Peyronie Disease: Practice Essentials, Problem, Epidemiology (original) (raw)

Practice Essentials

Peyronie disease (PD) is named after French surgeon François Gigot de la Peyronie, who described the condition in 1743. [1] PD is characterized by curvature in the penile shaft (see the image below) that is often preceded by painful erections and accompanied by an area of fibrosis. The characteristic angulation is frequently associated with erectile dysfunction (ED), either as a result of buckling of the penile shaft with intromission or because of a lack of rigidity distal to the area of associated fibrosis. This lack of rigidity seems to be the result of compromise to the distal penile blood supply.

Penile angulation indicative of Peyronie disease. Courtesy of Allen Seftel, MD.

Over the years, various medical and surgical therapies have been used to treat this condition, whose etiology remains uncertain. The number and variety of these attempts at treatment stand as a testament to their relative lack of effectiveness. [2, 3]

This article defines the problem of PD, outlines a reasonable evaluation of patients with PD, reviews the medical therapies that have been used, and presents the surgical options that are currently available. The indications for treatment are discussed, as are the expected outcomes. The goal is to impart a practical approach to the diagnosis and treatment of PD in the clinical setting.

For patient education information, see Peyronie's Disease (Curvature of the Penis).

Problem

PD is a curvature of the penis that is usually associated with a palpable area of fibrosis in the tunica albuginea. The curvature is usually obvious when the penis is erect but is occasionally noticeable even when the penis is flaccid. The fibrotic area, known as a plaque, can vary in firmness and sometimes becomes calcified. The penile curvature is often preceded by painful erections and may be associated with ED.

Epidemiology

Frequency

The rate of PD is reported to be 0.39-3%. However, that is probably an underestimation because of the embarrassment most men feel about having this condition. Underreporting may also result from men whose symptoms are mild or nondebilitating not seeking medical attention. Although this condition usually affects men aged 40-70 years, several authors have reported cases in younger individuals. [4, 5, 6]

Schwarzer et al found a prevalence of 3.2% for the new appearance of a palpable plaque, in a large population-based self-report survey sent to 8000 men and answered by 4432 (55.4%). The prevalence by age was 1.5% for men aged 30-39 years, 3% for men aged 40-49 years, 3% for men aged 50-59 years, 4% for men aged 60-69 years, and 6.5% for men aged 70 or older. Associated with the plaque, 84% reported penile angulation; 47% reported painful erections; 32% noted the triad of plaque, angulation, and pain; and 41% also reported ED. [7]

Mulhall et al found the prevalence of PD to be 8.9% in 534 men who were screened for prostate cancer in the United States. These investigators also found that a significant proportion of men with PD also had hypertension and diabetes. [8]

Etiology

The etiology of PD remains enigmatic. PD has been associated with deficiency in vitamin E, ingestion of beta-blocking agents, and elevations of serotonin levels. PD is associated with Dupuytren contractures and with HLA-B7, implying a genetic link to its etiology. [9]

More recently, PD has been thought to result from vascular trauma or injury to the penis. The injury may be trivial or involve only microscopic vessels and tissues. This triggers the release of cytokines that activate fibroblast proliferation and produce collagen, the main matrix component of a Peyronie plaque, within the tunica albuginea.

Usta et al found that the presence of diabetes, hyperlipidemia, hypercholesteremia, or hypertension was not statistically related to the severity of penile curvature in men with PD. The number of comorbidities also did not affect the degree of curvature. The rates of hypertension, hypercholesterolemia, diabetes, hyperlipidemia, and heart disease were significantly higher in men with PD and ED compared with those with PD alone, but the authors believed that this relationship was more likely related to the ED rather than to the PD. [10]

To evaluate the association between PD and ED, El-Sakka studied the prevalence of PD in a population of men known to have ED. [11] In this prospective study, 1440 men with ED were assessed with the International Index of Erectile Function (IIEF) and categorized as having mild (12%), moderate (38%), or severe (50%) ED. Eight percent were found to have PD primarily based on the presence of a penile plaque. An analysis of sociodemographic factors also identified significant associations between PD and the following risk factors for ED:

• Age
• Obesity
• Smoking (duration and number of cigarettes per day)
• Longer duration and increased severity of ED
• Diabetes mellitus
• Dyslipidemia
• Psychological disorders

No significant association was found between PD and hypertension or ischemic heart disease in this study. How much these risk factors contribute to the development of PD and how ED and PD influence each other remain unclear.

Bjekic et al examined the risk factors for PD in a case-controlled study of 82 men with PD matched against 264 men who had neither a history nor signs of PD. [12] The study identified the following as risk factors: (1) genetic predisposition in association with a family history of Dupuytren contracture; (2) minor vascular penile trauma, either accidental or iatrogenic from cystoscopy or transurethral resection of the prostate (TURP); (3) systemic vascular diseases, including diabetes mellitus, hypertension, and hyperlipidemia; and (4) smoking and alcohol consumption. The use of propranolol and a history of nongonococcal urethritis were also found to be risk factors for PD. How these risk factors contribute to the initiation of PD remains elusive.

Agrawal et al reported that patients with PD have evidence of systemic arterial impairment that is endothelial-dependent, compared with healthy controls without PD. [13] Both groups were free of other risk factors for endothelial dysfunction and atherosclerosis. The authors suggest that these systemic abnormalities might be of clinical relevance to the development of PD. Further evaluation is necessary to confirm and interpret these interesting findings.

Casabe et al identified ED and coital trauma as the only independent risk factors for developing PD, in a study that compared 317 consecutive patients with PD and a control group of 147 consecutive patients who presented for prostate examination. Patients were queried regarding ED, coital trauma (defined as strong pain or "cracking" during sexual intercourse), diabetes mellitus, hypertension, cardiovascular disease, dyslipidemia, and lower urinary tract symptoms. The authors speculate that coital trauma may be related to suboptimal penetration capacity in men with ED, and recommend treatment to improve the quality of erections in men with ED along with the use of lubricant gel to avoid friction during intercourse and to diminish coital trauma. [14]

A literature review by Gianazza et al found a significant prevalence of diabetes mellitus in patients with PD, based on data that were somewhat heterogeneous due to population selection. While these authors admit that the role of diabetes in the development of PD is controversial, they cite impairment in wound healing, penile elasticity, nociception, and smooth muscle collagenization due to diabetes as possible contributing factors in PD. [15] These authors also note that glycemic control an ameliorate PD symptoms, and that while patients with diabetes who undergo surgical treatment are less likely to experience recurrence of curvature, they are more likely to develop de novo ED after surgery and infection after implantation of a penile prosthesis.

