DISCUSSION
Surgical treatment
modalities of Peyronie’s disease are continually being explored and
increasing in diversity. However, surgical procedures can be performed
only in the chronic phase of the disease [4].
In the acute phase in
which inflammation is in progress, there are not many treatment methods
with proven effectiveness [5]. Today, the most effective acute phase
treatment is provided with collagenase clostridium histolyticum. This is
the only treatment method licensed by the FDA. The effectiveness of
Collagenase clostridium histolyticum has been proven by many recent
studies [14–16].
However, especially in
developing countries, using this agent can be very costly and the
procurement of the drug can be difficult.
There are many studies about the etiology and physiopathology of
Peyronie’s disease in the literature. These studies generally focus on
genetic, traumatic, and inflammatory processes [17–19].
However, regardless of
the underlying cause, the inflammatory process that occurs later in the
disease forms the basis of plaque formation. In the course of
inflammation, Peyronie’s disease occurs due to the production of
inducible nitric oxide synthase (iNOS), which leads to an increase of
nitric oxide and a corresponding increase in production of peroxynitrite
anion. These processes result in the proliferation of fibroblasts and
myo-fibroblasts and excessive production of collagen between the layers
of the tunica albuginea, which is called penile plaque [20].
Corticosteroids are
frequently considered to be an acute phase treatment modality of
Peyronie’s disease due to their intense anti-inflammatory effects
[21]. However, few studies have investigated the intralesional use
of steroids. Of those that have, positive results were obtained with
intralesional steroid use in terms of improving penile curvature angle,
plaque size, and penile pain and discomfort during erection
[22,23
However, the use of these drugs has not become widespread, and this is
largely due to the systemic side effects caused by the use of high doses
of steroids and the local side effects that appear around the area of
application. As far as we know, this study is the first research to
consider low dose methylprednisolone in the treatment of Peyronie’s
Disease. In our study, statistically significant improvements were found
for this treatment, especially in plaque size, severity of symptoms, and
penile pain and discomfort during erection. We believe that the use of
the drug in a low dose of 40 mg and with one-week intervals between
injections would prevent the expected complications of steroids.
PDQ is a questionnaire that has been used many times to investigate the
effectiveness of treatment methods used in Peyronie’s disease. Its
reliability and effectiveness have been proven [24,25]. It is a
scale that assesses the patient’s perspective on the disease, not just
in the physical sense, but also in the psychosexual perception. It was
observed that the complaint of pain—one of the typical findings of
Peyronie’s disease, which disturbs the patient and occurs during
erection—decreased significantly after methylprednisolone treatment.
Naturally, the sexual performance of patients will improve with the
reduction of this complaint. Our study showed an increase in IIEF-5
scores after treatment; however, this increase was not statistically
significant. This may be due to the low number of patients in our study.
Another reason could be that basal IIEF-5 values are already high, so
there may be no significant increase after treatment.