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Paulis G, De Giorgio G, Paulis A. Clinical Presentation of Peyronie's Disease: A Retrospective Study of 564 Cases. Diagnostics (Basel) 2024; 14:1125. [PMID: 38893650 PMCID: PMC11172383 DOI: 10.3390/diagnostics14111125] [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: 05/10/2024] [Revised: 05/26/2024] [Accepted: 05/28/2024] [Indexed: 06/21/2024] Open
Abstract
Peyronie's disease (PD) affects the penile albuginea, resulting in penile deformity, pain, erectile dysfunction (ED), and an anxious-depressive state. PD diagnosis involves a thorough medical history, penile palpation, documentation of the penile deformation, a dynamic penile echo color Doppler ultrasound (PCDU), and the completion of questionnaires for the evaluation of pain, ED, and psychometric tests. The aim of this study was to evaluate the symptoms of PD and their prevalence in PD patients in the active phase who had access to our andrology clinic. Inclusion criteria: availability of data on patients diagnosed with PD, including detailed medical history, blood tests, penile palpation, photographic documentation of penile deformity, and penile PCDU. Exclusion criteria: PD patients in the stable phase or those without the specified tests and data mentioned above. Our study found a higher prevalence of PD in younger patients (24.2%), a higher coexistence of PD with chronic prostatitis (35.6%), a higher percentage of cases of association between penile deformity and penile curvature (84.4%), a higher prevalence of "significant anxiety" (88.4%), a higher presence of plaque calcification (35.6%), and the detection of a longer duration of the first phase of PD (>18 months). The most frequently observed type of penile curvature was dorsal, followed by left lateral, right lateral, and, less commonly, ventral. We observed a significant statistical correlation between patient age and IIEF score, indicating that patients over the age of 40 years are at a higher risk of experiencing ED. We found a strong statistical relationship between VAS score and age. As age increases, the VAS score decreases, suggesting that younger patients reported more penile pain compared to those who were older than 40 years. Furthermore, we found that penile pain has a significant impact on the psychological state of PD patients. We also found that 38.8% of PD patients suffered from severe anxiety. In relation to this, psychotherapy should be integrated into PD treatment to improve the quality of life and treatment adherence.
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Affiliation(s)
- Gianni Paulis
- Department of Urology and Andrology, Peyronie’s Care Center, Castelfidardo Clinical Analysis Center, 00185 Rome, Italy
| | - Giovanni De Giorgio
- Section of Ultrasound Diagnostics, Department of Urology and Andrology, Castelfidardo Clinical Analysis Center, 00185 Rome, Italy;
| | - Andrea Paulis
- Bambino Gesu’ Children’s Research Hospital, IRCCS (Istituti di Ricovero e Cura a Carattere Scientifico), 00165 Rome, Italy;
- Neurosystem for Applied Psychology and Neuroscience, Janet Clinical Centre, 00195 Rome, Italy
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2
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Cilio S, Pozzi E, Fallara G, Belladelli F, Raffo M, Lanzaro F, Bertini A, Boeri L, Capogrosso P, d'Arma A, Palmieri A, Imbimbo C, Mirone V, Montorsi F, Salonia A. Unrecognised orgasmic phase disorders in men presenting with new-onset erectile dysfunction-Findings from a real-life, cross-sectional study. Andrology 2024; 12:606-612. [PMID: 37555487 DOI: 10.1111/andr.13506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 07/09/2023] [Accepted: 07/30/2023] [Indexed: 08/10/2023]
Abstract
BACKGROUND Orgasmic phase disorders in men worsen the burden of erectile dysfunction on sexual satisfaction. OBJECTIVES To investigate the prevalence of and predictors of unreported orgasmic phase disorder in a cohort of men looking for their first urological assessment for new-onset erectile dysfunction in a real-life setting. MATERIALS AND METHODS Data from 1107 heterosexual, sexually active men consecutively assessed for new-onset erectile dysfunction were analysed. Throughout a comprehensive medical and sexual history, all patients were asked to self-report any orgasmic phase disorder and to complete the International Index of Erectile Function and the Beck's Inventory for Depression (depressive symptoms scored as Beck's Inventory for Depression ≥11). Men self-reporting orgasmic phase disorder during the interview were excluded from further analyses. The median value of the International Index of Erectile Function-orgasmic function domain was arbitrarily used to categorise men with (International Index of Erectile Function-orgasmic function ≤5) and without unreported orgasmic phase disorder (International Index of Erectile Function-orgasmic function >5). Circulating hormones were measured in every patient. Descriptive statistics and logistic regression models were used to test the association between clinical variables and unreported orgasmic phase disorder. RESULTS Of 1098 patients with non-self-reporting orgasmic phase disorder, 314 (28.6%) had International Index of Erectile Function-orgasmic function ≤5. Patients with erectile dysfunction + unreported orgasmic phase disorder were older (median [interquartile range]: 58 [44-66] years vs. 51 [40-60] years), had higher body mass index [25.8 (23.7-28.1) kg/m2 vs. 25.2 (23.3-27.4) kg/m2 ], higher prevalence of type 2 diabetes (36 [11.5%] vs. 45 [5.7%]) and lower International Index of Erectile Function-erectile function scores (6 [2-10] vs. 18 [11-24]) than men with erectile dysfunction-only (all p < 0.05). Patients with erectile dysfunction + unreported orgasmic phase disorder depicted higher rates of severe erectile dysfunction (75.5% vs. 25%) and Beck's Inventory for Depression ≥11 (22.6% vs. 17.9%) (all p < 0.05). In the multivariable logistic regression analysis, older age (odds ratio: 1.02) and lower International Index of Erectile Function-erectile function scores (odds ratio: 0.83) were independently associated with unreported orgasmic phase disorder (all p < 0.05). CONCLUSIONS Almost one in three men seeking first medical help for erectile dysfunction depicted criteria suggestive of unreported orgasmic phase disorder. Men with unreported orgasmic phase disorder were older and had higher rates of severe erectile dysfunction and concomitant depressive symptoms. These real-life findings outline the clinical relevance of a comprehensive investigation of concomitant sexual dysfunction in men only complaining of erectile dysfunction to more effectively tailor patient management.
