. Journal of endourology/Endourological Society, 19, 11–14.
Hatzichristodoulou, G., Meisner, C., Liske, P., Stenzl, A., & Lahme, S. (2006). Efficacy of extracorporeal shock wave therapy (ESWT) in patients with Peyronie’s disease (PD)-first results of a prospective, randomized, placebo-controlled, single-blind study. The Journal of Urology, 175, 320.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2011 Springer Science+Business Media, LLC
About this chapter
Cite this chapter
Smith, J.F., Brant, W.O., Lue, T.F. (2011). Peyronie’s Disease: Natural History, Diagnosis, and Medical Therapy. In: McVary, K. (eds) Contemporary Treatment of Erectile Dysfunction. Contemporary Endocrinology. Humana Press. https://doi.org/10.1007/978-1-60327-536-1_16
Download citation
DOI: https://doi.org/10.1007/978-1-60327-536-1_16
Published:
Publisher Name: Humana Press
Print ISBN: 978-1-60327-535-4
Online ISBN: 978-1-60327-536-1
eBook Packages: MedicineMedicine (R0)