Over the years, a wide variety of medications have been used to treat Peyronie's disease. Some patients have benefitted, while others have found their medications seemed to make little difference. This variation in treatment outcome and the resulting lack of consensus regarding the drug(s) of choice reflects in part an uncertainty with strategy. While doctors can't say with precision what causes the disorder in each individual case, there does seem to be a common disease-producing process in all men. Yet where, in this complex spectrum extending from early wound healing to late scar formation, do we intervene with medications? This question remains a topic of clinical research.

In general, changes in tissue elasticity that accompany the inflammation of early Peyronie's disease are reversible, whereas the loss of elasticity associated with the end-stage scarring characteristic of the later illness is not. Since it is a consequence of local change in elasticity, bending responds best to medical therapy in the early stage, a period that generally lasts about six months.

In order to evaluate medical treatments, we should know how a case of Peyronie's disease evolves on its own, in the absence of therapy. Understanding this so-called natural history of the disease provides a basis for comparison, and a means for deciding when surgical intervention may be appropriate. During the intial six months of the disorder, erections can be painful. Eventually, even in the absence of treatment, the pain usually goes away. Unfortunately, bending does not always follow the same pattern. Though it may improve or resolve spontaneously in a minority of men, most untreated men with Peyronie's disease will retain some degree of penile distortion. Most medical treatments have a success rate of about 60% in improving bending. Some factors associated with a tendency for bending to persist are: the presence of dupuytren's contractures, the presence of heavy plaque calcification, and the presence of severe (greater than 45 degrees) curvature.

Some of the contemporary medications in use are:

• VITAMIN E: this anti-oxidant has other uses in the treatment of scars, and has been employed in the treatment of Peyronie's disease since 1945.

• POTABA or potassium para amino benzoate is designated by the FDA as "possibly effective". Large doses are required, which may cause intestinal upset.

• COLCHICINE is a medication used for many years in the treatment of gout. It acts against inflammation, and interferes with the manufacture of scar tissue.

• VERAPAMIL is usually given by direct injection into the plaque. It also interferes with the synthesis of scar tissue precursors.

• COLLAGENASE is an investigational drug that enzymatically digests scar.