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Razdan S, Zisman A, Valenzuela R. Scrotal approach for tunica expansion procedure (TEP) for penile girth and length restoration during penile prosthesis implantation in patients with penile angulation due to Peyronie's disease and erectile dysfunction: technique and outcomes. Int J Impot Res 2024; 36:146-150. [PMID: 36528741 DOI: 10.1038/s41443-022-00652-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 11/21/2022] [Accepted: 11/28/2022] [Indexed: 12/23/2022]
Abstract
Peyronie's disease is often comorbid with erectile dysfunction and can cause significant penile shortening. We describe our modified tunica expansion procedure (TEP) technique of penile length preservation and girth enhancement with correction of penile angulation in patients with mild Peyronie's disease (<30 degree angulation, or hourglass deformity, no hinging) and erectile dysfunction presenting for inflatable penile prosthesis (IPP) surgery. A retrospective review of IPP placement from one high volume surgeon was performed. A total of 474 patients' charts from June 2017 to June 2021 were reviewed and those charts of patients undergoing modified TEP in the setting of Peyronie's disease were analyzed. Average increase in length and girth were measured and means with standard deviations calculated. The modified TEP is performed through a scrotal approach and involves complete eversion of the penis with dissection of Buck's fascia off the underlying tunica. Subsequently, staggered scorings of the underlying tunica are performed allowing for circumferential girth enhancement and length preservation. In men with Peyronie's disease, these scorings are preferentially concentrated on the side of the plaque to allow straightening without loss of length. A total of 32 patients with Peyronie's disease from the larger cohort underwent the modified TEP. Mean increase in length of distal corpora was 2.8 ± 0.8 cm (range 2.0-3.4 cm) (measured using Furlow before and after penile eversion with TEP), while mean increase in girth (measured at midphallus prior to prosthesis insertion and after IPP inflation) was 1.6 ± 0.4 cm (range 1.2-2.2 cm). There were no reported complications. A scrotal approach to TEP is an easy to perform technique that can be used to restore length and enhance girth in men with Peyronie's disease undergoing insertion of IPP. Additionally, it is a customizable approach that can also be used to correct mild penile angulation.
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Affiliation(s)
- Shirin Razdan
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA.
| | - Ariel Zisman
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Robert Valenzuela
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
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Kozub A, Suleja A, Chłosta M, Kupilas A, Pradere B, Rivas JG, Rajwa P, Miszczyk M. Current trends in non-surgical management of Peyronie's disease-A narrative review. Andrology 2024; 12:505-517. [PMID: 37593783 DOI: 10.1111/andr.13512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 07/21/2023] [Accepted: 07/25/2023] [Indexed: 08/19/2023]
Abstract
Peyronie's disease (PD) is a connective tissue disorder affecting the tunica albuginea. It can cause pain and penile deformation, and its prevalence increases with age. Although surgery is the gold standard for the chronic phase of the disease, there are several conservative treatment methods available, and the optimal management of the acute phase of the disease remains a matter of debate. In this article, we aim to summarize the recent trends in research on the subject of non-surgical treatment of PD. The search was performed in PubMed, Scopus, and Web of Science databases and included studies in English published between 2012 and 2022 investigating the clinical outcomes of non-surgical PD management in humans. We have identified 20 distinct conservative treatment strategies. Among the oral therapeutics, only the use of phosphodiesterase type 5 inhibitors is currently recommended for clinical use in patients with concomitant erectile dysfunction. The use of collagenase from Clostridium histolyticum is supported by the best quality evidence in terms of intralesional injections for patients suffering from significant penile curvature; however, interferon alpha-2b can also be an option in such patients. Among other non-invasive methods, extracorporeal shockwaves can be useful for pain reduction, and penile traction therapy can lead to a reduction in penile curvature and plaque size. Despite a wide range of non-surgical methods available for PD treatment, the majority are not supported by sufficient scientific evidence, and the treatment efficacy is underwhelming. Further research on the subject of non-surgical management of PD is highly warranted.
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Affiliation(s)
- Anna Kozub
- IIIrd Department of Radiotherapy and Chemotherapy, Maria Sklodowska-Curie National Research Institute of Oncology (MSCNRIO), Gliwice, Poland
| | - Agata Suleja
- IIIrd Department of Radiotherapy and Chemotherapy, Maria Sklodowska-Curie National Research Institute of Oncology (MSCNRIO), Gliwice, Poland
| | - Marcin Chłosta
- Department of Urology, Jagiellonian University, Collegium Medicum, Krakow, Poland
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Andrzej Kupilas
- Department of Urology and Urooncology, City Hospital, Gliwice, Poland
| | - Benjamin Pradere
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Urology, University of Tours, Tours, France
| | - Juan Gómez Rivas
- Department of Urology, Hospital Clínico San Carlos, Madrid, Spain
| | - Paweł Rajwa
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Urology, Medical University of Silesia, Zabrze, Poland
| | - Marcin Miszczyk
- IIIrd Department of Radiotherapy and Chemotherapy, Maria Sklodowska-Curie National Research Institute of Oncology (MSCNRIO), Gliwice, Poland
- Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
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Capogrosso P, Pozzi E, Russo GI, Hatzichristodoulou G, Cocci A, Falcone M, Martinez-Salamanca JI, Fernández-Pascual E, Candela L, Schifano N, Dehò F, Salonia A. Patients' attitude with surgery for Peyronie's disease: results from a multicentric European study. J Sex Med 2023; 21:54-58. [PMID: 37973410 DOI: 10.1093/jsxmed/qdad145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 09/26/2023] [Accepted: 10/01/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Despite the existence of conservative therapies for Peyronie's disease (PD), surgery is commonly utilized for the treatment of bothersome curvatures due to its potential effectiveness, although it carries intrinsic risks and may not universally lead to satisfactory outcomes. AIM To explore the rate and factors influencing patients' willingness to undergo surgery for PD. METHODS Data were prospectively collected in 5 European academic centers between 2016 and 2020. Data included age, time from PD onset, penile pain, curvature degree, difficulty at penetration, hourglass deformity, erectile dysfunction (ED), and previous treatments. All patients were offered conservative treatments, either medications or injections. Tunical shortening or lengthening procedures were offered as an alternative to conservative treatments, when indicated. Penile prosthesis was offered to those with concomitant ED. Patients' attitudes with surgery were recorded. Logistic regression analyses tested the profile of patients who were more likely to be willing to undergo surgery. OUTCOMES Patients' willingness to undergo surgery for PD. RESULTS This study included 343 patients with a median age of 57.3 years (IQR, 49.8-63.6) and a median penile curvature of 40.0° (IQR, 30.0°-65.0°). Overall, 161 (47%) experienced penetration difficulties and 134 (39%) reported ED. Additionally, hourglass deformity and penile shortening were reported by 48 (14%) and 157 (46%), respectively. As for previous treatments, 128 (37%) received tadalafil once daily; 54 (16%) and 44 (13%), intraplaque verapamil and collagenase injections; and 30 (9%), low-intensity shock wave therapy. Significant curvature reduction (≥20°) was observed in 69 (20%) cases. Only 126 (37%) patients were open to surgery for PD when suggested. At logistic regression analysis after adjusting for confounders, younger age (odds ratio [OR], 0.97; 95% CI, 0.95-1.00; P = .02), more severe curvatures (OR, 1.04; 95% CI, 1.03-1.06; P < .0001), and difficulty in penetration (OR, 1.88; 95% CI, 1.04-3.41; P = .03) were associated with a greater attitude to consider surgical treatment. CLINICAL IMPLICATIONS The need for effective nonsurgical treatments for PD is crucial, as is comprehensive patient counseling regarding surgical risks and benefits, particularly to younger males with severe curvatures. STRENGTHS AND LIMITATIONS Main limitations are the cross-sectional design and the potential neglect of confounding factors. CONCLUSIONS Patients with PD, having a lower inclination toward surgery, emphasize the need for effective nonsurgical alternatives and accurate counseling on the risks and benefits of PD surgery, particularly for younger men with severe curvatures.
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Affiliation(s)
- Paolo Capogrosso
- Department of Urology, Circolo & Fondazione Macchi Hospital-ASST Sette Laghi, Varese 28001, Italy
| | - Edoardo Pozzi
- Vita-Salute San Raffaele University, Milan 20151, Italy
- Division of Experimental Oncology, Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan 20151, Italy
| | - Giorgio I Russo
- Urology Section, Department of Surgery, University of Catania, Catania 95100, Italy
| | | | - Andrea Cocci
- Department of Urology, University of Florence, Careggi Hospital, Florence 50100, Italy
| | - Marco Falcone
- Division of Urology, Department of Surgical Sciences, Molinette Hospital, University of Turin, Turin 10024, Italy
| | | | | | - Luigi Candela
- Vita-Salute San Raffaele University, Milan 20151, Italy
- Division of Experimental Oncology, Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan 20151, Italy
| | - Nicolò Schifano
- Department of Urology, Circolo & Fondazione Macchi Hospital-ASST Sette Laghi, Varese 28001, Italy
| | - Federico Dehò
- Department of Urology, Circolo & Fondazione Macchi Hospital-ASST Sette Laghi, Varese 28001, Italy
| | - Andrea Salonia
- Vita-Salute San Raffaele University, Milan 20151, Italy
- Division of Experimental Oncology, Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan 20151, Italy
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Paulis G, Paulis A, Perletti G. Congenital penile curvature as a possible risk factor for the onset of Peyronie's disease, and psychological consequences of penile curvature. Arch Ital Urol Androl 2023; 95:11238. [PMID: 36924365 DOI: 10.4081/aiua.2023.11238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 02/17/2023] [Indexed: 03/17/2023] Open
Abstract
OBJECTIVE To investigate a possible relationship between a history of congenital penile curvature (CPC) and Peyronie's disease (PD), and to characterize the psychological profile of patients suffering from PD, with or without concomitant CPC. METHODS We included 519 patients with Peyronie's disease (PD), of which 73 were found to have underlaying CPC. As a comparator population, we selected 2166 patients without PD, referring to our tertiary care clinic. In this population we detected 15 subjects with CPC. All patients completed the GAD-7 (Generalized-Anxiety-Disorder - 7 questions) and the PHQ-9 (Patient-Health-Questionnaire - 9 questions) questionnaires. RESULTS The overall prevalence of CPC in PD-patients was 14.07%, compared to a prevalence of 0.69% in the non-PD control population (p < 0.00001). Moderate-to-severe anxiety was found to be present in 89.4% of all PD-patients. Significantly higher proportions of patients with CPC associated with PD showed severe anxiety, compared to patients with PD alone (57.5% vs. 36.7%, respectively, p = 0.0008). Moderate- severe depression was found to be present in 57.8% of all PD- patients. Significantly higher proportions of PD patients with a history of CPC showed severe depression, compared to patients with PD alone (13.6% vs. 3.36%, respectively, p < 0.0002). GAD-7 median scores were significantly higher in patients with more severe penile curvatures (> 45°; p = 0.029). We did not detect a statistically significant difference between PHQ-9 medi- an scores based on the severity of PD (p = 0.53). Analysis of PHQ-9 and GAD-7 median scores showed significantly worse depressive and anxious symptoms in younger patients (p < 0.001 and p = 0.0013, respectively). CONCLUSIONS The presence of congenital-penile-curvature may represent a risk factor for the subsequent onset of Peyronie's disease. Moderate/severe anxiety and moderate/severe depression were reported in a high fraction of cases. Anxiety was significantly higher in patients with more severe penile-curvatures, and depression was present independently of the degree of penile curvature. Depression and anxiety were found to be more severe in younger subjects.
