Nonsurgical Management ofPeyronie's Disease-Are We Making Any Progress?

摘要

Management of Peyronie's disease remains one of the most vexing issues in sexual medicine. Described in 1743 by Francois Gigo de LaPeyronie, First Surgeon to King Louis XV, the etiology of this condition continues to be a topic of debate.1 Due in part, perhaps, to our incomplete understanding of the pathogenesis of Peyronie's disease, the nonsurgical treatment of this entity has progressed surprisingly little since Peyronie described 3 cases being cured by the healing waters of the thermal springs at Bareges.The prevalence of Peyronie's disease has been estimated to be 3.2% among men 30 to 80 years old. With the introduction of phosphodiesterase type 5 inhibitors and the attendant efforts to encourage men with erectile dysfunction to openly discuss this problem with medical providers, sexual dysfunction has shifted from a taboo subject to a common topic of physician-patient discussions. One of the benefits of this climate of improved communication is that men with other types of sexual dysfunction suchas premature ejaculation and decreased libido may also be more likely to seek help. In a similar vein, men with Peyronie's disease will likely be more at ease discussing the seemingly mysterious changes in penile morphology and function that are part of this condition. For this reason, as well as the general aging of our population, the management of Peyronie's disease will likely comprise an increasing part of urological practice in the years to come.The surgical management of Peyronie's disease has been relatively effective in correcting penile curvature. Plication procedures have proven to be safe and effective but are associated with penile shortening.4 The technique of plaque excision has advanced over the years, incorporating the interposition of a variety of substances to fill the resulting corporeal defect. Penile prosthesis implantation has assumed a primary role in the treatment of patients with Peyronie's disease who experience severe, refractory erectile dysfunction.