François de la Peyronie and the disease named after him

• Published in: The Lancet (British edition) 2001-06, Vol.357 (9273), p.2049-2051
• Main Authors: Hauck, Ekkehard W, Weidner, Wolfgang
• Format: Article
• Language: English
• Subjects: Algorithms; Biological and medical sciences; Disease; Genital system. Mammary gland; History, 18th Century; Humans; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Middle Aged; Penile Induration - diagnosis; Penile Induration - history; Penile Induration - therapy; Personal profiles; Peyronie, Francois de la; Sexual disorders; Teachers; Tissues; Ultrasonic investigative techniques; Urology
• ISSN: 0140-6736; 1474-547X
• DOI: 10.1016/S0140-6736(00)05119-9

Because of the absence of concrete knowledge about the definite causes, all therapeutic trials remain symptom-- directed and are generally inconclusive. As a result of the high rate of spontaneous regression,2 only results from double-blind placebo trials are really acceptable. Thus, conservative treatment is required in the earlier inflammatory, painful stages with unproven causes. With regard to intralesional treatment, none of the substances used so far in a controlled approach have shown any longterm effect. Surgical procedures should be only done after an interval of at least 12 months with no disease progression-otherwise the result might be jeopardised by recurrent curvature if the disorder progresses. Surgical treatment follows an algorithm depending on the degree of penile curvature and the occurrence of concomitant erectile dysfunction.4 In cases of normal potency and a curvature of less than 60 deg , plaque-contralateral corporoplasty is the treatment of choice. Unfortunately, this type of surgical straightening results in penile shortening. If angulation is severe or the penis relatively short, a combination of plaque incision or excision with grafting-eg, with vein or alloplastic material to cover the defect-should be chosen, because these techniques safeguard penile length. The advantage of incisional procedures can be seen in the lower rate of postoperative erectile dysfunction compared with complete plaque resection. If Peyronie's disease is combined with erectile dysfunction, conservative treatment with sildenafil, intracavernous injection treatment, or a vacuum erection device is judged to be in the first line of treatment. In non-responders, such as in the patient mentioned above, implantation of a penile prosthesis usually is accepted as a standard procedure. The curvature can be corrected by modelling the penis over an inflated device or alternatively by plaque incision or excision with consecutive grafting. The table shows a possible therapeutical algorithm, which has been successfully used by our Peyronie's disease study group.