Peyronie's disease - Beyond the bend

In spite of the increase of knowledge on Peyronie’s disease (PD) over the past decades, there is no curative treatment. We summarise the most recent guidelines and discuss the clinical picture, epidemiological and historical aspects, and describe current views therapeutic options. Further, we give an overview of 48 nonsurgical treatments for PD and reflect on future developments. We next summarise the long-term outcomes of surgical interventions. Overall, we concluded that after surgical treatment of PD, sexual function improves to a level equal to that of untreated patients. However, results varied between the different interventions in as much as patients after plaque incision and grafting reported high dissatisfaction rates compared with those undergoing a Nesbit procedure.For many homosexual men, penile erection is of utmost importance and linked to body image. We discuss the effects through interviews with a homosexual man suffering a mild curvature in relation to the limited literature. It shows that psychological effects in homosexual PD patients could be more extensive than in heterosexual patients. PD, Dupuytren’s, and Ledderhose’s diseases (DD and LD) are related fibroproliferative disorders. We report on a large DD population. Both PD and LD were underreported by plastic surgeons, which signifies the need for awareness and referral to a urologist when conditions are bothersome.Previously, our group presented the association of a single nucleotide polymorphism (SNP) rs4730775. We now present the first ever genome-wide association study for PD. SNPs within three loci were found to be significantly associated with PD. Lastly, we examined effects of verteporfin, a registered compound used in macular degeneration. Our results suggest inhibition of fibrosis in the YAP cascade, downstream of YAP. Progress regarding PD treatments has been stagnant for decades because it requires shifting the focus from treating the curvature to finding and treating the systemic basis of PD. International, multidisciplinary research groups should develop protocols to assess multimodal treatments, such as combining pharmacotherapy, stretching devices and/or surgery.

Dissertation: http://hdl.handle.net/11370/83052749-51a9-4f4c-a112-18e95af7fc8e