madman
Super Moderator
ABSTRACT
Aim There are a few types of drugs that can be used in the active phase of Peyronie’s disease. Methylprednisolone is a corticosteroid with a strong anti-inflammatory effect. In this study, we aimed to evaluate the effect of intralesional low dose methylprednisolone treatment on patients in the active phase of Peyronie’s disease.
Patients and Methods Forty-eight patients suffering from Peyronie’s disease active phase symptoms were included in the study. Methylprednisolone was administered intralesionally for 8 weeks, once per week, at a dose of 40 mg. The injection was applied to the plaques, which causes maximum curvature. Patients were evaluated before and after treatment for plaque size, angle of curvature, and erectile dysfunction according to the International Index of Erectile Function-5 and Peyronie’s Disease Questionnaire.
Results The mean age of the patients was 61.1 (43-78) years. The mean duration of the symptoms was 3.4 (0- 9) months. The average plaque size before treatment was 13.6 mm (7.1-16.8) and after treatment, this value decreased to 10.8 mm (4.3-14.6) (p:0.025). The average scores of Peyronie’s Disease Questionnaire elements; symptom severity, penile pain, and bother/discomfort were 12.3, 19.1, and 6.2, respectively before the treatment. These scores were decreased to 8.9, 9.6, and 4.4, respectively after treatment. All subgroups of Peyronie’s Disease Questionnaire scores were significantly improved after treatment (p:0.001, p<0.001, p:0.045, respectively). No adverse events were observed during or after treatment.
Conclusion In order to recover the symptoms and signs, new and easily accessible drugs, are required for use in the acute period of Peyronie's disease. In this context, treatment with intralesional low dose methylprednisolone in acute phase Peyronie’s Disease is a promising and safe treatment option.
INTRODUCTION
Peyronie's disease is a condition characterized by the formation of plaque due to collagen accumulation inside the tunica albuginea that surrounds the structures of the penile corpus cavernosum. This plaque can cause deformities such as penile shortening and curvature [1]. Penile pain and discomfort may occur during the active period of the disease, sexual functions are negatively affected, and erectile dysfunction may occur [2]. The incidence of Peyronie's disease was found to be 3.2-8.9% [3]. Although young men are also affected occasionally, the disease is more common among older men—specifically, those over the age of 45—and its incidence increases with age [4].
Surgical treatment is not recommended in the active period of the disease. In this period, it is aimed to stop the formation of new plaques, avoid the plaque growth, to eliminate the pain. Approaches to treatment include the use of oral treatment agents and intralesional agents [5]. Oral therapies being used today include vitamin E, carnitine, colchicine, potassium amino benzoate, and phosphodiesterase type 5 inhibitors. However, none of these agents' effectiveness has been fully proven [6].
Molecules such as corticosteroids, verapamil, interferon, and collagenase clostridium histolyticum are commonly used in intralesional therapy [5]. Among these, collagenase clostridium histolyticum stands out as the most effective agent, and there are many studies that have proven its effectiveness [1,7–9]. However, in some countries, this drug is difficult to obtain, and the cost of treatment protocols with this drug can be excessive. In addition, collagenase was withdrawn from the European market for commercial reasons. Therefore, there is a search for more accessible treatment methods that can be used during Peyronie's active period, especially in developing countries.
Methylprednisolone is a corticosteroid with a strong anti-inflammatory effect. It is used in the treatment of rheumatic diseases, acute/chronic inflammatory diseases, and allergic reactions [10]. It is a fairly inexpensive drug and easy to obtain. Since systemic and local side effects are also rare, it is probable that methylprednisolone could serve as an alternative treatment option in the acute period of Peyronie's disease where inflammatory reactions are at the forefront [11].
The purpose of our study was to investigate the effectiveness and safety of intralesional methylprednisolone treatment in patients presenting in the acute period of Peyronie's disease.
Conclusion
The etiology of Peyronie's disease has not been fully elucidated, but the inflammatory process has an important place in the disease’s physiopathology. The fact that the only drug that is licensed for the acute phase of the disease is collagenase clostridium histolyticum, and that the effectiveness of other previously-attempted methods has not been fully proven, makes us predict that new treatment modalities will be investigated in the future as well. Our study shows that intralesional usage of low dose methylprednisolone is effective for improving symptoms and signs during the active period of Peyronie's disease. Thus, it may lead to a more progressive transition of the disease from the acute phase to the chronic phase, resulting in less penile deformity and less subsequent complicated correctional surgeries for affected patients.
