Table 1. Non-conventional therapies for Peyronie’s disease.
| Treatment | Studies included | Efficacy (% of patients noticing improvement) | Degree of improvement (degrees in penile curvature corrected) | Complications | Availability |
|---|---|---|---|---|---|
| Platelet-rich plasma | Culha et al. (2019); Matz et al. (2018) | Animal models: 0% of mice exhibited improvement. No significant improvement in pathological examination of treated plaques; Patient outcomes: IIEF-5 scores improved by an average of 4.14 points (100% of PD patients; 12/12) | Not provided. 80% of patients reported subjective improvement in their degree of curvature | Not provided. Urethral bleeding (n=4) | A blood sample obtained from the patient being treated, easily available |
| Hyaluronic acid | Zucchi et al. (2016); Favilla et al. (2017) | Patient outcomes: 2 mm change in plaque size after treatment (P<0.0001); IEEF-5 score improved by 1 point (P<0.0001); VAS score improved from 6/10 to 8/10 on average; PGI-I questionnaire improved to 69%. Patient global impression of improvement (PGI-I) was found in the hyaluronic acid (HA) group compared to Verapamil (4.0 vs. 2.0; P<0.05) | Penile curvature changed by a mean of 10 degrees after treatment (P<0.0001). Penile curvature decreased 4.60 degrees (P<0.001) | None. None | Hyaluronic acid is abundant and accessible, provided in several sexual health clinics across North America |
| Shockwave therapy | Claro et al. (2004); Di Mauro et al. (2019) | Patient outcomes: 8 patients (32%) reported improvement in spontaneous erections; Penile plaque size improved from 1.78 to 1.53 cm2; penile length increased from 13.0 to 14.0 cm; Pain on VAS decreased from 7 to 3 on average; improvement in each of the IIEF sub-domains (P<0.001) and all three PD questionnaire domains (P<0.001) in a patient population of 325 | Mean reduction of 21 degrees at 3 months (18/25 patients, 72%). Curvature improved from 30.4 to 25.0 degrees on average | Urethral bleeding (n=2). None | Shockwave therapy is accessible and provided in many sexual health clinics across North America |
| Combination hyaluronic acid and platelet rich plasma | Virag et al. (2017) | Patient outcomes: improvement in mean PDQ questionnaire in PDQ1 with P=0.002 (95% CI: 0.720; 2.968), PDQ2 with P=0.021 (95% CI: 0.275; 3.225) and PDQ3 with P<0.001 (95% CI: 1.520; 3.220). For patients with prior ED (n=11), observed a decrease in their deformation, improvement in erections, sexual activity improved. 73.3% of these ED patients demonstrated satisfactory results | Mean reduction of 18.08 degrees at 2 months | Ecchymosis was present in 16.7% of the patients and marked hematoma in 10%. Two patients suffered from transient hypotension after local anaesthesia | Not provided |
| Stem cell therapy | Ma et al. (2012); Castiglione et al. (2013); Gokce et al. (2014); Gocke et al. (2015); Levy et al. (2015) | Patient outcomes: Better preserved cavernosal function and erectile function with stem cell-seeded grafts in tunica albuginea reconstruction compared to graft alone; In PD patients, close to a 100% reduction in plaque volume at 6 months (10/10 plaques). No improvement in IIEF-5. Animal models: in rat models, decrease in fibrosis and elastosis. Increased collagen degradation via altered TIMPs and MMPs expression and activity. Improved erectile function | In one study, mean reduction of 49.7 degrees at 6 weeks | In one study, plaque development (n=1), priapism (n=1) | Adipose-derived stem cells are abundant and accessible. Avoids ethical and logistical issues with embryonic stem cells |
| Mycophenolate mofetil | Antoniassi et al. (2019) | Animal models: following 30 days of treatment in rats with TGF-β induced PD, the integrity of elastin and ratio of collagen type III/I were similar to control group | No significant improvement | None | Commercially available |
| H-100 | Twindell and Levine (2016) | Patient outcomes: at 6 months, treated patients (n=11, with PD <12 months duration) reported a 22.6% increase in mean stretched penile length, 40.8% reduction in curvature, and 85.7% reduction in pain level | Mean reduction of 20.2 (range, 3–55) degrees at 6 months | Mild rash (n=3) | Components of H-100 are commercially available |
IIEF, International Index of Erectile Function Questionnaire.