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Affiliation(s)
- Simone Cilio
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, Urology Unit, University of Naples 'Federico II', Naples, Italy
| | - Edoardo Pozzi
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Giuseppe Fallara
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Federico Belladelli
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Massimiliano Raffo
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Francesco Lanzaro
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Alessandro Bertini
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Luca Boeri
- Department of Urology, Foundation IRCCS Ca' Granda-Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Paolo Capogrosso
- Department of Urology, Circolo & Fondazione Macchi Hospital-ASST Sette Laghi, Varese, Italy
| | - Alessia d'Arma
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Alessandro Palmieri
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, Urology Unit, University of Naples 'Federico II', Naples, Italy
| | - Ciro Imbimbo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, Urology Unit, University of Naples 'Federico II', Naples, Italy
| | - Vincenzo Mirone
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, Urology Unit, University of Naples 'Federico II', Naples, Italy
| | - Francesco Montorsi
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Andrea Salonia
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
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3
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Cilio S, Boeri L, Pozzi E, Fallara G, Belladelli F, Corsini C, Capogrosso P, d'Arma A, Imbimbo C, Palmieri A, Mirone V, Montorsi F, Salonia A. Prevalence and predictors of unrecognised low sexual desire/interest in men with new onset erectile dysfunction: findings from a cross-sectional, real-life study. Int J Impot Res 2024; 36:83-88. [PMID: 36496478 DOI: 10.1038/s41443-022-00647-4] [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: 08/26/2022] [Revised: 11/22/2022] [Accepted: 11/22/2022] [Indexed: 12/14/2022]
Abstract
The interrelationship between male sexual desire and erectile dysfunction (ED) has been scantly investigated. Thus, we aimed at investigating the prevalence of and the predictors of unrecognised low sexual desire/interest (uLSD/I) in a cohort of men with new onset ED. Complete data from 1587 men seeking for first medical help for ED between 2010 and 2021 were analysed. Comorbidities were scored with the Charlson Comorbidity Index (CCI). At entrance, all patients were asked to self-report low sexual desire/interest and completed the International Index of Erectile Function (IIEF) and the Beck Depression Inventory (BDI) (depressive symptoms scored as BDI ≥ 11). The IIEF-erectile function (IIEF-EF) domain was categorised according to Cappelleri's criteria. The median value of the IIEF-sexual desire domain (IIEF-SD) was used to dichotomise men with uLSD/I along with ED (IIEF-SD < 7) vs. ED-only (IIEF-SD ≥ 7). Circulating hormones were measured in every patient. Hypogonadism was defined as total testosterone (tT) <3.0 ng/mL. Descriptive statistics and logistic regression models tested the association between clinical variables and uLSD/I. Of 1197 patients not self-reporting LSD/I, 369 (30.8%) had IIEF-SD < 7. Patients with ED + uLSD/I were older [median (IQR) 54(41-63) vs. 49(36-59) years], had lower IIEF-EF [10.5(5-22) vs. 22(11-28)] but higher BDI [6(3-12) vs. 4(1-8)] and lower tT [4.3(3.2-5.7) vs. 4.8(3.2-6.3) ng/mL] compared to ED-only men (all p < 0.05). Overall, ED + uLSD/I men had higher rate of severe ED (49.9% vs. 23.9%), and of BDI ≥ 11 (30.6% vs. 18.2%) (all p < 0.05). At multivariable logistic regression analysis, lower tT (OR: 0.82), lower IIEF-EF scores (OR:0.95) and BDI ≥ 11 (OR:2.51) were independently associated with ED + uLSD/I, after accounting for age (all p < 0.05). Almost 30% of men seeking first medical help for ED-only had also uLSD/I. Men with both conditions were older, had higher rates of severe ED and more depressive symptoms. A detailed investigation of sexual desire should be always included in men self-complaining only of ED.
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Affiliation(s)
- Simone Cilio
- Division of Experimental Oncology/Unit of Urology, URI; IRCCS Ospedale San Raffaele, Milan, Italy
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, Urology Unit, University of Naples "Federico II", Naples, Italy
| | - Luca Boeri
- Department of Urology, Foundation IRCCS Ca' Granda -Ospedale Maggiore Policlinico, Milan, Italy
| | - Edoardo Pozzi
- Division of Experimental Oncology/Unit of Urology, URI; IRCCS Ospedale San Raffaele, Milan, Italy
- University Vita-Salute San Raffaele, Milan, Italy
| | - Giuseppe Fallara
- Division of Experimental Oncology/Unit of Urology, URI; IRCCS Ospedale San Raffaele, Milan, Italy
- University Vita-Salute San Raffaele, Milan, Italy
| | - Federico Belladelli
- Division of Experimental Oncology/Unit of Urology, URI; IRCCS Ospedale San Raffaele, Milan, Italy
- University Vita-Salute San Raffaele, Milan, Italy
| | - Christian Corsini
- Division of Experimental Oncology/Unit of Urology, URI; IRCCS Ospedale San Raffaele, Milan, Italy
- University Vita-Salute San Raffaele, Milan, Italy
| | - Paolo Capogrosso
- Department of Urology, Circolo & Fondazione Macchi Hospital -ASST Sette Laghi, Varese, Italy
| | - Alessia d'Arma
- Division of Experimental Oncology/Unit of Urology, URI; IRCCS Ospedale San Raffaele, Milan, Italy
| | - Ciro Imbimbo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, Urology Unit, University of Naples "Federico II", Naples, Italy
| | - Alessandro Palmieri
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, Urology Unit, University of Naples "Federico II", Naples, Italy
| | - Vincenzo Mirone
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, Urology Unit, University of Naples "Federico II", Naples, Italy
| | - Francesco Montorsi
- Division of Experimental Oncology/Unit of Urology, URI; IRCCS Ospedale San Raffaele, Milan, Italy
- University Vita-Salute San Raffaele, Milan, Italy
| | - Andrea Salonia
- Division of Experimental Oncology/Unit of Urology, URI; IRCCS Ospedale San Raffaele, Milan, Italy.
- University Vita-Salute San Raffaele, Milan, Italy.
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Traunero F, Di Grazia M, Ongaro L, Rizzo M, Cocci A, Verze P, Zucchi A, Cai T, Salamè L, Garaffa G, Trombetta C, Liguori G. Validation of the Italian version of the Peyronie's Disease Questionnaire (PDQ). Int J Impot Res 2023:10.1038/s41443-023-00792-4. [PMID: 37978202 DOI: 10.1038/s41443-023-00792-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 10/22/2023] [Accepted: 11/03/2023] [Indexed: 11/19/2023]
Abstract
Peyronie's disease (PD) is a connective tissue disorder characterized by the formation of fibrous plaques in the tunica albuginea of the penis which can result in pain, deformity and erectile dysfunction (ED). The Peyronie's Disease Questionnaire (PDQ) assesses the severity of symptoms, including pain, penile curvature and ED, as well as the impact on sexual function, emotional well-being, and overall quality of life of PD patients. Previous studies validated the PDQ in languages other than English and confirmed its test-retest reliability and clinical utility. Despite this, in many countries the unavailability of an adequate PDQ validation in native language hampers its use in clinical practice. In the present non-interventional, observational study we aimed at validating the Italian version of the PDQ (PDQ-I). Between January 2019 and November 2021, 79 PD patients from 6 Italian high-volume centers were administrated the PDQ-I in two separated office visits distanced by a period of 6 months. Intraclass correlation coefficients (ICCs) were used to evaluate the association between the three PDQ scale scores at visit 1 and 2. Paired t-tests were used to evaluate significant score changes between the 2 visits. Cronbach's alpha was used to assess internal consistency reliability. PDQ-I demonstrated an excellent test-retest reliability in the Italian population (ICC 0.78-0.92) as well as a strong internal consistency, with all three scale scores showing a Cronbach's alpha coefficient above 0.70. PDQ-I proved to be a useful tool which allows to reliably evaluate Italian PD patients' quality of life in both everyday andrological practice and clinical research. External validation of our results is pending.