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Affiliation(s)
- Gianni Paulis
- Peyronie's Care Center, Department of Uro-Andrology, Castelfidardo Clinical Analysis Center, Rome.
| | - Andrea Paulis
- Neurosystem Center for applied Psychology and Neuroscience, Janet Clinical Centre, Rome.
| | - Gianpaolo Perletti
- Department of Biotechnology and Life Sciences, Section of Medical and Surgical Sciences, University of Insubria, Varese.
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Achraf C, Abdelghani PA, Jihad PEA. Platelet-rich plasma in patients affected with Peyronie's disease. Arab J Urol 2022; 21:69-75. [PMID: 37234679 PMCID: PMC10208162 DOI: 10.1080/2090598x.2022.2135284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 10/09/2022] [Indexed: 11/02/2022] Open
Abstract
Objectives The objective of our study is to discover and evaluate the effects of repeated intralesional injections inside the tunica albuginea of platelet-rich plasma (PRP) in the treatment of Peyronie's disease (PD). Methods As part of a prospective study over 12 months from February 2020 until February 2021, on Sixty-five patients with Peyronie's disease, and penile curvature between 25 and 45°. Patients were stratified into two groups, the first with a curvature between 25 and 35° and the second between 35 and 45°. Gathered data included patient-demographics, Injection technique, outcomes: both quantitative (curvature assessments) and qualitative (state of erectile function, pain during intercourse), and complications. Results Patients in both groups received an average of 6.1 injections of PRP during the study period. Angulation was significantly improved in both groups an average final improvement of 16.88° (SD = 3.35) (p < 0.001) in the first group and 17.27° (SD = 4.22) (p < 0.001) in the second group. Pain during sex decreased from 70.7% to 34.25%, and 55.5% of patients had easier sexual intercourse. Conclusions The positive results of our series of treatment for Peyronie's disease by injection of platelet-rich plasma are encouraging both methodologically (simplicity) and clinical (safety and efficacy) as well as patient satisfaction.
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Krishnappa P, Manfredi C, Sinha M, Arcaniolo D, Matippa P, Moncada I. Penile Modeling in Peyronie's Disease: A Systematic Review of the Literature. Sex Med Rev 2022; 10:434-450. [DOI: 10.1016/j.sxmr.2022.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 12/09/2021] [Accepted: 01/04/2022] [Indexed: 01/22/2023]
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Walker DT, Jiang T, Santamaria A, Osadchiy V, Daniels D, Sturm RM, Mills JN, Eleswarapu SV. 3D-printed phantoms to quantify accuracy and variability of goniometric and volumetric assessment of Peyronie's disease deformities. Int J Impot Res 2021; 34:786-789. [PMID: 34743194 DOI: 10.1038/s41443-021-00486-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 10/10/2021] [Accepted: 10/15/2021] [Indexed: 11/09/2022]
Abstract
Characterization of Peyronie's disease (PD) involves manual goniometry and penile length measurement. These techniques neglect volume loss or hourglass deformities. Inter-provider variability complicates accuracy. Using 3D-printed models, we aimed to evaluate measurement accuracy and variability and establish computational assessment workflows. Five digital phantoms were created: 13.0 cm cylinder, 13.0 cm hourglass cylinder, 15.0 cm cylinder with 40° angulation, 12.0 cm straight penis, and 12.9 cm PD penis with 68° angulation and hourglass. Lengths, volumes, and angles were determined computationally. Each phantom was 3D-printed. Ten urology providers determined lengths, angles, and volumes with measuring tape, goniometer, and volume calculator. Provider versus computational measurements were compared to determine accuracy using t-tests or Wilcoxon rank-sum tests. No significant differences were observed between manual assessment of length of penile models and designed length in penile models. Average curvature angles from providers for bent cylinder and PD phantoms were 38.3° ± 3.9° (p = 0.25) and 57.5° ± 7.2° (p = 0.006), respectively. When assessing for volume, hourglass cylinder and bent cylinder showed significant differences between designed volume and provider averages. All assessments of length, angle, and volume showed significant provider variability. Our results suggest manual measurements suffer from inaccuracy and variability. Computational workflows are useful for improved accuracy and volume assessment.
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Affiliation(s)
- Dyvon T Walker
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Tommy Jiang
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Alvaro Santamaria
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Vadim Osadchiy
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Doug Daniels
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Renea M Sturm
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Jesse N Mills
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Sriram V Eleswarapu
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
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Dos Santos VG, Dos Santos GA, Neto CB, Viana NI, Pimenta R, Guimarães VR, Candido P, Romão P, de Camargo JA, Leite KRM, Srougi M, Cury J, Nahas WC, Reis ST. Downregulation of miR-29b is associated with Peyronie's disease. Urologia 2021; 89:451-455. [PMID: 34346250 DOI: 10.1177/03915603211036628] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Peyronie's disease (PD) is characterized by the formation of fibrous plaque in tunica albuginea, causing several problems in patients. The etiology of this disease is not fully understood, and there are few effective treatments. To better understand the molecular pathways of PD, we studied miR-29b, a microRNA that could be involved with this illness. MicroRNAs are endogenous molecules that act by inhibiting messenger RNA. MiR-29b regulates 11 of 20 collagen genes and the TGF-β1 gene, which are related to PD progression. METHODS We compared miR-29b expression in 11 patients with PD and 14 patients without PD (control group). For the patients with PD, we utilized samples from the fibrous plaque (n = 9), from the tunica albuginea (n = 11), and from the corpus cavernosum (n = 8). For the control group, we utilized samples from the tunica albuginea (n = 14) and from the corpus cavernosum (n = 10). MiR-29b expression was determined by q-PCR. RESULTS We found a downregulation of miR-29b in the fibrous plaque, tunica albuginea and corpus cavernosum of patients with PD in comparison with the control group (p = 0.0484, p = 0.0025, and p = 0.0016, respectively). CONCLUSION Although our study has a small sample, we showed for the first time an evidence that the downregulation of miR-29b is associated with PD.
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Affiliation(s)
- Vinicius Genuino Dos Santos
- São Camilo University Center, Sao Paulo, Brazil.,Laboratory of Medical Investigation (LIM55), Urology Department, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Gabriel Arantes Dos Santos
- Laboratory of Medical Investigation (LIM55), Urology Department, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Cristóvão Barbosa Neto
- Sexual Medicine of the Hospital das Clinicals of University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Nayara Izabel Viana
- Laboratory of Medical Investigation (LIM55), Urology Department, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Ruan Pimenta
- Laboratory of Medical Investigation (LIM55), Urology Department, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Vanessa Ribeiro Guimarães
- Laboratory of Medical Investigation (LIM55), Urology Department, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Patrícia Candido
- Laboratory of Medical Investigation (LIM55), Urology Department, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Poliana Romão
- Laboratory of Medical Investigation (LIM55), Urology Department, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Juliana A de Camargo
- Laboratory of Medical Investigation (LIM55), Urology Department, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Katia Ramos Moreira Leite
- Laboratory of Medical Investigation (LIM55), Urology Department, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Miguel Srougi
- Laboratory of Medical Investigation (LIM55), Urology Department, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - José Cury
- Sexual Medicine of the Hospital das Clinicals of University of Sao Paulo Medical School, Sao Paulo, Brazil
| | | | - Sabrina Thalita Reis
- Laboratory of Medical Investigation (LIM55), Urology Department, University of Sao Paulo Medical School, Sao Paulo, Brazil.,Athens University Center (UniAtenas), Passos, Minas Gerais, Brazil
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Canadian provider perspectives on Collagenase Clostridium histolyticum for the treatment of Peyronie's disease and the impact of its discontinuation. Int J Impot Res 2021; 34:599-602. [PMID: 34267363 DOI: 10.1038/s41443-021-00458-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 07/03/2021] [Accepted: 07/05/2021] [Indexed: 11/08/2022]
Abstract
Intralesional Collagenase Clostridium histolyticum (CCh) was the first non-surgical therapy approved for Peyronie's disease (PD). However, CCh's cost and poor market uptake has led to its discontinuation in Europe and Canada. In Canada, Xiaflex® is the trade name for CCh and it is produced by Paladin Labs Inc, an operating company of Endo International. The paper aims to better understand Canadian CCh providers' perspectives regarding its treatment efficacy and the potential impact of its discontinuation. All Xiaflex®-approved Canadian providers were asked to complete an anonymous 21-question survey using an online platform. Analysis consisted of descriptive statistics. Outcomes of interest included previous experience with CCh, protocols utilized, experience with insurance coverage, clinical and patient-reported outcomes, and provider perspectives on the discontinuation of CCh. Overall response rate was 48.3% (29/60). A total of 89% of respondents were male, 61% were in practice more than 10 years, 32% were in an academic practice, and 46% had completed an Andrology/Sexual Medicine fellowship. A total of 93% of respondents felt that CCh was superior to other intralesional therapies for PD. In all, 86% reported a patient satisfaction rate of at least 50%, and the majority (75%) saw a clinically meaningful response. Only 7% expressed difficulty obtaining insurance coverage, with many providers (71%) achieving an insurance approval rate between 75 and 100%. Only 54% of respondents reported that they would continue treating PD in light of CCh's discontinuation, and 96% felt that CCh's discontinuation represents a loss to Canadian patients. In light of CCh's discontinuation, most (79%) are now more likely to offer surgical treatment. In conclusion, most CCh providers found CCh to be effective and were dismayed by its discontinuation. The survey demonstrated that due to the withdrawal of CCh from Canada, physicians' abilities to offer effective medical therapy may become limited, with more providers offering surgical options for PD.
