Dr. Hellstrom answers: Initial management of the acute presentation of PD is conservative and non-surgical. Although there are numerous surgical options for the correction of PD, the choice of an initial treatment to choose is somewhat of a dilemma. It is recognized that 10-15% of acute PD will resolve naturally over the first year. Forty percent will stay the same, and 45% will get worse. For this reason most clinicians are inclined to prescribe medication. Oral treatment alternatives include; vitamin E, potassium aminobenzoate (Potaba), colchicine, tamoxifen, and L-carnitine. Most studies on oral therapies involve small numbers of patients with poor follow-up, lack of control or placebo groups, and poor objective parameters to measure improvement. None of them can be strongly recommended, despite their popularity. On the other hand, intralesional injections with various agents such as calcium channel blockers, clostridial collegenase, and interferons have also been used as minimally invasive treatment options for PD. Studies using interferon and verapamil injections are promising and may provide improvement and/or stabilization of the deformity. This makes injection therapy a reasonable option for patients with early-onset PD. Surgery for PD is contemplated only after stabilization of the disease process, which occurs after about 1 year and is generally reserved for men with severe penile deformities that impede satisfactory sexual intercourse.
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