Materiały źródłowe

• #1 Peyronie Disease – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK560628/

  The overall prognosis for Peyronie disease is favorable due to the availability of multiple treatment options, both surgical and nonsurgical. For many patients, conservative approaches such as oral medications, intralesional injections, traction therapy, and vacuum erection devices can lead to significant improvement in symptoms, including curvature and pain. In more severe cases, surgical interventions such as penile plication, grafting, or penile prosthesis implantation are effective in restoring function and alleviating deformity. The variety of treatment options allows for personalized care, contributing to positive outcomes for most patients, especially with early diagnosis and intervention. […] Patients should be counseled that their condition is unlikely to resolve without medical treatment, and a considerable number of men experience worsening symptoms over time. In general, only curvatures 30 are likely to interfere with sexual activity.

• #2 PEYRONIE’S DISEASE: A REVIEW OF ETIOLOGY, DIAGNOSIS, AND MANAGEMENT

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4535719/

  Peyronies Disease (PD) is a superficial fibrosing disorder of the penis resulting in plaque formation and penile deformity. Once considered rare, PD has more recently been found in up to 13% of men, and can negatively affect sexual and psychosocial function of both patients and their partners. […] The natural history of PD is often divided into acute and chronic phases. The acute phase is characterized by progression of penile deformity and may be associated with pain in the erect and/or flaccid states. The length of the acute phase varies from 6-18 months. In contrast, the chronic phase of PD is defined by stability of penile deformity for at least 3-6 months, with improvement in or resolution of pain. […] Williams and Thomas were the first to report on the natural history of PD during the 1970s, observing spontaneous symptom resolution in 50% of the patients in a small cohort. This high PD resolution rate has not been confirmed in subsequent studies.

• #3 Peyronie disease – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/peyronies-disease/symptoms-causes/syc-20353468

  Peyronie disease rarely goes away on its own. In most people with the condition, it will remain as is or may get slightly worse early on. Early treatment soon after you get the condition may keep it from getting worse or even improve symptoms. […] Pain during erections usually gets better within 1 to 2 years. The scar tissue, penile shortening and curving often remain. It’s not common, but the curving and pain of Peyronie disease can get better without treatment. […] Early treatment gives you the best chance to improve the condition or keep it from getting worse.

• #4 PEYRONIE’S DISEASE: A REVIEW OF ETIOLOGY, DIAGNOSIS, AND MANAGEMENT

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4535719/

  Peyronies Disease (PD) is a superficial fibrosing disorder of the penis resulting in plaque formation and penile deformity. Once considered rare, PD has more recently been found in up to 13% of men, and can negatively affect sexual and psychosocial function of both patients and their partners. […] The natural history of PD is often divided into acute and chronic phases. The acute phase is characterized by progression of penile deformity and may be associated with pain in the erect and/or flaccid states. The length of the acute phase varies from 6-18 months. In contrast, the chronic phase of PD is defined by stability of penile deformity for at least 3-6 months, with improvement in or resolution of pain. […] Williams and Thomas were the first to report on the natural history of PD during the 1970s, observing spontaneous symptom resolution in 50% of the patients in a small cohort. This high PD resolution rate has not been confirmed in subsequent studies.

• #5 PEYRONIE’S DISEASE: A REVIEW OF ETIOLOGY, DIAGNOSIS, AND MANAGEMENT

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4535719/

  Berookhim et al. reported a 12% improvement rate in untreated men with uniplanar PD, with time to presentation of 6 months and younger age as predictors of improvement. […] Another study observed a 30% progression rate in 307 men with PD over 8 months, with resolution occurring in only 0.65% of cases. […] The hallmark of PD is acquired penile deformity, which must be differentiated from congenital penile curvature and normal anatomic variants. PD-related deformity consists of curvature during erection, with associated findings including loss of flaccid stretched penile length, tunical indentations or hourglass deformity with erection, and buckling or penile instability on minimal axial loading despite maximal erection. […] Subjective loss of penile length is a common complaint, reported by 84% of patients undergoing expectant PD management. In one study, which followed 246 men with PD, mean stretched penile length decreased from 12.2 cm on initial assessment to 11.4 cm after a mean of 14.5 months follow-up (p=0.035).