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García Rojo E, García Gómez B, Manfredi C, Alonso Isa M, Medina Polo J, Carpintero Miguel M, Romero Otero J. Efficacy and safety of dorsal penile nerve block before collagenase of clostridium histolyticum injections in peyronie's disease patients: Results from a prospective pilot study. Andrologia 2020; 52:e13740. [DOI: 10.1111/and.13740] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 05/31/2020] [Accepted: 06/05/2020] [Indexed: 11/28/2022] Open
Affiliation(s)
- Esther García Rojo
- Department of Urology Instituto de Investigación Sanitaria Hospital Universitary Hospital 12 de Octubre Madrid Spain
| | - Borja García Gómez
- Department of Urology Instituto de Investigación Sanitaria Hospital Universitary Hospital 12 de Octubre Madrid Spain
- Department of Urology University HM Montepríncipe Hospital Madrid Spain
| | - Celeste Manfredi
- Department of Urology Instituto de Investigación Sanitaria Hospital Universitary Hospital 12 de Octubre Madrid Spain
- Urology Unit Department of Neurosciences, Reproductive Sciences, and Odontostomatology University of Naples “Federico II” Naples Italy
| | - Manuel Alonso Isa
- Department of Urology Instituto de Investigación Sanitaria Hospital Universitary Hospital 12 de Octubre Madrid Spain
- Department of Urology University HM Montepríncipe Hospital Madrid Spain
| | - José Medina Polo
- Department of Urology Instituto de Investigación Sanitaria Hospital Universitary Hospital 12 de Octubre Madrid Spain
- Department of Urology University HM Montepríncipe Hospital Madrid Spain
| | - Marta Carpintero Miguel
- Department of Urology Instituto de Investigación Sanitaria Hospital Universitary Hospital 12 de Octubre Madrid Spain
| | - Javier Romero Otero
- Department of Urology Instituto de Investigación Sanitaria Hospital Universitary Hospital 12 de Octubre Madrid Spain
- Department of Urology University HM Montepríncipe Hospital Madrid Spain
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Peyronie's Disease and the Female Sexual Partner: A Comparison of the Male and Female Experience. J Sex Med 2020; 17:2456-2461. [PMID: 33067161 DOI: 10.1016/j.jsxm.2020.08.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 08/06/2020] [Accepted: 08/13/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Peyronie's disease (PD) is characterized by penile pain, deformity, and sexual dysfunction, often resulting in an impaired sexual experience and significant psychological bother for the patient. However, there are limited data on the impact of PD on female sexual partners (FSPs). AIM To compare the psychosexual experience of men with PD and their FSPs. METHODS We retrospectively reviewed all prospectively enrolled men and their FSPs who presented for initial PD evaluation to our sexual health clinic from July 2018 to February 2020. All men completed a PD-specific survey and the PD questionnaire (PDQ). If the patient was accompanied by an FSP during initial evaluation, she completed the PDQ for Female Sexual Partners and Female Sexual Function Index. We further queried our database that included information on patient demographics and clinical characteristics. OUTCOMES The main outcome of this study is retrospective comparison of responses with the PDQ and PDQ for Female Sexual Partners. RESULTS Data were available for 44 men with PD (median age, 56 years; interquartile range, 49-63) and their FSPs (median age, 54 years; interquartile range, 50-61). The majority of men presented in the chronic phase (35 of 44, 79.5%), and median objective composite curvature was 75° (interquartile range, 50-90°). Owing to PD, female and male partners reported similar difficulty with vaginal intercourse (VI) (74.3% vs 81.5%, P = .555), decreased frequency of VI (70.6% vs 85.2%, P = .228), and at least moderate discomfort/pain with VI (48.6% vs 33.3%, P = .232). FSPs were "very" or "extremely" bothered by the appearance of their partner's erect penis less often than male partners (20.0% vs 59.3%, P < .001). FSPs were "very" or "extremely" bothered by their partner's PD during VI less often than men with PD (32.3% vs 65.2%, P = .017). Few FSPs (22.9%) had "severe" or "very severe" concern with damaging their partner's penis during VI. CLINICAL IMPLICATIONS The sexual experience for men with PD and their FSPs differs, thus emphasizing the importance of active engagement of both men with PD and FSP during initial PD evaluation. STRENGTHS AND LIMITATIONS This initial study draws data from a single, high-volume men's health clinic with a limited sample size. Survey responses may have been shared by patients with PD and their FSPs. CONCLUSION PD impacts the sexual experience for both men and FSPs. A similarly large proportion of men with PD and FSP noted decreased frequency of and difficulty with vaginal intercourse. Yet, FSPs were less bothered by the appearance of the erect penis and the deformity during VI compared with men. Farrell MR, Ziegelmann MJ, Bajic P, et al. Peyronie's Disease and the Female Sexual Partner: A Comparison of the Male and Female Experience. J Sex Med 2020;17:2456-2461.
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Surgical Planning and Strategies for Peyronie's Disease. Sex Med Rev 2020; 9:478-487. [PMID: 33023863 DOI: 10.1016/j.sxmr.2020.07.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 07/20/2020] [Accepted: 07/27/2020] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Peyronie's disease results in penile curvature, shortening, instability, or pain upon erection-hindering sexual performance and leading to psychological distress. Despite extensive research, surgery is still the mainstay of treatment. OBJECTIVE To present an organized description of the most common surgical techniques used in the correction of Peyronie's disease and to propose a surgical algorithm to guide management. METHODS Using PubMed, we reviewed the published literature regarding surgical treatment of Peyronie's disease and its outcomes. We identified original articles, review articles, and editorials addressing the subject, with a focus on surgical techniques, their indications, and outcomes. RESULTS Peyronie's disease can be treated by corporoplasty or penile prosthesis implantation. Corporoplasty includes convex side-shortening procedures and concave side lengthening procedures. It is indicated when the erectile function is adequate. Shortening procedures include excisional, incisional, and plication-only techniques, and lengthening procedures include partial excision or incision followed by grafting. When refractory erectile dysfunction is present, placement of a penile prosthesis with or without further straightening maneuvers is recommended. We reviewed the indications, advantages, disadvantages, and outcomes of the available techniques and proposed a surgical algorithm to guide management. CONCLUSION Penile shortening procedures are usually indicated in curvatures <60°, in penises with adequate length. Partial excision/incision and grafting are indicated for curvatures >60°, hourglass or hinge deformities, and short penises, if the patient's erectile function is adequate. The presence of "borderline" erectile function and/or ventral curvature tilts the choice toward shortening procedures, and refractory erectile dysfunction is an indication for penile prosthesis placement. Peyronie's disease management remains challenging with many options available, making an accurate risk/benefit assessment of each case and meticulous patient counseling critically important. Almeida JL, Felício J, Martins FE. Surgical Planning and Strategies for Peyronie's Disease. Sex Med Rev 2021;9:478-487.
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Parikh NN, Heslop DL, Bajic P, Bole R, Farrell MR, Levine LA, Ziegelmann MJ. A Review of Treatment-Related Outcomes in Female Partners of Men With Peyronie's Disease—An Opportunity for Improved Assessment. Sex Med Rev 2020; 8:548-560. [DOI: 10.1016/j.sxmr.2020.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 04/18/2020] [Accepted: 04/28/2020] [Indexed: 12/22/2022]
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Abstract
Aim: The etiology of the disease of Peyronie is not certainly known. However, penile micro traumas are thought to be important in the pathogenesis of Peyronie's disease (PD) in genetically predisposed individuals. In this study, we aimed to determine the relationship of some trace element and heavy metals with PD.Material and methods: Thirty Peyronie patients and 26 healthy volunteers were included in the study. In individuals in both groups, levels of serum trace elements (Manganese [Mn], Cu, Cobalt (Co), zinc [Zn], Cd, and iron [Fe]) were determined separately by Atomic Absorption Spectrophotometer method in Yüzüncü Yıl University Central Research Laboratory.Results: Mn, Cu, Zn, and Fe levels in Peyronie patients were statistically significantly lower when compared to the healthy control group (p < .05). Cd and Co levels were similar for both groups but not statistically significant (p > .05).Conclusions: The changes in trace element levels are related to the etiopathogenesis of PD. We think that our study is the first from this aspect.
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Affiliation(s)
- Mustafa Gunes
- Health Sciences University, Derince Training and Research Hospital, Kocaeli, Turkey
| | - Rahmi Aslan
- Department of Urology, Medical Faculty, Yuzuncu Yıl University, Van, Turkey
| | - Recep Eryılmaz
- Department of Urology, Medical Faculty, Yuzuncu Yıl University, Van, Turkey
| | - Halit Demir
- Department of Chemistry, Science Faculty, Yuzuncu Yıl University, Van, Turkey
| | - Kerem Taken
- Department of Urology, Medical Faculty, Yuzuncu Yıl University, Van, Turkey
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Can O, Özbir S, Atalay HA, Çakır SS, Culha MG, Canat HL. The relationship between testosterone levels and Peyronie's disease. Andrologia 2020; 52:e13727. [PMID: 32589321 DOI: 10.1111/and.13727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 05/06/2020] [Accepted: 05/31/2020] [Indexed: 12/23/2022] Open
Abstract
Aetiologic and predisposing factors are still controversial about Peyronie's disease (PD). However, it is thought to be the result of connective tissue disorder or healing defect. Androgens are known to affect collagen metabolism and wound healing in the body. The aim of this study was to investigate the relationship between PD and low testosterone levels. One hundred and forty-seven Peyronie patients and 137 healthy volunteers were included in the study. In both groups, demographic data, medical history, physical examination and erectile capacity were recorded. Blood samples were collected from all subjects in the early morning hours after an overnight fast. The mean level of serum total testosterone was lower in men with PD compared with the controls (3.9 ± 1.1 vs. 4.2 ± 1.7 ng/ml respectively) (p = .062). However, statistically significant relationship was not found between PD and low serum testosterone levels. There was no significant correlation between penile plaque dimension or penile curvature degree and testosterone levels. Large randomised-controlled prospective studies are needed to reveal this possible association.
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Affiliation(s)
- Osman Can
- Department of Urology, Basaksehir City Hospital, Istanbul, Turkey
| | - Sait Özbir
- Department of Urology, Cemil Taşcıoglu City Hospital, Istanbul, Turkey
| | | | - Süleyman Sami Çakır
- Department of Urology, Atlas University, Medicine Hospital, Istanbul, Turkey
| | | | - Halil Lütfi Canat
- Department of Urology, Cemil Taşcıoglu City Hospital, Istanbul, Turkey
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Salter CA, Nascimento B, Terrier JE, Taniguchi H, Bernie H, Miranda E, Jenkins L, Schofield E, Mulhall JP. Evaluating the Impact of Penile Girth Discrepancy on Patient Bother in Men With Peyronie's Disease: An Observational Study. J Sex Med 2020; 17:1560-1565. [PMID: 32576497 DOI: 10.1016/j.jsxm.2020.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 04/23/2020] [Accepted: 05/04/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Men with Peyronie's disease (PD) may experience penile narrowing. Little data on penile girth changes and their psychosocial impact exist. AIM To assess girth discrepancy in men with PD and its association with patient bother. METHODS This was a retrospective observational study. All patients with PD at our institution who were seen in the sexual medicine clinic and who completed 3 validated instruments the PD questionnaire (PDQ), Self-Esteem and Relationship (SEAR) questionnaire, and a depression questionnaire, the Center for Epidemiologic Studies Depression Scale (CES-D), and a curvature assessment were included. Patient and PD characteristics are described. Associations of instability and bother to girth differences are assessed. 2 outcomes for girth differences are classified as (i) girth difference of ≥ 1 cm vs less and (ii) girth differences of ≥10% vs less. Unadjusted and adjusted effects of PD and patient characteristics are assessed on the outcome of high bother using logistic regression models. OUTCOMES The main outcomes of this study were penile girth changes, instability, and questionnaire scores. High bother was defined as a PDQ bother score of ≥9. RESULTS A total of131 men had midshaft curvature and were the focus of the study. Their mean age was 59 ± 9 (range 31-78) years. PD duration was 16 ± 25 (range 1-180) months, with a mean degree of primary curvature of 37 ± 20o. Mean girth difference between base and point of maximum curvature was 0.78 ± 0.53 cm equating to a mean girth difference at point of maximum curvature of 6 ± 4%. Instability was present in 53% of men. There were 54 men with a girth difference of ≥ 1 cm and 23 men with a ≥10% change in girth. There was no difference in CES-D, SEAR, or PDQ domain scores or high bother in men with significant girth changes. Univariable analysis of predictors of high bother included the degree of curvature (odds ratio [OR]: 1.06; P < .001), instability (OR 6.62; P < .001), CES-D sum (OR 1.09; P = .002), and SEAR score (OR 0.96; P = .001). On multivariate analysis, only the degree of primary curvature was predictive of high bother (OR 1.06; P < .001). CLINICAL IMPLICATIONS Penile girth changes have little impact on overall psychosocial well-being. The degree of penile curvature is the primary predictor of patient bother. STRENGTHS AND LIMITATIONS Strengths include a large patient population and use of validated questionnaires. Limitations include single-center, retrospective study and subjective instability grading. CONCLUSIONS Penile girth discrepancy in men with PD has limited psychosocial impact. Clinically significant bother was associated with the degree of primary curvature. Salter CA, Nascimento B, Terrier, JE, et al. Evaluating the Impact of Penile Girth Discrepancy on Patient Bother in Men With Peyronie's Disease: An Observational Study. J Sex Med 2020;17:1560-1565.