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Affiliation(s)
- Fabio Traunero
- Urological Clinic, Department of Medical, Surgical and Health Sciences, Cattinara Hospital, University of Trieste, Trieste, Italy.
| | - Massimo Di Grazia
- Department of Pediatric Urology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Luca Ongaro
- Urological Clinic, Department of Medical, Surgical and Health Sciences, Cattinara Hospital, University of Trieste, Trieste, Italy
| | - Michele Rizzo
- Urological Clinic, Department of Medical, Surgical and Health Sciences, Cattinara Hospital, University of Trieste, Trieste, Italy
| | - Andrea Cocci
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Paolo Verze
- Department of Urology, University of Naples Federico II, Naples, Italy
| | - Alessandro Zucchi
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Tommaso Cai
- Department of Urology, Santa Chiara Regional Hospital, Trento, Italy
| | - Leonardo Salamè
- Department of Urology, "Cardinale G. Panico" Hospital, Tricase (Lecce), Italy
| | - Giulio Garaffa
- Department of Urology, St. George's University Hospital, London, United Kingdom
| | - Carlo Trombetta
- Urological Clinic, Department of Medical, Surgical and Health Sciences, Cattinara Hospital, University of Trieste, Trieste, Italy
| | - Giovanni Liguori
- Urological Clinic, Department of Medical, Surgical and Health Sciences, Cattinara Hospital, University of Trieste, Trieste, Italy
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5
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Cilio S, Fallara G, Capogrosso P, Candela L, Belladelli F, Pozzi E, Corsini C, Raffo M, Schifano N, Boeri L, d'Arma A, Imbimbo C, Mirone V, Montorsi F, Salonia A. The symptomatic burden of Peyronie's disease at presentation according to patient age: A critical analysis of the Peyronie's disease questionnaire (PDQ) domains. Andrology 2023; 11:501-507. [PMID: 36426559 DOI: 10.1111/andr.13352] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 11/14/2022] [Accepted: 11/21/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Peyronie's disease (PD) has a huge impact on patients' physical and psychological wellbeing. OBJECTIVES To investigate whether patients' age has an impact on PD symptomatic burden at first presentation. MATERIALS AND METHODS Data from 129 consecutive heterosexual patients seeking first medical attention for PD at a single andrological tertiary-referral centre were collected. All patients completed the International Index for Erectile Function (IIEF) and the PD questionnaire (PDQ). Descriptive statistics were used to compare clinical features between younger (≤40years) and older (>40 years) patients. Multivariable linear model assessed the impact of age, the degree of penile curvature and their impact on PDQ (total scores and its domains), after adjusting for PD duration and IIEF-erectile function domain scores. RESULTS Of 129, 24 (18.6%) patients were ≤40 years old. Young patients presented with a less severe curvature than older patients (median [interquartile ranges] 20° [15-36] vs. 50° [40-80]; p = 0.04). However, younger age was associated with higher psychological and physical symptoms, PDQ-penile pain and PDQ-symptom bother scores (Coeff -0.11, -0.21 and -0.17, respectively) (all p < 0.05). Moreover, the greater the degree of curvature, the higher the PDQ-psychological and physical symptoms and the PDQ-symptom bother scores (Coeff. 0.21 and 0.22, respectively; all p < 0.05). CONCLUSION Around one in five men seeking first medical help for PD is younger than 40 years at presentation in the real-life setting. PD-related distress varies according to patients' age, with younger men presenting with a greater risk of penile pain and symptom bother despite lower curvature.
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Affiliation(s)
- Simone Cilio
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.,Department of Neurosciences, Reproductive Sciences and Odontostomatology, Urology Unit, University of Naples 'Federico II', Naples, Italy
| | - Giuseppe Fallara
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Paolo Capogrosso
- Department of Urology, Circolo and Fondazione Macchi Hospital -ASST Sette Laghi, Varese, Italy
| | - Luigi Candela
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Federico Belladelli
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Edoardo Pozzi
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Christian Corsini
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Massimiliano Raffo
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Nicolò Schifano
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Luca Boeri
- Department of Urology, Foundation IRCCS Ca' Granda -Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Alessia d'Arma
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Ciro Imbimbo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, Urology Unit, University of Naples 'Federico II', Naples, Italy
| | - Vincenzo Mirone
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, Urology Unit, University of Naples 'Federico II', Naples, Italy
| | - Francesco Montorsi
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Andrea Salonia
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
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Yang CH, Lin DY, Lin YS, Hsu CY, Tung MC, Tan KT, Ou YC. The Immunological Microenvironment and the Emerging Role of Stem Cells Therapy in Peyronie's Disease: A Systematic Narrative Review. Int J Mol Sci 2023; 24:ijms24010777. [PMID: 36614220 PMCID: PMC9821411 DOI: 10.3390/ijms24010777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 12/25/2022] [Accepted: 12/26/2022] [Indexed: 01/03/2023] Open
Abstract
Current literature has indicated that Peyronie's disease (PD) could be initiated by microtrauma and the subsequent inflammation episodes that follow. PD could be sorted into acute or chronic status, and it can differ when selecting the clinical therapeutics. PD would cause pain and penile deformity to diseased men and impair their erectile function. Occasionally, surgical revision of the penis might be needed to correct the penile curvature. We find that there are limited effective options of intra-lesion injections for the PD plaques. By searching the databases and screening the literature with the PRISMA 2020 guideline, we observed that several preclinical studies that applied stem cell therapy in treating PD were fruitful in the acute phase. Although in the chronic phase of PD, erectile parameters were not significantly improved, and therefore, future studies might be better elevated in certain aspects, such as the sites selected for harvesting stem cells or changing the centrifugation forces. In this review, we concluded the contemporary understanding of inflammatory microenvironments in PD, the stem cell therapy in PD, and our perspectives on future studies. We concluded that there may be great potential in stem cell therapy for treating both acute and chronic phases PD.
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Affiliation(s)
- Che-Hsueh Yang
- Division of Urology, Department of Surgery, Tungs’ Taichung MetroHarbor Hospital, Taichung 435, Taiwan
| | - Dian-Yu Lin
- Division of Urology, Department of Surgery, Tungs’ Taichung MetroHarbor Hospital, Taichung 435, Taiwan
- Joshua Taipei Hernia Center, Central Clinic & Hospital, Taipei 106, Taiwan
- Department of Urology, College of Medicine and Shu-Tien Urological Research Center, National Yang Ming Chiao Tung University, Taipei 106, Taiwan
| | - Yi-Sheng Lin
- Division of Urology, Department of Surgery, Tungs’ Taichung MetroHarbor Hospital, Taichung 435, Taiwan
| | - Chao-Yu Hsu
- Division of Urology, Department of Surgery, Tungs’ Taichung MetroHarbor Hospital, Taichung 435, Taiwan
| | - Min-Che Tung
- Division of Urology, Department of Surgery, Tungs’ Taichung MetroHarbor Hospital, Taichung 435, Taiwan
| | - Kok-Tong Tan
- Division of General Surgery, Department of Surgery, Tungs’ Taichung MetroHarbor Hospital, Taichung 435, Taiwan
- Correspondence: (K.-T.T.); (Y.-C.O.)
| | - Yen-Chuan Ou
- Division of Urology, Department of Surgery, Tungs’ Taichung MetroHarbor Hospital, Taichung 435, Taiwan
- Correspondence: (K.-T.T.); (Y.-C.O.)
