In this review I discuss the current non-surgical treatment options for
Peyronie's disease (PD), which remains a therapeutic dilemma for the treating physician. This is despite a large array of treatments that have been used since the time of de la Peyronie in the mid-18th century. Part of the problem with finding an effective treatment is the incomplete understanding of the aetiopathophysiology of this
scarring disorder. Published articles in peer-reviewed journals were assessed, recognising that most of the reported trials are compromised by being single-centre studies with no placebo control. Various treatment options have emerged, most with limited and unreliable benefit, but a few treatments have shown a consistent, albeit incomplete, response rate. Currently the only scientifically sensible oral agents appear to be
pentoxifylline,
l-arginine, and possibly the
phosphodiesterase type-5 inhibitors. The current
intralesional injection treatment options include
verapamil and
interferon, with a reported benefit in reducing
deformity and improving sexual function. Intralesional clostridial
collagenase is in the midst of phase-3 trial analysis by the USA Food and Drug Administration. External mechanical
traction therapy has recently emerged as a technique to reduce the curvature, recover lost length, and possibly obviate surgery. Currently there is no clear, reliable and effective non-surgical treatment for PD, but it appears that several of the available treatments can reduce the
deformity and improve sexual function, and might at least stabilise the disease process.