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Affiliation(s)
- Carolyn A Salter
- Department of Urology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Bruno Nascimento
- Department of Urology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jean-Etienne Terrier
- Department of Urology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Hisanori Taniguchi
- Department of Urology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Helen Bernie
- Department of Urology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Eduardo Miranda
- Department of Urology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Lawrence Jenkins
- Department of Urology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Elizabeth Schofield
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - John P Mulhall
- Department of Urology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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Impact of treatment-related adverse events on efficacy of intralesional collagenase therapy for Peyronie's disease. Int J Impot Res 2020; 33:128-130. [PMID: 32457499 DOI: 10.1038/s41443-020-0311-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 04/27/2020] [Accepted: 05/14/2020] [Indexed: 11/08/2022]
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Treatment of peyronie's disease with combination of clostridium histolyticum collagenase and penile traction therapy: a prospective, multicenter, single-arm study. Int J Impot Res 2020; 33:325-331. [PMID: 32366987 DOI: 10.1038/s41443-020-0292-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 04/09/2020] [Accepted: 04/16/2020] [Indexed: 12/25/2022]
Abstract
The aim of this paper is to analyze our experience with intraplaque administration of collagenase from Clostridium Histolyticum (CCH) together with penile modeling for selected patients with Peyronie's disease (PD). We conducted a prospective, multicenter, single-arm study. Patients were included from October 2015 to August 2019. We carried out the I + E PROTOCOL (IMPRESS + extender). Each cycle involved administration of two injections of CCH separated 24-72 h, up to a maximum of four cycles. 24-48 h after injection patients underwent penile modeling maneuvers with the use of a PTD at home for at least 4 h a day. After each cycle, penile curvature was evaluated by the Kelami test. Mean pretreatment curvature was 57° (30-100). Eighty-seven patients underwent at least a single cycle and were eligible for analysis. Mean number of cycles administered was 2. Final average curvature after treatment, regardless of the number of cycles was 34°, with a mean reduction in curvature of -23.29° (-41%). Across the first three cycles we found statistically significant differences in the means in terms of the degrees of curvature after each cycle (p < 0.05), however this was not maintained in the fourth cycle. Statistical significance was also found when comparing the initial and final curvature after the complete treatment. We can conclude that treatment with CCH for PD is safe and effective. The concomitant use of CCH and PTT may limit the number of treatment cycles necessary to optimize outcomes when compared with CCH alone.
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Bajic P, Wiggins AB, Ziegelmann MJ, Levine LA. Characteristics of Men With Peyronie's Disease and Collagenase Clostridium Histolyticum Treatment Failure: Predictors of Surgical Intervention and Outcomes. J Sex Med 2020; 17:1005-1011. [DOI: 10.1016/j.jsxm.2020.02.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Revised: 01/28/2020] [Accepted: 02/02/2020] [Indexed: 01/16/2023]
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Abdessater M, Kanbar A, Gas J, Bart S, Coloby P, Beley S, Sleiman W. [Non-surgical management of Peyronie's disease: State of current knowledge]. Prog Urol 2020; 30:353-364. [PMID: 32279954 DOI: 10.1016/j.purol.2020.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 02/01/2020] [Accepted: 03/05/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Peyronie's disease is an inflammatory disorder of the penis, where scar tissue creates a plaque at the level of the albuginea, limits its extension, and leads to a bent and shorter penis during erections. There are no international standards for the evaluation and the treatment of the disease. The aim of this article is to review the current knowledge about the management of Peyronie's disease and to suggest an algorithm to help physicians evaluate and manage this condition. MATERIAL AND METHODS A literature review was conducted through PubMed database following PRISMA guidelines using the Mesh terms: Peyronie, disease, treatment and diagnosis. Results are presented in a descriptive manner. RESULTS Multiple treatment strategies have been proposed, but no conclusive randomized clinical trial is done to assess their efficacies. The oral treatment was shown to be more beneficial in the setting of a multi-modal approach to treat the acute phase. The non-steroidal anti-inflammatories and the potassium para-aminobenzoate are superior to the other molecules of oral therapy for pain management. Local treatment with topical verapamil, iontophoresis and intra-lesional injection of verapamil, interferon alfa-2b and collagenase clostridium histolyticum (CCH) revolutionized the management of the disease by the modification of the plaque size and angulation. Alternative treatments using extra-corporeal shock wave or traction devices are promising. Intra-lesional injection of CCH is the only therapy approved by the Food and Drug Administration for this condition after the stabilization of the disease. The channeling of the plaque before CCH injections is making better results than the initial protocol, concerning angulation improvement. CONCLUSION Multiple therapeutic strategies exist for the management of the Peyronie's disease, but they lack evidence based data. Further randomized clinical trials are needed to evaluate the current practices and to study more efficient treatments.
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Affiliation(s)
- M Abdessater
- Service d'urologie et de transplantation rénale, hôpital universitaire Pitié-Salpêtrière, AP-HP, Paris, France.
| | - A Kanbar
- Service d'urologie, groupe hospitalier diaconesses, Croix-Saint-Simon, Paris, France
| | - J Gas
- Département d'urologie, andrologie et transplantation rénale, centre hospitalier universitaire de Toulouse, Toulouse, France
| | - S Bart
- Service d'urologie, centre hospitalier René-Dubos, Pontoise, France
| | - P Coloby
- Service d'urologie, centre hospitalier René-Dubos, Pontoise, France
| | - S Beley
- Service d'urologie, groupe hospitalier diaconesses, Croix-Saint-Simon, Paris, France
| | - W Sleiman
- Service d'urologie, centre hospitalier René-Dubos, Pontoise, France
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Moussa M, Abou Chakra M, Moussa Y. Advances in stem cell therapy for the treatment of Peyronie's disease. Intractable Rare Dis Res 2020; 9:10-13. [PMID: 32201669 PMCID: PMC7062597 DOI: 10.5582/irdr.2019.01130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Peyronie's disease (PD) is a connective tissue disorder of the penis characterized by fibrosis and plaque formation within the tunica albuginea. PD is characterized by painful penile curvature that impairs sexual intercourse. Stem cell therapy is one of the recent non-invasive treatment options for patients with PD and it has promising results. Stem cells are undifferentiated cells that are capable of self-renewal and differentiation, promoting the repair of tissues via their immunomodulatory and anti-inflammatory action. Adipose-derived stem cells (ADSC) are used most widely due to their abundant tissue source and ease of isolation. Multiple studies have indicated the efficacy of stem cell therapy as a potential treatment for fibrotic diseases. Clearly, ADSCs may represent a way to treat and prevent PD in both rat and human models. Further clinical studies are needed to confirm the efficacy of stem cell therapy for PD in humans.
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Affiliation(s)
- Mohamad Moussa
- Department of Urology, Zahraa Hospital, University Medical Center, Lebanese University, Beirut, Lebanon
| | - Mohamad Abou Chakra
- Department of Urology, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
- Address correspondence to:Mohamad Abou Chakra, Department of Urology, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon. E-mail:
| | - Yasmin Moussa
- Clinic of Dermatology, Dr. Brinkmann, Schult & Samimi-Fard, Gladbeck, Germany
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Geng Q, Wang F, Han Q, Chen SF, Ouyang B, Li Z, Zhao Y, Gao QH, Yu GJ, Guo J. Antioxidant Mechanism of Xiaojin Pill () for Treatment of Peyronie's Disease in Rats Based on Matrix Metalloproteinases. Chin J Integr Med 2019; 25:671-676. [PMID: 31650486 DOI: 10.1007/s11655-019-3203-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2018] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To evaluate the effects of Xiaojin Pill () in the treatment of Peyronie's disease (PD) in a rat model. METHODS Twenty-four male Sprague-Dawley rats were randomly divided into four groups with 6 in each: sham operation, PD model, vehicle control and Xiaojin Pill groups. The rats in the sham operation group received penile tunica albsginea (TA) injection with 50 μL vehicle, while the rats in the other 3 groups received 50 μL penile TA injection of 50 μg transforming growth factor (TGF)-β1. Forty-two days after the injection, rats in the vehicle control and Xiaojin Pill groups received 0.5 mL water and Xiaojin Pill solution (107 mg/kg of body weight), respectively by gavage for 28 days, while those in the sham operation and PD model groups did not receive any intervention. After intervention, the expressions of matrix metalloproteinase 2/9 (MMP2/9), nitric oxidesynthase (NOS), superoxide dismutase (SOD) and malondialdehyde (MDA) were measured. RESULTS Rats in the PD model and vehicle control groups presented obvious fibrosis in corpus cavernosum (CC) and demonstrated a significantly increased expressions of MMP2 and MMP9 in the CC compared with the sham operation group (all P<0.01). In contrast, the expressions of MMP2 and MMP9 in the Xiaojin Pill group were significantly down-regulated (both P<0.01). In addition, the levels of NOS and MDA in CC were significantly increased while the activity of SOD was decreased in the PD model and vehicle control groups compared with the sham operation group (all P<0.01). After Xiaojin Pill treatment, the levels of MDA, NOS and SOD appeared to be corrected (all P<0.01). CONCLUSIONS Xiaojin Pill could reduce fibrosis in the CC by decreasing the expressions of MMPs, NOS and MDA, and by increasing the activity of SOD. Therefore, Xiaojin Pill might be a therapeutic option for PD.
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Affiliation(s)
- Qiang Geng
- Department of Andrology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China
| | - Fu Wang
- Department of Andrology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China
| | - Qiang Han
- Department of Andrology, Beijing's Capital Medical University Traditional Chinese Medicine Hospital, Beijing, 100010, China
| | - Shao-Feng Chen
- Department of Andrology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China
| | - Bin Ouyang
- Department of Andrology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China
| | - Zhong Li
- Department of Andrology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China
| | - Yu Zhao
- Department of Andrology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China
| | - Qing-He Gao
- Department of Andrology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China
| | - Guo-Jin Yu
- Department of Andrology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China
| | - Jun Guo
- Department of Andrology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China.
