How intralesional therapies have changed the treatment of Peyronie’s disease

Denise Asafu-Adjei, MD, MPH

Urology Times® is celebrating its 50th anniversary in 2022. To mark the occasion, we are highlighting 50 of the top innovations and developments that have transformed the field of urology over the past 50 years. In this installment, Denise Asafu-Adjei, MD, MPH, discusses the development of intralesional therapies for Peyronie’s disease and how they have improved the treatment of this condition. Asafu-Adjei is a urologist and medical director of male reproductive medicine at Loyola University, Chicago, Illinois.

Please provide an overview of the development of intralesional therapies for Peyronie’s disease.

Peyronie's disease has really seen a wide range of intralesional options through the years. Steroid injections for Peyronie's disease were first described in 1957 by Clement A. Furey Jr, MD. Interferon was first investigated as a treatment for Peyronie's disease in 1991 by Matthew R. Duncan, MD, and his group. Interferon decreases the rate of plaque proliferation and the production of extracellular collagen. The first reported use of verapamil, another intralesional option for Peyronie's disease, was first described by Laurence Levine, MD, in 1994. Verapamilworks by inhibiting fibroblast proliferation of Peyronie's plaques. Finally, clostridial collagenase [Xiaflex] was the first FDA-approved drug for the treatment of Peyronie's disease, discovered by Martin Gelbard, MD, initially in 1982, specifically with the formal prospective studies being first described in 1993. This treatment works by degrading collagen types 1 and 3, which had been shown to be elevated in Peyronie's disease.

What makes intralesional therapies an innovation in urology?

These therapies are all innovations because they provide minimally invasive options for an otherwise pretty devastating disease with associated deformities. So now, men have the option to seek out something minimally invasive before surgical options are breached.

How have intralesional therapies improved the treatment of men with Peyronie’s disease?

All of the aforementioned treatments are in the American Urological Association guidelines, so they have really stood the test of time in terms of being efficacious treatments for Peyronie's disease. They're really just excellent ways to nonsurgically manage patients with this devastating disease, and it really has changed the way that we have approached our treatment paradigm for Peyronie's disease.