背景:Peyronie病是泌尿外科咨询的常见原因。围绕其治疗的许多争议。迄今为止,尚未发布任何法国准则。因此,法国泌尿外科协会男科和性医学委员会提供了一系列基于证据的建议。
方法:这些建议是根据ADAPTE方法提出的,基于欧洲(EAU,ESSM),美国人(AUA,ISSM)和加拿大(CAU)建议,由于治疗的可用性,整合了法国的特异性,以及最近参考书目的更新。
结果:对该疾病的评估是临床的。患有功能障碍或显著心理影响的患者可以接受治疗。应向患者解释每种治疗的益处和缺点。关于非手术治疗,在法国,没有可用的治疗方法获得市场授权。不推荐使用维生素E。可以根据需要提供镇痛(口服或低强度冲击波)或勃起治疗,以及牵引疗法。由于无法注射胶原酶,可以提供维拉帕米注射。在疾病的稳定阶段应考虑手术治疗,包括执行折叠,根据患者的意愿进行切口移植或阴茎植入物的放置,曲率和阴茎大小,以及勃起功能。可以提供组合治疗。
结论:佩罗尼病的治疗是复杂的,治疗的证据水平普遍较低。治疗的成功与否将取决于初步评估的质量,患者的信息和对预期效果的理解,和从业者的经验。
BACKGROUND: Peyronie\'s disease is a common cause for consultation in urology. Many controversies surround its treatment. No French
Guidelines have been published so far. The Committee of Andrology and Sexual Medicine of the French Association of Urology therefore offers a series of evidence-based recommendations.
METHODS: These recommendations are made according to the ADAPTE method, based on European (EAU, ESSM), American (AUA, ISSM) and Canadian (CAU) recommendations, integrating French specificities due to the availability of treatments, and an update of the recent bibliography.
RESULTS: The assessment of the disease is clinical. Patients with functional impairment or significant psychological repercussions may be offered treatment. The benefits and drawbacks of each treatment should be explained to the patient. Regarding non-surgical treatments, no available treatment has market authorization in France. Vitamin E is not recommended. Analgesic (oral or low-intensity shock waves) or proerectile treatments may be offered as needed, as well as traction therapy. Due to the unavailability of collagenase injections, verapamil injections may be offered. Surgical treatments are to be considered in the stabilized phase of the disease, and consist of performing a plication, an incision-
graft or the placement of a penile implant according to the patient\'s wishes, the curvature and the penis size, as well as erectile function. Combination treatments can be offered.
CONCLUSIONS: The management of Peyronie\'s disease is complex, and the levels of evidence for treatments are generally low. The success of treatment will depend on the quality of the initial assessment, the patient\'s information and understanding of the expected effects, and the practitioner\'s experience.