Injection therapy in the acute phase of Peyronie's disease: a systematic review of current evidence

Background: Injection therapy has emerged as a possible treatment for the acute phase of Peyronie’s disease (PD). Aim: To systematically review the current evidence on the efficacy and safety of injection therapy for patients in the acute phase of PD. Methods: A comprehensive bibliographic search on the MEDLINE, Scopus, and Web of Science Core Collection databases was conducted in June 2024. Articles were selected if they included patients with PD in acute phase (P) undergoing injection therapy (I) with or without comparison with other treatments (C), evaluating its efficacy or safety (O). Prospective and retrospective original studies were included (S). Articles were assessed for risk of bias using Cochrane risk-of-bias tool for randomized trials version 2, risk of bias in non-randomized studies-of interventions, and Joanna Briggs Institute critical appraisal tool. Data were synthesized narratively. Outcomes: Primary outcomes were penile curvature, penile pain, and adverse events. Results: A total of 20 studies (1291 patients) were included, with 4 (20%) being randomized controlled trials. The mean/median duration of PD symptoms ranged from 2.0 to 18.6 months across the papers. The injectable agents tested included calcium channel blockers, hyaluronic acid, Collagenase Clostridium histolyticum, interferon, and corticosteroids. In most studies, improvements in penile curvature and pain were observed, with variable magnitude and in a varying percentage of patients. Adverse events were mostly mild and localized, including bruising, swelling, and ecchymosis. No severe complications were reported in any of the studies. Clinical Implications: Limited evidence support the feasibility of injection therapy for the acute phase of PD. Strengths and Limitations: The first systematic review on injection therapy for acute PD. Low-to-intermediate quality and heterogeneous methodology of primary studies, impossibility of reliable quantitative data synthesis. Conclusion: Injection therapy for the acute phase of PD demonstrates variable efficacy depending on the agent used and a relatively favorable safety profile; however, the overall quality of evidence remains low and is characterized by significant methodological limitations.