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7
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Flores JM, Nascimento B, Punjani N, Salter CA, Bernie HL, Taniguchi H, Miranda E, Terrier JE, Schofield E, Jenkins L, Mulhall JP. Predictors of Curvature Improvement in Men with Peyronie's Disease Treated with Intralesional Collagenase Clostridium Histolyticum. J Sex Med 2022; 19:1680-1686. [PMID: 36127227 PMCID: PMC10164446 DOI: 10.1016/j.jsxm.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 07/26/2022] [Accepted: 08/07/2022] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Penile curvature is the most common abnormality that is observed by men with Peyronie's disease (PD). Collagenase Clostridium histolyticum (CCH) has become a standard treatment for PD patients. AIM To identify predictor factors associated with improvements of penile curvature outcomes in men with PD treated with CCH. METHODS We retrospectively collected the data of patients with PD treated with CCH up to 8 injections divided into 4 cycles between January 2014 and July 2020. Per protocol, penile curvature was assessed at baseline, and after the second and ford CCH cycle. If after cycle 2, curvature demonstrated no improvement, or penile curvature was significantly improved and the patient was happy, no further treatment was recommended. However, if penile curvature was significantly improved and the patient remained dissatisfied, 4 cycles were completed. Three categories of response were evaluated: improvement (≥10 degrees or ≥20%, either 1 happens), unchanged (±10 degrees or ±20%) or worsened (≥10 degrees or ≥20%, either 1 happens). Logistic regression analyses were performed to evaluate predictive factors associated with penile curvature improvements. OUTCOMES Degrees of the curvature changes between the baseline and after the cycles of CCH. RESULTS A total of 114 patients underwent CCH treatment. Median age was 57 years. Median PD duration was 11 months. At baseline, mean curvature was 47 degrees, 65% had dorsal curvature, 53% mid-shaft location, and 15% calcification. After CCH treatment, the mean final curvature was 40 degrees. A total of 44% improved the curvature, 39% had no change while 17% worsened after CCH treatment. Of men who had penile curvature improvement with CCH treatment, the mean curvature decreasing in degrees and percentage were 22 degrees and 41%, respectively. Men with baseline curvature ≤ 30, 31-59, and ≥ 60 degrees, the percentage curvature improvement were 29%, 43%, and 60%, respectively. Baseline curvature was the only significant predictor of penile curvature improvement after CCH (OR 1.33, 95% CI = 1.1, 1.7). CLINICAL IMPLICATIONS We confirmed baseline penile curvature is the most important predictive factor, and this is the first report describing proportions of penile curvature improvement with CCH treatment. STRENGTHS AND LIMITATIONS This study has several strengths, including the use of validated instruments. Nonetheless, there are limitations: the retrospective nature of the study, a single institution; and modelling device was not controlled. CONCLUSION Penile curvature improvement was significantly more common in patients with greater baseline curvature, reaching up to 60% for patients with ≥ 60 degrees.
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Affiliation(s)
- Jose M Flores
- Sexual & Reproductive Medicine Program Urology Service Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Bruno Nascimento
- Sexual & Reproductive Medicine ProgramUrology ServiceMemorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Nahid Punjani
- Sexual & Reproductive Medicine Program Urology Service Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Carolyn A Salter
- Sexual & Reproductive Medicine Program Urology Service Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Helen L Bernie
- Sexual & Reproductive Medicine Program Urology Service Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Hisanori Taniguchi
- Sexual & Reproductive Medicine Program Urology Service Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Eduardo Miranda
- Sexual & Reproductive Medicine Program Urology Service Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jean-Etienne Terrier
- Sexual & Reproductive Medicine Program Urology Service 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
| | - Lawrence Jenkins
- Sexual & Reproductive Medicine Program Urology Service Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - John P Mulhall
- Sexual & Reproductive Medicine Program Urology Service Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Geelhoed JP, Wegelin O, Tromp E, de Boer B, de Jong I, Beck JJH. Improvement in the ability to have sex in patients with Peyronie's disease treated with Collagenase Clostridium histolyticum. BJUI COMPASS 2022; 4:66-73. [PMID: 36569498 PMCID: PMC9766863 DOI: 10.1002/bco2.185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 07/20/2022] [Accepted: 07/21/2022] [Indexed: 11/05/2022] Open
Abstract
Objective To describe the results of intralesional Collagenase Clostridium histolyticum (CCH) treatment in patients with Peyronie's disease (PD) in real-world setting. PD is characterized by curvature of the erect penis caused by fibrotic tissue in the tunica albuginea. Patients and methods Patients with stable PD and curvature of 30° to 90° were prospectively enrolled. CCH injections were initially given using a scheme of four cycles of two injections within 48-72 h every 6 weeks. Later using a modified scheme of three injections every 4 weeks, combined with a vacuum erection device (VED) twice daily. All patients were requested to take pictures of the erect penis prior to and following treatment, from above and laterally. Curvature was measured by three independent researchers based on the provided pictures using a goniometer. Furthermore, patients filled in the Peyronie Disease Questionnaire-NL (PDQ-NL) and Patient Reported Outcome Measurement (PROM). The primary outcome was reduction in curvature and the ability to have penetrating sex again. Secondary outcomes include pain scores during injections, changes in PDQ-NL, PROM and complications of CCH treatment. Results Sixty-three patients were included, mean age was 56.0 years (range 39-70) and mean reduction in curvature 20.6° (SD 10.2, range 5-49); 74.5% of the patients were able to have penetrating sex again following treatment, compared with 41.2% prior to treatment. According to the PROM questions, sexual improvement was seen in 66.7% of patients. The satisfaction rate was 6.8 (SD 1.8). All patients save two recommend treatment. Conclusions Intralesional treatment with CCH in men with PD leads to a mean curvature improvement of 20.6°. Following treatment, 74.5% of men were able to have sexual intercourse and 54.9% of the couples were satisfied with their sex life. No major complications occurred in the patients treated with CCH. CCH is not available in Europe anymore despite good results.
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Affiliation(s)
| | - Olivier Wegelin
- St. Antonius ZiekenhuisNieuwegeinThe Netherlands,University Medical Center UtrechtUtrechtThe Netherlands
| | - Ellen Tromp
- St. Antonius ZiekenhuisNieuwegeinThe Netherlands,GGD regio UtrechtUtrechtThe Netherlands
| | | | - Igle‐Jan de Jong
- University Medical Center Groningen, Department of UrologyUniversity of GroningenGroningenThe Netherlands
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Piraino J, Chaudhary H, Ames K, Okoye F, Sterling M, Clavell-Hernandez J, Levine L, Ziegelmann MJ. A Consistent Lack of Consistency in Defining the Acute and Chronic Phases of Peyronie's Disease: A Review of the Contemporary Literature. Sex Med Rev 2022; 10:698-713. [PMID: 37051957 DOI: 10.1016/j.sxmr.2022.08.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 07/21/2022] [Accepted: 08/10/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Treatment recommendations for Peyronie's Disease (PD) differ based on whether a patient is in the acute/active versus chronic/stable phase of the disease, yet there are no agreed upon criteria for defining these clinical entities. OBJECTIVES To review the criteria used to define acute and chronic phase PD in modern PD intervention studies. METHODS We performed a search engine review to identify indexed publications for PD intervention studies and review articles / meta-analyses from the year 2011-2020. Outcomes results were catalogued and summarized across articles. As a result of the substantial heterogeneity of outcome measures and follow-up intervals, meta-analytic techniques were not applied to the data analysis. RESULTS We identified a total of 104 studies that met inclusion criteria and had available information for review (n = 79 primary intervention studies; n = 25 review articles/meta-analyses/guidelines). Among the queried studies, we were unable to identify a consensus with respect to the criteria used to define acute and chronic phases of PD. 33% of primary intervention studies did not specifically define their criteria for acute and chronic phase PD, despite referencing these populations as part of the inclusion criteria in many instances. Studies used heterogenous criteria including total symptom duration, duration of "stable" symptoms, and presence/absence of pain. CONCLUSION Due to varying definitions across the literature, we were unable to create a standardized definition of acute and chronic phase Peyronie's in terms of time. Our findings emphasize the need for greater consensus in defining the treatment cohorts with future studies that assess treatment for men with PD.
