Peyronie’s Disease Caused By Cialis


Posted by admin on

Does Viagra Help Peyronie’s Disease

Efficacy of oral therapy evaluated by randomized trials

Current and emerging treatment options for Peyronie’s disease

This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited.

Abstract

Peyronie’s disease (PD) is a condition of the penis, characterized by the presence of localized fibrotic plaque in the tunica albuginea. PD is not an uncommon disorder, with recent epidemiologic studies documenting a prevalence of 3–9% of adult men affected. The actual prevalence of PD may be even higher. It is often associated with penile pain, anatomical deformities in the erect penis, and difficulty with intromission. As the definitive pathophysiology of PD has not been completely elucidated, further basic research is required to make progress in the understanding of this enigmatic condition. Similarly, research on effective therapies is limited. Currently, nonsurgical treatments are used for those men who are in the acute stage of PD, whereas surgical options are reserved for men with established PD who cannot successfully penetrate. Intralesional treatments are growing in clinical popularity as a minimally invasive approach in the initial treatment of PD. A surgical approach should be considered when men with PD do not respond to conservative, medical, or minimally invasive therapies for approximately 1 year and cannot have satisfactory sexual intercourse. As scientific breakthroughs in the understanding of the mechanisms of this disease process evolve, novel treatments for the many men suffering with PD are anticipated.

Keywords: oral therapy, intralesional treatment, topical therapy, extracorporeal shockwave therapy, traction devices, plication, incision and grafting, penile prosthesis

Introduction

Peyronie’s disease (induratio penis plastica; PD) is a condition of the penis, characterized by the presence of localized fibrotic plaques in the tunica albuginea and affecting 3.2–8.9% of the adult male population.1–3 The true prevalence of PD may be even higher as many patients are reluctant to discuss their condition with a physician or may not seek medical help if the symptoms are not disabling.4 At present, most authorities support the hypothesis that PD generally arises from repetitive (micro)trauma to the erect penis during sexual activities. However, not all penile trauma leads to the development of PD. Abnormal wound healing appears to be more common in men with PD and there is evidence for a genetic predisposition.5 Furthermore, studies have shown that risk factors for atherosclerosis and endothelial dysfunction such as hypertension, dyslipidemia, diabetes mellitus, and smoking are more common in men with PD.6–8

The underlying etiology of PD appears to be an imbalance between profibrotic and antifibrotic substances. Profibrotic substances include transforming growth factor β-1 (TGF-β1), fibrin, plasminogen activator inhibitor-1, and tissue inhibitors of metalloproteinases, and are found to be overexpressed or aberrantly expressed.9 Antifibrotic substances include matrix metalloproteinases, which are a class of molecules responsible for collagen degradation.10 The wound healing cascade begins with exposure of platelets to collagen and the release of chemoattractant molecules such as TGF-β1, platelet-derived growth factor, tumor necrosis factor-α, interleukin-1, and fibrin, which act as a matrix for repair.9 Inhibition of the fibrinolytic system or an inability to degrade the intravasated fibrin leads to its persistence in the tunica and continues to exert a proinflammatory response.11 This response ultimately leads to the formation of a palpable plaque secondary to the excessive deposition of collagen and extracellular matrix, with disorganization of collagen fibers and loss of elastic fibers.11 There are other theories on plaque formation which include cytokine and/or growth factor overexpression and free radical production.12

PD usually presents in men aged 40–70 years and has two phases. The acute phase, lasting for 6–18 months, is often characterized by the development of penile curvature and onset of pain with erection. The acute phase is followed by a chronic phase, characterized by negligible penile pain, and the establishment of a stable penile abnormality.6 Patients presenting with PD can exhibit any single or combination of penile plaque, curvature, pain, and erectile dysfunction (ED). Plaques are typically located on the dorsal or lateral aspect of the penis, causing an upward or lateral defection during erection. As many patients are embarrassed by or unaware of their PD, they are unlikely to mention the topic unless specifically questioned by a treating physician.13 PD is generally a progressive disorder that uncommonly resolves completely. It is difficult to predict an individual’s prognosis at the initiation of the disease. Only penile pain, if present, resolves spontaneously within the first year in the majority of patients.14 In most circumstances, PD progressively worsens over time, as reported in 48% of men with PD in a recent study.15 Two-thirds of patients with PD are likely to have risk factors for arterial disease and therefore will develop ED over the long term.8 Treatment options are chosen based upon disease severity, patient preference, and surgeon’s training. Options include oral medications, intralesional injection therapy, plication procedures, incision and grafting, and placement of a penile prosthesis with or without manual modeling or other ancillary straightening techniques.2

