Peyronie’s disease (Bent Penis): What to do we know and how do we treat it?

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madman

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Introduction: Peyronie’s disease is a common, benign condition characterized by an acquired penile abnormality due to fibrosis of the tunica albuginea. This may lead to penile curvature, deformity, discomfort, pain, and erectile dysfunction, resulting in emotional and psychosocial effects on patients. Therefore, it is important for urologists to thoroughly evaluate the extent of the patient’s bother and discuss treatment goals, therapeutic options, and expectations.

Materials and methods: We provide a review of the current landscape for the diagnosis, management, and treatment of Peyronie’s disease, including oral, topical, intralesional, external energy, and surgical therapies.

Results: The hallmark of managing Peyronie’s disease is attentive to patient counseling. Patients may be hesitant to discuss their symptoms unless inquired directly and may not be aware that treatments exist. It is not uncommon for Peyronie’s disease to be diagnosed incidentally during a routine or unrelated healthcare visit, with reported rates of incidental diagnosis as high as 16%. Treatment options are stratified by disease phase which is defined by whether symptoms (e.g. penile deformity and discomfort) are actively changing or have stabilized. Conservative therapy is the most common recommendation during the active phase with more invasive treatments reserved for the passive phase. Conservative therapy may include oral or topical medication, intralesional injection, and external energy therapy. These treatments may also have a role in improving symptoms during the passive phase prior to undergoing more definitive surgical treatment. Surgical interventions include tunical plication, plaque incision or excision with or without grafting, and penile prosthesis implantation. Despite the variety of treatment options available to patients, each has a distinct efficacy and adverse effect profile, warranting thorough discussion to meet patients’ goals and manage expectations.

Conclusion: Peyronie’s disease is a common condition that is underdiagnosed and undertreated. Patients with Peyronie’s disease will benefit from a comprehensive evaluation and in-depth counseling so that they may become familiar with the natural disease course and have appropriate expectations of each treatment option.

Medical treatments

Oral and topical therapies

Injection therapies

External therapies



Surgical treatments

Penile plication

Plaque incision or excision with or without grafting

Penile prosthesis



Other potential treatments

Vacuum therapy

Autologous platelet-rich plasma


Conclusion

PD is a common condition that can potentially result in physical, emotional, and/or psychological distress. Patients may be embarrassed to seek professional help or may be unaware of their available treatment options. As a result, patients may not discuss their signs or symptoms unless directly asked. For these reasons, PD is likely underdiagnosed and therefore undertreated. Urologists should become comfortable with discussing and managing these issues with patients in order to properly diagnose patients, educate them on disease progression and timeline, target treatment goals, reach a shared decision regarding possible treatment, and manage expectations. Treatment options offered may vary based on practice resources and surgeon experience. In fact, due to the complex nature of managing and treating PD, the role may be best suited for experts with appropriate and specific experience, tools, and surgical skillset. As new medical and surgical treatments are being studied, the landscape of PD management may continue to evolve and should target the maximizing of patient satisfaction while minimizing adverse events.
 

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  • 2020SEPT4-PEYRONIES-Cdn_JU27-S3_06_DrChung_S.pdf
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Nelson Vergel

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