• #6 PEYRONIE’S DISEASE: A REVIEW OF ETIOLOGY, DIAGNOSIS, AND MANAGEMENT

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4535719/

  Berookhim et al. reported a 12% improvement rate in untreated men with uniplanar PD, with time to presentation of 6 months and younger age as predictors of improvement. […] Another study observed a 30% progression rate in 307 men with PD over 8 months, with resolution occurring in only 0.65% of cases. […] The hallmark of PD is acquired penile deformity, which must be differentiated from congenital penile curvature and normal anatomic variants. PD-related deformity consists of curvature during erection, with associated findings including loss of flaccid stretched penile length, tunical indentations or hourglass deformity with erection, and buckling or penile instability on minimal axial loading despite maximal erection. […] Subjective loss of penile length is a common complaint, reported by 84% of patients undergoing expectant PD management. In one study, which followed 246 men with PD, mean stretched penile length decreased from 12.2 cm on initial assessment to 11.4 cm after a mean of 14.5 months follow-up (p=0.035).

• #7 Treatment of Peyronie’s disease with oral colchicine: long‐term results and predictive parameters of successful outcome | International Journal of Impotence Research

  https://www.nature.com/articles/3900519

  Oral colchicine treatment was initiated in 60 Peyronie’s patients during their acute phase (mean duration of disease: 5.74.3 months). […] Longterm results, based on changes of subjective and objective criteria, were assessed and predictive factors of successful outcome were investigated. […] After a mean followup of 10.74.7 months, the penile deformity improved in 30%, remained unchanged in 48.3% and deteriorated in 21.7%. […] Best results were obtained in those with no risk factor for vascular disease, presenting during the initial 6 months of disease, degree of curvature 30, no erectile dysfunction by history and positive response to combined injection and stimulation test. […] In conclusion since tunica albuginea is affected as a whole in Peyronie’s disease, systemic oral agents, such as colchicine, may be preferred in the early phase of the disease.

• #8 Peyronie Disease – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK560628/

  The overall prognosis for Peyronie disease is favorable due to the availability of multiple treatment options, both surgical and nonsurgical. For many patients, conservative approaches such as oral medications, intralesional injections, traction therapy, and vacuum erection devices can lead to significant improvement in symptoms, including curvature and pain. In more severe cases, surgical interventions such as penile plication, grafting, or penile prosthesis implantation are effective in restoring function and alleviating deformity. The variety of treatment options allows for personalized care, contributing to positive outcomes for most patients, especially with early diagnosis and intervention. […] Patients should be counseled that their condition is unlikely to resolve without medical treatment, and a considerable number of men experience worsening symptoms over time. In general, only curvatures 30 are likely to interfere with sexual activity.

• #9 Treatment of Peyronie’s disease with oral colchicine: long‐term results and predictive parameters of successful outcome | International Journal of Impotence Research

  https://www.nature.com/articles/3900519

  Oral colchicine treatment was initiated in 60 Peyronie’s patients during their acute phase (mean duration of disease: 5.74.3 months). […] Longterm results, based on changes of subjective and objective criteria, were assessed and predictive factors of successful outcome were investigated. […] After a mean followup of 10.74.7 months, the penile deformity improved in 30%, remained unchanged in 48.3% and deteriorated in 21.7%. […] Best results were obtained in those with no risk factor for vascular disease, presenting during the initial 6 months of disease, degree of curvature 30, no erectile dysfunction by history and positive response to combined injection and stimulation test. […] In conclusion since tunica albuginea is affected as a whole in Peyronie’s disease, systemic oral agents, such as colchicine, may be preferred in the early phase of the disease.

• #10 Peyronie Disease Treatment & Management: Medical Therapy, Surgical Therapy, Preoperative Details

  https://emedicine.medscape.com/article/456574-treatment

  In general, the outcome of treatment of Peyronie disease (PD) can be judged in 2 ways: first, by the degree of improvement in penile curvature and plaque, and second by the return to satisfactory sexual functioning. Either may be the primary goal of an individual patient. The most satisfying results are obtained when the primary goal of the patient is identified early in the course of treatment. The likelihood of achieving these goals is very good if all of the potential interventions listed are included. […] The most recent available data have identified some new trends in the treatment of PD, as follows: When oral treatments are used, a combination of colchicine and vitamin E appears most likely to be successful. Topical verapamil alone does not seem to be as effective as when it is used with electromotive drug administration (EMDA) to transport it into the tunica.

• #11 PEYRONIE’S DISEASE: A REVIEW OF ETIOLOGY, DIAGNOSIS, AND MANAGEMENT

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4535719/

  Surgical intervention should be avoided during the acute phase of PD, as the risk of progression or recurrence of curvature during this phase may interfere with optimal outcomes. […] Surgical treatment, indicated in men with significant, stable deformity, includes plication of the tunica albuginea, plaque incision/excision and grafting, and placement of inflatable penile prosthesis (IPP) with or without additional maneuvers to achieve desired results, and has high success rates.