Aim There are a few types of drugs that can be used in the active phase of Peyronie’s disease. Methylprednisolone is a corticosteroid with a strong anti-inflammatory effect. In this study, we aimed to evaluate the effect of intralesional low dose methylprednisolone treatment on patients in the active phase of Peyronie’s disease.
Patients and Methods Forty-eight patients suffering from Peyronie’s disease active phase symptoms were included in the study. Methylprednisolone was administered intralesionally for 8 weeks, once per week, at a dose of 40 mg. The injection was applied to the plaques, which causes maximum curvature. Patients were evaluated before and after treatment for plaque size, angle of curvature, and erectile dysfunction according to the International Index of Erectile Function-5 and Peyronie’s Disease Questionnaire.
Results The mean age of the patients was 61.1 (43-78) years. The mean duration of the symptoms was 3.4 (0- 9) months. The average plaque size before treatment was 13.6 mm (7.1-16.8) and after treatment, this value decreased to 10.8 mm (4.3-14.6) (p:0.025). The average scores of Peyronie’s Disease Questionnaire elements; symptom severity, penile pain, and bother/discomfort were 12.3, 19.1, and 6.2, respectively before the treatment. These scores were decreased to 8.9, 9.6, and 4.4, respectively after treatment. All subgroups of Peyronie’s Disease Questionnaire scores were significantly improved after treatment (p:0.001, p<0.001, p:0.045, respectively). No adverse events were observed during or after treatment.
Conclusion In order to recover the symptoms and signs, new and easily accessible drugs, are required for use in the acute period of Peyronie's disease. In this context, treatment with intralesional low dose methylprednisolone in acute phase Peyronie’s Disease is a promising and safe treatment option.
INTRODUCTION
Peyronie's disease is a condition characterized by the formation of plaque due to collagen accumulation inside the tunica albuginea that surrounds the structures of the penile corpus cavernosum. This plaque can cause deformities such as penile shortening and curvature [1]. Penile pain and discomfort may occur during the active period of the disease, sexual functions are negatively affected, and erectile dysfunction may occur [2]. The incidence of Peyronie's disease was found to be 3.2-8.9% [3]. Although young men are also affected occasionally, the disease is more common among older men—specifically, those over the age of 45—and its incidence increases with age [4].
Surgical treatment is not recommended in the active period of the disease. In this period, it is aimed to stop the formation of new plaques, avoid the plaque growth, to eliminate the pain. Approaches to treatment include the use of oral treatment agents and intralesional agents [5]. Oral therapies being used today include vitamin E, carnitine, colchicine, potassium amino benzoate, and phosphodiesterase type 5 inhibitors. However, none of these agents' effectiveness has been fully proven [6].
Molecules such as corticosteroids, verapamil, interferon, and collagenase clostridium histolyticum are commonly used in intralesional therapy [5]. Among these, collagenase clostridium histolyticum stands out as the most effective agent, and there are many studies that have proven its effectiveness [1,7–9]. However, in some countries, this drug is difficult to obtain, and the cost of treatment protocols with this drug can be excessive. In addition, collagenase was withdrawn from the European market for commercial reasons. Therefore, there is a search for more accessible treatment methods that can be used during Peyronie's active period, especially in developing countries.
Methylprednisolone is a corticosteroid with a strong anti-inflammatory effect. It is used in the treatment of rheumatic diseases, acute/chronic inflammatory diseases, and allergic reactions [10]. It is a fairly inexpensive drug and easy to obtain. Since systemic and local side effects are also rare, it is probable that methylprednisolone could serve as an alternative treatment option in the acute period of Peyronie's disease where inflammatory reactions are at the forefront [11].
The purpose of our study was to investigate the effectiveness and safety of intralesional methylprednisolone treatment in patients presenting in the acute period of Peyronie's disease.
Conclusion
The etiology of Peyronie's disease has not been fully elucidated, but the inflammatory process has an important place in the disease’s physiopathology. The fact that the only drug that is licensed for the acute phase of the disease is collagenase clostridium histolyticum, and that the effectiveness of other previously-attempted methods has not been fully proven, makes us predict that new treatment modalities will be investigated in the future as well. Our study shows that intralesional usage of low dose methylprednisolone is effective for improving symptoms and signs during the active period of Peyronie's disease. Thus, it may lead to a more progressive transition of the disease from the acute phase to the chronic phase, resulting in less penile deformity and less subsequent complicated correctional surgeries for affected patients.