Pathophysiology

During normal erectile function, neural stimulation results in relaxation of the cavernosal smooth muscle tissue and the cavernosal arteries, bringing blood into the penis and the trabecular spaces within the corporeal bodies. This state initially results in both increased blood flow into the corporeal bodies and pooling of more blood within these organs. As a result, they expand and stretch the surrounding tunica albuginea. This thick expansile layer is composed of collagen and elastic fibers in an irregular framework. It normally stretches in length and width to its maximum size.

Expansion results in stretching, compression, and closure of the subtunical venules that perforate the tunica and drain blood from the corpora. Consequently, blood cannot drain easily from the penis, which results in an increase in intracorporeal hydrostatic pressure. This increased pressure allows the penis to become rigid once the tunica has reached its maximum length and width. The process is similar to overinflating a car tire: Once the maximum length of the steel belts in the tire is reached, further inflation increases the tire's rigidity only.

In PD, the initial inflammatory response is characterized by chronic lymphocytic and plasmacytic infiltration of the tunica albuginea. This may be the result of minor penile trauma, as can happen unnoticed during intercourse. Devine et al propose that such trauma can result in a dorsal and ventral delamination injury to the tunica albuginea, causing inflammation, induration, and fibrin deposition between the tunical layers. [16] If scar tissue formation and extracellular matrix deposition exceed collagen and matrix degradation, as Levine et al postulate, then increased collagen is deposited in the tunica albuginea, resulting in fibrosis and plaque formation.

Luangkhot et al reported that men with PD have more type III collagen than type I collagen in their tunica albuginea. [17] Chiang et al also found increased type III collagen in the adjacent penile tissue in men with PD and in the tunica in men with corporeal veno-occlusive dysfunction (venous leak syndrome). [18] This may indicate that a more generalized penile abnormality is involved in PD.

Transforming growth factor–beta (TGF-beta) is a cytokine involved in tissue repair and scar formation. El-Sakka et al showed that its production is up-regulated in men with PD and that it may be responsible for the increase in collagen deposition associated with this condition. [19]

Gonzalez-Cadavid and Rajfer used two rat models to explore the relationship of TGF-beta1 and fibrin in PD. [20] These models consisted of injection of either TGF-beta1 or fibrin into the tunica of the rat. The authors were able to derive and confirm several conclusions as to the role of microtrauma, cytokines, myofibroblasts, and oxidative stress in the initiation and progression of plaque. Among the several other findings of the study, they also helped to characterize the antifibrotic effects of long-term phosphodiesterase type 5 (PDE5) inhibitor use in these patients.

Presentation

The natural history of PD is variable. Progression can occur over several years. If the fibrosis becomes calcified, the angulation becomes quite stable. Earlier studies described PD as being a self-limited condition, with spontaneous resolution in most cases. However, this does not appear to be accurate. In 1990, Gelbard et al found that the plaque completely resolved without treatment in only 13% of men, while 40% described their condition as progressive and 47% noted no change. [4] Because spontaneous resolution is unlikely in most men, most investigators recommend intervention if and when the condition impacts significantly upon sexual function. Devine et al proposed that the earlier that medical intervention is initiated, the more likely it is to be successful. [21]

Men with PD may present with any combination of the following:

• Penile pain, which is more pronounced during erections
• Penile angulation, which may be apparent only with an erection or may be noted in a flaccid penis
• A plaque that is usually palpable at the site of and on the acute side of the angulation
• An indentation in the shaft, typically at the site of the plaque (causing an hour-glass deformity in the shaft)
• Decreased erectile function, either from loss of rigidity or from penile buckling caused by the angulation

The signs and symptoms often follow the usual progression of PD. Progressive angulation can approach a maximum angle of 90°, thus complicating intromission.

Penile pain per se almost always resolves without therapy, and this has led to controversy in assessing therapeutic outcomes. Alternatively, some patients note pain in the penis that may subside before the appearance of a palpable plaque or of penile angulation. A less common manifestation is a palpable plaque with no associated pain or angulation.

For practical purposes, PD can be divided into acute and chronic phases. The acute phase usually lasts for the first 18-24 months and is characterized by a changing inflammatory pattern that may include penile pain, some curvature, and a penile nodule. The chronic phase is characterized by a stable plaque, often with calcification, and penile angulation. Loss of erectile ability is associated more often with the chronic phase.

Indications

If Peyronie disease (PD) is diagnosed early in the disease course (ie, within the first 6 mo of the onset of any symptoms), attempt nonsurgical therapy. If it is not initially successful, maintain such therapy for a reasonable time (≥6 mo) before considering more invasive measures.

Waiting for a sufficient duration after the inception of symptoms is necessary to ensure that the condition is stable and to be certain that spontaneous resolution will not occur. This duration is governed by the severity and debilitating effects of the symptoms. It should be in the range of 1-2 years. During this time, nonsurgical treatments can be applied. A significant endpoint in the observation period is the presence of calcification in the plaque. This usually indicates a stable plaque, and no further angulation or resolution can be anticipated at this point. If the plaque and/or penile angulation have remained unchanged for 6 months, the condition can be assumed to be stable and surgical intervention can be contemplated.

Surgery should not be undertaken unless the condition is debilitating, preventing satisfactory intercourse. Erectile dysfunction (ED) that is not responsive to pharmacologic therapy is an indication to use surgical approaches that address both the curvature and the ED. The authors do not believe that operating to correct small curvatures simply for cosmetic reasons is reasonable. Usually, some degree of curvature remains afterwards, either from residual disease or from resultant scar tissue, and patients are not satisfied with the results.

Relevant Anatomy

The penile shaft is made up of 3 erectile bodies: the 2 corpora cavernosa dorsally and the corpus spongiosum containing the urethra ventrally (see the image below). They are surrounded by vessels, fascia, and skin. The corpora are composed of erectile tissue that surrounds the cavernosal artery located within each corpus. This tissue is spongelike, being composed of many vascular spaces capable of expanding and filling with blood after adequate smooth muscle relaxation from proper neural stimulation.

Cross-section view of the penis is shown.

The corpora cavernosa are on adjacent sides of the median raphe. This fenestrated midline structure acts as a buttress to the shaft, connecting to the tunica albuginea dorsally and ventrally. It is composed of the same elastic fibers as the tunica albuginea and it allows free communication between the 2 corpora cavernosa.

The tunica albuginea is a tough fibrous layer that surrounds the corpora cavernosa. It is composed of 2 layers of elastic tissue and collagen. This layer gives the penis rigidity as the intracorporeal pressure increases. The plaque of Peyronie disease (PD) develops in this layer, although the plaque can also extend into the underlying corporeal tissue.

The deep dorsal vein lies in the dorsal sulcus between the 2 corpora. It is flanked on either side by a dorsal artery and a dorsal nerve bundle. The latter can either be in the form of a large visible nerve running lateral to each artery, or it can be fanned out into several fine nerve strands that progress distally along the dorsolateral aspect of the penile shaft. This second scenario can complicate reconstructive surgery because of the heightened chance of injuring one or more of these strands, resulting in anesthesia of some of the penile skin.

