3rd Annual Jefferson Urology Symposium: Men’s Health Forum

© The Canadian Journal of Urology TM : International Supplement, August 2020 Peyronie’s disease: what do we know and how do we treat it? Paul H. Chung, MD, Timothy M. Han, BA, Ben Rudnik, MD, Akhil K. Das, MD Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA CHUNG PH, HAN TM, RUDNIK B, DAS AK. Peyronie’s disease: what do we know and how do we treat it? Can J Urol 2020;27(Suppl 3):11-19. 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 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. Key Words: Peyronie’s disease, penile deformity, penile curvature, collagenase histolyticum, penile plication, plaque excision Address correspondence to Dr. Paul H. Chung, Thomas Jefferson University, Department of Urology, 1025 Walnut Street, Suite 1110, Philadelphia, PA 19107 USA Introduction Peyronie’s disease (PD) is a benign condition characterized by an acquired penile abnormality due to fibrosis of the tunica albuginea. It is a common condition with an estimated prevalence reported to range from0.5% to 20.3%within specific populations. 1,2 However, given that many patients may be reluctant or embarrassed to seek professional help from their doctors, PD is likely underdiagnosed and consequently undertreated. Often, PD is diagnosed incidentally during healthcare visits for other primary concerns, such as prostate cancer screening (reported 8.9% prevalence) or erectile dysfunction (reported 16% prevalence). 3,4 The most common inciting event is thought to be sexual activity, during which patients may experience penile buckling in the erect or semi- erect state resulting in microvascular trauma to the penile shaft. 5,6 This repetitive minor penile trauma initiates a collagen deposition cascade which results in plaque formation within the penile tunica albuginea. The plaques may be palpable or non-palpable and many patients do not recall a specific incident that preceded symptom onset. The plaque may restrict tunica lengthening on the affected side during erection leading to curvature with possible deformity, discomfort, pain, and/or erectile dysfunction (ED). These changes in penile appearance and function often take an emotional and psychosocial toll on patients resulting in bother, depression, and relationship difficulties. Therefore, it is important for urologists to thoroughly discuss the extent of bother, 11