Nonsurgical treatment of PD

Numerous nonsurgical treatment options have been utilized since PD was first descriptively named in 1743. The majority of studies evaluating oral medications lack controls or an adequate number of subjects, are of short duration, and focus on reduction of deformity as the critical measurement of outcome.16 Despite various reports in the literature of deformity stabilization and/or reduction outcomes, recent guidelines indicate that the available evidence shows generally no significant benefit from oral therapies for reducing penile deformity.16,17 However, the standard of care still involves an initial trial of either oral or intralesional treatment at first presentation.13 An accepted goal of medical therapy is to shorten the acute phase of PD in order to stabilize the plaque or diminish disease progression.18

Oral therapy

Vitamin E (tocopherol)

Vitamin E is a fat soluble natural antioxidant that theoretically plays a role in DNA repair.13 Its antioxidant properties have been hypothesized to inhibit nitric oxide synthesis as well as oxygen free radical-induced fibrosis in human cavernosal cells.19 Despite double-blind, placebo-controlled, randomized studies showing no significant improvement, tocopherol remains the most common nonsurgical therapy because of its safety, availability, and low cost.20,21

Potassium para-aminobenzoate (Potaba®)

Potassium para-aminobenzoate was first introduced in 1959 as an oral therapy for PD after it was shown to decrease collagen production in vitro when added to fibroblast cells.22 Its hypothesized mechanism of action involves the enhancement of three endogenous antifibrotic processes: oxygen uptake, glycosaminoglycan secretion, and monoamine oxidase activity.23 Two double-blind, placebo-controlled, randomized studies evaluating the efficacy of Potaba have been published. Shah et al in 1983 reported improvement of symptoms, particularly pain, when compared to placebo; however, these findings were not statistically significant.24 In a more recent study in 2005, Weidner et al published results that demonstrated significant stabilization of preexisting penile deviation and reduction of plaque size, but no significant reduction of pain or preexisting curvature.25 Potaba is currently a first-line therapy for PD because of its tolerability and availability.23

Colchicine

The mechanism of action of colchicine remains unknown but it is hypothesized to reduce lactic acid production, which decreases uric acid deposition and decrease collagen synthesis.13 Akkus et al demonstrated a reduction in plaque size, degree of curvature, and pain symptoms in response to colchicine therapy.26 In another uncontrolled study, Kadioglu et al demonstrated that the efficacy of colchicine increases when used in specified patient groups without any vascular disease risk factors, presenting in the first 6 months of disease, a degree of curvature less than 30 degrees, and without ED.27 A recent nonrandomized study demonstrated that using tocopherol with colchicine in the early stages of PD reduced plaque size, curvature, and pain.28 A recent study by Akman et al retrospectively evaluated patients that were treated with colchicine in the acute phase of PD. They found that the predictive factors for curvature alterations in PD patients were mild deformities mainly in those with lateral curvature, which mostly shifted to the dorsal side after treatment.29 However, another double-blind placebo-controlled study by Safarinejad demonstrated no difference in pain relief, plaque size, or penile curvature.30 Further studies are necessary to clarify the beneficial effects of colchicine in the treatment of PD. The side effects include nausea, vomiting, and diarrhea.13

Tamoxifen

Tamoxifen is a nonsteroidal antiestrogen. Its mechanism of action is unknown but it is hypothesized to modulate TGF-β1, which reduces fibrosis.13 Two uncontrolled studies, Apaydin et al in 199831 and Ralph et al in 1992,32 reported a decrease of plaque size, penile deviation, and pain. However the results of a double-blind, placebo-controlled randomized study done by Teloken et al reported that the effect on curvature, plaque size, and pain was not significant.33 In the absence of a demonstrable benefit, this drug is not routinely recommended for the treatment of PD.

L-carnitine

L-carnitine’s mechanism of action is not fully understood but it is hypothesized to increase mitochondrial respiration, which decreases free radical formation.34 Biagiotti and Cavallini performed a double-blind, randomized study in 2001 that compared acetyl-L-carnitine with tamoxifen, which was previously shown to have no benefit over placebo, and demonstrated that acetyl-L-carnitine was more effective in reducing pain and disease progression.35 Cavallini et al in 2002 compared the efficacy of oral propionyl-L-carnitine or tamoxifen combined with intralesional verapamil injections. They demonstrated that the combination of propionyl-L-carnitine and verapamil was efficacious and suggested it as the treatment of choice for advanced PD.36 Another doubleblind, placebo-controlled, randomized study by Safarinejad et al in 2007 found that oral propionyl-L-carnitine treatment was not superior to placebo.20 It is possible that an insufficient dose of this agent was used in light of a recent review suggesting that the minimum dose necessary for an effect was at least 3–3.5 g per day.37 The drug has a relatively safe profile, with reported side effects of mild euphoria and gastrointestinal upset.34