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Margolin EJ, Pagano MJ, Aisen CM, Onyeji IC, Stahl PJ. Beyond Curvature: Prevalence and Characteristics of Penile Volume-Loss Deformities in Men With Peyronie's Disease. Sex Med 2018; 6:309-315. [PMID: 30342867 PMCID: PMC6302132 DOI: 10.1016/j.esxm.2018.07.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 07/21/2018] [Accepted: 07/25/2018] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Non-curvature penile deformities associated with loss of erect penile volume are often overlooked and have not been thoroughly investigated. AIM To describe the prevalence and functional impact of penile volume-loss deformities in our cohort of men with Peyronie's disease (PD). METHODS We retrospectively examined medical records of patients with PD consecutively evaluated by a specialized urologist from December 2012 to June 2016. We excluded patients with prior surgical correction of PD, prior penile prosthesis, and inadequate erection during office examination. All patients underwent deformity assessment of the erect penis after intracavernosal injection. The assessment included measurement of penile curvature; evaluation for hourglass deformities, indentations, and distal tapering; and application of axial force to assess for penile buckling. Prior to the deformity assessment, each patient completed the Male Sexual Health Questionnaire and was asked if he experienced psychological distress and functional impairment related to his penile deformity. MAIN OUTCOME MEASURE The primary clinical parameters that we evaluated were presence or absence of axial instability, functional impairment, psychological distress, penile pain, erectile dysfunction, ejaculatory dysfunction, sexual dissatisfaction, decreased sexual activity, and decreased sexual desire. RESULTS 128 patients met criteria for inclusion. 83 patients (65%) had volume-loss deformities. Unilateral indentations, hourglass deformities, and distal tapering were present in 50 (39%), 30 (23%), and 16 (13%) patients, respectively. Penile curvature <10° degrees was present in 115 patients (90%). After controlling for angle of curvature, patients with volume-loss deformities had significantly higher rates of axial instability (odds ratio [OR] = 3.5, P = .01) and psychological distress (OR = 2.6, P = .03), as well as decreased sexual activity (OR = 2.7, P = .02), than patients with non-volume-loss deformities. CONCLUSION Volume-loss penile deformities are highly prevalent in men with PD. These deformities are associated with penile axial instability and psychological distress, which may contribute to decreased frequency of sexual activity. Margolin EJ, Pagano MJ, Aisen CM, et al. Beyond curvature: prevalence and characteristics of penile volume-loss deformities in men with Peyronie's disease. Sex Med 2018;6:309-315.
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Affiliation(s)
- Ezra J Margolin
- Department of Urology, Columbia University Medical Center, New York, NY, USA
| | - Matthew J Pagano
- Department of Urology, Columbia University Medical Center, New York, NY, USA
| | - Carrie M Aisen
- Department of Urology, Columbia University Medical Center, New York, NY, USA
| | - Ifeanyi C Onyeji
- Department of Urology, Columbia University Medical Center, New York, NY, USA
| | - Peter J Stahl
- Department of Urology, Columbia University Medical Center, New York, NY, USA.
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Reddy RS, McKibben MJ, Fuchs JS, Shakir N, Scott J, Morey AF. Plication for Severe Peyronie's Deformities Has Similar Long-Term Outcomes to Milder Cases. J Sex Med 2018; 15:1498-1505. [PMID: 30228083 DOI: 10.1016/j.jsxm.2018.08.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 08/14/2018] [Accepted: 08/14/2018] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Penile plication (PP) for Peyronie's disease (PD) is an established treatment option for mild to moderate curvature, but scant data exist regarding its utility in severe deformities. AIM To evaluate long-term outcomes among men undergoing PP for PD, comparing severe to mild/moderate penile deformities. METHODS We performed a retrospective review of patients who underwent PP for PD between 2009 and 2017. All patients underwent multiple parallel tunical plication without degloving. Severe PD was defined as either curvature ≥60 degrees or biplanar curvature ≥35 degrees. Patient demographics and surgical outcomes were analyzed. A modified PD Questionnaire and International Index of Erectile Function (IIEF)-5 were administered by telephone. MAIN OUTCOME MEASURE Long-term patient-reported outcomes were evaluated from a modified survey incorporating the PD Questionnaire and IIEF-5. RESULTS Of 327 PP patients, 102 (31%) responded to the telephone survey at a median 59.5 months (interquartile range 28.3-84) since surgery. Patients were equally distributed into severe (n = 51) and mild/moderate (n = 51) groups. Despite a greater mean degree of curvature in severe compared to mild/moderate patients (71.6 degrees vs 37.7 degrees, respectively, P < .001), correction of penile curvature was achieved in 91% of patients, with a mean change of 60.7 degrees in severe cases compared to 31.4 degrees in mild/moderate cases (P < .001). Equal numbers of patients in severe and mild/moderate groups reported improvement of penile curvature (74.5% vs 74.5%, P = 1.0) and sexual function (51.0% vs 49.0%, P = .84). PD Questionnaire metrics were likewise similar between severe and mild/moderate patients (P > .1), as were rates of subjective penile shortening (62.7% vs 62.7%, P = 1.0) and IIEF-5, both pre-operatively (19.5 vs 19.7, P = .9) and post-operatively (19.4 vs 17.6, respectively, P = .15). On multivariate logistic regression, worsening sexual function was significantly associated with increased age (odds ratio 1.07, P = .01) and pre-operative IIEF (odds ratio 1.14, P = .02). CLINICAL IMPLICATIONS PP should be considered in PD patients with severe deformities, as outcomes are favorable and comparable to those with milder curvature. STRENGTH & LIMITATIONS This is a novel study evaluating long-term patient-reported outcomes after PP, comparing patients with severe deformity to those with mild/moderate curvature. The study was limited by retrospective design, relatively low survey response rate (31%), and lack of validated post-operative PD questionnaire. CONCLUSION Long-term patient-reported outcomes of PP for severe PD deformities are comparable to mild/moderate cases, supporting broader application of PP beyond milder deformities. Reddy RS, McKibben MJ, Fuchs JS, et al. Plication for Severe Peyronie's Deformities Has Similar Long-Term Outcomes to Milder Cases. J Sex Med 2018;15:1498-1505.
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Affiliation(s)
- Rohit S Reddy
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Maxim J McKibben
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Joceline S Fuchs
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Nabeel Shakir
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jeremy Scott
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Allen F Morey
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
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Uribe A J, Vélez H A, Zuleta T J, Uribe T C. Cavernosopatía traumática crónica. Un nuevo síndrome de fibrosis peneana. UROLOGÍA COLOMBIANA 2018. [DOI: 10.1016/j.uroco.2017.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Introdución La llamada genéricamente «enfermedad de Peyronie» es un diagnóstico que explica un porcentaje de ciertos estados de fibrosis peneana grave, pero se queda corta para abarcar la amplia gama de grises de la fibrosis peneana secundaria a microtrauma sexual repetido.Objectivo Describir un nuevo síndrome por trauma repetido en el pene al que se propone denominar «cavernosopatía traumática crónica» (CTC), con 4 componentes: fibrosis (leve, moderada o grave), disfunción eréctil, curvatura y fugas venosas peneanas.Materiales y métodos Se realizó un estudio de corte transversal en una base de datos de 128 pacientes que tenían al menos una ecografía de pene con vasoactivo y en los que se había detectado algún grado de fibrosis cavernosa según la clasificación de Levine. Se evaluó la presencia de disfunción eréctil, curvas y fugas venosas según el grado de fibrosis. El estudio contó con la aprobación del Comité de Ética en Investigación.Resultados Se estudió a 128 pacientes con fibrosis, con 51,3 años de edad promedio (DE = 13). El grado de fibrosis fue leve (Levine 1) en 30 (23,43%), moderado (Levine 2) en 23 (17,96%) y grave (Levine 3) en 75 (58,6%). Se demostró que, a mayor fibrosis, mayor disfunción eréctil, 66,6; 83,6 y 96% para Levine 1, 2 y 3, respectivamente (p ≤ 0,0001). La frecuencia de curvatura secundaria (n = 71) fue de 0; 4,2 y 95,7% para Levine 1, 2 y 3, respectivamente (p ≤ 0,0001). La frecuencia en los 44 pacientes con fugas cavernosas fue de 9; 20,4 y 70,4% (p = 0,0060) y en los 15 de fugas dorsales fue de 80; 13,3 y 6,6% (p < 0,0001) para Levine 1, 2 y 3 respectivamente. El grupo de 79 pacientes (64,03%) con mayor posibilidad de CTC, con presencia de 3 o 4 criterios que incluyeran curvatura secundaria y fuga cavernosa, tuvo un promedio de edad de 59,2 años (DE = 8,7), comparado con 41,7 años (DE = 11,7) en el grupo de menor posibilidad, diferencia estadísticamente significativa (p ≤ 0,0001).Conclusiones Proponemos que existe un síndrome de microtrauma repetido en el pene, que puede denominarse CTC, análogo a la encefalopatía traumática crónica, con 4 componentes: fibrosis cavernosa, disfunción eréctil, curvatura peneana y fugas venosas. La fibrosis es un continuum que el paciente recorre por fases leves y moderadas, a menudo inapreciables para los clínicos. Las curvaturas secundarias y las fugas cavernosas están relacionadas directamente con el grado de fibrosis y con mayor riesgo de disfunción eréctil. La edad empeora algunos factores de la CTC.
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Affiliation(s)
- Juan Uribe A
- Servicio de Urología, Hospital Pablo Tobón Uribe, Medellín, Colombia
| | - Alejandro Vélez H
- Servicio de Patología, Hospital Pablo Tobón Uribe, Medellín, Colombia
| | - John Zuleta T
- Servicio de Epidemiología, Hospital Pablo Tobón Uribe, Medellín, Colombia
| | - Carlos Uribe T
- Servicio de Medicina Sexual, Hospital Pablo Tobón Uribe, Medellín, Colombia
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Sansalone S, Loreto C, Leonardi R, Vespasiani G, Musumeci G, Lombardo C, Castorina S, Cardile V, Caltabiano R. Microsurgical tunica albuginea transplantation in an animal model. Asian J Androl 2018; 19:694-699. [PMID: 28139472 PMCID: PMC5676430 DOI: 10.4103/1008-682x.192034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Several andrological diseases require surgical repair or reconstruction of tunica albuginea, which envelops the corpora cavernosa penis. Despite intense research efforts involving a variety of biological materials, such as skin, muscle aponeurosis, human dura mater, tunica vaginalis, and pericardium, engineered tunica albuginea suitable for graft use is yet to be obtained. The study investigates microsurgical tunica albuginea allotransplantation in an animal model with the purpose of creation of an organ-specific tissue bank to store penile tissue, from cadaveric donors and male-to-female trans-sexual surgery, for allogeneic transplantation. Materials were tunica albuginea tissue explanted from 15 donor rats, cryopreserved at −80°C, gamma-irradiated, and implanted in 15 recipient rats, of which three rats were used as controls. Penile grafts were explanted at different time intervals; after macroscopic evaluation of the organ, the grafts were processed to morphological, histochemical, and immunohistochemical examinations by light microscopy. Detection of pro-inflammatory cytokines was also performed. Examination of the tunica albuginea allografts collected 1, 3, or 6 months after surgery and of control tunica albuginea fragments showed that tunica albuginea implants achieved biointegration with adjacent tissue at all-time points. The integration of cryopreserved rat tunica albuginea allografts, documented by our study, encourages the exploration of tunica albuginea allotransplantation in humans. In conclusion, the effectiveness and reliability of the tunica albuginea conditioning protocol described here suggest the feasibility of setting up a tunica albuginea bank as a further tissue bank.