Lying in the ventral sulcus is the third erectile body, the corpus spongiosum. This envelops the urethra and is continuous distally with the glans penis. The corpus spongiosum is encased in Buck fascia, a tough elastic layer that continues dorsally to also enclose the corpora cavernosa, superficial to the tunica albuginea, the deep dorsal vein, and the dorsal arteries and nerves.

The next superficial layer is the Dartos fascia. This is composed of loose areolar tissue that allows free and easy movement of the skin over the penile shaft. Within this layer are contained the superficial veins of the penis. A prominent vein in this layer is the superficial dorsal vein, which is often visible through the penile skin. The outermost layer is composed of penile skin that folds back upon itself distally to form the prepuce.

Contraindications

In general, contraindications to treatment of Peyronie disease (PD) are based on the severity of signs and symptoms. If little or no loss of penile rigidity is present and if the curvature is minimal and does not compromise function, then intervention is contraindicated. In this setting, intervention is not likely to enhance function or appearance, although it will expose the patient to potential adverse effects, including a worsening of the symptoms.

Topical and/or oral treatments are contraindicated in any person who has a known hypersensitivity to any specific agent. Injectable agents are generally tolerated well and appear to have little if any systemic effects because of the small amounts injected. As with topical and oral agents, they should not be used in any person who has demonstrated an allergic reaction to the particular medication contemplated.

Surgical treatment is contraindicated in men who have minimal symptoms. In addition, surgery should not be used when the disease is not yet stable. If plaque excision is performed before the process of fibrosis is complete, the procedure is doomed to fail because further plaque and subsequent curvature will develop.

Implantation of a penile prosthesis is contraindicated in any person with an ongoing infection anywhere in the body. In addition to the contraindications mentioned above, an inflatable prosthesis is contraindicated in a patient who lacks the manual dexterity to operate the prosthesis.