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Goldstein I, Gelbard MK, Lipshultz LI. Clinical Significance of Shortened Penile Length and Alterations in Penile Length Following Treatment for Peyronie's Disease. Sex Med Rev 2022; 10:409-420. [PMID: 35772849 DOI: 10.1016/j.sxmr.2021.12.005] [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: 04/10/2021] [Revised: 12/15/2021] [Accepted: 12/20/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Across many cultures, penis size has been associated with virility, and concerns about penile length are commonplace. Peyronie's disease (PD) is a known acquired cause of penile shortening. OBJECTIVES This paper describes the psychosocial impacts of penile length on men and their partners, both generally and in men with PD, and evaluates the effect of PD treatments (eg, collagenase clostridium histolyticum , surgery, mechanical therapy) on this outcome measure. METHODS A PubMed database search was performed for English language articles through July 2021. Main outcome measures were association of penile length with emotional well-being, selfesteem, and relationship satisfaction in men with PD, and change from baseline penile length after treatment. RESULTS Shortened penile length caused by PD can negatively impact patient and partner quality of life, including effects on body image, emotional well-being, sexual function, and interpersonal relationships. In men with PD, studies have demonstrated an association between loss of penile length and emotional problems, reduced satisfaction with sexual performance, poor self-esteem, depression, and relationship difficulties. Loss of penile length can frequently occur after surgery for PD (including plication, plaque incision/excision with grafting, and penile implant). Advanced surgical techniques may preserve/increase penile length, but the increased risks associated with these complex procedures must be carefully considered. Treatment with collagenase clostridium histolyticum does not appear to negatively impact penile length, and 5-year follow-up data suggest potential longterm posttreatment improvements in this outcome measure. Penile traction therapy, either alone or as adjunctive therapy, may increase penile length in men with PD, but nonadherence may limit improvement. CONCLUSION Changes in penile length are important to many men, particularly those with PD, and should be considered during PD treatment selection. Penile length should be measured objectively before and after treatment for PD and should be included as an outcome measure in future studies on treatment effectiveness. Goldstein I, Gelbard MK, Lipshultz LI. Clinical Significance of Shortened Penile Length and Alterations in Penile Length Following Treatment for Peyronie's Disease. Sex Med Rev 2022;10:409-420.
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11
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Cao D, Li J, Lu Y, Huang Y, Chen B, Chen Z, Shen Y, Liu L, Wei Q. Efficacy and Safety of Collagenase Clostridium Histolyticum in the Treatment of Peyronie's Disease: An Evidence-Based Analysis. Front Med (Lausanne) 2022; 9:780956. [PMID: 35252236 PMCID: PMC8896480 DOI: 10.3389/fmed.2022.780956] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 01/11/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundPeyronie's disease (PD) is a chronic wound healing disorder, mainly involving tunica albuginea. Collagenase Clostridium Histolyticum (CCH) has shown its effectiveness in treating PD, but its efficacy and safety remain controversial, which propelled us to conduct the first evidence-based research on this topic.MethodsWe searched the Web of Science, PubMed, Embase, and ClinicalTrials.gov for related randomized controlled trials (RCTs). A systematic review and meta-analysis were performed to compare the penile curvature deformity (PCD), Peyronie's Disease Questionnaire peyronie's disease symptom bother (PDSB), penile pain score, total treatment-related adverse events (TAEs), and specific adverse events, including penile pain, penile edema, injection site pain, and contusion. Cochrane Collaboration's tool and Review Manager 5.3.0 version were applied, respectively, to evaluate the study quality and heterogeneity.ResultsFour articles (five RCTs) with 1,227 patients were finally included in the meta-analysis. The results revealed that CCH had excellent efficacy in relieving PCD (weighted mean difference [WMD]: −318.77, p < 0.001) and PDSB (WMD: −1.20, p < 0.001) compared to the placebo group, but there was no difference in the penile pain score (WMD: −0.64, P = 0.39) between the two groups. Furthermore, the incidence of TAEs in the CCH group was higher [odds ratio (OR): 12.86, p < 0.001].ConclusionsThe current evidence suggests that CCH has a significant effect on treating PD. Considering that all these adverse events are acceptable and curable, CCH could slow the disease progression in the acute phase or act as a substitute for patients unable or unwilling to undergo surgery. However, the conclusion could not be certainly drawn until RCTs with a larger scale proved it.
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Affiliation(s)
- Dehong Cao
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Jinze Li
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - You Lu
- Department of Child Healthcare, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Yin Huang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Bo Chen
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Zeyu Chen
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Yinzhi Shen
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Liangren Liu
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Qiang Wei
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
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The Prevalence and Predictors of Penile Pain in Men with Peyronie's Disease. Sex Med 2021; 9:100398. [PMID: 34246855 PMCID: PMC8360927 DOI: 10.1016/j.esxm.2021.100398] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 04/21/2021] [Accepted: 06/04/2021] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Penile pain is one of the most stressful symptoms in men with Peyronie's disease (PD). AIM To evaluate the prevalence, clinical presentation and risk factors associated with penile pain in men with PD as well as to assess the psychosocial impact. METHODS We revised our institution's database of men diagnosed with PD. The information collected included penile pain assessments, and the scores of the PD Questionnaire (PDQ), Self-Esteem and Relationship Questionnaire (SEAR) and Center for Epidemiologic Studies Depression Scale Questionnaire (CES-D). Descriptive and comparative statistics were used. Logistic regression analyses were performed to evaluate predictive factors associated with penile pain. MAIN OUTCOME MEASURES Penile pain descriptive assessment and factors associated with penile pain in men with PD. Comparison of SEAR, CES-D and PDQ domain scores of men with and without penile pain. RESULTS 431 men with PD were included for this analysis with a mean age of 55.9 years. Penile pain was reported by 36.7%; 65.2% of those had painful erection, 7% pain with flaccid state only, and 20% in both stages. The median pain severity was 3 with erection and 1 with flaccid stage. After adjusted logistic regression analyses, advanced age was associated with less pain (OR 0.94, P ≤ 0.001). Men with penile pain had no significant difference in CES-D and SEAR mean scores compared to men without penile pain. The PDQ scores for the physical/psychological symptoms domain and the bother domain were significantly higher in men with penile pain (12 vs 8.7; P < 0.01 and 9 vs 7.1; P < 0.01 respectively). Men with penile pain had a higher rate of clinically significant bother scores than men without penile pain (52% vs 35%, P ≤ 0.001). CONCLUSION Penile pain is common in men with PD. It was more common in young men and was associated with physical and psychological bothers in this population. Flores JM, Salter CA, Nascimento B, et al. The Prevalence and Predictors of Penile Pain in Men with Peyronie's Disease. Sex Med 2021;9:100398.