• #12 Peyronie Disease Treatment & Management: Medical Therapy, Surgical Therapy, Preoperative Details

  https://emedicine.medscape.com/article/456574-treatment

  Some tenets of treatment remain, as follows: Mild cases of PD (ie, minimal or no pain, the ability to achieve penile erections, curvature that does not prevent intercourse) may improve spontaneously. A trial of conservative treatment with observation and reassurance is indicated. Pain usually resolves with or without treatment and is not a good predictor of successful therapy. Oral or topical therapy should be initiated first, especially in men with unstable plaque. Indications for surgical intervention should include the following: (1) symptom duration of at least 12 months with stability in those symptoms for 3 or more months, (2) a degree of curvature and/or narrowing that interferes with sexual penetration, (3) an assessment of concurrent ED and of preoperative penile length and curvature, and (4) a realistic discussion of patient expectations and likely results. The last should address the fact that the patient’s penis will not return to exactly the way it was before the onset of his symptoms, no matter what intervention is taken. Consider penile plication when the erectile function is good, the curvature is simple and 60 or less, and the penis does not have a significant hourglass or hinge-type deformity. Simple plication of the tunica without excision or plication after linear incision appears to maximize results with minimal side effects. Some loss of penile length can be anticipated. Proper patient selection and counseling are necessary to maximize postoperative satisfaction. If the patient retains erectile capability but has a complex curvature or one that is greater than 60 or if he has erectile instability due to an hourglass or hinge deformity, plaque incision with graft placement should be considered. When PD and ED are both present, the best therapy appears to be implantation of a penile prosthesis with modeling or, in men with extreme curvature, plaque incision with or without graft placement. Endoscopic plaque incision combined with implantation of an inflatable penile prosthesis may become a useful tool to treat men with significant curvature requiring dissection of the dorsal neurovascular bundle(s) associated with refractory ED. Further experience with this technique is eagerly anticipated.

• #13 Peyronie Disease Treatment & Management: Medical Therapy, Surgical Therapy, Preoperative Details

  https://emedicine.medscape.com/article/456574-treatment

  Some tenets of treatment remain, as follows: Mild cases of PD (ie, minimal or no pain, the ability to achieve penile erections, curvature that does not prevent intercourse) may improve spontaneously. A trial of conservative treatment with observation and reassurance is indicated. Pain usually resolves with or without treatment and is not a good predictor of successful therapy. Oral or topical therapy should be initiated first, especially in men with unstable plaque. Indications for surgical intervention should include the following: (1) symptom duration of at least 12 months with stability in those symptoms for 3 or more months, (2) a degree of curvature and/or narrowing that interferes with sexual penetration, (3) an assessment of concurrent ED and of preoperative penile length and curvature, and (4) a realistic discussion of patient expectations and likely results. The last should address the fact that the patient’s penis will not return to exactly the way it was before the onset of his symptoms, no matter what intervention is taken. Consider penile plication when the erectile function is good, the curvature is simple and 60 or less, and the penis does not have a significant hourglass or hinge-type deformity. Simple plication of the tunica without excision or plication after linear incision appears to maximize results with minimal side effects. Some loss of penile length can be anticipated. Proper patient selection and counseling are necessary to maximize postoperative satisfaction. If the patient retains erectile capability but has a complex curvature or one that is greater than 60 or if he has erectile instability due to an hourglass or hinge deformity, plaque incision with graft placement should be considered. When PD and ED are both present, the best therapy appears to be implantation of a penile prosthesis with modeling or, in men with extreme curvature, plaque incision with or without graft placement. Endoscopic plaque incision combined with implantation of an inflatable penile prosthesis may become a useful tool to treat men with significant curvature requiring dissection of the dorsal neurovascular bundle(s) associated with refractory ED. Further experience with this technique is eagerly anticipated.

• #14 Erectile Dysfunction and Peyronie’s Disease – Medical Clinical Policy Bulletins | Aetna

  https://es.aetna.com/cpb/medical/data/1_99/0007.html

  Aetna considers ESWT experimental, investigational, or unproven for Peyronies disease because of a lack of evidence from prospective randomized controlled clinical studies of the effectiveness of ESWT for this indication. […] Aetna considers surgical correction of Peyronies disease (e.g., plaque excisions and venous graft patching, tunica plication, Nesbit tuck procedure) medically necessary for the treatment of members with Peyronie’s disease for 12 or more months with significant morbidity who have failed conservative medical treatment. Surgical correction of Peyronie’s disease is considered experimental, investigational, or unproven when criteria are not met. […] Aetna considers testosterone injection experimental, investigational, or unproven for Peyronies disease because of a lack of evidence from prospective randomized controlled clinical studies of the effectiveness of this approach for this indication.

