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Peyronie's disease: Diagnosis and medical management
Authors
William O Brant, MD
Anthony J Bella, MD, FRCSC
Tom F Lue, MD, ScD (Hon), FACS Section Editor
Michael P O'Leary, MD, MPH Deputy Editor
Pracha Eamranond, MD, MPH
Last literature review version 18.2: May 2010 | This topic last updated: February 12, 2010
INTRODUCTION — Peyronie's disease (Peyronies Disease) is an acquired, localized fibrotic disorder of the
tunica albuginea resulting in penile deformity, pain, and in some men,
erectile dysfunction (
Erectile Dysfunction). The disorder is named after Francois Gigot de la Peyronie, surgeon to King Louis XIV, who in 1743 described rosary beads of scar tissue extending the full length of the
dorsal penis in a treatise on ejaculatory failure [1].
Peyronies Disease can resolve spontaneously in a minority of cases while others have stable disease. However, nearly half of patients will have worsening within one year. Peyronies Disease can be a psychologically and physically disabling disorder, leading to a lower quality of life. Diagnosis is generally straightforward, based on history and physical examination. Ultrasound can also be used to confirm fibrotic
plaque.
The efficacy of medical management for Peyronies Disease is limited. Treatment options typically include oral or intralesional drug therapy. In most cases, medical management should be initiated once the diagnosis of Peyronies Disease is made. Surgical management may be considered for patients who have penile deformity compromising sexual function and whose Peyronies Disease has persisted for more than 12 months, regardless of previous medical therapy.
The diagnosis and medical management of Peyronies Disease will be reviewed here. Surgical management of Peyronies Disease and general issues relating to male sexual dysfunction are discussed separately. (See "Surgical management of Peyronie's disease" and "Overview of male sexual dysfunction".)
EPIDEMIOLOGY — Many clinicians, including urologists, have the misconception that Peyronies Disease is a rare condition, based on previous case reports documenting prevalence of ≤ 1 percent [2,3]. Contemporary estimates are several-fold higher, perhaps partly due to the introduction of PDE-5 inhibitors for
erectile dysfunction leading to improved general awareness among patients and clinicians.
The current prevalence of Peyronies Disease is approximately 5 percent in men. Rates range from 3 percent in a community-based survey of 8000 men (mean age 57.
to 16 percent among 488 men undergoing evaluation for
Erectile Dysfunction (mean age 52.
[4,5]. In 534 men undergoing routine prostate screening (without a specific urologic complaint), the prevalence of Peyronies Disease was 8.9 percent [6]. The mean age of those with Peyronies Disease was 68.2 years compared to 61.8 years of those without Peyronies Disease. The true prevalence of Peyronies Disease may be underestimated as men might be reluctant to report a condition to their clinician that they consider embarrassing, and/or older men may accept the condition as a by-product of aging.
PATHOGENESIS — The underlying pathogenesis of Peyronies Disease is unknown but is likely multifactorial with an interplay between genetic predisposition, trauma, and tissue ischemia. The underlying lesion of Peyronies Disease is a fibrous
plaque(s) that contains excessive
collagen, an altered framework of reduced and fragmented elastic fibers, and fibroblastic proliferation that alters penile anatomy. The fibrous
plaque causes focal inelasticity and can compromise erectile function. Plaques may be fibrous, contain areas of calcification, or are completely ossified. Most authorities postulate that Peyronies Disease results from repeated minor blunt trauma to the penis during intercourse.
Peyronies Disease is thought to be due to a localized aberration of the wound healing process. For susceptible individuals, bleeding within the
tunica albuginea, trapping of fibrin and inflammatory cells, and overexpression of matrix proteins secondary to upregulation of cytokines and growth factors in the local environment lead to
plaque formation [7]. Excess fibrin deposition in response to microvascular injury and upregulation of transforming growth factor-1 results in one or more areas of
plaque formation (figure 1) [8].
Risk factors — A family history of Peyronies Disease has been observed in 2 percent of patients [9]. Twenty-one percent of patients with Peyronies Disease may also have Dupuytren's contracture [10]. Patterns of gene expression in families with Peyronies Disease and Dupuytren's disease are similar, particularly in regard to
collagen degradation, ossification, and myofibroblast differentiation [11].