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13
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Discordant erectile function assessment between validated questionnaire scores and penile Doppler ultrasound in Peyronie's disease. Int J Impot Res 2021; 34:452-455. [PMID: 33981011 DOI: 10.1038/s41443-021-00416-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 12/17/2020] [Accepted: 02/01/2021] [Indexed: 11/08/2022]
Abstract
Peyronie's disease results in curvature of the penis which may cause difficulty with penetrative intercourse. The diagnosis of Peyronie's disease is easily obtained through history and physical examination alone, but the severity of erectile dysfunction relies on patient history and use of validated questionnaires. However, erectile dysfunction questionnaires were not validated in the Peyronie's disease population and may not be a reliable assessment. Penile Doppler ultrasound is a noninvasive tool that assesses vascular function. We hypothesized that penile Doppler ultrasound will be discordant with International Index of Erectile Function (IIEF) results in men with Peyronie's disease and erectile dysfunction. In this cross-sectional study, we reviewed a prospectively collected database of men with Peyronie's disease. In total, 108 men had questionnaire and ultrasound data. Of them, 87 had erectile dysfunction based on IIEF-EF or IIEF-5 (SHIM). However, 48 (55%) of those men had normal vascular parameters. Interestingly, among a subgroup of 33 men with severe erectile dysfunction on IIEF-EF or IIEF-5, 20 (61%) had normal vascular parameters. Our study demonstrates significant discordance between questionnaires and penile Doppler ultrasound. Therefore, ultrasound may be a useful tool in the workup of men with Peyronie's disease and erectile dysfunction.
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Bole R, Jimbo M, Parikh N, Britton C, Gopalakrishna A, Yang D, Trost L, Helo S, Kohler T, Ziegelmann M. Patient Attitudes Towards Surgical Management of Peyronie's Disease Prior to Men's Health Consultation. Urology 2021; 153:199-203. [PMID: 33676956 DOI: 10.1016/j.urology.2021.02.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 01/28/2021] [Accepted: 02/23/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate clinical characteristics associated with patient attitudes toward surgical treatment of Peyronie's disease (PD) prior to consultation in a high-volume male sexual health clinic. METHODS From 2014-2018 a prospective database was created of patients presenting to the sexual health clinic at our institution. Multivariable regression analysis was conducted to determine factors associated with pre-visit consideration of surgery. RESULTS Of 1359 men presenting to clinic, 342 had a chief complaint of PD. Prior to consultation, 79% of patients (n = 270) stated they were willing to consider surgery to correct their PD symptoms. Factors associated with consideration of surgery included younger patient age (mean 55.8 vs 60.0 years; P = .008), history of depression/anxiety (21% vs 8%, P = .01), greater penile curvature (43.3 vs 34.6 degrees; P = .002), penile shortening (64% vs 44%; P = .003), pain with erections (46% vs 33%; P = .05) and decreased ability to have penetrative intercourse (51.9% vs 65.3%, P = .04). On multivariable analysis, age, history of depression, penile shortening, and mean curvature remained significantly associated. Symptom duration and relationship factors were not associated with a difference in the stated preference to consider surgery prior to consultation (P >.05 for all). CONCLUSION Nearly 4 out of 5 patients reported willingness to consider surgical intervention for their PD-related symptoms prior to urologic consultation. On multivariable analysis, younger age, history of depression/anxiety, penile shortening, and curvature were associated with a greater likelihood of considering surgery. This information provides important insight into patient attitude toward undergoing surgery and will help drive patient counseling for men with PD.
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Affiliation(s)
- Raevti Bole
- Department of Urology, Mayo Clinic, Rochester, MN.
| | - Masaya Jimbo
- Department of Urology, Mayo Clinic, Rochester, MN
| | - Niki Parikh
- Department of Urology, Mayo Clinic, Rochester, MN
| | | | | | - David Yang
- Department of Urology, Mayo Clinic, Rochester, MN
| | - Landon Trost
- Department of Urology, Mayo Clinic, Rochester, MN
| | - Sevann Helo
- Department of Urology, Mayo Clinic, Rochester, MN
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15
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Ure I, Ozen A. Intralesional low-dose methylprednisolone for the treatment of active phase Peyronie's disease: A single-centre, preliminary prospective non-randomised study. Int J Clin Pract 2021; 75:e13754. [PMID: 33058393 DOI: 10.1111/ijcp.13754] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 10/05/2020] [Indexed: 11/25/2022] Open
Abstract
AIM There are a few types of drugs that can be used in the active phase of Peyronie's disease. Methylprednisolone is a corticosteroid with a strong anti-inflammatory effect. In this study, we aimed to evaluate the effect of intralesional low-dose methylprednisolone treatment on patients in the active phase of Peyronie's disease. PATIENTS AND METHODS Forty-eight patients suffering from Peyronie's disease active phase symptoms were included in the study. Methylprednisolone was administered intralesionally for 8 weeks, once per week, at a dose of 40 mg. The injection was applied to the plaques, which causes maximum curvature. Patients were evaluated before and after treatment for plaque size, angle of curvature, and erectile dysfunction according to the International Index of Erectile Function-5 and Peyronie's Disease Questionnaire. RESULTS The mean age of the patients was 61.1 (43-78) years. The mean duration of the symptoms was 3.4 (0-9) months. The average plaque size before treatment was 13.6 mm (7.1-16.8) and after treatment, this value decreased to 10.8 mm (4.3-14.6) (P: .025). The average scores of Peyronie's Disease Questionnaire elements; symptom severity, penile pain, and bother/discomfort were 12.3, 19.1, and 6.2, respectively, before the treatment. These scores were decreased to 8.9, 9.6, and 4.4, respectively, after treatment. All subgroups of Peyronie's Disease Questionnaire scores were significantly improved after treatment (P: .001, P < .001, P: .045, respectively). No adverse events were observed during or after treatment. CONCLUSION In order to recover the symptoms and signs, new and easily accessible drugs are required for use in the acute period of Peyronie's disease. In this context, treatment with intralesional low-dose methylprednisolone in acute phase Peyronie's Disease is a promising and safe treatment option.
