The list of treatments mentioned in various sources for Peyronie's disease includes the following list. Always seek professional medical advice about any treatment or change in treatment plans.
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Men with Peyronie's disease usually seek medical attention because of painful erections and difficulty with intercourse. Since the cause of the disease and its development are not well understood, doctors treat the disease empirically; that is, they prescribe and continue methods that seem to help. The goal of therapy is to keep the Peyronie's patient sexually active. Providing education about the disease and its course often is all that is required. No strong evidence shows that any treatment other than surgery is effective. Experts usually recommend surgery only in long-term cases in which the disease is stabilized and the deformity prevents intercourse. (Source: excerpt from Peyronie's Disease: NIDDK)
Because the course of Peyronie's disease is different in each patient and because some patients experience improvement without treatment, medical experts suggest waiting 1 to 2 years or longer before attempting to correct it surgically. During that wait, patients often are willing to undergo treatments whose effectiveness has not been proven.
Some researchers have given men with Peyronie's disease vitamin E orally in small-scale studies and have reported improvements. Yet, no controlled studies have established the effectiveness of vitamin E therapy. Similar inconclusive success has been attributed to oral application of para-aminobenzoate, a substance belonging to the family of B-complex molecules.
Researchers have injected chemical agents such as verapamil, collagenase, steroids, and calcium channel blockers directly into the plaques. These interventions are still considered unproven because studies have included low numbers of patients and have lacked adequate control groups. Steroids, such as cortisone, have produced unwanted side effects, such as the atrophy or death of healthy tissues. Another intervention involves iontophoresis, the use of a painless current of electricity to deliver verapamil or some other agent under the skin to the plaque.
Radiation therapy, in which high-energy rays are aimed at the plaque, has also been used. Like some of the chemical treatments, radiation appears to reduce pain, but it has no effect at all on the plaque itself and can cause unwelcome side effects. Although the variety of agents and methods used points to the lack of a proven treatment, new insights into the wound healing process may yield more effective therapies in the near future.
Peyronie's disease has been treated with some success by surgery. The two most common surgical methods are removal or expansion of the plaque followed by placement of a patch of skin or artificial material, and removal or pinching of tissue from the side of the penis opposite the plaque, which cancels out the bending effect. The first method can involve partial loss of erectile function, especially rigidity. The second method, known as the Nesbit procedure, causes a shortening of the erect penis.
Some men choose to receive an implanted device that increases rigidity of the penis. In some cases, an implant alone will straighten the penis adequately. In other cases, implantation is combined with a technique of incisions and grafting or plication (pinching or folding the skin) if the implant alone does not straighten the penis.
Most types of surgery produce positive results. But because complications can occur, and because many of the phenomena associated with Peyronie's disease (for example, shortening of the penis) are not corrected by surgery, most doctors prefer to perform surgery only on the small number of men with curvature so severe that it prevents sexual intercourse. (Source: excerpt from Peyronie's Disease: NIDDK)
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Treatment is designed to remove or alleviate the underlying cause of cirrhosis or fibrosis, prevent further liver damage, and prevent or treat complications. The patient may benefit from a high-calorie and moderate- to high-protein diet, but developing hepatic encephalopathy mandates restricted protein intake. In addition, sodium is usually restricted to 200 to 500 mg/day and fluids to 1 to 1½ qt (1 to 1.5 L)/day.
If the patient’s condition continues to deteriorate, he may need tube feedings or total parenteral nutrition. He may also need supplemental vitamins — A, B complex, D, and K — to compensate for the liver’s inability to store them and vitamin B12, folic acid, and thiamine for deficiency anemia. Rest, moderate exercise, and avoidance of exposure to infections and toxic agents are essential.
Drug therapy requires special caution because the cirrhotic liver can’t detoxify harmful substances efficiently. When absolutely necessary, vasopressin may be prescribed for esophageal varices, and diuretics may be given for edema. However, diuretics require careful monitoring because fluid and electrolyte imbalance may precipitate hepatic encephalopathy. Encephalopathy is treated with lactulose. Antibiotics are used to decrease intestinal bacteria and reduce ammonia production, which causes encephalopathy. Coagulopathy may be treated with blood products or vitamin K.
Low-protein diets are controversial. They aid in managing acute hepatic encephalopathy but are rarely necessary in chronic conditions because of the underlying protein-calorie malnutrition.
Paracentesis and infusions of salt-poor albumin, in addition to fluid and salt restriction, may alleviate ascites. Surgical procedures include treatment of varices by upper endoscopy with banding or sclerosis, splenectomy, esophagogastric resection, and splenorenal or portacaval anastomosis to relieve portal hypertension. (See Portal hypertension and esophageal varices, page 758, and Circulation in portal hypertension, page 759.)
Source: Professional Guide to Diseases (Eighth Edition), 2005
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