Pentoxifylline

Pentoxifylline is a nonspecific phosphodiesterase inhibitor with a hypothesized mechanism of action of upregulating cyclic adenosine monophosphate and decreasing type I collagen production, which remedies the abnormal collagen phenomenon.34 Valente et al in 2003 collected data from in vivo and in vitro models that demonstrated decreased levels of profibrotic factors and plaque size after treatment with pentoxifylline.38 Other studies document that pentoxifylline reduced calcium content in the plaque and collagen fiber deposition and altered elastogenesis by antagonizing the effects of TGF-β1.39–41 Safarinejad et al conducted a doubleblind, placebo-controlled, randomized study that reported a significant effect of pentoxifylline therapy on reducing penile curvature and plaque volume particularly in patients in the early stages of established PD.42 These somewhat promising results with pentoxifylline need further confirmation. This drug is associated with relatively mild side effects, most commonly nausea, dizziness, and headache.34

Phosphodiesterase type 5 (PDE5) inhibitors

PDE5 inhibitors have been shown to decrease oxidative stress-associated inflammatory changes, as observed in the pathophysiology of PD. Its mechanism of action results in an increase of cavernosal smooth muscle levels of cyclic guanosine monophosphate. PDE5 inhibitors, when given continuously over long periods, induce an elevation of nitric oxide and cyclic guanosine monophosphate which act as antifibrotic agents to reduce collagen deposition, profibrotic factor release, oxidative stress, and myofibroblast numbers.11 Levine and Latchamsetty demonstrated that sildenafil was a safe, effective, and well-tolerated first-line therapy for PD patients with ED.43 In another study by Levine et al, sildenafil reduced the incidence of postoperative ED in patients who underwent surgical correction of PD using pericardial grafting after plaque incision. However these results were not statistically significant.44 Valente et al performed a study in a rat model with a PD-like plaque induced by TGF-β1, demonstrating that sildenafil caused a reduction in plaque size.38 Ferrini et al performed a similar rat model study with a PD-like plaque elicited by TGF-β1 or fibrin injection into the tunica albuginea. Long-term oral treatment with vardenafil slowed and reversed the early stages of the PD-like plaque in this rat model.45 Chung et al reported septal scar resolution and improved International Index of Erectile Function-5 questionnaire symptom scores in a study with low-dose daily tadalafil.46 Palmieri et al concluded that extracorporeal shockwave therapy (ESWT) in addition to 5 mg of tadalafil once daily produced significant improvement in erectile function and quality of life for patients with PD and ED.47 Further studies are mandated before any of these methods of treatment can be recommended.

The oral pharmacotherapies as evaluated by randomized controlled trials are summarized in Table 1 .

Table 1

Efficacy of oral therapy evaluated by randomized trials

Treatment Study Mode of study Effect
Vitamin E (tocopherol) Safarinejad et al20 Placebo-controlled, double-blind No significant difference
Potaba® Shah et al24 Placebo-controlled, double-blind No significant difference
Weidner et al25 Placebo-controlled, double-blind Decreased plaque size in treatment arm
Colchicine Safarinejad30 Placebo-controlled, double-blind No significant difference
Tamoxifen Teloken et al33 Placebo-controlled, double-blind No significant difference
L-carnitine Biagiotti and Cavallini35 Double-blind Decreased plaque size, curvature, and penile pain
Pentoxifylline Safarinejad et al42 Placebo-controlled, double-blind Decreased penile curvature and plaque volume in early chronic Peyronie’s disease

Intralesional injection therapy

Corticosteroids

The mechanism of action of corticosteroids was hypothesized to inhibit phospholipase A2 and suppress immune response.48 Historically, the first documented use of intralesional corticosteroids for PD was reported by Bodner et al in 1954, which noted a decrease in plaque size and penile pain following therapy.49 Follow-up studies demonstrated that corticosteroid injections had no therapeutic benefit,50,51 as seen in the single-blinded, placebo-controlled, randomized study performed by Cipollone et al in 1998, which showed no statistically significant benefit.52 Lack of evidence for benefit and side effects such as local tissue atrophy, fibrosis, and immune suppression currently limit the clinical use of this option. Therefore corticosteroid injections are not currently recommended as an intralesional therapy for PD.23

