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.