1. Peyronie F de la. Sur quelques obstacles qui s'opposent a l'ejaculation naturelle de la semence. Memoires de l'Academie de Chirurgie. 1743. 1:318.
2. Oberlin DT, Liu JS, Hofer MD, Milose J, Matulewicz RS, Flury SC, et al. An Analysis of Case Logs From American Urologists in the Treatment of Peyronie's Disease. Urology. 2016 Jan. 87:205-9. [QxMD MEDLINE Link].
3. Pires J, Travis M, Ellsworth P. Peyronie's Disease: Overview and Recent Treatment Advances. Urol Nurs. 2015 Jul-Aug. 35 (4):164-78. [QxMD MEDLINE Link].
4. Gelbard MK, Dorey F, James K. The natural history of Peyronie's disease. J Urol. 1990 Dec. 144(6):1376-9. [QxMD MEDLINE Link].
5. Carson CC. Francois Gigot de la Peyronie (1678-1747). Invest Urol. 1981 Jul. 19(1):62-3. [QxMD MEDLINE Link].
6. Lindsay MB, Schain DM, Grambsch P, Benson RC, Beard CM, Kurland LT. The incidence of Peyronie's disease in Rochester, Minnesota, 1950 through 1984. J Urol. 1991 Oct. 146(4):1007-9. [QxMD MEDLINE Link].
7. Schwarzer U, Sommer F, Klotz T, Braun M, Reifenrath B, Engelmann U. The prevalence of Peyronie's disease: results of a large survey. BJU Int. 2001 Nov. 88(7):727-30. [QxMD MEDLINE Link].
8. Mulhall JP, Creech SD, Boorjian SA, Ghaly S, Kim ED, Moty A, et al. Subjective and objective analysis of the prevalence of Peyronie's disease in a population of men presenting for prostate cancer screening. J Urol. 2004 Jun. 171(6 Pt 1):2350-3. [QxMD MEDLINE Link].
9. Herati AS, Pastuszak AW. The Genetic Basis of Peyronie Disease: A Review. Sex Med Rev. 2016 Jan. 4 (1):85-94. [QxMD MEDLINE Link].
10. Usta MF, Bivalacqua TJ, Jabren GW, Myers L, Sanabria J, Sikka SC, et al. Relationship between the severity of penile curvature and the presence of comorbidities in men with Peyronie's disease. J Urol. 2004 Feb. 171(2 Pt 1):775-9. [QxMD MEDLINE Link].
11. El-Sakka AI. Prevalence of Peyronie's disease among patients with erectile dysfunction. Eur Urol. 2006 Mar. 49(3):564-9. [QxMD MEDLINE Link].
12. Bjekic MD, Vlajinac HD, Sipetic SB, Marinkovic JM. Risk factors for Peyronie's disease: a case-control study. BJU Int. 2006 Mar. 97(3):570-4. [QxMD MEDLINE Link].
13. Agrawal V, Ellins E, Donald A, Minhas S, Halcox J, Ralph DJ. Systemic vascular endothelial dysfunction in Peyronie's disease. J Sex Med. 2008 Nov. 5(11):2688-93. [QxMD MEDLINE Link].
14. Casabé A, Bechara A, Cheliz G, De Bonis W, Rey H. Risk factors of Peyronie's disease. What does our clinical experience show?. J Sex Med. 2011 Feb. 8(2):518-23. [QxMD MEDLINE Link].
15. Gianazza S, Belladelli F, Leni R, Masci F, Rossi P, Gianesini G, et al. Peyronie's disease development and management in diabetic men. Andrology. 2023 Feb. 11 (2):372-378. [QxMD MEDLINE Link].[Full Text].
16. Devine CJ Jr, Somers KD, Ladaga LE. Peyronie's disease: pathophysiology. Prog Clin Biol Res. 1991. 370:355-8. [QxMD MEDLINE Link].
17. Luangkhot R, Rutchik S, Agarwal V, Puglia K, Bhargava G, Melman A. Collagen alterations in the corpus cavernosum of men with sexual dysfunction. J Urol. 1992 Aug. 148(2 Pt 1):467-71. [QxMD MEDLINE Link].
18. Chiang PH, Chiang CP, Shen MR, Huang CH, Wang CJ, Huang IY, et al. Study of the changes in collagen of the tunica albuginea in venogenic impotence and Peyronie's disease. Eur Urol. 1992. 21(1):48-51. [QxMD MEDLINE Link].
19. El-Sakka AI, Hassoba HM, Pillarisetty RJ, Dahiya R, Lue TF. Peyronie's disease is associated with an increase in transforming growth factor-beta protein expression. J Urol. 1997 Oct. 158(4):1391-4. [QxMD MEDLINE Link].
20. Gonzalez-Cadavid NF, Rajfer J. Experimental models of Peyronie's disease. Implications for new therapies. J Sex Med. 2009 Feb. 6(2):303-13. [QxMD MEDLINE Link].
21. Devine CJ Jr, Jordan GH, Schlossberg SM. Surgery of the penis and urethra. Walsh PC, Retic AB, Stamey TA.Campbell's Urology. 6th ed. Philadelphia, Pa: WB Saunders; 1992. 2957-3032.
22. Erdogru T, Boz A, Koksal T, Usta MF, Yildiz A, Gungor F, et al. Penile scintigraphy with 99mTc-human immunoglobulin G: a novel method for distinguishing the unstable and stable phases of Peyronie's disease. BJU Int. 2002 Nov. 90(7):703-6. [QxMD MEDLINE Link].
23. Riversi V, Tallis V, Trovatelli S, Belba A, Volterrani L, Iacoponi F, et al. Realtime-elastosonography of the penis in patients with Peyronie's disease. Arch Ital Urol Androl. 2012 Sep. 84(3):174-7. [QxMD MEDLINE Link].
24. Shenoy-Bhangle A, Perez-Johnston R, Singh A. Penile imaging. Radiol Clin North Am. 2012 Nov. 50(6):1167-81. [QxMD MEDLINE Link].
25. Bacal V, Rumohr J, Sturm R, Lipshultz LI, Schumacher M, Grober ED. Correlation of degree of penile curvature between patient estimates and objective measures among men with Peyronie's disease. J Sex Med. 2009 Mar. 6(3):862-5. [QxMD MEDLINE Link].
26. Mulhall JP, Schiff J, Guhring P. An analysis of the natural history of Peyronie's disease. J Urol. 2006 Jun. 175(6):2115-8; discussion 2118. [QxMD MEDLINE Link].
27. Tanner Pharma Group Initiates Named Patient Program for XIAFLEX®. https://www.tannerpharma.com/. Available athttps://www.tannerpharma.com/tanner-pharma-group-initiates-named-patient-program-xiaflex/#:~:text=March%202%2C%202020%2008%3A00%20AM%20Eastern%20Daylight%20Time&text=XIAPEX%C2%AE%2C%20also%20owned%20by,on%20safety%20or%20efficacy%20concerns.. March 2, 2020; Accessed: January 27, 2023.
28. Müller A, Mulhall JP. Peyronie's disease intervention trials: methodological challenges and issues. J Sex Med. 2009 Mar. 6(3):848-61. [QxMD MEDLINE Link].
29. Brimley SC, Yafi FA, Greenberg J, Hellstrom WJG, Tue Nguyen HM, Hatzichristodoulou G. Review of Management Options for Active-Phase Peyronie's Disease. Sex Med Rev. 2019 Apr. 7 (2):329-337. [QxMD MEDLINE Link].[Full Text].
30. Zarafonetis CJ, Horrax TM. Treatment of Peyronie's disease with potassium para-aminobenzoate (potaba). J Urol. 1959 Jun. 81(6):770-2. [QxMD MEDLINE Link].
31. Carson CC. Potassium para-aminobenzoate for the treatment of Peyronie's disease: is it effective?. Tech Urol. 1997. 3(3):135-9. [QxMD MEDLINE Link].
32. Colletta AA, Wakefield LM, Howell FV, van Roozendaal KE, Danielpour D, Ebbs SR, et al. Anti-oestrogens induce the secretion of active transforming growth factor beta from human fetal fibroblasts. Br J Cancer. 1990 Sep. 62(3):405-9. [QxMD MEDLINE Link].
33. Ralph DJ, Brooks MD, Bottazzo GF, Pryor JP. The treatment of Peyronie's disease with tamoxifen. Br J Urol. 1992 Dec. 70(6):648-51. [QxMD MEDLINE Link].
34. Teloken C, Rhoden EL, Grazziotin TM, Ros CT, Sogari PR, Souto CA. Tamoxifen versus placebo in the treatment of Peyronie's disease. J Urol. 1999 Dec. 162(6):2003-5. [QxMD MEDLINE Link].
35. Fell HB, Lawrence CE, Bagga MR, Hembry RM, Reynolds JJ. The degradation of collagen in pig synovium in vitro and the effect of colchicine. Matrix. 1989 Mar. 9(2):116-26. [QxMD MEDLINE Link].
36. Harris ED Jr, Krane SM. Effects of colchicine on collagenase in cultures of rheumatoid synovium. Arthritis Rheum. 1971 Nov-Dec. 14(6):669-84. [QxMD MEDLINE Link].
37. Akkus E, Carrier S, Rehman J, Breza J, Kadioglu A, Lue TF. Is colchicine effective in Peyronie's disease? A pilot study. Urology. 1994 Aug. 44(2):291-5. [QxMD MEDLINE Link].
38. Levine LA. Peyronie's disease: a difficult sexual dysfunction problem. West J Med. 1998 Sep. 169(3):168-9. [QxMD MEDLINE Link].
39. Prieto Castro RM, Leva Vallejo ME, Regueiro Lopez JC, Anglada Curado FJ, Alvarez Kindelan J, Requena Tapia MJ, et al. Combined treatment with vitamin E and colchicine in the early stages of Peyronie's disease. BJU Int. 2003 Apr. 91(6):522-4. [QxMD MEDLINE Link].
