Management of Peyronie's disease in the aging male

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Peyronie's disease (PD) is an acquired inelastic scar of the tunica albuginea of the penis, resulting in penile pain, curvature and other deformities, and sexual dysfunction, as well as significant psychological morbidity and relationship/partner issues. Contemporary data suggest an incidence of one in 20 men, with peak occurrence between ages of 50–55 years. Initial diagnosis of PD is made by thorough medical history and examination of the external genitalia; early referal to an urologist experienced in PD management is recommended. Evidence for nonsurgical treatment options is limited; the most commonly used, vitamin E, has not been shown to have benefit over placebo. Recent double-blinded placebo-controlled evidence suggests a role for oral pentoxifylline as a first-line agent. Intralesional injection therapy with verapamil is a frequently utilized option, as first- or second-line treatment, or in combination with other modalities. IFN-β2b injections into the penile plaque have also shown benefit over placebo in decreasing penile curvature, plaque size, penile pain and plaque density. Penile traction is currently under investigation for a potential role in PD management. The gold standard treatment for clinically significant deformity after PD has stabilized remains surgery. Several surgical options are available, including minimally invasive plication procedures, incision of the plaque and grafting or a penile prosthesis (when concurrent treatment-resistant erectile dysfunction is present).

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