Effect of Phosphodiesterase Type 5 Inhibitors in the Active Phase of Peyronie’s Disease: A Retrospective Cohort Study

Abstract

Abstract Objectives Experimental models and preliminary human trials have implied that continuous treatment with Phosphodiesterase Type 5 inhibitors (PDE5is) may be a viable treatment of Peyronie’s disease (PD) in the active phase. The purpose of this study is to assess the effect of PDE5is on penile curvature in the management of PD in the active phase. Subjects and Methods We performed a retrospective cohort study of patients with PD in the active phase seen between 2017 and 2021. Patient age, comorbidities, BMI, erectile function, and PD characteristics including pain, treatment, and curvatures at each visit were registered. The primary outcome was the change in penile curvature between visits in patients receiving daily PDE5i treatment compared to patients receiving no treatment. Results 133 patients were identified, with 101 (75.9%) receiving treatment with daily PDE5is (Group 1) and 32 (24.1%) receiving no treatment (Group 2). The mean age was 58.5 (SD 10) years in group 1 and 59 (SD 13.7) years in group 2. The mean time between the onset of symptoms and the first clinical visit was 10.6 (SD 7.3) months in group 1 and 13.4 (SD 19) months in group 2. The mean change in penile curvature between the first and last observations in group 1 and group 2 was + 0.87° (CI: -1.8, 3.5) and + 5.72° (95% CI: 1.4, 10), respectively (p = 0.07). A multivariate analysis controlling for baseline curvature and time between the onset of symptoms and the first clinical visit showed no significant differences in penile curvature changes between the groups (-4.7, 95% CI: -10, 0.6) (p = 0.08). Conclusions Continuous PDE5i treatment appeared to have no influence on the progression of PD in the active phase. The main limitation of the study is its retrospective nature. Randomized controlled trials are needed to draw a definitive conclusion.