Collagenase

Collagenase, also classified as specific matrix metal loproteinase-1, 8, and 13, degrades interstitial collagens, specifically type II collagen.13 The therapeutic potential of collagenase was initially introduced more than two decades ago in both in vitro and in vivo studies by Gelbard et al.53,54 These researchers utilized highly purified clostridial collagenases to test their effect on various human tissues in vitro, including human pericardium, human corpus cavernosum, tunica albuginea, and PD plaques. These experiments with collagenase resulted in a remarkable reduction in the size of the PD plaque, along with microscopic fraying and dispersal of collagen bundles, when compared with plaques injected with normal saline. Moreover, elastic fibers, vascular smooth muscle, and axonal myelin sheaths were not affected by collagenase application.53 In the following period, the investigators performed an in vivo pilot study that injected intralesional collagenase in 31 men with PD.54 After 4 weeks of treatment, 65% of patients exhibited objective improvement, 93% reported elimination of pain, and intercourse was restored in 75% of patients. Additionally, the researchers noted that penile plaques were either significantly altered or disappeared in four patients and reduced by 20%–100% in 16 others. Studies have reported that immunoglobulin G antibodies to collagenase were higher in men with PD versus healthy men, implying that intralesional collagenase has a documented benefit.55 A double-blind, placebo-controlled, randomized study demonstrated a significant response with collagenase injections in patients with small plaques and minor penile deformity.56 Although not placebo-controlled, a recent study employing two intralesional collagenase injections within 24–72 hours over three injection cycles demonstrated improvement with decreases in both plaque size and penile curvature in men with PD.57 Collagenase can be used in both the acute and chronic phases of PD. Because of its potential efficacy, intralesional collagenase has just completed phase III clinical trials in men with PD. Collagenase is associated with minimal adverse side effects such as injection site pain, ecchymosis, and rarely corporal rupture.13,23

Verapamil

Verapamil is a calcium channel antagonist that augments collagenase activity, increases cytokine expression associated with early inflammation and wound formation, and inhibits in vitro fibroblast proliferation in PD plaques.58,59 Levine et al in 1994 reported that intralesional verapamil injection resulted in a significant reduction in penile curvature.60 Additional uncontrolled studies have reported a decrease in penile pain, curvature, deformity, an increase in girth and rigidity, improved erectile function, and subjective softening of the plaque.61,62 Rehman et al performed the only randomized placebo-controlled study in 1998 with verapamil injection therapy and demonstrated that there was no statistically significant change in penile curvature reduction.63 Because only one study evaluating the efficacy of verapamil included a placebo arm, more controlled studies are required. Verapamil remains a relatively safe and inexpensive form of therapy with minor adverse effects such as nausea, lightheadedness, penile pain, and ecchymosis.23

Interferons

Interferons are cytokines that play a regulatory role in the inflammatory response of the immune system. Interferon-α-2b inhibits the proliferation of fibroblasts, increases collagenase activity, decreases collagen production, and has been used in a number of studies for intralesional injection treatment of P D. 18 Initial in vitro studies demonstrated the inhibitory role of interferon-α and interferon-β on collagen production in fibroblasts derived from Peyronie’s plaques.64 Since then, several studies confirmed the beneficial effect in men with PD.65–68 Two single-blind, placebo-controlled studies showed a statistically significant benefit of interferon-α-2b with improvements in penile curvature, plaque size and density, penile pain on erection, erectile function, and penile hemodynamics. This therapy is associated with minor side effects such as sinusitis, minor penile swelling with ecchymosis, and flu-like symptoms of fever, chills, and arthralgia.69,70 The use of over-the-counter anti-inflammatory agents prior to intralesional injection can abrogate the flu-like such effect.

Randomized controlled intralesional therapy studies are summarized in Table 2 .

Table 2

Efficacy of intralesional therapy evaluated by randomized trials

Treatment Study Mode of study Effect
Corticosteroids Cipollone et al52 Placebo-controlled, single-blind No significant difference between treatment and placebo
Collagenase Gelbard et al56 Placebo-controlled, double-blind Decreased curvature and plaque size
Verapamil Rehman et al63 Placebo-controlled, single-blind No significant difference between treatment and placebo
Interferons Judge et al69 Placebo-controlled, single-blind Significant improvement in penile curvature, plaque size, penile pain, and erectile function
Hellstrom et al70 Placebo-controlled, single-blind