• #15 Peyronie Disease Treatment & Management: Medical Therapy, Surgical Therapy, Preoperative Details

  https://emedicine.medscape.com/article/456574-treatment

  Some tenets of treatment remain, as follows: Mild cases of PD (ie, minimal or no pain, the ability to achieve penile erections, curvature that does not prevent intercourse) may improve spontaneously. A trial of conservative treatment with observation and reassurance is indicated. Pain usually resolves with or without treatment and is not a good predictor of successful therapy. Oral or topical therapy should be initiated first, especially in men with unstable plaque. Indications for surgical intervention should include the following: (1) symptom duration of at least 12 months with stability in those symptoms for 3 or more months, (2) a degree of curvature and/or narrowing that interferes with sexual penetration, (3) an assessment of concurrent ED and of preoperative penile length and curvature, and (4) a realistic discussion of patient expectations and likely results. The last should address the fact that the patient’s penis will not return to exactly the way it was before the onset of his symptoms, no matter what intervention is taken. Consider penile plication when the erectile function is good, the curvature is simple and 60 or less, and the penis does not have a significant hourglass or hinge-type deformity. Simple plication of the tunica without excision or plication after linear incision appears to maximize results with minimal side effects. Some loss of penile length can be anticipated. Proper patient selection and counseling are necessary to maximize postoperative satisfaction. If the patient retains erectile capability but has a complex curvature or one that is greater than 60 or if he has erectile instability due to an hourglass or hinge deformity, plaque incision with graft placement should be considered. When PD and ED are both present, the best therapy appears to be implantation of a penile prosthesis with modeling or, in men with extreme curvature, plaque incision with or without graft placement. Endoscopic plaque incision combined with implantation of an inflatable penile prosthesis may become a useful tool to treat men with significant curvature requiring dissection of the dorsal neurovascular bundle(s) associated with refractory ED. Further experience with this technique is eagerly anticipated.

• #16 Peyronie Disease Treatment & Management: Medical Therapy, Surgical Therapy, Preoperative Details

  https://emedicine.medscape.com/article/456574-treatment

  In general, the outcome of treatment of Peyronie disease (PD) can be judged in 2 ways: first, by the degree of improvement in penile curvature and plaque, and second by the return to satisfactory sexual functioning. Either may be the primary goal of an individual patient. The most satisfying results are obtained when the primary goal of the patient is identified early in the course of treatment. The likelihood of achieving these goals is very good if all of the potential interventions listed are included. […] The most recent available data have identified some new trends in the treatment of PD, as follows: When oral treatments are used, a combination of colchicine and vitamin E appears most likely to be successful. Topical verapamil alone does not seem to be as effective as when it is used with electromotive drug administration (EMDA) to transport it into the tunica.

• #17 Peyronie Disease Treatment & Management: Medical Therapy, Surgical Therapy, Preoperative Details

  https://emedicine.medscape.com/article/456574-treatment

  Some tenets of treatment remain, as follows: Mild cases of PD (ie, minimal or no pain, the ability to achieve penile erections, curvature that does not prevent intercourse) may improve spontaneously. A trial of conservative treatment with observation and reassurance is indicated. Pain usually resolves with or without treatment and is not a good predictor of successful therapy. Oral or topical therapy should be initiated first, especially in men with unstable plaque. Indications for surgical intervention should include the following: (1) symptom duration of at least 12 months with stability in those symptoms for 3 or more months, (2) a degree of curvature and/or narrowing that interferes with sexual penetration, (3) an assessment of concurrent ED and of preoperative penile length and curvature, and (4) a realistic discussion of patient expectations and likely results. The last should address the fact that the patient’s penis will not return to exactly the way it was before the onset of his symptoms, no matter what intervention is taken. Consider penile plication when the erectile function is good, the curvature is simple and 60 or less, and the penis does not have a significant hourglass or hinge-type deformity. Simple plication of the tunica without excision or plication after linear incision appears to maximize results with minimal side effects. Some loss of penile length can be anticipated. Proper patient selection and counseling are necessary to maximize postoperative satisfaction. If the patient retains erectile capability but has a complex curvature or one that is greater than 60 or if he has erectile instability due to an hourglass or hinge deformity, plaque incision with graft placement should be considered. When PD and ED are both present, the best therapy appears to be implantation of a penile prosthesis with modeling or, in men with extreme curvature, plaque incision with or without graft placement. Endoscopic plaque incision combined with implantation of an inflatable penile prosthesis may become a useful tool to treat men with significant curvature requiring dissection of the dorsal neurovascular bundle(s) associated with refractory ED. Further experience with this technique is eagerly anticipated.

