Contemporary Surgical and Non-Surgical Management of Peyronie's Disease

George F. Wayne; Billy H. Cordon

Disclosures

Transl Androl Urol. 2018;7(4):603-617. 

In This Article

Abstract and Introduction

Abstract

Numerous treatments have been proposed for Peyronie's disease (PD). As the evidence base has expanded, the field of operative and non-operative options for patients has narrowed. Collagenase clostridium hystolyticum (CCH) injection now comprises the medical option, and surgical possibilities entail penile plication, plaque incision/excision and grafting, and prosthesis implantation. Still, questions abound regarding the optimal approach and indication for each of these treatments. We conducted a review of literature exploring the contemporary management of PD with a particular focus on work since the last American Urologic Association's (AUA) guidelines update for PD. Recent results and discussion indicate trends toward minimal invasiveness, toward a more holistic approach to the PD patient, and away from algorithmic management, galvanized, in part, by data challenging long-held beliefs.

Introduction

In 1743, French Surgeon Francois De La Peyronie described a dorsal bend of the penis, attributed to irregular scarring of the shaft.[1] Subsequent generations proposed a variety of surgical and non-surgical therapies for Peyronie's disease (PD), though relatively few enjoy the support of high-level evidence.[2,3] Today urologists are largely adopting collagenase clostridium hystolyticum (CCH) as the non-operative treatment of choice and have chosen between plication, plaque incision or excision and grafting (PIG or PEG), and prosthetic implantation for definitive, surgical management. Nonetheless, the urologic literature since the publication of the American Urologic Association's (AUA) guidelines in 2015[2] continues to raise fundamental questions about the best application of each of these treatment modalities. Simultaneously, research continues to elucidate our understanding of the disease, and, while alternative therapies are persistently revisited, evidence-based practice continues to narrow towards scientifically rigorous options.

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