40. Safarinejad MR. Therapeutic effects of colchicine in the management of Peyronie's disease: a randomized double-blind, placebo-controlled study. Int J Impot Res. 2004 Jun. 16(3):238-43. [QxMD MEDLINE Link].
41. Gelbard M, Goldstein I, Hellstrom WJ, McMahon CG, Smith T, Tursi J, et al. Clinical efficacy, safety and tolerability of collagenase clostridium histolyticum for the treatment of peyronie disease in 2 large double-blind, randomized, placebo controlled phase 3 studies. J Urol. 2013 Jul. 190(1):199-207. [QxMD MEDLINE Link].
42. Ziegelmann MJ, Viers BR, McAlvany KL, Bailey GC, Savage JB, Trost LW. Restoration of Penile Function and Patient Satisfaction with Intralesional Collagenase Clostridium Histolyticum Injection for Peyronie's Disease. J Urol. 2016 Apr. 195 (4 Pt 1):1051-6. [QxMD MEDLINE Link].
43. Tsambarlis PN, Yong R, Levine LA. Limited success with clostridium collagenase histolyticum following FDA approval for the treatment of Peyronie's disease. Int J Impot Res. 2019 Jan. 31 (1):15-19. [QxMD MEDLINE Link].
44. Wymer K, Ziegelmann M, Savage J, Kohler T, Trost L. Plaque calcification: An important predictor of collagenase clostridium histolyticum treatment outcomes for men with Peyronie's Disease. Urology. 2018 Jun 14. [QxMD MEDLINE Link].
45. Cocci A, Russo GI, Briganti A, Salonia A, Cacciamani G, Capece M, et al. Predictors of treatment success after collagenase Clostridium histolyticum injection for Peyronie's disease: development of a nomogram from a multicentre single-arm, non-placebo controlled clinical study. BJU Int. 2018 May 23. [QxMD MEDLINE Link].
46. Abdel Raheem A, Johnson M, Abdel-Raheem T, Capece M, Ralph D. Collagenase Clostridium histolyticum in the Treatment of Peyronie's Disease-A Review of the Literature and a New Modified Protocol. Sex Med Rev. 2017 Oct. 5 (4):529-535. [QxMD MEDLINE Link].
47. Capoccia E, Levine LA. Contemporary Review of Peyronie's Disease Treatment. Curr Urol Rep. 2018 May 17. 19 (7):51. [QxMD MEDLINE Link].
48. Zhang F, Xiong Y, Wang W, Wu C, Qin F, Yuan J. The efficacy and safety of intralesional injection of collagenase Clostridium histolyticum for Peyronie's disease: A meta-analysis of published prospective studies. Front Pharmacol. 2022. 13:973394. [QxMD MEDLINE Link].[Full Text].
49. Culha M, Mutlu N, Acar O, Alici B. Patient-partner satisfaction with intracavernous medication supported with oral agents in selected cases of Peyronie's disease. A ten-month follow-up study. Int Urol Nephrol. 1999. 31(2):257-62. [QxMD MEDLINE Link].
50. Winter CC, Khanna R. Peyronie's disease. Results with dermo-jet injection of dexamethasone. J Urol. 1954. 72:400-403.
51. Williams G, Green NA. The non-surgical treatment of Peyronie's disease. Br J Urol. 1980 Oct. 52(5):392-5. [QxMD MEDLINE Link].
52. Cipollone G, Nicolai M, Mastroprimiano G, Iantorno R, Longeri D, Tenaglia R. [Betamethasone versus placebo in Peyronie's disease]. Arch Ital Urol Androl. 1998 Sep. 70(4):165-8. [QxMD MEDLINE Link].
53. Lamprakopoulos A, Zorzos I, Lykourinas M. The use of betamethasone and hyaluronidase injections in the treatment of Peyronie's disease. Scand J Urol Nephrol. 2000 Dec. 34(6):355-60. [QxMD MEDLINE Link].
54. Lee RC, Ping JA. Calcium antagonists retard extracellular matrix production in connective tissue equivalent. J Surg Res. 1990 Nov. 49(5):463-6. [QxMD MEDLINE Link].
55. Levine LA, Merrick PF, Lee RC. Intralesional verapamil injection for the treatment of Peyronie's disease. J Urol. 1994 Jun. 151(6):1522-4. [QxMD MEDLINE Link].
56. Lasser A, Vandenberg TL, Vincent MJ, Hellstrom WJ. Intraplaque verapamil injection for treatment of Peyronie's disease. J La State Med Soc. 1998 Sep. 150(9):431-4. [QxMD MEDLINE Link].
57. Rehman J, Benet A, Melman A. Use of intralesional verapamil to dissolve Peyronie's disease plaque: a long-term single-blind study. Urology. 1998 Apr. 51(4):620-6. [QxMD MEDLINE Link].
58. Cavallini G, Modenini F, Vitali G. Open preliminary randomized prospective clinical trial of efficacy and safety of three different verapamil dilutions for intraplaque therapy of Peyronie's disease. Urology. 2007 May. 69(5):950-4. [QxMD MEDLINE Link].
59. Soh J, Kawauchi A, Kanemitsu N, Naya Y, Ochiai A, Naitoh Y, et al. Nicardipine vs. saline injection as treatment for Peyronie's disease: a prospective, randomized, single-blind trial. J Sex Med. 2010 Nov. 7(11):3743-9. [QxMD MEDLINE Link].
60. Moskovic DJ, Alex B, Choi JM, Nelson CJ, Mulhall JP. Defining predictors of response to intralesional verapamil injection therapy for Peyronie's disease. BJU Int. 2011 Jul 6. [QxMD MEDLINE Link].
61. Favilla V, Russo GI, Zucchi A, Siracusa G, Privitera S, Cimino S, et al. Evaluation of intralesional injection of hyaluronic acid compared with verapamil in Peyronie's disease: preliminary results from a prospective, double-blinded, randomized study. Andrology. 2017 Jul. 5 (4):771-775. [QxMD MEDLINE Link].[Full Text].
62. Cocci A, Di Maida F, Cito G, Verrienti P, Laruccia N, Campi R, et al. Comparison of Intralesional Hyaluronic Acid vs. Verapamil for the Treatment of Acute Phase Peyronie's Disease: A Prospective, Open-Label Non-Randomized Clinical Study. World J Mens Health. 2021 Apr. 39 (2):352-357. [QxMD MEDLINE Link].[Full Text].
63. Riedl CR, Plas E, Engelhardt P, Daha K, Pflüger H. Iontophoresis for treatment of Peyronie's disease. J Urol. 2000 Jan. 163(1):95-9. [QxMD MEDLINE Link].
64. Montorsi F, Salonia A, Guazzoni G, Barbieri L, Colombo R, Brausi M, et al. Transdermal electromotive multi-drug administration for Peyronie's disease: preliminary results. J Androl. 2000 Jan-Feb. 21(1):85-90. [QxMD MEDLINE Link].
65. Martin DJ, Badwan K, Parker M, Mulhall JP. Transdermal application of verapamil gel to the penile shaft fails to infiltrate the tunica albuginea. J Urol. 2002 Dec. 168(6):2483-5. [QxMD MEDLINE Link].
66. Levine LA, Estrada CR, Shou W, Cole A. Tunica albuginea tissue analysis after electromotive drug administration. J Urol. 2003 May. 169(5):1775-8. [QxMD MEDLINE Link].
67. Di Stasi SM, Giannantoni A, Capelli G, Jannini EA, Virgili G, Storti L, et al. Transdermal electromotive administration of verapamil and dexamethasone for Peyronie's disease. BJU Int. 2003 Jun. 91(9):825-9. [QxMD MEDLINE Link].
68. Di Stasi SM, Giannantoni A, Stephen RL, Capelli G, Giurioli A, Jannini EA, et al. A prospective, randomized study using transdermal electromotive administration of verapamil and dexamethasone for Peyronie's disease. J Urol. 2004 Apr. 171(4):1605-8. [QxMD MEDLINE Link].
69. Wessells H. Exploring cause and effect relationships in male sexual dysfunction. J Urol. 2004 Apr. 171(4):1609-10. [QxMD MEDLINE Link].
70. Srirangam SJ, Manikandan R, Hussain J, Collins GN, O'Reilly PH. Long-term results of extracorporeal shockwave therapy for Peyronie's disease. J Endourol. 2006 Nov. 20(11):880-4. [QxMD MEDLINE Link].
71. Mirone V, Imbimbo C, Palmieri A, Fusco F. Our experience on the association of a new physical and medical therapy in patients suffering from induratio penis plastica. Eur Urol. 1999 Oct. 36(4):327-30. [QxMD MEDLINE Link].
72. Husain J, Lynn NN, Jones DK, Collins GN, O'Reilly PH. Extracorporeal shock wave therapy in the management of Peyronie's disease: initial experience. BJU Int. 2000 Sep. 86(4):466-8. [QxMD MEDLINE Link].
