Current issues of pathogenesis, diagnostic visualization and methods of treatment Peyronie’s disease

Abstract

This paper presents current survey data on the epidemiology, etiopathogenesis, diagnostic imaging, conservative and surgical methods of the treatment for Peyronie’s disease. The review of literature ends with a conclusion that there is no single point of view on causes and mechanisms of this disease. Particular theories of etiopathogenesis were observed: anatomical, autoimmune, genetic, oxidative stress theories and TGF-β impact role. Early diagnosis is necessary to achieve optimal effects of the treatment. Sonography with or without cavernosography are recommended as routine diagnostic visualization methods. Magnetic resonance imaging also could be used according to the indications. Morphometric penile evaluation could be performed with different modern methods; quantitative assessment has a particular role. In addition, comparative characteristics of diagnostic imaging methods were described. Among nonsurgical therapeutic methods, we spotted peroral, injection and shock wave therapy. Peroral therapy does not impact plaque size and penile curvature and should be used only in active phase to stabilize the process. Shock wave therapy does not affect plaque size as well, but has a positive effect on pain syndrome and erectile function. Injection therapy with collagenase clostridium histolyticum is the most effective method among nonsurgical ones. Main surgical techniques such as plication, grafting, penile prosthesis placement and also rehabilitation in postoperative period were observed in this review. Surgery maintains to be golden standard in Peyronie’s disease and is performed in patients with stable phase, as well as in patients with severe deformity and with drug-refractory condition.