Severe, Disabling, and/or Chronic Penile Pain Associated with Peyronie’s Disease: Management with non-intralesional Administration of Steroids
Rian J. Dickstein, M.D., Jayant Uberoi, M.D., Ricardo Munarriz, M.D..
Boston Medical Center, Boston, MA, USA.
BACKGROUND: Penile pain is one of the most distressing, limiting, and difficult to treat manifestations of Peyronie’s Disease. The use of steroid injections in the management of penile deformities associated with Peyronie’s Disease has been ineffective. However, use of steroid injections in the management of penile pain has been poorly investigated. The aim of this study was to examine the efficacy and safety of subcutaneous, non-intralesional steroid injections in patients with severe, disabling, and/or chronic penile pain associated with Peyronie’s Disease.
METHODS: This is a single institution retrospective study of 17 patients with severe, disabling, and/or chronic penile pain associated with Peyronie’s Disease who underwent subcutaneous non-intralesional injections of Triamcinolone (50 mg) every 4-6 weeks between 2004 and 2006. Pre- and post-injection analog pain scales (ranging from 0 without pain to 10 with the most severe pain) were used to assess treatment efficacy.
RESULTS: All 17 patients, (mean age 47.2 ± 10.8 years) had severe, disabling, and/or chronic penile pain associated with erections for an average of 14.5 months (range 5-36) prior to Triamcinolone injections. Mean pre- and post- Triamcinolone injection penile pain scores were 6.6 ± 2.1 and 0.5 ± 0.5 respectively, illustrating a statistically significant improvement in pain (p<0.001). The mean pain-free duration was 23.8 months (range 3-52). The mean dose of Triamcinolone was 73.5 mg (range 50-200) with a mean of 1.5 injections (range 1-4). Of the 17 patients, all had overall improvement in pain scores. Twelve out of 17 (70.6%) patients required no further treatment after a single injection (50 mg) of Triamcinolone, 15 out of 17 (88.2%) were improved after two injections (100 mg), and 16 out of 17 (94.1%) were improved after three injections (150 mg). There were no adverse events or geometric penile changes after injections.
CONCLUSIONS: Subcutaneous, non-intralesional injection of Triamcinolone is an effective, safe, and durable means of managing severe, disabling, and/or chronic penile pain in patients with PD. Future studies are needed to validate these findings.