How is Peyronies disease treated

Most physicians recommend an initial conservative approach during the acute, inflammatory phase of Peyronie's disease, which can last from 6 to 18 months and is characterized by penile pain, curvature, and a palpable plaque. During this period, medical treatment options include oral therapy (Vitamin E, POTABA, Tamoxifen, Colchicine) and intralesional therapies (Verapamil, Interferon). None of these therapies are FDA approved for the treatment of Peyronie's disease, and there are limited well-designed studies evaluating their efficacy.

• Vitamin E—100 mg of Vitamin E three times a day for a minimum of 4 months. Vitamin E is an antioxi-dant, and it is thought that it decreases further plaque formation, although some studies suggest it is no more effective than placebo.

• Injectable verapamil—Although it has been used, it has not been shown to be better than placebo.

• POTABA (potassium para aminobenzoate)—POTABA is a member of the vitamin B complex and is believed to prevent fibrosis (scarring) from occurring through its effects on increased oxygen uptake by the tissues. It is rapidly excreted in the urine and as a result it needs to be taken frequently throughout the day, every 3 to 4 hours. The standard regimen is 12 grams/ day, divided into 6 doses of four 500 mg tabs, for a total of 24 tabs per day. It is recommended that POTABA be used for 6 to 12 months.

• Cortisone injection—There are two agents that have been used, dexamethasone (decadron) in a dose of 0.2 to 0.4 mg injected directly into the plaque weekly for a course of 10 weeks, and triamcinolone hexace-tonide (Aristospan) 2 mg injected into the lesion once every 6 weeks for a total of 6 injections.

Surgical intervention is reserved for those individuals whose Peyronie's disease fails to resolve/improve with conservative therapy. Criteria for surgical intervention include: severe penile curvature which prevents intercourse, stable and unchanged disease for at least 3 months, and severe penile shortening.

There are three main approaches to the surgical management of Peyronie's disease:

1. Shortening of the tunica albuginea (plication procedure or corporoplasty) on the contralateral corpora

2. Lengthening of the affected corpora by incision or excision of the plaque and placement of a graft

3. Placement of a penile prosthesis to straighten the penis and restore erectile function

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Dealing With Erectile Dysfunction

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