Table 2: Intralesional therapies

From: Review of non-surgical treatment options for Peyronie's Disease

Treatment (dose)MechanismClinical benefitSide effectsICSM guidelines14
Collagenase (10 000 Units × 3 injections at 0 and 3 months)58Lyses collagen, the primary component of PD plaques57% had 25% reduced curvature58Penile pain, swelling, contusions, ecchymosesSeveral small non-controlled trials showed limited benefit
     
Verapamil (10 mg bi-weekly × 12 injections)31Inhibits local extracellular matrix production, reduces fibroblast proliferation, increases local collagenase activity60% with mean decrease of 30°,45 57% with decreased plaque volume and trend towards decreased curvature48Nausea, light-headedness, penile pain, ecchymoses, no cardiovascular eventsAppears to make scientific sense but no large scale placebo controlled trials
     
Nicardipine (10 mg biweekly × 6 injections)50Ca2+ channel blocker, mechanism likely similar to verapamilImprovement in IIEF scores, and plaque size, no specific values given50Headache, no hypotension or cardiovascular eventsNo guidelines
     
Corticosteroids (25 mg per week)64 (50 mg subQ q4–6 weeks)65Anti-inflammatory100% resolution of pain,65 no significant difference in curvature, or plaque sizeTissue atrophy, thinning of skin, and immunosuppressionNo objective measures of therapeutic benefit
     
Orgotein (4 mg q2weeks)86Anti-inflammatory with pronounced superoxide dismutase activityNo benefit with regard to pain, deformity, or plaque sizePain, swelling, stiffness, dysesthesias, and skin rashesNot addressed by ICSM guidelines
     
Interferons (1–10 000 U per week)54Decrease fibroblast proliferation in vitro, reduce extracellular matrix production, and increase collagenaseDecreased curvature of 27%, resolution of pain in 67%, decreased plaque size by 54.6%54Myalgias, flu-like symptoms, feverOne placebo-controlled trial showed an outcome benefit with interferon over saline
  1. Abbreviations: ICSM, International Consultation on Sexual Medicine; IIEF, International Index of Erectile Function; PD, Peyronie's disease.