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Affiliation(s)
- Salvatore Sansalone
- Department of Experimental Medicine and Surgery, Tor Vergata University, Rome, Italy
| | - Carla Loreto
- Department of Biomedical and Technological Sciences, Section of Human Anatomy and Histology, University of Catania, Catania, Italy
| | | | - Giuseppe Vespasiani
- Department of Experimental Medicine and Surgery, Tor Vergata University, Rome, Italy
| | - Giuseppe Musumeci
- Department of Biomedical and Technological Sciences, Section of Human Anatomy and Histology, University of Catania, Catania, Italy
| | - Claudia Lombardo
- Department of Biomedical and Technological Sciences, Section of Human Anatomy and Histology, University of Catania, Catania, Italy
| | - Sergio Castorina
- Department of Biomedical and Technological Sciences, Section of Human Anatomy and Histology, University of Catania, Catania, Italy
| | - Venera Cardile
- Department of Bio-Medical Sciences, Section of Physiology, University of Catania, Catania, Italy
| | - Rosario Caltabiano
- Department of Medical and Surgical Sciences and Advanced Technology "G.F. Ingrassia", Section of Anatomic Pathology, University of Catania, Catania, Italy
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Beilan JA, Wallen JJ, Baumgarten AS, Morgan KN, Parker JL, Carrion RE. Intralesional Injection of Collagenase Clostridium histolyticum May Increase the Risk of Late-Onset Penile Fracture. Sex Med Rev 2018; 6:272-278. [DOI: 10.1016/j.sxmr.2017.07.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 07/23/2017] [Accepted: 07/23/2017] [Indexed: 11/25/2022]
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Ziegelmann MJ, Alom M, Hebert K, Avant R, Köhler T, Trost L. Clinical Factors Negatively Impacting Sexual Relationships in Men With Peyronie's Disease. JOURNAL OF SEX & MARITAL THERAPY 2018; 44:468-474. [PMID: 29144850 DOI: 10.1080/0092623x.2017.1405312] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Here, we sought to identify clinical factors associated with a negative impact on the relationships patients with Peyronie's disease (PD) have with their partners. During initial consultation, a detailed sexual questionnaire was administered, which included a question on whether or not PD negatively impacted the current sexual relationship. More than half (146/242; 60.3%) of patients reported that PD negatively impacted their sexual relationship. On multivariate analysis, penile shortening, partner pain with intercourse, and shorter relationship duration were associated with a negative relationship effect. We did not identify significant differences in negative relationship effects based on objective physical examination findings including penile curvature, calcification, hourglass deformity, or penile length.
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Affiliation(s)
| | - Manaf Alom
- a Department of Urology , Mayo Clinic , Rochester , MN, USA
| | - Kevin Hebert
- a Department of Urology , Mayo Clinic , Rochester , MN, USA
| | - Ross Avant
- a Department of Urology , Mayo Clinic , Rochester , MN, USA
| | - Tobias Köhler
- a Department of Urology , Mayo Clinic , Rochester , MN, USA
| | - Landon Trost
- a Department of Urology , Mayo Clinic , Rochester , MN, USA
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Safety Profile of Collagenase Clostridium Histolyticum Stratified by Degree of Penile Curvature in Patients With Peyronie Disease. Urology 2017; 106:237.e9-237.e14. [DOI: 10.1016/j.urology.2017.05.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 05/01/2017] [Accepted: 05/02/2017] [Indexed: 11/17/2022]
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Madbouly K, AlHajeri D, Habous M, Binsaleh S. Association of the modified frailty index with adverse outcomes after penile prosthesis implantation. Aging Male 2017; 20:119-124. [PMID: 28590832 DOI: 10.1080/13685538.2017.1292499] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES To investigate frailty as a predictor of surgical outcome in elderly patients undergoing penile prosthesis implantation. MATERIAL AND METHODS A total of 54 elderly patients, above 60 years of age, underwent penile prosthesis implantation between 2012 and 2014. Their data were collected and retrospectively analyzed. A modified frailty index (mFI) was calculated for each patient based on 11 risk factors from the Canadian Study of Health and Aging Frailty Index. The 1-year adverse outcomes were correlated with mFI, patients' and procedure's risk factors. RESULTS Mean age was 64.9 ± 5.2 years. No mortality was reported in our patients, however, one-year adverse outcomes were encountered in 43 (79.6%) patients. Among all studied variables, the 1-year adverse outcomes was not significantly association with mFI, but with preoperative glycosylated hemoglobin A1c (HbA1c) (p = 0.031) and associated Peyronie's disease (PD) (p = 0.000). HbA1c, dyslipidemia, hypertension, PD and duration of the procedure were predictive of infection complications (p < 0.05). Only PD and HbA1c sustained an independent significant impact. CONCLUSIONS mFI is not a predictive of post-penile prosthesis implantation adverse outcomes in elderly patients with impotence. Degree of diabetic control and association with PD was associated with the 1-year adverse outcomes and infection complications.
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Affiliation(s)
- Khaled Madbouly
- a Department of Urology , Prince Mohammed Bin Abdulaziz Hospital , Riyadh , Saudi Arabia
| | - Dulaim AlHajeri
- b Division of Urology , Department of Surgery, Faculty of Medicine, King Saud University , Riyadh , Saudi Arabia , and
| | - Mohamad Habous
- c Urology Department, Elaj Medical Group , Jeddah , Saudi Arabia
| | - Saleh Binsaleh
- b Division of Urology , Department of Surgery, Faculty of Medicine, King Saud University , Riyadh , Saudi Arabia , and
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Kuhlmann PK, DeLay KJ, Anaissie J, Hellstrom WJG, Yafi FA. Collagenase Clostridium histolyticum in the treatment of Peyronie's disease: patient selection and perspectives. Patient Prefer Adherence 2017; 11:431-448. [PMID: 28280315 PMCID: PMC5338950 DOI: 10.2147/ppa.s113507] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The safety and efficacy of the use of collagenase Clostridium histolyticum (CCH) for the treatment of Peyronie's disease has been confirmed over the past several years. However, identification of the ideal patient population for use of this treatment is not well established. Multiple studies have attempted to delineate various patient-specific factors that may predict response to treatment with CCH, with the intent of enhancing patient selection. To date, these include baseline curvature severity, duration of disease, disease phase at presentation, plaque calcification, baseline erectile function, plaque size, age, comorbid diabetes, previous penile trauma, responsiveness to first treatment cycle, baseline penile shortening or pain, prior treatment with intralesional injection, compliance with plaque modeling, and atypical curvature. In addition, other studies have sought to explore various aspects of treatment with CCH that may affect patient perspective of treatment. They have focused on patient-reported outcomes, female partner considerations, cost of treatment, and potential confounders of patient satisfaction. This review provides a summary and analysis of currently available literature on topics of patient selection and perspectives in regard to treatment of Peyronie's disease with CCH.
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Affiliation(s)
- Paige K Kuhlmann
- University of Missouri-Columbia School of Medicine, Columbia, MO
| | - Kenneth J DeLay
- Department of Urology, Tulane University School of Medicine, New Orleans, LA
| | - James Anaissie
- Department of Urology, Tulane University School of Medicine, New Orleans, LA
| | - Wayne JG Hellstrom
- Department of Urology, Tulane University School of Medicine, New Orleans, LA
| | - Faysal A Yafi
- Department of Urology, University of California Irvine, Orange, CA, USA
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Anaissie J, Yafi FA, Traore EJ, Sikka SC, Hellstrom WJG. Survey of patient and partner satisfaction following collagenase Clostridium histolyticum
treatment for Peyronie's disease. Andrology 2017; 5:274-277. [DOI: 10.1111/andr.12302] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 09/16/2016] [Accepted: 10/20/2016] [Indexed: 11/29/2022]
Affiliation(s)
- J. Anaissie
- Department of Urology; Tulane University School of Medicine; New Orleans LA USA
| | - F. A. Yafi
- Department of Urology; University of California at Irvine; Orange CA USA
| | - E. J. Traore
- Department of Urology; Tulane University School of Medicine; New Orleans LA USA
| | - S. C. Sikka
- Department of Urology; Tulane University School of Medicine; New Orleans LA USA
| | - W. J. G. Hellstrom
- Department of Urology; Tulane University School of Medicine; New Orleans LA USA
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A pilot study of penile hemodynamics in men with penile curvatures. Int J Impot Res 2017; 29:86-88. [PMID: 28077881 DOI: 10.1038/ijir.2016.52] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Revised: 05/17/2016] [Accepted: 12/01/2016] [Indexed: 11/08/2022]
Abstract
Penile curvature (PC) is bothersome to the patient. PC is either congenital or acquired. In most of the circulatory system, blood flows in a laminar profile with minimal energy expenditure. When a fluid passes in a curved tube, the laminar profile is disturbed and changed into a turbulent flow. It increases the energy expenditure and reduces the flow. Turbulent flow may have a role in the development of an atherosclerotic plaque and in localizing its site. The aim of this research was to study penile hemodynamics before and after correction of PC. This prospective study included 20 participants, with PC more than 30°. For each participant, preoperative color duplex doppler ultrasonography (CDDU), correction of the curvature using 16 dot plication technique and post-operative CDDU were done. Furhtermore, arterial systolic velocity was estimated distal to the site of curvature/correction every 5 min for 25 min. The degree of curvature ranged from 30° to 90° with a mean of 55±18.98. Comparative study between the preoperative and post-operative data proved a significantly higher postoperative peak systolic velocity distal to the site of correction, whereas CDDU data had insignificant differences. We concluded that correction of PC is associated with improvement of penile arterial blood flow distal to the site of correction.
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Al-Thakafi S, Al-Hathal N. Peyronie's disease: a literature review on epidemiology, genetics, pathophysiology, diagnosis and work-up. Transl Androl Urol 2016; 5:280-9. [PMID: 27298774 PMCID: PMC4893516 DOI: 10.21037/tau.2016.04.05] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Accepted: 03/25/2016] [Indexed: 12/28/2022] Open
Abstract
Peyronie's disease (PD), a fibromatous disorder of the tunica albuginea of the penile corpus cavernosum, named after the French physician Francois de la Peyronie, is characterized by pain, plaque formation, penile curvature, and plaque calcification. The epidemiological data on PD is inconsistent, with recent reports stating a prevalence of up to 9%, and the condition affecting men of all ages, from teenagers to septuagenarians. We are just beginning to elucidate the role of genetics as a causative factor for PD. Chromosomal abnormalities and single-nucleotide polymorphisms have been shown to be associated with fibrotic diatheses. Tunical mechanical stress and microvascular trauma are major contributory factors to the pathophysiology of PD. The diagnosis of PD can be made using a combination of clinical history, physical examination and, sometimes, imaging modalities. A better understanding of the molecular pathophysiology of this condition remains paramount for the development of newer and more effective disease-targeted interventions.