Topical therapy and iontophoresis

Aminopropionitrile, hydrocortisone, and verapamil are topical medications with varying results in the treatment of PD.71–74 Iontophoresis is the utilization of electrokinetic transport of charged molecules for the enhancement of transdermal drug delivery to diseased tissue, particularly plaques in PD.75 Martin et al demonstrated that topically administered verapamil gel was not present in the tunica albuginea at excisional surgery the next day,73 but was detected to a small degree in PD plaques after iontophoresis.76 In spite of initial successful reports with iontophoresis of dexamethasone and verapamil,77–79 recent double-blind placebo-controlled randomized trials failed to demonstrate statistically significant improvements in penile curvature. Greenfield et al suggest iontophoresis in patients whose major complaint is pain or those who have mild penile curvature and do not wish to undergo intralesional therapy or surgical correction of their penile curvature.80

Extracorporeal shockwave therapy (ESWT)

Penile ESWT has been proposed as a possible nonsurgical PD treatment, but few reports have reported any beneficial effects.81,82 Most studies did not observe any significant improvement in penile curvature.83–85 An exploratory meta-analysis in 2004 by Hauck et al did not reveal any significant benefits of ESWT on improvement of penile curvature or plaque size.86 Two double-blind, placebo-controlled, randomized trials have been published. Chitale et al did not observe any significant benefit of ESWT on PD.87 Palmieri et al demonstrated that ESWT appears to expedite pain resolution compared to the natural course of the disease.88 Currently, ESWT is not recommended as a treatment for PD because it has not been shown to improve or even stabilize the plaque or penile curvature.89

Penile traction devices

Gradual expansion of tunica tissue by traction exerted by a penile extender device induces new connective tissue formation.90 Preliminary studies conducted by Levine et al and Gontero et al have demonstrated nonsignificant curvature reduction and increased penile length.91,92 Further long-term controlled studies are necessary. Raheem et al suggested that vacuum pump therapy may have similar effects on improving penile curvature and pain symptoms.93

Surgical options for PD

The ideal candidate for surgical intervention for PD is a patient whose plaque has stabilized (normally at least 12 months since diagnosis) and penile curvature prevents satisfactory sexual intercourse. Attempts at medical management are attempted initially but, with more severe curvature – normally greater than 60 degrees – surgery may be considered as a primary treatment. Concomitant ED is always evaluated when deciding on surgical options for patients with severe PD.94

A proposed treatment algorithm for PD is provided in Figure 1 .

Does Viagra Help Peyronie’s Disease?

The Department of Urology at Columbia University suggests that Viagra® may be beneficial to those in the early stages of Peyronie’s disease, but the adverse side effects associated with male enhancement pills such as Viagra® are serious and well-documented.

According to Mayo Clinic, side effects that may arise after taking male enhancement pills such as Viagra® and other oral medications include:

  • Back pain
  • Indigestion
  • Blurred vision
  • Headaches
  • A blue tinge to the vision
  • Sensitivity to light
  • Congestion

According to Healthline, some more serious effects of taking male enhancement pills may include:

A man must weigh whatever benefits he believes could arise from taking Viagra® to treat Peyronie’s disease against these possible side effects. He must also know that treatments are available that could help treat his PD without the threat of these side effects.

Possible Causes of Peyronie’s Disease

Before choosing a treatment, a man should consult his doctor about his Peyronie’s disease to try to identify the root of the problem.

According to Healthline, Peyronie’s disease may be caused by a genetic predisposition to the ailment. Injury may also be the cause, as acute or chronic trauma to the penis is known to cause Peyronie’s disease, according to Mayo Clinic

Some of the circumstances that may lead to a penis injury include:

Sometimes, patients cannot recall any trauma at all. Each man’s situation is unique and different.

Additional Risk Factors for Peyronie’s Disease

According to the Mayo Clinic, certain behavioral and health factors may pose an increased risk of developing Peyronie’s disease. Some of the possible risk factors include:

  • Smoking
  • Advanced age
  • Prostate surgery
  • Health disorders such as Dupuytren’s contracture and other connective tissue disorders
  • Aging, which can weaken penis tissue and increase the risk of injury

Men should always attempt to identify the source of their Peyronie’s disease, as the cause may require treatment of its own. Regardless of whether men are able to pinpoint the reason that they developed Peyronie’s disease, they must pursue treatment for the pain and related effects of PD.

Leaving Peyronie’s Disease Untreated is Not an Option

Peyronie’s disease can inflict great pain on a man each time that he gets an erection, and depending on the pain and curvature caused by his Peyronie’s disease, it may completely prevent him from having a comfortable and enjoyable sex life. Men in this situation can experience serious emotional and psychological consequences.

According to an article published in The American Journal of Managed Care, Peyronie’s disease and its effects on a man’s life could lead to:

The pain associated with Peyronie’s disease would be enough to seek treatment, but the secondary conditions that may arise from Peyronie’s—depression, loss of a love life, diminished self-esteem—make it all the more important that men seek safe treatment for their ailment.