Genital and/or perineal injuries, radical prostatectomy, plantar fascial contractures, tympanosclerosis, urethral instrumentation, Paget's disease, gout, and lipomas have been associated, albeit weakly, with Peyronies Disease [12,13]. Hypertension, smoking, hyperlipidemia, and diabetes have been proposed as risk factors, but they are more likely related to underlying
erectile dysfunction, as current research does not show a relation between these factors and severity of penile curvature [13]. An association with vascular comorbidities is controversial [5,6,14], as is the role of overt trauma such as
penile fracture [15].
Natural history — Although historical data suggested that the natural history of Peyronies Disease is often one of spontaneous resolution with conservative management, contemporary studies have shown that this is incorrect. Untreated Peyronies Disease resolves in only 12 percent of men, with 40 to 48 percent of men demonstrating worsening of curvature at 12 months, while curvature remains stable in the remaining men [16]. The mean change was 15 degrees in those in whom curvature improved, while the mean change was 22 degrees in those in whom curvature worsened.
The disease state may often be divided into an
acute (or inflammatory) phase and a
chronic phase. During the former, there may be penile pain, even when
flaccid, and there are often dynamic changes of penile malformation. During the latter, pain resolves and the malformation stabilizes in its characteristics.
CLINICAL MANIFESTATIONS — The presenting symptoms of Peyronies Disease are penile pain, nodule or induration, penile curvature or shortening during erection, and/or sexual dysfunction. Penile pain occurs primarily during erection, and usually resolves within 12 to 24 months of Peyronies Disease onset (94 percent of 246 men who did not receive medical or surgical treatment reported complete resolution of pain, mean 18 months) [16].
Peyronies Disease deformities are varied but may manifest as curvature, indentation, palpable
plaque or nodule, hour-glass narrowing, penile shortening (with or without curvature), or in combination. Peyronies Disease is most evident during erection, as tunical compliance is compromised and the paired corpora cavernosa are unable to expand normally. In a review of 307 men with Peyronies Disease, 46 percent had
dorsal curvature, 29 percent lateral, and 9 percent
ventral, with the remaining being a combination of curvatures [17].
Severe or complex curvature and compromised penile rigidity may make penetrative intercourse impossible.
Erectile dysfunction is present in 20 to 50 percent of men with Peyronies Disease, and occurs due to deformity preventing coitus, flail penis (cavernous
fibrosis or vascular compromise), performance anxiety (psychological), or impaired erections due to venoocclusive dysfunction. Patient and partner quality of life are significantly impacted, as men with Peyronies Disease are at increased risk of depression, lowered self-esteem, and relationship difficulties (especially maintenance of intimacy or dating), in addition to body-image issues and pain [16].
DIAGNOSIS AND ASSESSMENT — Diagnosis is usually apparent from patient history and penile examination. Patients can be given a preliminary diagnosis of Peyronies Disease when they present with classic symptoms of the disease: penile nodules (plaques), curvature, and/or pain. Possible associated disorders (eg, Dupuytren's contractures or vascular disease) and inciting events (eg, trauma or genitourinary instrumentation) should be evaluated. It is important to define the psychological effect of Peyronies Disease on the patient and partner, as well as determine the extent of associated
erectile dysfunction.
Objectively, clinicians may measure penile length,
plaque size, and penile curvature. In classical Peyronies Disease, a well-defined
plaque or induration is palpable on physical examination, even if the patient is unaware. Among men with Peyronies Disease affecting the
dorsal side of the penis, two thirds will have associated
plaque (figure 2) [18]. Lateral or
ventral plaques are less common, but when present, can result in more coital difficulties (figure 3). Plaques located primarily in the penile septum, or equally distributed on both the
ventral and
dorsal aspects of the penis, may cause penile shortening without angulation [19]. Abnormal tissue may extend beyond the palpable lesion or even into the corporal tissue [20]. It is often helpful to have the patient take photographs of the erect penis at home to characterize the deformity. If the patient cannot or will not do this, office pharmacoerection can be performed.
If the diagnosis of Peyronies Disease is uncertain after history and physical examination, imaging may be helpful. Various imaging modalities have been used to diagnose Peyronies Disease, including ultrasound, plain radiography, computerized tomography, and magnetic resonance. Ultrasound has the highest sensitivity for plaques in the tunica albuguinea compared to other methods [21]. Ultrasonography has additional advantages due to its easy availability, low risk, and ability to image and quantify both calcified and soft tissue elements of Peyronies Disease as well as assess vascular status if a reconstructive procedure is being considered.