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Ostrowski KA, Gannon JR, Walsh TJ. A review of the epidemiology and treatment of Peyronie's disease. Res Rep Urol 2016; 8:61-70. [PMID: 27200305 PMCID: PMC4857830 DOI: 10.2147/rru.s65620] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Introduction Peyronie’s disease (PD) has significant effect on patients and their partners. We provide a current review of the epidemiology as well as the nonsurgical and surgical treatment of PD. Materials and methods Review of literature pertaining to PD with focus on epidemiology and treatment options. Conclusion PD is common and likely underreported. The availability of new and highly effective treatment options will catalyze patient awareness and subsequently the prevalence of disease.
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Affiliation(s)
| | - John R Gannon
- Department of Urology, University of Washington, Seattle, WA, USA
| | - Thomas J Walsh
- Department of Urology, University of Washington, Seattle, WA, USA
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36
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Yafi FA, Anaissie J, Zurawin J, Sikka SC, Hellstrom WJ. Results of SMSNA Survey Regarding Complications Following Intralesional Injection Therapy With Collagenase Clostridium Histolyticum for Peyronie’s Disease. J Sex Med 2016; 13:684-9. [DOI: 10.1016/j.jsxm.2016.02.105] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 01/29/2016] [Accepted: 02/04/2016] [Indexed: 01/24/2023]
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Peak TC, Mitchell GC, Yafi FA, Hellstrom WJ. Role of collagenase clostridium histolyticum in Peyronie's disease. Biologics 2015; 9:107-16. [PMID: 26491251 PMCID: PMC4598203 DOI: 10.2147/btt.s65619] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Peyronie's disease is a localized connective tissue disease characterized by an active, inflammatory phase and a stable, quiescent phase, with the eventual development of collagenous plaques within the tunica albuginea of the penis. Risk factors primarily associated with Peyronie's disease include Dupuytren's contracture, penile trauma, and family history. A variety of treatment strategies have been utilized, including oral and topical agents, electromotive drug administration, intralesional injections, extracorporeal shockwave therapy, penile traction, and surgery. However, most of these strategies are ineffective, with surgery being the only definitive treatment. Collagenase clostridium histolyticum is a newly US Food and Drug Administration-approved agent for intralesional injection. It is thought to downregulate many of the disease-related genes, cytokines, and growth factors and degrade collagen fibers. It also suppresses cell attachment, spreading, and proliferation. Collagenase clostridium histolyticum has been clinically proven to be a safe and effective therapeutic option, demonstrating decreases in penile curvature and plaque consistency, as well as increases in patient satisfaction. During clinical evaluation, the Peyronie's Disease Questionnaire was validated as an effective tool for assessing treatment outcomes.
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Affiliation(s)
- Taylor C Peak
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Gregory C Mitchell
- Section of Andrology, Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Faysal A Yafi
- Section of Andrology, Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Wayne J Hellstrom
- Section of Andrology, Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA
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Libby RP, Yafi FA, Anaissie J, Hellstrom WJG. Evaluation of collagenase Clostridium histolyticum for the treatment of Peyronie’s disease. Expert Opin Orphan Drugs 2015. [DOI: 10.1517/21678707.2015.1092870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Lipshultz LI, Goldstein I, Seftel AD, Kaufman GJ, Smith TM, Tursi JP, Burnett AL. Clinical efficacy of collagenase Clostridium histolyticum in the treatment of Peyronie's disease by subgroup: results from two large, double-blind, randomized, placebo-controlled, phase III studies. BJU Int 2015; 116:650-6. [PMID: 25711400 DOI: 10.1111/bju.13096] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVES To examine the efficacy of intralesional collagenase Clostridium histolyticum (CCH) in defined subgroups of patients with Peyronie's disease (PD). PATIENTS AND METHODS The efficacy of CCH compared with placebo, assessed from baseline to week 52, was examined in subgroups of participants from the Investigation for Maximal Peyronie's Reduction Efficacy and Safety Studies (IMPRESS) I and II. The subgroups were defined according to: severity of penile curvature deformity at baseline (30-60° [n = 492] and 61-90° [n = 120]); PD duration (1 to ≤2 [n = 201], >2 to ≤4 [n = 212] and >4 years [n = 199]); degree of plaque calcification (no calcification [n = 447], non-contiguous stippling [n = 103] and contiguous calcification that did not interfere with injection of CCH [n = 62]); and baseline erectile function (International Index of Erectile Function [IIEF] scores 1-5 [n = 22], 6-16 [n = 106] and ≥17 [n = 480]). RESULTS Reductions in penile curvature deformity and PD symptom bother were observed in all subgroups. Penile curvature deformity reductions were significantly greater with CCH than with placebo for the following subgroups: baseline penile curvature 30-60° and 61-90°; disease duration >2 to ≤4 years and >4 years; no calcification; and IIEF score ≥17 (high IIEF-erectile function score; P < 0.05 for all). PD symptom bother reductions were significantly greater in the CCH group for: penile curvature 30-60°; disease duration >4 years; no calcification; and IIEF score 1-5 (no sexual activity) and ≥17 (P < 0.05 for all). CONCLUSIONS In this analysis, clinical efficacy of CCH treatment for reducing penile curvature deformity and PD symptom bother was found across subgroups. In the IMPRESS I and II overall, adverse events (AEs) were typically mild or moderate, although treatment-related serious AEs, including corporal rupture or penile haematoma, occurred. Future studies could be considered to directly assess the efficacy and safety of CCH treatment in defined subgroups of PD patients, with the goal of identifying predictors of optimum treatment success.
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Affiliation(s)
- Larry I Lipshultz
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA
| | - Irwin Goldstein
- San Diego Sexual Medicine, Alvarado Hospital, San Diego, CA, USA
| | | | | | - Ted M Smith
- Auxilium Pharmaceuticals, Inc., Chesterbrook, PA, USA
| | - James P Tursi
- Auxilium Pharmaceuticals, Inc., Chesterbrook, PA, USA
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Carson CC, Sadeghi-Nejad H, Tursi JP, Smith TM, Kaufman GJ, Gilbert K, Honig SC. Analysis of the clinical safety of intralesional injection of collagenaseClostridium histolyticum(CCH) for adults with Peyronie's disease (PD). BJU Int 2015; 116:815-22. [DOI: 10.1111/bju.13120] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Culley C. Carson
- Department of Surgery; University of North Carolina; Chapel Hill NC USA
| | - Hossein Sadeghi-Nejad
- Rutgers New Jersey Medical School and Hackensack University Medical Center; Hackensack NJ USA
| | | | | | | | | | - Stanton C. Honig
- Department of Urology; Yale University School of Medicine; New Haven CT USA
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41
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Goldstein I, Hartzell R, Shabsigh R. The Impact of Peyronie's Disease on the Patient: Gaps in Our Current Understanding. JOURNAL OF SEX & MARITAL THERAPY 2015; 42:178-190. [PMID: 25405853 DOI: 10.1080/0092623x.2014.985351] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Peyronie's disease results in a fibrous inelastic scar or hard plaque of the tunica albuginea of the penis that causes penile curvature deformity during erection that can be painful, distressing, and an impediment to sexual intercourse. In this article, the authors examine the knowledge gaps and research needs regarding the effect of Peyronie's disease on the patient's physical and psychological quality of life and on interpersonal relationships. On PubMed, the authors used the search terms Peyronie's disease, psychological, psychotherapy, male sexual dysfunction, partner, comorbid disease, satisfaction, and pain. Four categories describing the effect of Peyronie's disease were identified: (a) sexual dysfunction due to pain and altered penile shape, (b) psychological effects, (c) partner and relationship effects, and (d) effects of treatment options for Peyronie's disease. Results indicate that the examination of interventions aimed at education, coping, relationship distress, and sex therapy that may significantly improve patient quality of life is a core unmet need in Peyronie's disease. For many patients, the effect of Peyronie's disease is functional and psychological. Both aspects should be evaluated and treated in patients, which may require a referral. The physical pain, emotional distress and isolation, and partner and relationship discord that may be present require more attention.
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Affiliation(s)
- Irwin Goldstein
- a San Diego Sexual Medicine , Alvarado Hospital , San Diego , California , USA
| | - Rose Hartzell
- a San Diego Sexual Medicine , Alvarado Hospital , San Diego , California , USA
| | - Ridwan Shabsigh
- b Department of Surgery , St. Barnabas Hospital , Bronx , New York , USA
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42
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Levine LA, Larsen SM. Surgical Correction of Persistent Peyronie's Disease Following Collagenase Clostridium Histolyticum Treatment. J Sex Med 2015; 12:259-64. [DOI: 10.1111/jsm.12721] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Hartzell R. Psychosexual Symptoms and Treatment of Peyronie's Disease Within a Collaborative Care Model. Sex Med 2014; 2:168-77. [PMID: 25548648 PMCID: PMC4272248 DOI: 10.1002/sm2.45] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Peyronie's disease (PD) can be emotionally and sexually debilitating for patients and may negatively impact partner relationships. AIMS This study aims to present an ongoing collaborative care model for patients with PD and to discuss the critical need for integration of patient care among sexual medicine physicians and mental health practitioners or sex therapists. METHODS PubMed searches using the terms "Peyronie's disease" and "natural history," "treatment," "psychosexual," "depression," "relationship," and "partner" were conducted. Expert opinion based on review of the relevant published literature and clinical experience was used to identify meaningful treatment targets for patients with PD within a collaborative care model. MAIN OUTCOME MEASURE Characteristics of PD, medical treatment, and important assessment and treatment targets, including physical, emotional, psychosexual, and relationship concerns, from peer-reviewed published literature and clinical experience. RESULTS PD can result in significant patient and partner distress and relationship disruption. Sex therapy interventions may be directed at acute emotional, psychosexual, and relationship problems that occur during the initial diagnosis of PD, the period following minimally invasive or surgical treatment for PD, or recurring problems over the lifelong course of the disease. Sex therapy to improve self-acceptance, learn new forms of sexual intimacy, and improve communication with partners provides comprehensive treatment targeting emotional, psychosexual, and relationship distress. Ongoing communication between the mental health practitioner and physician working with the patient with PD about key assessments, treatment targets, and treatment responses is necessary for coordinated treatment planning and patient care. CONCLUSIONS Men with PD are more likely now than in the past to see both a sexual medicine physician and a mental health practitioner or sex therapist, and the integration of assessments and treatment planning is essential for optimal patient outcomes.