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Affiliation(s)
- Iyimser Ure
- Department of Urology, Faculty of Medicine, Osmangazi University, Eskisehir, Turkey
| | - Ata Ozen
- Department of Urology, Faculty of Medicine, Osmangazi University, Eskisehir, Turkey
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Jensen CFS, Jacobsen FM, Quallich S, Fode M, Sønksen J, Malaeb BS, Ohl DA. Patient‐reported outcomes from a single‐centre prospective post‐marketing study on Collagenase
Clostridium Histolyticum
injections for Peyronie's disease. Andrologia 2020; 52:e13733. [DOI: 10.1111/and.13733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/23/2020] [Accepted: 06/05/2020] [Indexed: 11/26/2022] Open
Affiliation(s)
- Christian Fuglesang S. Jensen
- Department of Urology, Herlev and Gentofte Hospital University of Copenhagen Copenhagen Denmark
- Department of Urology University of Michigan Ann Arbor MI USA
| | - Frederik M. Jacobsen
- Department of Urology, Herlev and Gentofte Hospital University of Copenhagen Copenhagen Denmark
| | | | - Mikkel Fode
- Department of Urology, Herlev and Gentofte Hospital University of Copenhagen Copenhagen Denmark
| | - Jens Sønksen
- Department of Urology, Herlev and Gentofte Hospital University of Copenhagen Copenhagen Denmark
| | - Bahaa S. Malaeb
- Department of Urology University of Michigan Ann Arbor MI USA
| | - Dana A. Ohl
- Department of Urology University of Michigan Ann Arbor MI USA
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Bertolotto M, Campo I, Sachs C, Ciabattoni R, Bucci S, Cova MA, Van Nieuwenhove S. Sonography of the penis/erectile dysfunction. Abdom Radiol (NY) 2020; 45:1973-1989. [PMID: 32285181 DOI: 10.1007/s00261-020-02529-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Erectile dysfunction (ED) is defined as the persistent inability to achieve and/or maintain an erection for a satisfactory sexual activity. It is secondary to several organic, psychogenic, and combined causes, and represents a serious health dilemma affecting both men and their partners. The diagnostic approach to erectile dysfunction has significantly changed in the last years with the advent of phosphodiesterase-5 (PDE5) inhibitors, and with the recognition that surgical treatment of both arterial insufficiency and penile venous leak have poor long-term clinical outcomes. Although imaging modalities have diminished in importance, differentiating among causes of erectile dysfunction remains mandatory in good medical practice, and ultrasound (US) still remains the cornerstone of the diagnostic workup. US provides an objective, minimally invasive evaluation of penile hemodynamics. Moreover, it provides an excellent depiction of the penile anatomy and of its changes in pathological conditions such as in patients with Peyronie's disease, priapism, and posttraumatic erectile dysfunction.
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Affiliation(s)
- Michele Bertolotto
- Department of Radiology, University of Trieste, Ospedale di Cattinara, Strada di Fiume 447, 34149, Trieste, Italy.
| | - Irene Campo
- Department of Radiology, Ospedale Civile di Conegliano, ULSS 2 Marca Trevigiana, Via Brigata Bisagno, 2, 31015, Conegliano, TV, Italy
| | - Camilla Sachs
- S.C. Radiologia Pordenone - Sacile, Azienda sanitaria Friuli Occidentale (ASFO), Via della Vecchia Ceramica, 1, 33170, Pordenone, PN, Italy
| | - Riccardo Ciabattoni
- Department of Radiology, University of Trieste, Ospedale di Cattinara, Strada di Fiume 447, 34149, Trieste, Italy
| | - Stefano Bucci
- Department of Urology, University of Trieste, Ospedale di Cattinara, Strada di Fiume 447, 34149, Trieste, Italy
| | - Maria Assunta Cova
- Department of Radiology, University of Trieste, Ospedale di Cattinara, Strada di Fiume 447, 34149, Trieste, Italy
| | - Sandy Van Nieuwenhove
- Department of Radiology, Cliniques Universitaires Saint-Luc, Avenue Hippocrate, 10, 1200, Brussels, Belgium
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El-Khatib FM, Osman MM, Kopelevich A, Towe M, Yafi FA. Treatment-related Outcomes for Patients With Atypical Peyronie's Disease Using Xiaflex Injections. Urology 2020; 143:153-158. [PMID: 32590080 DOI: 10.1016/j.urology.2020.05.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 05/18/2020] [Accepted: 05/19/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To evaluate the efficacy and safety of collagenase Clostridium histolyticum (CCH) for the management of penile deformities in patients presenting with different categories of atypical Peyronie's disease (PD). METHODS We conducted a retrospective review of charts of patients who presented to a men's health clinic with atypical PD between October 2016 and June 2019. We included patients in the stable phase of the disease, had completed a penile duplex Doppler ultrasound before any intervention, and proceeded with CCH treatment. Gathered data included patient demographics, treatment details, outcomes, and complications. Outcomes collected were both quantitative (curvature assessments) and qualitative using the symptom bother domain (last 6 questions; Q10 to Q15) of the Peyronie's Disease Questionnaire. RESULTS Twenty-one men with stable PD underwent CCH inject therapy after penile duplex Doppler ultrasound. The mean number of injections was 8.4 (standard deviation [SD] = 3.3), and the mean follow-up was 20.5 months (SD = 5.9). The overall mean change in penile curvature was -19.2° ± 8.3°, which corresponded to a -39% ± 13% improvement in curvature (P = .0079). In men who presented with an indentation or hourglass deformity, 11 of 17 (64%) were satisfied and reported subjective improvement in narrowing/indentation after receiving CCH injections. The average composite symptom bother domain of the Peyronie's Disease Questionnaire decreased by 6.7 (P = .0029). CONCLUSION Our results suggest that CCH appears to be safe and provide significant clinical improvements in men presenting with atypical PD.
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Ziegelmann MJ, Heslop D, Houlihan M, Bajic P, Helo S, Trost L, Kohler T. The Influence of Indentation Deformity on Outcomes With Intralesional Collagenase Clostridium Histolyticum Monotherapy for Peyronie's Disease. Urology 2020; 139:122-128. [DOI: 10.1016/j.urology.2020.01.035] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 01/23/2020] [Accepted: 01/27/2020] [Indexed: 11/24/2022]
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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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Farrell MR, Abdelsayed GA, Ziegelmann MJ, Levine LA. A Comparison of Hemostatic Patches Versus Pericardium Allograft for the Treatment of Complex Peyronie's Disease With Penile Prosthesis and Plaque Incision. Urology 2019; 129:113-118. [PMID: 30914333 DOI: 10.1016/j.urology.2019.03.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 03/06/2019] [Accepted: 03/12/2019] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To compare outcomes between hemostatic patches (HP) versus pericardium allografts (PA) for complex Peyronie's disease with erectile dysfunction managed with inflatable penile prosthesis (IPP) and plaque incision and grafting (PIG). METHODS We reviewed all men who underwent IPP with PIG for PD at our institution (4/2010-9/2018). PIG was performed via relaxing tunical incisions during IPP implantation following manual modeling if there was persistent curve >30° and/or significant narrowing. Tunical defects >2 cm were grafted. PA (Coloplast, Minneapolis, MN) or HP consisting of either Evarrest, Nu-Knit (Ethicon Inc., Somerville, NJ), or TachoSil (Baxter Int., Deerfield, IL) were used. RESULTS HP was placed in 18 men (n = 10 Evarrest, n = 6 Nu-Knit, and n = 2 TachoSil), 15 had PA. There was no difference in mean age, preoperative curvature (HP:75° vs PA:78°), or grafted area (HP:11.9 cm2 vs PA:10.9 cm2) between HP and PA cohorts. Mean operative time was shorter for HP (122 vs 166 minutes, P = .01). Median follow-up: 6.6 months (range: 2-27 months) for HP and 34.6 months (range: 13-103 months) for PA. Residual curvature >20° was present following HP in 16.7% (n = 3) and PA in 13.3% (n = 2; P = 1.0). There were no complications attributable to HP/PA material and no IPP herniation through the tunical defect. Postoperatively, 94.4% (n = 17) of HP and 93.3% (n = 14) of PA patients were engaged in penetrative intercourse (P = 1.0). CONCLUSION HP are effective materials to cover the tunical defect over an IPP following plaque incision for PD. HP outcomes are similar to PA, while operative time is shorter for HP.
