Hayat S. et al., 2022: A systematic review of non-surgical management in Peyronieʼs disease
Hayat S, Brunckhorst O, Alnajjar HM, Cakir OO, Muneer A, Ahmed K.
MRC Centre for Transplantation, Guy’s Hospital Campus, King’s College London, King’s Health Partners, London, United Kingdom.
Department of Urology, University College London Hospitals NHS Foundation Trust, London, United Kingdom.
Division of Surgery and Interventional Science, University College London, London, United Kingdom.
NIHR Biomedical Research Centre, University College London Hospital, London, United Kingdom.
Department of Urology, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates.
Male Genital Cancer Centre, University College London, London, United Kingdom.
Khalifa University, Abu Dhabi, United Arab Emirates.
Department of Urology, King’s College Hospital NHS Foundation Trust, London, United Kingdom.
The efficacy of many non-surgical treatments for Peyronie’s disease is unclear. This systematic review aims to critically assess the currently available options and provide a recommendation for treatment based on this. A systematic literature search utilising the Medline (Pubmed), Embase, global health and Cochrane library databases was conducted up to May 2021. All randomised controlled trials assessing non-surgical treatment modalities for Peyronie’s Disease were included. Individual study risk of bias was evaluated using the Cochrane tool and GRADE was used to assess evidence strength. Outcome measures were the change in penile curvature (degrees), plaque size (volume or size), International Index of Erectile Function score, pain scores and change in penile length. Prospero registration number: CRD42017064618. Amongst the 5549 articles identified, 41 studies (42 reports) were included. Seven different oral treatment options including vitamin E supplementation showed evidence for improving outcomes such as penile curvature and plaque size. Of the intralesional treatments, Collagenase Clostridium Histolyticum showed evidence for improving penile curvature (Range: 16.3–17 degrees, moderate level certainty of evidence). Intralesional Interferon demonstrated some improvement in curvature (Range: 12–13.5 degrees), plaque size (Range: 1.67–2.2 cm2) and pain, whilst intralesional calcium channel blockers such as Verapamil showed variable evidence for changes in the plaque size and pain. Extracorporeal Shockwave Therapy consistently demonstrated evidence for improving penile pain in stable disease, and two mechanical traction devices improved curvature. Iontophoresis, topical medications, and combination therapies did not demonstrate any consistent improvements in outcome measures. Intralesional options demonstrate the best potential. Overall, results varied with few high-quality randomised trials present.
IJIR: Your Sexual Medicine Journal; https://doi.org/10.1038/s41443-022-00633-w
Comments 1
This is an extensive research of the literature up to May 2021. It covers basically all modalities of non-surgical treatment of Peyronie`s disease, including medication, intralesional and regional therapy.
It is evident, that none of the oral therapies has any significant impact on the disease. Consequently, medication should be abandoned as first-line therapy. However, adjuvant use of PDE5-inhibitors like taldalafil have a significant impact on the pain of the patients and should be used in combination with regional therapy (i.e. ESWT).
Intralesional therapy with collagenase clostridium histolyticum has a limited effect, but it may lead to serious complications such as rupture of the tunica albuginea.
Among regional therapies, ESWT has several advantages. It has basically no complications and is well tolerated by the patients. Low-intensity ESWT has significant impact on pain, which has been shown by all RCTs. Plaque and IIEF score improvement were seen in only one randomized study. Unfortunately, in this review, recent ideas about the combination of high-intensity and low-intensity ESWT in the management of severe plaques of induration penis plastica has not been considered or discussed. Evidently, future studies have to take such ideas into account.
The authors conclude, that it is clear that whilst many non-surgical treatment modalities have emerged, there is still a lack of good quality, randomized data for the majority of these, requiring more investigation to identify the best modality and patient cohort for utilization.
Jens Rassweiler