73. Hauck EW, Hauptmann A, Bschleipfer T, Schmelz HU, Altinkilic BM, Weidner W. Questionable efficacy of extracorporeal shock wave therapy for Peyronie's disease: results of a prospective approach. J Urol. 2004 Jan. 171(1):296-9. [QxMD MEDLINE Link].
74. Chung E. Peyronie's disease and low intensity shock wave therapy: Clinical outcomes and patient satisfaction rate in an open-label single arm prospective study in Australian men. Korean J Urol. 2015 Nov. 56 (11):775-80. [QxMD MEDLINE Link].
75. Hauck EW, Mueller UO, Bschleipfer T, Schmelz HU, Diemer T, Weidner W. Extracorporeal shock wave therapy for Peyronie's disease: exploratory meta-analysis of clinical trials. J Urol. 2004 Feb. 171(2 Pt 1):740-5. [QxMD MEDLINE Link].
76. Duncan MR, Berman B, Nseyo UO. Regulation of the proliferation and biosynthetic activities of cultured human Peyronie's disease fibroblasts by interferons-alpha, -beta and -gamma. Scand J Urol Nephrol. 1991. 25(2):89-94. [QxMD MEDLINE Link].
77. Wegner HE, Andresen R, Knipsel HH, Miller K. Treatment of Peyronie's disease with local interferon-alpha 2b. Eur Urol. 1995. 28(3):236-40. [QxMD MEDLINE Link].
78. Judge IS, Wisniewski ZS. Intralesional interferon in the treatment of Peyronie's disease: a pilot study. Br J Urol. 1997 Jan. 79(1):40-2. [QxMD MEDLINE Link].
79. Ahuja S, Bivalacqua TJ, Case J, Vincent M, Sikka SC, Hellstrom WJ. A pilot study demonstrating clinical benefit from intralesional interferon alpha 2B in the treatment of Peyronie's disease. J Androl. 1999 Jul-Aug. 20(4):444-8. [QxMD MEDLINE Link].
80. Astorga R, Cantero O, Contreras D, del Rio-Martín A, Labarta-Beceiro V, Gutiérrez-Elvírez A, et al. Intralesional recombinant interferon alpha-2b in Peyronie's disease. Arch Esp Urol. 2000 Sep. 53(7):665-71. [QxMD MEDLINE Link].
81. Brake M, Loertzer H, Horsch R, Keller H. Treatment of Peyronie's disease with local interferon-alpha 2b. BJU Int. 2001 May. 87(7):654-7. [QxMD MEDLINE Link].
82. Hellstrom WJ, Kendirci M, Matern R, Cockerham Y, Myers L, Sikka SC, et al. Single-blind, multicenter, placebo controlled, parallel study to assess the safety and efficacy of intralesional interferon alpha-2B for minimally invasive treatment for Peyronie's disease. J Urol. 2006 Jul. 176(1):394-8. [QxMD MEDLINE Link].
83. Inal T, Tokatli Z, Akand M, Ozdiler E, Yaman O. Effect of intralesional interferon-alpha 2b combined with oral vitamin E for treatment of early stage Peyronie's disease: a randomized and prospective study. Urology. 2006 May. 67(5):1038-42. [QxMD MEDLINE Link].
84. Sokhal AK, Jain NK, Jhanwar A, Singh K, Saini DK. Prospective study to evaluate the clinical outcome of intralesional interferon-α2b in the management of Peyronie's disease. Urol Ann. 2018 Apr-Jun. 10 (2):154-158. [QxMD MEDLINE Link].[Full Text].
85. Alkandari MH, Touma N, Carrier S. Platelet-Rich Plasma Injections for Erectile Dysfunction and Peyronie's Disease: A Systematic Review of Evidence. Sex Med Rev. 2022 Apr. 10 (2):341-352. [QxMD MEDLINE Link].
86. Alizadeh M, Karimi F, Fallah MR. Evaluation of verapamil efficacy in Peyronie's disease comparing with pentoxifylline. Glob J Health Sci. 2014 Sep 18. 6 (7 Spec No):23-30. [QxMD MEDLINE Link].[Full Text].
87. Paulis G, Barletta D, Turchi P, Vitarelli A, Dachille G, Fabiani A, et al. Efficacy and safety evaluation of pentoxifylline associated with other antioxidants in medical treatment of Peyronie's disease: a case-control study. Res Rep Urol. 2016. 8:1-10. [QxMD MEDLINE Link].[Full Text].
88. Chung E, Yafi FA. Pharmacotherapy in Peyronie's disease: a state-of-the-art review on established contemporary and emerging drugs. Expert Opin Pharmacother. 2022 Jun. 23 (9):1035-1042. [QxMD MEDLINE Link].
89. Leslie S. Use of external vacuum devices in Peyronie's disease. Personal communication, Unpublished data. 2001.
90. Levine LA, Newell MM. FastSize Medical Extender for the treatment of Peyronie's disease. Expert Rev Med Devices. 2008 May. 5(3):305-10. [QxMD MEDLINE Link].
91. Gontero P, Di Marco M, Giubilei G, Bartoletti R, Pappagallo G, Tizzani A. Use of penile extender device in the treatment of penile curvature as a result of Peyronie's disease. Results of a phase II prospective study. J Sex Med. 2009 Feb. 6(2):558-66. [QxMD MEDLINE Link].
92. Campbell JD, Matti D, Abed H, Di Pierdominico A. Technological Advancements for Treating Erectile Dysfunction and Peyronie's Disease. Urol Clin North Am. 2022 Feb. 49 (1):175-184. [QxMD MEDLINE Link].
93. Moncada I, Krishnappa P, Romero J, Torremade J, Fraile A, Martinez-Salamanca JI, et al. Penile traction therapy with the new device 'Penimaster PRO' is effective and safe in the stable phase of Peyronie's disease: a controlled multicentre study. BJU Int. 2019 Apr. 123 (4):694-702. [QxMD MEDLINE Link].
94. Ziegelmann M, Savage J, Toussi A, Alom M, Yang D, Kohler T, et al. Outcomes of a Novel Penile Traction Device in Men with Peyronie's Disease: A Randomized, Single-Blind, Controlled Trial. J Urol. 2019 Sep. 202 (3):599-610. [QxMD MEDLINE Link].
95. Krishnappa P, Manfredi C, Sinha M, Arcaniolo D, Matippa P, Moncada I. Penile Modeling in Peyronie's Disease: A Systematic Review of the Literature. Sex Med Rev. 2022 Jul. 10 (3):434-450. [QxMD MEDLINE Link].
96. Incrocci L, Wijnmaalen A, Slob AK, Hop WC, Levendag PC. Low-dose radiotherapy in 179 patients with Peyronie's disease: treatment outcome and current sexual functioning. Int J Radiat Oncol Biol Phys. 2000 Jul 15. 47(5):1353-6. [QxMD MEDLINE Link].
97. Mulhall JP, Branch J, Lubrano T, Shankey TV. Radiation increases fibrogenic cytokine expression by Peyronie's disease fibroblasts. J Urol. 2003 Jul. 170(1):281-4. [QxMD MEDLINE Link].
98. Segal RL, Burnett AL. Surgical Management for Peyronie's Disease. World J Mens Health. 2013 Apr. 31(1):1-11. [QxMD MEDLINE Link].
99. Greenfield JM, Lucas S, Levine LA. Factors affecting the loss of length associated with tunica albuginea plication for correction of penile curvature. J Urol. 2006 Jan. 175(1):238-41. [QxMD MEDLINE Link].
100. Lue TF, El-Sakka AI. Venous patch graft for Peyronie's disease. Part I: technique. J Urol. 1998 Dec. 160(6 Pt 1):2047-9. [QxMD MEDLINE Link].
101. El-Sakka AI, Rashwan HM, Lue TF. Venous patch graft for Peyronie's disease. Part II: outcome analysis. J Urol. 1998 Dec. 160(6 Pt 1):2050-3. [QxMD MEDLINE Link].
102. Devine CJ Jr, Horton CE. Surgical treatment of Peyronie's disease with a dermal graff. J Urol. 1974 Jan. 111(1):44-9. [QxMD MEDLINE Link].
103. Treiber U, Gilbert P. Surgical treatment of Peyronie's disease. Urol Int. 1991. 47(4):240-4. [QxMD MEDLINE Link].
104. Fournier GR Jr, Lue TF, Tanagho EA. Peyronie's plaque: surgical treatment with the carbon dioxide laser and a deep dorsal vein patch graft. J Urol. 1993 May. 149(5 Pt 2):1321-5. [QxMD MEDLINE Link].
105. Ganabathi K, Dmochowski R, Zimmern PE, Leach GE. Peyronie's disease: surgical treatment based on penile rigidity. J Urol. 1995 Mar. 153(3 Pt 1):662-6. [QxMD MEDLINE Link].
106. Krishnamurti S. Penile dermal flap for defect reconstruction in Peyronie's disease: operative technique and four years' experience in 17 patients. Int J Impot Res. 1995 Dec. 7(4):195-208. [QxMD MEDLINE Link].
107. Yachia D, Erlich N. Bio-fragmentable anastomosis ring in urological surgery involving the gastrointestinal tract: early experience and a historical review of mechanical intestinal anastomosis. J Urol. 1995 May. 153(5):1426-8. [QxMD MEDLINE Link].