Surgery for Peyronie’s Disease is No Guarantee

According to the University of California San Francisco, having surgery to correct Peyronie’s disease could leave a man in a worse condition, as side effects of surgery may include:

  • Impotence, or the inability to get or maintain an erection
  • Nerve injury, which may also affect his ability to get or maintain an erection
  • Anesthesia-related complications

There are other options for addressing Peyronie’s disease besides male enhancement pills and surgery, and these treatments have the backing of clinical studies.

Shockwave Therapy is a Proven Treatment for Peyronie’s Disease

Shockwave therapy, and GAINSWave® therapy specifically, is a non-invasive treatment for Peyronie’s disease.

Shockwave therapy involves the use of low-intensity soundwaves to alter the tissue that may be causing Peyronie’s disease. Shockwave therapy improves blood flow to the penis, promoting the growth of new blood vessels and removing plaque that may be contributing to the deformation of a man’s penis. The combined effects of soundwave therapy like GAINSWave® treatment may represent the end of the conditions that are inhibiting his sex life and causing him pain.

Studies Supporting the Efficacy of Shockwave Therapy

Urologist Daniel Shoskes writes in the Cleveland Clinic’s digital publication that shockwave therapy promotes blood vessel growth in the penis. Results of this kind may end many men’s erectile dysfunction. Stokes also treatment for erectile dysfunction notes that shockwave therapy has a “long track record” for “efficacy and safety” as a.

Another study published in Translational Andrology and Urology focused specifically on shockwave therapy’s effects on those suffering from Peyronie’s disease. The study found that shockwave therapy is an effective treatment for Peyronie’s disease, with author Eric Chung noting that shockwave therapy is “a useful and valid minimally invasive treatment option for men with PD.”

Men Can Call a GAINSWave® Treatment Provider Today to Learn More

Peyronie’s disease is an insidious condition that can cause immediate pain and may also lead to psychological and emotional degradation if left untreated. A man suffering from PD could consider shockwave therapy as one of the more conservative forms of treatment for PD.

Men who are interested can call a GAINSWave® therapy provider today to take the next steps toward restoring their sex lives.

Daily Tadalafil May Be Effective for Peyronie’s Disease

XIAFLEX (collagenase clostridium histolyticum)
This slideshow reviews drug information for XIAFLEX (collagenase clostridium histolyticum).Table of ContentsSlide 3: Indication, Dosage & AdministrationSlide 6: Use in Specific PopulationsSlide 8: Clinical PharmacologySlide 11: Warnings & PrecautionsSlide 14: Clinical Safety & EfficacySlide 20: Drug Storage & Supply

Daily tadalafil has the potential to be a treatment option for Peyronie’s disease (PD), according to data presented at the Sexual Medicine Society of North America 18 th Annual Fall Scientific Meeting in San Antonio, Texas.

In a small study of PD patients, treatment with the drug, a phosphodiesterase type 5 (PDE5) inhibitor that is FDA approved for treating erectile dysfunction, was associated with decreased pain on erection and degree of penile curvature and improved erectile function.

Hyun Jun Park, MD, PhD, and Nam Cheol Park, MD, PhD, from Pusan National University School of Medicine in Busan, Korea, divided 66 PD patients into 3 groups: Group 1, which included 20 patients treated with an intralesional injection of verapamil (IVI); group 2, which included 23 patients treated with tadalafil 5 mg once daily for 12 weeks; and group 3, which included 23 patients who received IVI and tadalafil 5 mg once daily for 12 weeks. Groups 1, 2, and 3 had means ages of 53.2, 56.1, and 55.3 years, respectively. At baseline, the groups had no significant differences in age, erectile function, or duration and characteristics of PD, according to the researchers.

Pain resolution was achieved in 55%, 70%, and 78.3% of groups 1, 2, and 3, respectively, after 12 weeks, the researchers reported in a poster presentation. The changes in the mean degree of penile curvature were -4.6, -6.2, and -7.2 degrees, respectively. The changes in mean plaque size were 0.2, 0.2, and 0.3 cm 2 . Further, groups 2 and 3 showed a greater increase in International Index of Erectile Function (IIEF)-Erectile Function domain score compared with group 1 (3.8 and 3.8 vs 0.4, respectively). Commonly reported adverse events (AEs) included hematoma at the injection site (4 cases), myalgia (3 cases), and dyspepsia, headache, and flushing (1 case each). No patient discontinued treatment due to AEs, the investigators reported.

The researchers said it has been speculated the PDE5 inhibitors may have an effect on PD by inhibiting tissue remodeling after acute injury and decreasing the oxidative stress responsible for inflammation and fibrosis.