Differential diagnosis — Typically the diagnosis of Peyronies Disease is clinically apparent, but infrequently it can present similarly to developmental penile deformities including
congenital ventral curvature, chordee without hypospadias, or curvature associated with epispadias. A chordee is a curved erection of the penis usually due to a
congenital lack of distensibility of the
corpus cavernosum urethrae. A chordee can also be caused by gonorrheal infection, subsequent
inflammation, and scar tissue formation. In contrast, Peyronies Disease occurs due to acquired lesions/plaques of the
tunica albuginea.
Although rare, other conditions such as sclerosing lymphangitis or rare neoplasms (epithelioid or angiosarcomas) have been reportedly confused with Peyronies Disease [22,23].
INDICATIONS FOR UROLOGY REFERRAL — As Peyronies Disease is an uncommon condition and most primary care clinicians have limited experience in managing Peyronies Disease, the primary care clinician should refer the patient to a urologist when the diagnosis of Peyronies Disease is established, or in any patient with a penile deformity. The urologist can coordinate both medical and surgical therapy for Peyronies Disease. Surgical management may be considered for patients who have penile deformity compromising sexual function and whose Peyronies Disease has persisted for more than 12 months, regardless of previous medical therapy. (See "Surgical treatment of
erectile dysfunction".)
MEDICAL MANAGEMENT — Options for the management of Peyronies Disease include observation, medical, or surgical therapy, depending upon the severity of the disease. There are few trials examining the efficacy of the available treatment options. Most studies are hampered by low patient numbers, lack of control groups or reproducibility, and/or the inability to distinguish efficacy from spontaneous improvement of the disease process [24]. Critical appraisal of contemporary literature identifies widespread use of inappropriate clinical endpoints, especially improvement in penile pain, as pain resolves spontaneously in the vast majority of patients. Improvement or resolution of penile deformity (curvature measured after an erection elicited by intracavernous injection) remains the gold standard by which therapies should be measured, while rigorous measurement of
plaque size as a secondary endpoint may also be useful. It is important to note, however, that a reduction in
plaque size has not been shown to correlate with reduction in curvature [25,26]. (See 'Natural history' above.)
Critical analysis of non-surgical approaches indicates that there is no mode of treatment able to relieve all symptoms for men with Peyronies Disease. Nonetheless, early medical intervention while the disease is still evolving is more likely to have therapeutic effect compared with intervention when the disease is stable or even calcified. Thus, the need for early diagnosis and consideration of treatment of Peyronies Disease is important.
We suggest initiating medical management in Peyronies Disease patients without a penile deformity causing sexual dysfunction and whose Peyronies Disease has persisted for less than 12 months, regardless of previous medical therapy. We suggest using pentoxifylline as first-line oral therapy with moderate to severe curvature (>30 degrees). In patients who do not have a good response (ie, decrease in penile deformity), intralesional injections of
verapamil or interferon alpha-2b may also be of benefit, and can be used in conjunction with pentoxifylline.
Observation — Watchful waiting is an appropriate option for select patients with Peyronies Disease. We suggest observation for men with stable, mild curvature (≤ 30 degrees) who have satisfactory erectile function, although large observational studies and
randomized trials are lacking in this patient population. Such patients who undergo observation should be told that Peyronies Disease may progress with worsening curvature or formation of new penile plaques in the future. If mild curvature worsens or causes sexual dysfunction, medical and/or surgical management should be considered. (See 'Indications for urology referral' above.)
Oral therapy — Oral therapy is indicated in men with moderate to severe curvature (30 degrees or more). We suggest pentoxifylline for first-line oral therapy.
Pentoxifylline — The exact mechanism of action of pentoxifylline is not known. Pentoxifylline blocks transforming growth factor (TGF)-beta 1-mediated
inflammation, prevents deposition of
collagen type I, and acts as a non-specific PDE inhibitor. In a rat model, both sildenafil and pentoxifylline reduced the
plaque size in tunical
fibrosis induced by injection of TGF beta-1 [27]. This agent has been previously used in humans for a variety of inflammatory and fibrotic conditions.
There are very few studies evaluating the use of pentoxifylline in the treatment of Peyronies Disease [28,29]. In a six-month, blinded trial of pentoxifylline (400 mg po bid) versus
placebo in 228 patients with Peyronies Disease for < 12 months, mean reductions in penile curvature were significantly better in the pentoxifylline group (-22, -20, and -40 degrees compared with baseline in those with
dorsal, lateral, and
ventral curvature, respectively) compared with an increase in curvature of +31, +22, and +27 degrees, respectively, in the
placebo group [29]. Total
plaque volumes, erectile function, and peak systolic velocity of blood flow through the cavernous arteries improved significantly for the pentoxifylline group compared to the
placebo group. Pentoxifylline was safe and well-tolerated in this study. Further investigations are required to optimize patient response, including optimum dosing and duration of treatment, as well as use in combination with intralesional treatments.