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Affiliation(s)
- M Ryan Farrell
- Division of Urology, Rush University Medical Center, Chicago, IL
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Comment on "Patient perspectives on Peyronie's disease: results of poststudy interviews from a phase 2 trial of collagenase clostridium histolyticum". Int J Impot Res 2018; 31:300. [PMID: 30266972 DOI: 10.1038/s41443-018-0040-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 04/15/2018] [Indexed: 11/09/2022]
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Wayne GF, Cordon BH. Contemporary surgical and non-surgical management of Peyronie's disease. Transl Androl Urol 2018; 7:603-617. [PMID: 30211050 PMCID: PMC6127552 DOI: 10.21037/tau.2018.04.06] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 03/28/2018] [Indexed: 12/11/2022] Open
Abstract
Numerous treatments have been proposed for Peyronie's disease (PD). As the evidence base has expanded, the field of operative and non-operative options for patients has narrowed. Collagenase clostridium hystolyticum (CCH) injection now comprises the medical option, and surgical possibilities entail penile plication, plaque incision/excision and grafting, and prosthesis implantation. Still, questions abound regarding the optimal approach and indication for each of these treatments. We conducted a review of literature exploring the contemporary management of PD with a particular focus on work since the last American Urologic Association's (AUA) guidelines update for PD. Recent results and discussion indicate trends toward minimal invasiveness, toward a more holistic approach to the PD patient, and away from algorithmic management, galvanized, in part, by data challenging long-held beliefs.
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Affiliation(s)
- George F. Wayne
- Mount Sinai Medical Center Division of Urology, Miami Beach, FL, USA
| | - Billy H. Cordon
- Columbia University Division of Urology at Mount Sinai Medical Center, Miami Beach, FL, USA
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The relationship between penile deformity, age, psychological bother, and erectile dysfunction in a sample of men with Peyronie's Disease (PD). Int J Impot Res 2018; 30:171-178. [PMID: 29795530 DOI: 10.1038/s41443-018-0029-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 02/13/2018] [Accepted: 02/20/2018] [Indexed: 01/19/2023]
Abstract
The aim of the present study was to investigate which PD specific factors (e.g., degree of penile curvature, levels of pain) cause most distress and to further explore whether there are specific subgroups of patients that report particularly high levels of psychological distress. Data were available for N = 119 men with a clinical diagnosis of PD presenting at a private Uro-Andrology in Germany. The strongest complaint of men with PD was being bothered by the look of the penis as opposed to being distressed by the pain (3.48 vs. 2.11). 75.4% reported having significantly less intercourse due to PD and for 61.4% this was very bothersome. Plaque size correlated positively with the level of symptom bother (r = 0.73, p < 0.05). Furthermore, men with a stronger curvature reported more concerns regarding size and form of the penis (r = 0.18, p < 0.05), more overall sexual dissatisfaction (r = -0.38, p < 0.001), and more PD related psychological and physiological symptoms (r = 0.58, p < 0.001). 44.4% of patients had a concurrent ED. Highest level of symptom bother was reported by men with a a strong curvature and a comorbid ED. Clinicians should pay special attention to patients presenting with extreme penile deformity and impaired sexual functioning, as they show the highest levels of psychological distress. Here, additional psychosexual support might be necessary.
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Punjani N, Stern N, Brock G. Characterization of Septal and Punctate Scarring in Peyronie's Disease. Urology 2018; 118:87-91. [PMID: 29800632 DOI: 10.1016/j.urology.2018.05.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 05/04/2018] [Accepted: 05/11/2018] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To characterize patients with isolated septal scarring (ISS) and punctate scarring (PS) in Peyronie's disease (PD) and to highlight the importance of duplex ultrasonography in the workup of patients with PD. MATERIALS AND METHODS Data from all men undergoing duplex ultrasonography at London Health Sciences Center for PD or erectile dysfunction over a 3-year period were retrospectively reviewed. RESULTS Our cohort included 722 patients with duplex ultrasound. ISS were demonstrated in 217 patients (30%), and PS in 197 (27%), with 72 (33%) and 148 (75%), respectively, having a normal physical examination. In both ISS and PS groups, more than half of patients also had associated erectile dysfunction. Predictive factors for ISS on multivariate analysis included trauma history (odds ratio [OR] 1.90, P = .04) and age (OR 1.02, P = .01). Patients with ISS were more likely to have dorsal curvature (OR 3.81, P <.01). CONCLUSION Limited data exist in the literature regarding ISS and PS in PD. Our study illustrates that one-third of ISS and three-quarters of PS would have remained unrecognized without duplex ultrasonography, and it highlights its importance in the workup and subsequent management of these patients. Further studies are needed to better understand and to determine the at-risk patient and the associated clinical implications of ISS and PS, and to ultimately provide optimized and individualized management strategies.
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Affiliation(s)
- Nahid Punjani
- Division of Urology, Department of Surgery, Western University, London, Ontario, Canada
| | - Noah Stern
- Division of Urology, Department of Surgery, Western University, London, Ontario, Canada
| | - Gerald Brock
- Division of Urology, Department of Surgery, Western University, London, Ontario, Canada.
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Cwikla DJ, Yafi FA. Intralesional collagenase Clostridium histolyticum in the management of Peyronie's disease: current best practice. Ther Adv Urol 2018; 10:139-153. [PMID: 29560030 PMCID: PMC5851106 DOI: 10.1177/1756287218755020] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 12/31/2017] [Indexed: 11/16/2022] Open
Abstract
The use of Clostridium histolyticum collagenase (CCH) has become increasingly widespread for the treatment of Peyronie's disease (PD) in recent years. Numerous trials have confirmed both its safety and efficacy in appropriately selected patients with this condition. The purpose of this review is to examine pivotal trials demonstrating the efficacy of CCH, revisit viable candidates for treatment with intralesional injection therapy, and provide a summary of injection technique and appropriate management of patients receiving this treatment at the time of therapy and in follow up.
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Affiliation(s)
- Daniel J. Cwikla
- Department of Urology, University of California Irvine, Orange, CA, USA
| | - Faysal A. Yafi
- Department of Urology, University of California Irvine, 333 The City Blvd W, Suite 2100, Orange, CA 92868, USA
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Akerman J, Kovac JR. Treatment of Peyronie's disease via preoperative intralesional collagenase clostridium histolyticum followed by placement of an inflatable penile prosthesis: the new standard of care? Transl Androl Urol 2017; 6:S822-S823. [PMID: 29239395 PMCID: PMC5715171 DOI: 10.21037/tau.2017.11.04] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Affiliation(s)
- Jason Akerman
- Department of Urology, McMaster University, Hamilton, Ontario, Canada
| | - Jason R Kovac
- Men's Health Center, Indianapolis, Indiana 46260, USA
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