The new study is not the first investigation to demonstrate the potential usefulness of tadalafil in treating PD. In a paper published in Urology Annals (2015;7:345-349) Lucio Dell’Atti, MD, of University Hospital S. Anna, Ferrara, Italy, reported that combined treatment with tadalafil and IVI was associated with better pain control and reduced penile curvature and improved erectile function than IVI or tadalafil alone. The study included 59 PD patients, who were divided into 3 groups. Group A had 23 patients treated with IVI, group B had 19 patients treated with tadalafil 5 mg once daily for 12 weeks, and group C had 17 patients treated with IVI and tadalafil 5 mg once daily for 12 weeks. At baseline, groups A, B, and C had mean IIEF-5 scores of 12.90, 12.51, and 11.58, respectively.

At 12 weeks, pain resolved completely in 57%, 61%, and 76% of groups A, B, and C, respectively. The final mean curvature degree decreased in all groups, with not significant difference among the groups. Mean plaque size did not decrease significantly in group A (1.57 vs 1.59 cm 2 at baseline) and group B (1.51 vs 1.52 cm 2 at baseline), but decreased significantly in group C (1.46 vs 1.58 cm 2 at baseline). The mean IIEF-5 score improved significantly in group C compared with groups A and B (23.1 vs 14.4 and 18.2, respectively).

Related Articles

Reference

Park HJ, Park NC. Daily tadalafil therapy: A new treatment option for Peyronie’s disease? Presented in poster format at the Sexual Medical Society of North American 18 th Annual Fall Scientific Meeting in San Antonio, Texas. Poster 134.

Ask the Expert: Can Peyronie’s Disease Treatments Cure Erectile Dysfunction?

While some people with Peyronie’s disease may develop erectile dysfunction, the majority of people report that the erectile problems came before the Peyronie’s disease symptoms.

It’s estimated that up to a third of people with Peyronie’s disease will also have erectile dysfunction, with more than half of those people reporting that the erectile dysfunction started first. If erectile dysfunction develops after Peyronie’s disease symptoms begin, it may be a result of the pain or curvature from the condition.

Some cases of Peyronie’s disease are caused by trauma to the penis. This forms scar tissue, or “plaque.” It can also damage blood vessels and nerves responsible for erectile function.

It’s important to remember that erectile dysfunction is often due to a variety of factors. The distress from penile curvature, possible performance anxiety, and pain can play a role in diminished erectile function.

What’s more, a 2021 Swedish study showed that men with Peyronie’s disease were more likely to have a substance use disorder, anxiety, and depression. All of these can impact erectile function in different ways.

It’s important that erectile dysfunction be addressed in people with Peyronie’s disease, and in general should be treated before or in conjunction with treatment for Peyronie’s disease.

Some treatments for Peyronie’s disease may improve erectile function.

In the active phase of Peyronie’s disease, pain can be a significant factor in limiting erectile function. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, can provide enough pain relief to improve erectile function.

A 2018 research review shows that shockwave treatment to the penis may help ease pain in the active phase of Peyronie’s disease and treat erectile dysfunction as well. However, it’s not proven to treat curvature or improve erectile function over the long term.

PDE5 inhibitors, like sildenafil, have been shown to improve both Peyronie’s disease and erectile dysfunction symptoms at doses as low as 25 milligrams.

In complex cases of Peyronie’s disease with severe erectile dysfunction, a penile prosthesis can be surgically implanted, which can fix both issues at once.

Pain from Peyronie’s disease may resolve without medical treatment in 12 to 18 months for as many as 90 percent of people with the condition, according to a 2019 study . Only about 3 to 13 percent of people with Peyronie’s disease will see improvements in penile curvature without treatment, though.

As one can imagine, people with more severe curvature are less likely to see spontaneous improvement, and those with compromised sexual function or significant distress are more likely to need treatment.

It’s important to consider the psychological impact as well. Up to 80 percent of men with a Peyronie’s disease diagnosis will experience mental health conditions, such as anxiety, depression, or both. These conditions may worsen over time without treatment.

There are several ways to break up plaque in people with Peyronie’s disease who need treatment.

A physician may inject medications directly into the plaque to break up the deposited collagen. The injection options include:

  • verapamil (a blood pressure medication)
  • interferon alpha-2b (an immune system modulator)
  • collagenase clostridium histolyticum (Xiaflex)

Each of these medications has associated risks and side effects, which you should discuss with your healthcare provider.

Plaques can also be removed surgically or through incision to correct the curvature.

While shockwave treatment is currently recommended only for pain management in the active phase, researchers are looking into the use of this treatment to disrupt plaque as well.

