Research helps unmask fallacies about Peyronie's

May 15, 2008

Misconceptions about the origin of Peyronie's disease can lead to therapeutic strategies that have little or no chance of succeeding, according to Dr. Mulcahy.

Key Points

Many beliefs and clinical management practices related to Peyronie's disease have come about because of a lack of understanding about the nature of the condition. John Mulcahy, MD, PhD, a private practice urologist in Phoenix, says that several presentations at the 2008 AUA annual meeting will unmask some of the fallacies of Peyronie's disease and offer a more realistic perspective.

Misconceptions about the origin of Peyronie's disease can lead to therapeutic strategies that have little or no chance of succeeding, according to Dr. Mulcahy.

"For years, the urology community has speculated about the potential causes, including infection, inflammation, and immune system dysregulation. None of these explanations is plausible," he said.

He recommends the textbook, Peyronie's Disease: A Guide to Clinical Management, by Laurence A. Levine, MD, as a good source of information for urologists who don't have a lot of experience with the disease. Of particular interest is a chapter on medical management of Peyronie's disease, in which the authors of the chapter conclude that medical management is ineffective. Again, urologists experienced in the treatment of Peyronie's disease have known this for years.

"Most urologists treat Peyronie's disease with medication," Dr. Mulcahy said. "A recent survey of urologists' management of Peyronie's disease showed that a majority preferred a conservative strategy based on medical therapy."

Another ambiguous issue in the management of Peyronie's disease relates to the frequency and severity of erectile dysfunction after surgical treatment that includes plaque incision and grafting. In contrast to the perception of an infrequent consequence of plaque incision and grafting, significant reduction in erectile rigidity occurs in a substantial number of men, according to Dr. Mulcahy. Urologists who use this surgical technique must be prepared to diagnose, evaluate, and treat post-surgical erectile dysfunction.

The role of the penile prosthesis in managing of severe fibrosis is another unresolved issue. Conventional clinical thinking has held that dense penile fibrosis contraindicates use of a prosthesis.

"Emerging evidence on the topic increasingly suggests that, in the hands of an experienced urologic surgeon, a penile prosthesis can be successfully implanted in a patient, regardless of the extent or density of fibrotic tissue," Dr. Mulcahy said.

Infection is a risk common to all surgical specialties. Though the risk is minimal with many urologic procedures, the emergence of an infection can have serious consequences. "No-touch" surgery is one of the newest strategies for reducing the risk of surgery-related infections during surgery to treat Peyronie's, according to Dr. Mulcahy. The method involves covering the skin with a drape, making an incision through the drape, and then using small hook-like devices to separate the incision and hold the skin back during surgery. The technique has the potential to substantially reduce the risk of infection in penile surgical procedures.

For some time, the Nesbit procedure has been the preferred strategy for surgical correction of congenital curvature of the penis. However, some urologists believe the modified Nesbit, or Yachia, procedure leads to better overall outcomes. Data presented at the AUA meeting will continue the debate on the issue.