Mulhall JP et al. (2006) An analysis of the natural history of Peyronie's disease. J Urol 175: 2115–2118

Since a study in the 1970s suggested that half of all cases of Peyronie's disease resolve spontaneously, treatment of this disorder has, typically, been conservative. Later studies, however, found that spontaneous resolution occurred in as few as 13% of cases, and that Peyronie's disease commonly progresses. Mulhall and colleagues used an objective measure of penile abnormality (assessment during erectogenic, intracavernous injection) in their prospective study, which investigated the natural history of Peyronie's disease.

They recruited 246 men (mean age at presentation 52±22 years) with untreated, recent-onset Peyronie's disease (duration <6 months). Penile curvature was the primary abnormality in 217 men; the curvature was located dorsally (72% of cases), ventrally (17%), or laterally (11%). Participants were allowed to continue vitamin E treatment, but starting this treatment during the study was discouraged.

At follow-up (mean 14.5 months), mean curvature was significantly more pronounced than at baseline (45±22° vs 62±37°; P<0.001). Curvature had worsened in 48% of men, and improved in 12%. Objective and subjective measures of penile length were decreased, and 25% more men reported difficulty in penetration at follow-up than at study start. All men with penile pain at baseline reported an improvement; in most men, pain completely resolved during follow-up.

As the mean duration of Peyronie's disease was 18±7 months at follow-up, the authors conclude that participants had moved from the acute phase to stable disease; however, fibrosis seemed to have stabilized, rather than regressed. These findings should help physicians give patients a more realistic idea of the course of Peyronie's disease.