108. Montorsi F, Salonia A, Briganti A. Five year follow-up of plaque incision and vein grafting for Peyronie's disease. J Urol. 2004. 171:331.
109. Kadioglu A, Tefekli A, Usta M, Demirel S, Tellaloglu S. Surgical treatment of Peyronie's disease with incision and venous patch technique. Int J Impot Res. 1999 Apr. 11(2):75-81. [QxMD MEDLINE Link].
110. Arena F, Peracchia G, di Stefano C, Barbieri A, Cortellini P. Peyronie's disease--incision and dorsal vein grafting combined with contralateral plication in straightening the penis. Scand J Urol Nephrol. 1999 Jun. 33(3):181-5. [QxMD MEDLINE Link].
111. Lue TF, El-Sakka AI. Lengthening shortened penis caused by Peyronie's disease using circular venous grafting and daily stretching with a vacuum erection device. J Urol. 1999 Apr. 161(4):1141-4. [QxMD MEDLINE Link].
112. Chow AK, Sidelsky SA, Levine LA. Surgical Outcomes of Plaque Excision and Grafting and Supplemental Tunica Albuginea Plication for Treatment of Peyronie's Disease With Severe Compound Curvature. J Sex Med. 2018 Jul. 15 (7):1021-1029. [QxMD MEDLINE Link].
113. Kadioglu A, Akman T, Sanli O. Surgical treatment of Peyronie's disease: a critical analysis. Eur Urol. 2006. 49:987-97.
114. Essed E, Schroeder FH. New surgical treatment for Peyronie disease. Urology. 1985 Jun. 25(6):582-7. [QxMD MEDLINE Link].
115. Gholami SS, Lue TF. Correction of penile curvature using the 16-dot plication technique: a review of 132 patients. J Urol. 2002 May. 167(5):2066-9. [QxMD MEDLINE Link].
116. Egydio PH, Lucon AM, Arap S. A single relaxing incision to correct different types of penile curvature: surgical technique based on geometrical principles. BJU Int. 2004 Nov. 94(7):1147-57. [QxMD MEDLINE Link].
117. Kadioglu A, Sanli O, Akman T, Ersay A, Guven S, Mammadov F. Graft materials in Peyronie's disease surgery: a comprehensive review. J Sex Med. 2007 May. 4(3):581-95. [QxMD MEDLINE Link].
118. Kalsi JS, Christopher N, Ralph DJ, Minhas S. Plaque incision and fascia lata grafting in the surgical management of Peyronie's disease. BJU Int. 2006 Jul. 98(1):110-4; discussion 114-5. [QxMD MEDLINE Link].
119. Taylor FL, Levine LA. Surgical correction of Peyronie's disease via tunica albuginea plication or partial plaque excision with pericardial graft: long-term follow up. J Sex Med. 2008 Sep. 5(9):2221-8; discussion 2229-30. [QxMD MEDLINE Link].
120. Wilson SK, Delk JR 2nd. A new treatment for Peyronie's disease: modeling the penis over an inflatable penile prosthesis. J Urol. 1994 Oct. 152(4):1121-3. [QxMD MEDLINE Link].
121. Hellstrom WJ, Reddy S. Application of pericardial graft in the surgical management of Peyronie's disease. J Urol. 2000 May. 163(5):1445-7. [QxMD MEDLINE Link].
122. Ralph DJ. The surgical treatment of Peyronie's disease. Eur Urol. 2006 Aug. 50(2):196-8. [QxMD MEDLINE Link].
123. Ebbehoj J, Metz P. New operation for "krummerik" (penile curvature). Urology. 1985 Jul. 26(1):76-8. [QxMD MEDLINE Link].
124. van der Horst C, Martínez Portillo FJ, Melchior D, Bross S, Alken P, Juenemann KP. Polytetrafluoroethylene versus polypropylene sutures for Essed-Schroeder tunical plication. J Urol. 2003 Aug. 170(2 Pt 1):472-5. [QxMD MEDLINE Link].
125. Van Der Horst C, Martínez Portillo FJ, Seif C, Alken P, Juenemann KP. Treatment of penile curvature with Essed-Schröder tunical plication: aspects of quality of life from the patients' perspective. BJU Int. 2004 Jan. 93(1):105-8. [QxMD MEDLINE Link].
126. Hauck EW, Bschleipfer T, Diemer T, Manning M, Schroeder-Printzen I, Weidner W. Long-term results of plaque thinning with carbide burs, small incisions and venous grafting for correcting complex penile curvature in Peyronie's disease: poor results of an "ideal" approach. J Urol. 2002 May. 167(5):2070-3. [QxMD MEDLINE Link].
127. Hatzichristou DG, Hatzimouratidis K, Apostolidis A, Tzortzis V, Bekos A, Ioannidis E. Corporoplasty using tunica albuginea free grafts for penile curvature: surgical technique and long-term results. J Urol. 2002 Mar. 167(3):1367-70. [QxMD MEDLINE Link].
128. Adeniyi AA, Goorney SR, Pryor JP, Ralph DJ. The Lue procedure: an analysis of the outcome in Peyronie's disease. BJU Int. 2002 Mar. 89(4):404-8. [QxMD MEDLINE Link].
129. Bella AJ, Beasley KA, Obied A, Brock GB. Minimally invasive intracorporeal incision of Peyronie's plaque: initial experiences with a new technique. Urology. 2006 Oct. 68(4):852-7. [QxMD MEDLINE Link].
130. Sansalone S, Garaffa G, Djinovic R, Pecoraro S, Silvani M, Barbagli G, et al. Long-term results of the surgical treatment of Peyronie's disease with Egydio's technique: a European multicentre study. Asian J Androl. 2011 Jul 11. [QxMD MEDLINE Link].
131. Flores S, Choi J, Alex B, Mulhall JP. Erectile dysfunction after plaque incision and grafting: short-term assessment of incidence and predictors. J Sex Med. 2011 Jul. 8(7):2031-7. [QxMD MEDLINE Link].
132. Chung E, Clendinning E, Lessard L, Brock G. Five-year follow-up of Peyronie's graft surgery: outcomes and patient satisfaction. J Sex Med. 2011 Feb. 8(2):594-600. [QxMD MEDLINE Link].
133. Shaeer O. Trans-corporal incision of Peyronie's plaques. J Sex Med. 2011 Feb. 8(2):589-93. [QxMD MEDLINE Link].
134. Montorsi F, Salonia A, Maga T, Colombo R, Cestari A, Guazzoni G, et al. Reconfiguration of the severely fibrotic penis with a penile implant. J Urol. 2001 Nov. 166(5):1782-6. [QxMD MEDLINE Link].
135. Mulhall JP, Ahmed A, Anderson M. Penile prosthetic surgery for Peyronie's disease: defining the need for intraoperative adjuvant maneuvers. J Sex Med. 2004. 1(3):318-21. [QxMD MEDLINE Link].[Full Text].
136. Rolle L, Ceruti C, Timpano M, Sedigh O, Destefanis P, Galletto E, et al. A new, innovative, lengthening surgical procedure for Peyronie's disease by penile prosthesis implantation with double dorsal-ventral patch graft: the "sliding technique". J Sex Med. 2012 Sep. 9 (9):2389-95. [QxMD MEDLINE Link].
137. Haney NM, Gabrielson A, Kohn TP, Hellstrom WJG. The Use of Stromal Vascular Fraction in the Treatment of Male Sexual Dysfunction: A Review of Preclinical and Clinical Studies. Sex Med Rev. 2018 Jun 27. 41:101-51. [QxMD MEDLINE Link].
138. [Guideline] Nehra A, Alterowitz R, Culkin DJ, Faraday MM, Hakim LS, Heidelbaugh JJ, et al. Peyronie's Disease: AUA Guideline. J Urol. 2015 Sep. 194 (3):745-53. [QxMD MEDLINE Link].[Full Text].
139. [Guideline] Bella AJ, Lee JC, Grober ED, Carrier S, Benard F, Brock GB. 2018 Canadian Urological Association guideline for Peyronie's disease and congenital penile curvature. Can Urol Assoc J. 2018 May. 12 (5):E197-E209. [QxMD MEDLINE Link].[Full Text].
140. [Guideline] Osmonov D, Ragheb A, Ward S, Blecher G, Falcone M, Soave A, et al. ESSM Position Statement on Surgical Treatment of Peyronie's Disease. Sex Med. 2022 Feb. 10 (1):100459. [QxMD MEDLINE Link].[Full Text].
141. Babu A, Kayes O. Recent advances in managing Peyronie's disease. F1000Res. 2020. 9:[QxMD MEDLINE Link].[Full Text].
142. Rosen R, Catania J, Lue T, Althof S, Henne J, Hellstrom W, et al. Impact of Peyronie's disease on sexual and psychosocial functioning: qualitative findings in patients and controls. J Sex Med. 2008 Aug. 5 (8):1977-84. [QxMD MEDLINE Link].
143. Krieger JR, Rizk PJ, Kohn TP, Pastuszak A. Shockwave Therapy in the Treatment of Peyronie's Disease. Sex Med Rev. 2019 Jul. 7 (3):499-507. [QxMD MEDLINE Link].

