title: Peyronie's disease.
abstract: BACKGROUND
  Peyronie's disease is a sexual medicine condition that may adversely affect male sexual function.
  
  
  OBJECTIVE
  To provide expert opinions/recommendations concerning state-of-the-art knowledge for the pathophysiology, diagnosis and treatment of Peyronie's disease.
  
  
  METHODS
  An International Consultation in collaboration with the major urology and sexual medicine associations assembled over 200 multidisciplinary experts from 60 countries into 17 committees. Committee members established specific objectives and scopes for various male and female sexual medicine topics. The recommendations concerning state-of-the-art knowledge in the respective sexual medicine topic represent the opinion of experts from five continents developed in a scientific and debate process. Concerning the Peyronnie's disease committee, there were 10 experts from six countries.
  
  
  METHODS
  Expert opinions/recommendations are based on grading of evidence-based medical literature, extensive internal committee discussion over 2 years, public presentation and deliberation.
  
  
  RESULTS
  Peyronie's disease is characterized by an inflammatory response beneath the tunica albuginea with fibroblast proliferation forming a thickened fibrous plaque that may cause penile pain, penile curvature and erectile dysfunction. Medical treatments have been described but few prospective controlled trials have revealed significant clinical benefits. Surgical treatments (penile plication, Nesbit excision, plaque incision and grafting and penile prosthesis insertion) should be considered after Peyronie's disease has stabilized. Surgical outcome studies reveal that a stable deformity is best corrected with the least postoperative ED by a Nesbit procedure. Plaque incision and grafting should be reserved for men with good erectile function and marked penile shortening although there is a higher prevalence of postoperative ED. Implantation of a penile prosthesis is an excellent option for men with an accompanying erectile deficit.
  
  
  CONCLUSIONS
  Safe and effective treatments for Peyronie's disease examined by prospective, placebo-controlled, multi-institutional clinical trials are needed.
authors.affiliation: Institute of Urology, London University, London, UK. jpryor@andrology.co.uk
authors.forename: John
authors.initials: J
authors.lastname: Pryor
authors.forename: Emre
authors.initials: E
authors.lastname: Akkus
authors.forename: Gary
authors.initials: G
authors.lastname: Alter
authors.forename: Gerald
authors.initials: G
authors.lastname: Jordan
authors.forename: Thierry
authors.initials: T
authors.lastname: Lebret
authors.forename: Laurence
authors.initials: L
authors.lastname: Levine
authors.forename: John
authors.initials: J
authors.lastname: Mulhall
authors.forename: Sava
authors.initials: S
authors.lastname: Perovic
authors.forename: David
authors.initials: D
authors.lastname: Ralph
authors.forename: Walter
authors.initials: W
authors.lastname: Stackl
mesh_terms: D032921:Consensus; D007172:Erectile Dysfunction / Q000209:etiology / Q000601:surgery*; D019317:Evidence-Based Medicine; D006801:Humans; D008297:Male; D019935:Penile Implantation; D010411:Penile Induration / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D015917:Penile Prosthesis; D010413:Penis / Q000002:abnormalities / Q000601:surgery*; D017410:Practice Guidelines as Topic / Q000592:standards