Intralesional collagenase is an effective treatment for Peyronie’s disease plaque. The Food and Drug Administration (FDA) approved it in 2013 and it has since become widely used.

It works by chemically digesting the scar tissue, which can help straighten the penis and ultimately improve erectile function.

  • new topical therapies like magnesium and liposomal recombinant human superoxide dismutase
  • injections
  • mechanical therapies such as penile stretching

Peyronie’s disease pain can often go away on its own. Penile curvature is less likely to resolve without treatment, but it does happen for some people.

Perhaps a bigger question is whether patients with Peyronie’s disease need to be treated or not. Though Peyronie’s can be a distressing condition, it’s not life threatening — so treatment decisions should be determined on an individual basis.

People with minimal curvature or mild symptoms are unlikely to benefit from treatment. In the same vein, people with more severe curvature who aren’t concerned about sexual function, don’t have pain, and aren’t distressed by the condition may not need treatment, either.

Phosphodiesterease inhibitors like Viagra (sildenafil) have been studied both alone and in conjunction with other therapies to treat erectile dysfunction and penile curvature from Peyronie’s disease.

A 2014 study showed that using sildenafil helps improve erectile function and curvature. At least one study showed that the combination of sildenafil with collagenase offered more improvements to curvature than collagenase alone.

People who have both erectile dysfunction and Peyronie’s disease should get treatment for the erectile dysfunction first, as that can impact treatment decisions for Peyronie’s.

Peyronie’s disease has a variable course. Most people will see improvements in their pain levels over time, with or without treatment.

Curvature improves spontaneously in some people with Peyronie’s disease. But for most people, the curvature will stabilize or continue to progress.

PDE5 inhibitors like sildenafil may have some benefit in reducing fibrosis of the penis and slowing down the progression of the disease.

Some studies also suggest that injections of certain medications during the active phase of Peyronie’s disease could influence the natural progression of the disease, but more research is needed.

As with any condition, people experiencing symptoms of Peyronie’s disease should speak with their primary care physician or urologist to learn how their condition can best be managed.

Dr. Joseph Brito provides general urologic care at Yale Medicine with a special focus on minimally invasive surgical techniques and urologic oncology. Dr. Brito received his MD from George Washington University School of Medicine and Health Sciences. Dr. Brito completed a residency in Urology at Rhode Island Hospital and Alpert Medical School of Brown University and trained at Yale School of Medicine in clinical oncology. Dr. Brito is a member of the American Urological Association.

How we reviewed this article:

Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. We avoid using tertiary references. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.

  • Brimley SC, et al. (2019). Review of management options for active-phase Peyronie’s disease.
    pubmed.ncbi.nlm.nih.gov/30503796/
  • Capoccia E, et al. (2018). Contemporary review of Peyronie’s disease treatment.
    link.springer.com/article/10.1007/s11934-018-0800-5
  • Cocci A, et al. (2018). Sildenafil 25 mg ODT + collagenase clostridium hystoliticum vs collagenase clostridium hystoliticum alone for the management of Peyronie’s disease: A matched-pair comparison analysis.
    pubmed.ncbi.nlm.nih.gov/30245025/
  • El-Sakka AI. (2006). Prevalence of Peyronie’s disease among patients with erectile dysfunction.
    pubmed.ncbi.nlm.nih.gov/16386353/
  • Gaffney CD, et al. (2020). Peyronie disease.
    jamanetwork.com/journals/jama/fullarticle/2774409
  • Kuja-Halkola, R, et al. (2021). Mental disorders in Peyronie’s disease: A Swedish cohort study of 3.5 million men.
    pubmed.ncbi.nlm.nih.gov/33081594/
  • Nehra A, et al. (2015). Peyronie’s disease.
    auanet.org/guidelines/peyronies-disease-guideline
  • Ozturk U, et al. (2014). Effects of sildenafil treatment on patients with Peyronie’s disease and erectile dysfunction.
    pubmed.ncbi.nlm.nih.gov/24190613/
  • Raheem AA, et al. (2017). Safety and effectiveness of collagenase clostridium histolyticum in the treatment of Peyronie’s disease using a new modified shortened protocol.
    pubmed.ncbi.nlm.nih.gov/28612401/
  • Randhawa, K, et al. (2019). Non-invasive treatment in the management of Peyronie’s disease.
    ncbi.nlm.nih.gov/pmc/articles/PMC6376494/
  • Terrier, JE, et al. (2016). Psychological aspects of Peyronie’s disease.
    ncbi.nlm.nih.gov/pmc/articles/PMC4893509/

Our experts continually monitor the health and wellness space, and we update our articles when new information becomes available.