Encouraged by pentoxifylline's observed suppression of
collagen production in Peyronie's cells in tissue culture [30], as well as its efficacy in other human fibrotic disorders, we have been offering patients treatment with pentoxifylline (400 mg po tid) as a treatment option for Peyronies Disease since 2002. The earliest meaningful improvement in degree of curvature may take four months or more. The patient may be reassessed in four to five month intervals. If interval improvement is observed, pentoxifylline may be continued up to two years.
Vitamin E — Vitamin E is a potent antioxidant that is thought to reduce
collagen deposition within the injured
tunica albuginea. Although Vitamin E is a widely used agent for Peyronies Disease in the US, there is little evidence to support its superiority over
placebo [31-33]. As examples:
In a
randomized, double blind trial of 236 men with Peyronies Disease, Vitamin E did not significantly improve penile curvature or
plaque size compared to
placebo [32].
In a trial of Vitamin E alone or in combination with carnitine (n = 236), there was no significant improvement in penile curvature or
plaque size compared to
placebo [32].
In contrast, vitamin E was effective in men with mild curvature when used in combination with
colchicine. In a
randomized trial report of 45 men with mild curvature (<30 degrees) and <6 months from Peyronies Disease onset, there was improvement in
plaque size with
colchicine (1 mg/twice daily) and Vitamin E (600 mg/day in two divided doses) combination treatment compared to ibuprofen [33].
Given the lack of efficacy as monotherapy in
randomized trials, Vitamin E is not a recommended treatment option for Peyronies Disease.
Potassium para-aminobenzoate — Potassium para-aminobenzoate (
Potaba™) is an antifibrotic agent that has been used in a variety of disease states. It is thought to increase tissue levels of monoamine oxidase, thereby decreasing levels of serotonin, which are thought to contribute to scar formation. Although potassium para-aminobenzoate has been available for decades, very few studies have examined its efficacy in the treatment of Peyronies Disease.
In a 12-month trial, in which 103 men with Peyronies Disease were randomly assigned to potassium para-aminobenzoate (3 g four times/day for one year) versus
placebo, a greater proportion of patients in the active treatment group achieved the primary outcome, defined as a reduction in
plaque size and/or reduction in penile curvature of at least 30 percent (74 versus 50 percent) [34]. However, the data were not analyzed by intention to treat, and therefore it is unclear if potassium para-aminobenzoate protects against Peyronies Disease progression. Further studies are warranted.
Current evidence does not support potassium para-aminobenzoate for first-line therapy of Peyronies Disease. Potassium para-aminobenzoate carries a significant cost, requires the patient to ingest up to 24 tablets daily, and is known for its low tolerability due to gastrointestinal side effects.
Colchicine — Based upon basic science and animal model investigations of Peyronies Disease, colchine inhibits
collagen synthesis and subsequent
fibrosis. Although observational studies demonstrated improvement in penile pain and curvature [35,36], a
randomized,
placebo-controlled trial (n = 78) did not demonstrate any difference in
plaque size or penile curvature between
colchicine (0.5 to 2.5 mg daily) and
placebo [37].
Colchicine was effective in men with mild curvature when used in combination with vitamin E [33]. (See 'Vitamin E' above.)
Gastrointestinal side effects are relatively common. Additionally,
colchicine may cause bone marrow suppression. Due to the side effect profile and lack of efficacy,
colchicine is not commonly used to treat Peyronies Disease.
Tamoxifen — Efficacy of tamoxifen in the treatment of Peyronies Disease has not been shown in controlled trials to date. It is unlikely that an adequate tamoxifen concentration can be attained in the Peyronie's
plaque via oral administration [3]. In a
randomized, double-blind trial of tamoxifen versus
placebo (n = 25), there was no difference in correction of curvature (46 versus 42 percent) [38].
Carnitine — Carnitine, an acetyle coenzyme-A inhibitor, has shown mixed results in comparison to other medications or
placebo, as illustrated by the following blinded
randomized trials:
In a trial of carnitine versus tamoxifen (n = 48), the improvement in curvature was greater in the carnitine group (15.9 versus 8.4 degrees) [39]. It is unclear if this difference represents a meaningful clinical effect.
