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Karakus S, Unal S, Dai D, Joseph C, Du Comb W, Levy JA, Hawksworth D, Burnett AL. Early-onset and uncontrolled diabetes mellitus factors correlate with complications of Peyronie's disease. J Sex Med 2024:qdae069. [PMID: 38971577 DOI: 10.1093/jsxmed/qdae069] [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: 11/06/2023] [Revised: 06/05/2024] [Accepted: 06/17/2024] [Indexed: 07/08/2024]
Abstract
BACKGROUND Peyronie's disease (PD) is a connective tissue disorder that affects the penis and is characterized by abnormal collagen structure in the penile tunica albuginea, resulting in plaque formation and penile deformity. PD's overall prevalence is estimated at 3.2% to 8.9%, with rates as high as 20.3% among men with type 2 diabetes mellitus (DM). However, the characteristics of DM associated with PD complications remain unclear. AIM To explore clinical associations between DM characteristics and PD complications. METHODS We conducted a retrospective analysis of patients with DM and PD who presented at our institution between 2007 and 2022. We examined patients' clinical histories, DM- and PD-related clinical parameters, and complications. Penile deformities were assessed through physical examination, photographs, and penile Doppler ultrasound. Patients were categorized into subgroups based on age of DM onset: early (<45 years), average (45-65 years), and late (>65 years). OUTCOMES Outcomes included effects of DM characteristics on PD development, progression, and severity. RESULTS In total, 197 patients were included in the evaluation. Early-onset diabetes and elevated hemoglobin A1c (HbA1c) levels exhibited significant correlations with the early development of PD (ρ = 0.66, P < .001, and ρ = -0.24, P < .001, respectively). Furthermore, having DM at an early age was associated with the occurrence of penile plaque (ρ = -0.18, P = .03), and there were no significant differences in plaque dimensions (ρ = -0.29, P = .053). A rise in HbA1c levels after the initial PD diagnosis displayed positive correlations with the formation of penile plaque (ρ = 0.22, P < .006). CLINICAL IMPLICATIONS These findings emphasize the need for comprehensive assessments and personalized treatment strategies for individuals with DM and PD. Enhanced management approaches can improve outcomes for those facing both challenges. STRENGTHS AND LIMITATIONS Limitations include the single-site retrospective design with potential selection bias, inaccuracies in medical record data, and challenges in controlling confounding variables. CONCLUSIONS This study highlights that early-onset diabetes and poor diabetes control, as indicated by a subsequent rise in HbA1c levels following PD diagnosis, are significantly correlated with the onset and severity of PD. Revealing the mechanisms behind these findings will help us develop better management strategies for individuals with DM and PD.
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Affiliation(s)
- Serkan Karakus
- The James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, United States
| | - Selman Unal
- The James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, United States
| | - Daisy Dai
- The James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, United States
| | - Crystal Joseph
- The James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, United States
| | - William Du Comb
- The James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, United States
| | - Jason A Levy
- The James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, United States
| | - Dorota Hawksworth
- The James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, United States
| | - Arthur L Burnett
- The James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, United States
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Chi J, Bi W, Lou K, Ma J, Wu J, Cui Y. Research advances in Peyronie's disease: a comprehensive review on genomics, pathways, phenotypic manifestation, and therapeutic targets. Sex Med Rev 2024; 12:477-490. [PMID: 38456235 DOI: 10.1093/sxmrev/qeae006] [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: 11/09/2023] [Revised: 01/02/2024] [Accepted: 01/26/2024] [Indexed: 03/09/2024]
Abstract
INTRODUCTION Penile induration disease, commonly known as Peyronie's disease (PD), is a connective tissue disorder that affects the penis, leading to the development of fibrous plaques, penile curvature, and erectile dysfunction. PD is a common male reproductive system disease with a complex etiology involving multiple genes, signaling pathways, and different phenotypes. OBJECTIVES The etiology and pathogenesis of PD remain poorly understood, hindering the development of effective treatment strategies. By understanding the underlying mechanisms of PD, we can pave the way for targeted therapies and improved patient outcomes. METHODS We reviewed the epidemiology and pathophysiology of PD. We performed database searches on Google Scholar, PubMed, Medline, and Web of Science from inception to September 2023. The literature reviewed included priapism guidelines, review articles, current trial studies, and various literature related to PD. RESULTS This article provides a comprehensive overview of the current research progress on the disease, focusing on its genetic factors, signaling pathways, cellular mechanisms, phenotypic manifestations, and therapeutic targets. It can help identify individuals at higher risk, aid in early detection and intervention, and provide insights into fibrosis and tissue remodeling. It can also reveal potential therapeutic targets, guide accurate diagnoses and treatment strategies, and address the impact of the disease on patients' quality of life. CONCLUSION By integrating insights from genomics, molecular pathways, clinical phenotypes, and therapeutic potentials, our research aims to achieve a deeper and more comprehensive understanding of PD, propelling the field toward innovative strategies that enhance the lives of those affected by PD. The complex manifestations and pathogenesis of PD necessitate the use of multiple treatment methods for personalized care.