Author

Pharmacy Editor

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment.

Chief Editor

Edward David Kim, MD, FACS Professor of Urology, Department of Urology, University of Tennessee Graduate School of Medicine; Consulting Staff, University of Tennessee Medical Center

Edward David Kim, MD, FACS is a member of the following medical societies: American Society for Reproductive Medicine, American Urological Association, Sexual Medicine Society of North America, Society for Male Reproduction and Urology, Society for the Study of Male Reproduction, Tennessee Medical Association

Disclosure: Nothing to disclose.

Additional Contributors

Leonard Gabriel Gomella, MD, FACS The Bernard W Godwin Professor of Prostate Cancer Chairman, Department of Urology, Associate Director of Clinical Affairs, Kimmel Cancer Center, Jefferson Medical College of Thomas Jefferson University

Leonard Gabriel Gomella, MD, FACS is a member of the following medical societies: American Association for Cancer Research, American College of Surgeons, American Medical Association, American Society for Laser Medicine and Surgery, American Urological Association, Sigma Xi, The Scientific Research Honor Society, Society for Basic Urologic Research, Society of University Urologists, Society of Urologic Oncology

Disclosure: Received consulting fee from GSK for consulting; Received honoraria from Astra Zeneca for speaking and teaching; Received consulting fee from Watson Pharmaceuticals for consulting.