In another trial of men with advanced Peyronies Disease (n = 60) treated with intralesional
verapamil, carnitine significantly reduced penile curvature (11.8 versus 1.9 degrees),
plaque size (7.6 versus 1.3 mm(2)), and need for surgery while increasing the International Index of Erectile Function score, compared to tamoxifen [40].
In a trial of carnitine alone or in combination with Vitamin E (n = 236), there was no significant improvement in penile curvature or
plaque size compared to
placebo [32].
Intralesional drug therapy — Intralesional drug injections are generally safe and well-tolerated (figure 4). There are three intralesional drug treatments that have shown efficacy in
randomized trials:
verapamil, interferon alpha-2b, and
collagenase.
There is currently no clinical role for the use of corticosteroid injections into Peyronie's plaques, as little supportive data exist, and therapy carries a risk of tissue atrophy or obliteration of native penile tissue planes which can make surgical correction more difficult [3,41].
Verapamil — Intralesional
verapamil is thought to influence fibroblast metabolism by increasing
collagenase activity and concurrently decreasing
collagen production [42].
Most [41,43-45] but not all [46] trials have shown improvement in symptoms and penile
plaque/curvature with intralesional
verapamil therapy. In a systematic review including four prospective studies of patients with mild Peyronies Disease (including only one small
randomized,
placebo-controlled trial),
verapamil showed some benefit in penile curvature,
plaque size, and penile pain [41].
Verapamil injection is safe, well-tolerated, and commonly used as part of non-surgical Peyronies Disease management.
Interferon alpha-2b — Limited clinical evidence suggests that interferon alpha-2b treatment may be efficacious for mild to moderate Peyronies Disease. The interferons (IFN) are low molecular weight proteins that are known to inhibit the proliferation of fibroblasts, increase
collagenase activity, and decrease
collagen production [41]. In a non-
randomized trial (n = 117), where investigators where not blinded to treatment arm compared with
placebo, men treated with interferon alpha-2b had greater improvement in curvature and
plaque size [47]. Interferon injections appear safe, with a primary side-effect of flu-like symptoms in some patients.
Collagenase —
Collagenase, a purified bacterial enzyme targeting
collagen for breakdown, has shown some efficacy in improving
plaque size and curvature in small, observational studies [48]. In a
randomized trial of
collagenase versus
placebo in 49 men, there was a small, but significant improvement in curvature (maximal change of 15 to 20 degrees) in the
collagenase group [49]. The treatment effect was mostly limited to patients with mild curvature (<30 degrees,
plaque size <2 cm). Treatment was well-tolerated. A larger multicenter clinical trial is underway.
Topical therapy — Topical therapy (eg,
verapamil, superoxide dismutase) is not currently recommended for the treatment of Peyronies Disease outside of clinical trials. In a
randomized trial, topical
verapamil gel was better than
placebo in eliminating pain on erection, decreasing
plaque size (84.7 versus 55 percent), decreasing curvature (61.1 versus 43.6 percent), and improving erection quality in patients with Peyronies Disease [50]. However, it is uncertain whether topical therapy has an effect on penile plaques, as topically (transdermal) administered
verapamil gel has not been shown to penetrate into the
tunica albuginea [51].
In a
randomized,
placebo controlled, crossover series in 39 men, liposomal recombinant human superoxide dismutase did not demonstrate significant effects upon
plaque size or penile curvature, although decreased penile pain was observed over the eight week treatment course [52].
OTHER TREATMENTS — Penile
traction,
iontophoresis, extracorporeal shock wave therapy (
ESWT), and radiation therapy are other treatment approaches to Peyronies Disease, but none have been shown to be conclusively effective in
randomized trials. Well-designed studies are needed to document a treatment effect, should it exist, prior to widespread use.
Penile
traction therapy — Penile
traction therapy, usually in conjunction with medical management, shows some efficacy with a good safety profile in pilot studies [53-55]. In a study of ten men with Peyronies Disease, nine of whom had failed medical therapy,
traction therapy for two to eight hours a day for six months led to reduced curvature in all men (10 to 45 degrees), stretched
flaccid penile length increased (0.5 to 2.0 cm), and erect
girth increased (0.5 to 1.0 cm). There were no adverse events including skin changes,
erectile dysfunction, or hypoesthesia. These results suggest
traction therapy may become a non-surgical option for Peyronies Disease.