• #18 PEYRONIE’S DISEASE: A REVIEW OF ETIOLOGY, DIAGNOSIS, AND MANAGEMENT

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4535719/

  Berookhim et al. reported a 12% improvement rate in untreated men with uniplanar PD, with time to presentation of 6 months and younger age as predictors of improvement. […] Another study observed a 30% progression rate in 307 men with PD over 8 months, with resolution occurring in only 0.65% of cases. […] The hallmark of PD is acquired penile deformity, which must be differentiated from congenital penile curvature and normal anatomic variants. PD-related deformity consists of curvature during erection, with associated findings including loss of flaccid stretched penile length, tunical indentations or hourglass deformity with erection, and buckling or penile instability on minimal axial loading despite maximal erection. […] Subjective loss of penile length is a common complaint, reported by 84% of patients undergoing expectant PD management. In one study, which followed 246 men with PD, mean stretched penile length decreased from 12.2 cm on initial assessment to 11.4 cm after a mean of 14.5 months follow-up (p=0.035).

• #19 Erectile Dysfunction and Peyronie’s Disease – Medical Clinical Policy Bulletins | Aetna

  https://es.aetna.com/cpb/medical/data/1_99/0007.html

  Aetna considers ESWT experimental, investigational, or unproven for Peyronies disease because of a lack of evidence from prospective randomized controlled clinical studies of the effectiveness of ESWT for this indication. […] Aetna considers surgical correction of Peyronies disease (e.g., plaque excisions and venous graft patching, tunica plication, Nesbit tuck procedure) medically necessary for the treatment of members with Peyronie’s disease for 12 or more months with significant morbidity who have failed conservative medical treatment. Surgical correction of Peyronie’s disease is considered experimental, investigational, or unproven when criteria are not met. […] Aetna considers testosterone injection experimental, investigational, or unproven for Peyronies disease because of a lack of evidence from prospective randomized controlled clinical studies of the effectiveness of this approach for this indication.

• #20 Erectile Dysfunction and Peyronie’s Disease – Medical Clinical Policy Bulletins | Aetna

  https://es.aetna.com/cpb/medical/data/1_99/0007.html

  Aetna considers ESWT experimental, investigational, or unproven for Peyronies disease because of a lack of evidence from prospective randomized controlled clinical studies of the effectiveness of ESWT for this indication. […] Aetna considers surgical correction of Peyronies disease (e.g., plaque excisions and venous graft patching, tunica plication, Nesbit tuck procedure) medically necessary for the treatment of members with Peyronie’s disease for 12 or more months with significant morbidity who have failed conservative medical treatment. Surgical correction of Peyronie’s disease is considered experimental, investigational, or unproven when criteria are not met. […] Aetna considers testosterone injection experimental, investigational, or unproven for Peyronies disease because of a lack of evidence from prospective randomized controlled clinical studies of the effectiveness of this approach for this indication.

• #21 Erectile Dysfunction and Peyronie’s Disease – Medical Clinical Policy Bulletins | Aetna

  https://es.aetna.com/cpb/medical/data/1_99/0007.html

  Aetna considers iontophoresis or intra-lesional injection of nicardipine or verapamil experimental, investigational, or unproven for Peyronies disease because of a lack of evidence from prospective randomized controlled clinical studies of the effectiveness of this approach for this indication. […] For treatment of Peyronies disease, see CPB 1061 – Collagenase Clostridium Histolyticum (Xiaflex).

• #22 Erectile Dysfunction and Peyronie’s Disease – Medical Clinical Policy Bulletins | Aetna

  https://es.aetna.com/cpb/medical/data/1_99/0007.html

  Aetna considers iontophoresis or intra-lesional injection of nicardipine or verapamil experimental, investigational, or unproven for Peyronies disease because of a lack of evidence from prospective randomized controlled clinical studies of the effectiveness of this approach for this indication. […] For treatment of Peyronies disease, see CPB 1061 – Collagenase Clostridium Histolyticum (Xiaflex).

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