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Gokce A, Abd Elmageed ZY, Lasker GF, Bouljihad M, Kim H, Trost LW, Kadowitz PJ, Abdel-Mageed AB, Sikka SC, Hellstrom WJ. Adipose tissue-derived stem cell therapy for prevention and treatment of erectile dysfunction in a rat model of Peyronie's disease. Andrology 2014; 2:244-51. [PMID: 24574095 DOI: 10.1111/j.2047-2927.2013.00181.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Revised: 11/27/2013] [Accepted: 12/16/2013] [Indexed: 12/14/2022]
Abstract
Peyronie's disease (PD) is a localized connective tissue disorder that involves the tunica albuginea (TA) of the penis. While surgical correction remains the gold standard, the search for an effective and less invasive therapy continues. The objective of this study was to evaluate the effects of intratunical injection of adipose tissue-derived stem cells (ADSCs) for the prevention and treatment of erectile dysfunction in a rat model of PD. Twenty-four male Sprague-Dawley rats (300-350 g) were randomly divided into four groups: sham, PD, PD + ADSC (prevention) and PD + ADSC (treatment). All rats underwent penile injections into the TA with 50 μL vehicle (sham) or 0.5 μg transforming growth factor (TGF)-β1 (remaining groups). The ADSC groups received intratunical injections with 0.5 million rat-labelled ADSCs on day 0 (prevention) or day 30 (treatment). Forty-five days following TGF-β1 injection, rats underwent cavernous nerve stimulation (CNS) with total intracavernous-to-mean arterial pressure ratio (ICP/MAP) and total ICP recorded to measure response to therapy. Tissues were evaluated histologically and for mRNA expression of tissue inhibitors of metalloproteinases (TIMPs), matrix metalloproteinases (MMPs) and zymographic activity of MMPs. Statistical analysis was performed by analysis of variance followed by the Tukey test for post hoc comparisons. In both prevention and treatment groups, intratunical injection of ADSCs resulted in significantly higher ICP/MAP and total ICP in response to CNS compared with the PD group. Local injection of ADSCs prevented and/or reduced Peyronie's-like changes by decreasing the expression of TIMPs, and stimulating expression and activity of MMPs. This study documents the preventive and therapeutic benefits of ADSC on penile fibrosis and erectile function in an animal model of PD.
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Affiliation(s)
- A Gokce
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA
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Levine LA, Cuzin B, Mark S, Gelbard MK, Jones NA, Liu G, Kaufman GJ, Tursi JP, Ralph DJ. Clinical safety and effectiveness of collagenase clostridium histolyticum injection in patients with Peyronie's disease: a phase 3 open-label study. J Sex Med 2014; 12:248-58. [PMID: 25388099 DOI: 10.1111/jsm.12731] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Collagenase clostridium histolyticum (CCH; Xiaflex, Auxilium Pharmaceuticals, Inc., Chesterbrook, PA, USA) is a Food and Drug Administration-approved, intralesional treatment for Peyronie's disease (PD). AIM The aim of this study was to assess the safety and effectiveness of CCH in the treatment of PD. METHODS This phase 3, open-label study enrolled subjects who were CCH-naïve, were enrolled in a previous pharmacokinetic study, or had received placebo in an earlier phase 2 CCH study. Each treatment cycle included two intralesional injections of CCH 0.58 mg, approximately 24-72 hours apart, and plaque modeling 24-72 hours after the second injection of each cycle. The treatment cycle was repeated after 6 weeks for ≤4 treatment cycles. MAIN OUTCOME MEASURES The co-primary end points were the mean percent change in penile curvature deformity and the mean improvement in PD bother score (range 0-16) from baseline to week 36. RESULTS Of the 347 subjects treated with ≥1 injection, 238 had both a penile curvature measurement and a Peyronie's Disease Questionnaire response at baseline and ≥1 subsequent time point. Mean baseline penile curvature deformity was 53.0° and mean PD symptom bother was 7.3. Statistically significant mean improvements from baseline to week 36 were observed in both penile curvature deformity (34.4% [95% confidence interval {CI}, 31.2%, 37.6%]) and PD symptom bother score (3.3 [95% CI, 2.8, 3.7]). Most adverse events (AEs) were mild or moderate in severity and local to the penis. There were three serious treatment-related AEs, two penile hematomas and one corporal rupture; all resolved with treatment. CONCLUSIONS Potentially clinically meaningful and statistically significant improvements in penile curvature deformity and PD symptom bother scores were observed with intralesional injection of CCH compared with baseline in men with PD. CCH was generally well tolerated, with AEs primarily transient and local to injection site. In conjunction with previous studies, the results of this open-label study support the use of CCH in the treatment of PD.
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Affiliation(s)
- Laurence A Levine
- Department of Urology, Rush University Medical Center, Chicago, IL, USA
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Egui Rojo MA, Moncada Iribarren I, Carballido Rodriguez J, Martinez-Salamanca JI. Experience in the use of collagenase clostridium histolyticum in the management of Peyronie's disease: current data and future prospects. Ther Adv Urol 2014; 6:192-7. [PMID: 25276229 DOI: 10.1177/1756287214537331] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Peyronie's disease (PD) is a chronic wound-healing disorder characterized by formation of fibrous inelastic scarring of the tunica albuginea resulting in a variety of penile deformities. In most cases, PD is accompanied by a physical and psychological impact. Xiaflex® is an injectable collagenase clostridium histolyticum (CCh) preparation consisting of a predetermined mixture of two distinct collagenases. Recently the US Food and Drug Administration (FDA) approved Xiaflex® for the nonsurgical treatment of men with PD with curvature of 30° or more and tangible scar tissue plaque in their penis. METHOD This article presents a comprehensive review of the updated information on the use of Xiaflex® for the nonsurgical treatment of PD. RESULTS Mean improvements in penile curvature ranging from 29% to 34% and in bother domain scores have been reported. The majority of the reported adverse effects are mild or moderate and 79% resolve without intervention. CONCLUSION The combined results of these trials have led to the FDA approval of CCh for the treatment of PD. However, the long-term effects and results need further investigation, with large follow-up series. Considering these results, future perspectives will probably result in the use of a combined or sequential therapy including CCh.
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Affiliation(s)
| | | | | | - Juan Ignacio Martinez-Salamanca
- Department of Urology, Hospital Puerta de Hierro-Majadahonda, Universidad Autónoma de Madrid, C/ Manuel de Falla no. 1, Majadahonda 28222, Madrid, Spain
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Jordan GH, Carson CC, Lipshultz LI. Minimally invasive treatment of Peyronie's disease: evidence-based progress. BJU Int 2014; 114:16-24. [DOI: 10.1111/bju.12634] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Gerald H. Jordan
- Department of Urology; Eastern Virginia Medical School; Norfolk VA USA
| | - Culley C. Carson
- Division of Urologic Surgery; University of North Carolina; Chapel Hill NC USA
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Abstract
The aims of the present review were to assess the literature on published outcomes and complications associated with surgical treatments for Peyronie's disease (PD) and to assist clinicians in the effective management of PD by increasing understanding and awareness of the outcomes associated with current surgical treatment options. A PubMed literature search was conducted to identify relevant, peer-reviewed clinical and review articles published between January 1980 and October 2013 related to outcomes of surgical correction of PD. Search terms for this non-systematic review included 'Peyronie's disease', 'outcomes', 'complications', 'erectile dysfunction or ED', 'patient expectation', and 'patient satisfaction'; search terms were searched separately and in combination. Case studies and editorials were excluded, primary manuscripts and reviews were included, and bibliographies of articles of interest were reviewed and key references were obtained. Assessment of the study design, methodology, clinical relevance and impact on the surgical outcomes of PD was performed on the sixty-one articles that were selected and analysed. Currently, there are several investigational minimally invasive and non-surgical treatment options for PD; however, surgical treatment remains the standard of care for patients with stable disease and disabling deformity or drug-resistant erectile dysfunction. Each of the different surgical procedures that are used for treatment of PD, including tunical shortening, tunical lengthening (plaque incisions or partial excision and grafting), and use of inflatable penile prostheses, carries its own advantages and disadvantages in terms of potential complications and postoperative satisfaction. Because of the variety of ways that PD may present in affected patients, no single, standard, surgical treatment for this disorder has prevailed and multiple variations of each type of procedure may exist. Surgical outcomes of the most commonly used procedures are not substantially different; therefore, the appropriateness of each treatment option may often depend on disease and patient characteristics (e.g. deformity and erectile function). Surgical algorithms have been published to guide surgeons and patients through the selection of surgical procedures in the absence of conclusive, long-term outcome data. Accumulating data on outcomes associated with established procedures, modifications to these procedures, and new surgical techniques and materials may serve to further guide practice and refine evidence-based selection of the surgical approach.
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Affiliation(s)
- Culley C Carson
- Department of Surgery, Division of Urologic Surgery, University of North Carolina School of Medicine, Chapel Hill, NC, USA
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Ko YH, Moon KH, Lee SW, Kim SW, Yang DY, Moon DG, Chung WS, Oh KJ, Hyun JS, Ryu JK, Park HJ, Park K. Urologists' Perceptions and Practice Patterns in Peyronie's Disease: A Korean Nationwide Survey Including Patient Satisfaction. Korean J Urol 2014; 55:57-63. [PMID: 24466399 PMCID: PMC3897632 DOI: 10.4111/kju.2014.55.1.57] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Accepted: 09/23/2013] [Indexed: 11/18/2022] Open
Abstract
PURPOSE A nationwide survey was conducted of Korean urologists to illustrate physicians' perceptions and real practical patterns regarding Peyronie disease (PD). MATERIALS AND METHODS A specially designed questionnaire exploring practice characteristics and attitudes regarding PD, as well as patient satisfaction with each treatment modality, was e-mailed to 2,421 randomly selected urologists. RESULTS Responses were received from 385 practicing urologists (15.9%) with a median time after certification as an urologist of 12 years. Regarding the natural course, 87% of respondents believed that PD is a progressive disease, and 82% replied that spontaneous healing in PD occurred in fewer than 20% of patients. Regarding diagnosis of PD, the methods used were, in order, history taking with physical examination (98%), International Index of Erectile Function questionnaires (40%), intracavernous injection and stimulation (35%), and duplex sonography (28%). Vitamin E was most preferred as an initial medical management (80.2%), followed by phosphodiesterase-5 inhibitors (27.4%) and Potaba (aminobenzoate potassium, 20.1%). For urologists who administered intralesional injection, the injected agent was, in order, corticosteroid (72.2%), verapamil (45.1%), and interferon (3.2%). The most frequently performed surgical procedure was plication (84.1%), followed by excision and graft (42.9%) and penile prosthesis implantation (14.2%). Among the most popular treatments in each modality, the urologists' perceptions regarding the suitability of treatment and patient satisfaction were significantly different, favoring plication surgery. CONCLUSIONS The practice pattern of urologists depicted in this survey is in line with currently available Western guidelines, which indicates the need for development of further local guidelines based on solid clinical data.
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Affiliation(s)
- Young Hwii Ko
- Department of Urology, Yeungnam University College of Medicine, Daegu, Korea
| | - Ki Hak Moon
- Department of Urology, Yeungnam University College of Medicine, Daegu, Korea
| | - Sung Won Lee
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sae Woong Kim
- Department of Urology, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Dae Yul Yang
- Department of Urology, Hallym University College of Medicine, Chuncheon, Korea
| | - Du Geon Moon
- Department of Urology, Korea University College of Medicine, Seoul, Korea
| | - Woo Sik Chung
- Department of Urology, Ewha Womans University School of Medicine, Seoul, Korea
| | - Kyung Jin Oh
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | - Jae Seog Hyun
- Department of Urology, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Ji Kan Ryu
- Department of Urology, Inha University School of Medicine, Incheon, Korea
| | - Hyun Jun Park
- Department of Urology, Busan National University School of Medicine, Yangsan, Korea
| | - Kwangsung Park
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
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Effects of sildenafil treatment on patients with Peyronie’s disease and erectile dysfunction. Ir J Med Sci 2013; 183:449-53. [DOI: 10.1007/s11845-013-1036-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Accepted: 10/28/2013] [Indexed: 11/30/2022]
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