Iontophoresis — Several reports have investigated the effect of electromotive drug administration, also known as
iontophoresis. Theoretically, electrokinetic transport of charged ionic molecules may enhance the delivery of transdermal medications to the target tissues, in this case the diseased
tunica albuginea, thereby improving local penetration without systemic side effects [56]. Increased levels of
verapamil were present after
iontophoresis in surgically retrieved
tunica albuginea specimens [56].
In a
randomized trial of
iontophoresis with
verapamil (5 mg) plus dexamethasone (8 mg) compared to
iontophoresis with 2 percent lidocaine in 96 men, there was objective improvement in
plaque size and curvature in the
verapamil group [57]. However, in another trial of
iontophoresis with
verapamil in 42 men with Peyronies Disease, there was no improvement in penile curvature compared to
iontophoresis with
placebo [58]. Further trials are needed, especially since it is unclear whether the electric current itself may be beneficial for wound healing [59].
Iontophoresis is well-tolerated, with the most common side effect being temporary erythema at the electrode site. If
iontophoresis continues to prove efficacious, widespread acceptance of
iontophoresis likely would occur since it can readily be performed at home [24].
Extracorporeal shock wave therapy — This modality remains an investigational treatment due to lack of well-designed trials with long-term follow-up. There are also concerns about the potential side-effects including penile
fibrosis, secondary Peyronies Disease scarring, and development of
erectile dysfunction [60].
There are limited clinical trial data evaluating the efficacy of
ESWT for the treatment of Peyronies Disease [61-63]. An exploratory meta-analysis of predominantly observational studies determined that
ESWT may be somewhat effective in improving penile pain and sexual dysfunction; however, there was insufficient evidence to determine its effect on penile
plaque size and curvature [61]. The meta-analysis was limited by several factors, including lack of prospective studies, no blinding in any of the studies, and use of non-standardized outcome measures.
In a subsequent
randomized trial comparing
ESWT versus
placebo in 100 patients who had not previously received Peyronies Disease-related treatment, there was a statistically significant decrease in mean
plaque size (-0.6 versus +1.4 mm2) and curvature (-1.4 versus +1.8 degrees), which is of uncertain clinical significance [63].
Radiation therapy — Radiation therapy for the treatment of Peyronies Disease has yielded mixed results [64,65]. Although radiation therapy may reduce pain and penile curvature, it may also compromise erectile function, especially in the aging male [64]. Well-designed trials are required, as no prospective,
randomized,
placebo-controlled studies have been published. There is insufficient evidence to recommend radiation therapy at this time, particularly since secondary malignancy risks have not been quantified.
SUMMARY AND RECOMMENDATIONS
The underlying pathogenesis of Peyronies' disease (Peyronies Disease) is unknown and most likely represents a combination of factors including
chronic minor injury and genetic susceptibility. (See 'Pathogenesis' above.)
The presenting symptoms of Peyronies Disease are penile pain, induration, curvature, and/or sexual dysfunction. Patient and partner quality of life are significantly impacted, as men with Peyronies Disease are at increased risk of depression, relationship difficulties, and body-image issues (see 'Clinical manifestations' above).
Diagnosis is usually apparent from patient history and penile examination. On exam, clinicians may observe a penile
plaque and penile curvature or deformity. (See 'Diagnosis and assessment' above.)
When primary care clinicians have limited experience in managing Peyronies Disease, the primary care clinician should refer the patient to a urologist once the diagnosis of Peyronies Disease is established, or in any patient with a penile deformity. (See 'Indications for urology referral' above.)
For patients who do not have penile deformity compromising sexual function and whose Peyronies Disease has persisted for less than 12 months, we suggest medical management rather than surgical management (Grade 2C). (See 'Medical management' above and "Surgical management of Peyronie's disease".)
For men with stable, mild curvature (≤ 30 degrees) who have satisfactory erectile function, we suggest observation (Grade 2C). If mild curvature worsens or causes sexual dysfunction, we suggest medical and/or surgical management (Grade 2B). (See 'Observation' above.)
For the initial medical management of men with moderate to severe Peyronies Disease (> 30 degrees), we suggest oral pentoxifylline rather than observation (Grade 2B). An alternative option is intralesional
verapamil, which may also be used concurrently with pentoxifylline. (See 'Medical management' above.)
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Topic: PENTOX & Other 1st Oral treatments per "Up To Date" Physician Reference & Studies (Read 73897 times)