Hellstrom Wayne J G
Tulane University School of Medicine, Department of Urology, 1430 Tulane Ave, New Orleans, LA 70112-2699, USA.
J Androl. 2009 Jul-Aug;30(4):397-405. doi: 10.2164/jandrol.108.006221. Epub 2008 Oct 30.
Peyronie's disease (PD) is a wound-healing disorder in which a fibrotic plaque forms in the tunica albuginea layer of the penis. It clinically presents as any combination of penile pain, angulation, and erectile dysfunction. Recent studies indicate that PD has a prevalence of 3%-9% in adult men. Although the exact etiology has not been established, PD likely results from a predisposing genetic susceptibility combined with an inciting event such as microtrauma during intercourse. During the initial acute phase (6-18 months), the condition may progress, stabilize, or regress. For this reason authorities recommend a more conservative treatment approach, with a trial of oral and/or intralesional pharmacotherapy, before surgical reconstruction is considered. Oral therapies most commonly employed include tocopherol (vitamin E) and paraaminobenzoate (Potaba), with colchicine, tamoxifen, propoleum, and acetyl-L-carnitine being used less often. There are a limited number of long-term placebo-controlled studies with these oral agents, and for the most part, studies have failed to show a consistent beneficial effect. Intralesional injection therapy for PD is more commonly used as a first-line therapy. The current standard of care includes injection with interferon-alpha-2b, verapamil, or collagenase. Interferon-alpha-2b, in particular, has been documented in a large, multicenter, placebo-controlled study to show significant benefit over placebo in decreasing penile curvature, plaque size, penile pain, and plaque density. However, intralesional interferon is associated with posttreatment flu-like symptoms unless patients are premedicated with a nonsteroid anti-inflammatory agent. Other available therapies that have not consistently shown efficacy in placebo-controlled studies include corticosteroids, orgotein, radiation, and extracorporeal shockwave therapy. Surgery is considered when men with PD do not respond to conservative or medical therapy for approximately 1 year and cannot perform satisfactory sexual intercourse. Ongoing basic research in PD will likely identify future targets for medical exploitation.
佩罗尼氏病（PD）是一种伤口愈合障碍疾病，阴茎白膜层会形成纤维化斑块。其临床症状表现为阴茎疼痛、阴茎弯曲和勃起功能障碍的任意组合。近期研究表明，成年男性中佩罗尼氏病的患病率为3% - 9%。尽管确切病因尚未明确，但佩罗尼氏病可能是由遗传易感性因素与性交时的微创伤等诱发事件共同导致的。在最初的急性期（6 - 18个月），病情可能进展、稳定或消退。因此，权威机构建议采用更保守的治疗方法，在考虑手术重建之前，先尝试口服和/或病灶内药物治疗。最常用的口服疗法包括生育酚（维生素E）和对氨基苯甲酸（Potaba），秋水仙碱、他莫昔芬、凡士林和乙酰左旋肉碱的使用频率较低。关于这些口服药物的长期安慰剂对照研究数量有限，而且在很大程度上，研究未能显示出一致的有益效果。病灶内注射疗法更常用于佩罗尼氏病的一线治疗。目前的护理标准包括注射α-2b干扰素、维拉帕米或胶原酶。特别是α-2b干扰素，在一项大型多中心安慰剂对照研究中已被证明，在减少阴茎弯曲、斑块大小、阴茎疼痛和斑块密度方面比安慰剂有显著益处。然而，病灶内注射干扰素会引发治疗后类似流感的症状，除非患者预先服用非甾体抗炎药。在安慰剂对照研究中未始终显示出疗效的其他可用疗法包括皮质类固醇、超氧化物歧化酶、放射治疗和体外冲击波疗法。当佩罗尼氏病患者对保守治疗或药物治疗约1年无反应且无法进行满意的性交时，考虑进行手术。佩罗尼氏病正在进行的基础研究可能会确定未来医学开发的靶点。