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Affiliation(s)
- Junpeng Chi
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, 264000, China
| | - Wenhua Bi
- Department of Urology, Weifang Hospital of Traditional Chinese Medicine, Weifang, 265400, China
| | - Keyuan Lou
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, 264000, China
| | - Jian Ma
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, 264000, China
| | - Jitao Wu
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, 264000, China
| | - Yuanshan Cui
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, 264000, China
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Gundogdu G, Nguyen T, Namasivayam A, Starek S, Gelman J, Mauney JR. Characterization of a novel rabbit model of Peyronie's disease. Int J Impot Res 2024; 36:269-274. [PMID: 36782023 PMCID: PMC11035118 DOI: 10.1038/s41443-023-00671-y] [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: 08/19/2022] [Revised: 01/25/2023] [Accepted: 01/30/2023] [Indexed: 02/15/2023]
Abstract
Peyronie's disease (PD) is a debilitating pathology which is associated with penile curvature and erectile dysfunction due to the formation of fibrotic plaques in the penile tunica albuginea. In the present study, we developed a novel rabbit model of PD via subtunical injection of recombinant transforming growth factor (TGF)-β1 protein and characterized erectile function and histopathological endpoints following plaque formation. Ten adult male, New Zealand white rabbits were randomized into 3 experimental groups including nonsurgical controls (NSC, N = 3) and those receiving subtunical injections of vehicle (N = 3) or TGF-β1 protein (0.5 µg/50 µl; N = 4). Following 1 month post-op, focal fibrous plaques composed of disorganized collagen type I and III bundles as well as fragmented elastin fibers at TGF-β1 injection sites were observed in contrast to control groups. Cavernosometric and cavernosographic evaluations revealed no significant differences in maximum intracorporal pressures or substantial curvature during papaverine-induced erection in either the vehicle or TGF-β1 cohorts. Immunohistochemical and histomorphometric analyses demonstrated significant increases in elastase 2B expression in TGF-β1-induced plaques as well as significant declines in matrix metalloproteinase (MMP)-2 and -9 expression relative to control levels. Our results demonstrate that PD-like fibrotic plaques can be created in the rabbit penile tunica albuginea following TGF-β1 injection.
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Affiliation(s)
- Gokhan Gundogdu
- Department of Urology, University of California, Irvine, Orange, CA, USA
| | - Travis Nguyen
- Department of Biomedical Engineering, University of California, Irvine, Irvine, CA, USA
| | - Aarthi Namasivayam
- Department of Biomedical Engineering, University of California, Irvine, Irvine, CA, USA
| | - Stephanie Starek
- Department of Urology, University of California, Irvine, Orange, CA, USA
| | - Joel Gelman
- Department of Urology, University of California, Irvine, Orange, CA, USA
| | - Joshua R Mauney
- Department of Urology, University of California, Irvine, Orange, CA, USA.
- Department of Biomedical Engineering, University of California, Irvine, Irvine, CA, USA.
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Gao D, Shen Y, Tang B, Ma Z, Chen D, Yu X, Li G, Chang D. The 100 most-cited publications on Peyronie's disease: a bibliometric analysis and visualization study. Int J Impot Res 2024; 36:110-117. [PMID: 37198341 DOI: 10.1038/s41443-023-00703-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 04/16/2023] [Accepted: 04/18/2023] [Indexed: 05/19/2023]
Abstract
This study aimed to summarize the characteristics of the top 100 most-cited publications on Peyronie's disease (PD) research and to analyse past and current research hotspots and trends. The SCI-E database of the Web of Science Core Collection (WoSCC) provided us with the top 100 most-cited publications in PD research, from which we took the following information: general trend of publication, year of publication, nation/region, institution, journal, author, and keywords. VOSviewer (version 1.6.18) and Excel (version 2016) were used for information analysis. Through a standardized search, we ultimately found 1019 papers in the field of PD research, from which we extracted the 100 articles that had received the highest citations. The articles were published between 1949 and 2016. The United States is a major contributor to PD research (n = 67). The University of California, Los Angeles, was the institution with the largest number of articles (n = 11). These articles were published in 16 journals, with the largest number appearing in the Journal of Urology (n = 47). The author with the most articles was Levine LA (n = 9). Gelbard MK's articles had the highest citation frequency (n = 1158). Erectile dysfunction (n = 19) was the keyword with the highest frequency, indicating that PD-related erectile dysfunction was the leading focus of research in this field. Most of the keywords that have appeared in the past decade are related to the clinical treatment of PD. Therefore, we believe that improving patients' erectile function to the greatest extent in clinical treatment is the frontier and hot spot of future research.
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Affiliation(s)
- Dawei Gao
- TCM Regulating Metabolic Diseases Key Laboratory of Sichuan Province, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yifeng Shen
- TCM Regulating Metabolic Diseases Key Laboratory of Sichuan Province, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Bo Tang
- TCM Regulating Metabolic Diseases Key Laboratory of Sichuan Province, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Ziyang Ma
- TCM Regulating Metabolic Diseases Key Laboratory of Sichuan Province, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Di'ang Chen
- TCM Regulating Metabolic Diseases Key Laboratory of Sichuan Province, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xujun Yu
- TCM Regulating Metabolic Diseases Key Laboratory of Sichuan Province, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
- School of Medicine and Life Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Guangsen Li
- TCM Regulating Metabolic Diseases Key Laboratory of Sichuan Province, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Degui Chang
- TCM Regulating Metabolic Diseases Key Laboratory of Sichuan Province, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China.
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Şahin A, Babayev H, Cirigliano L, Preto M, Falcone M, Altıntas E, Gül M. Unveiling the molecular Hallmarks of Peyronie's disease: a comprehensive narrative review. Int J Impot Res 2024:10.1038/s41443-024-00845-2. [PMID: 38454161 DOI: 10.1038/s41443-024-00845-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 01/26/2024] [Accepted: 02/12/2024] [Indexed: 03/09/2024]
Abstract
Peyronie's disease, a fibroinflammatory disorder, detrimentally impacts the sexual well-being of men and their partners. The manifestation of fibrotic plaques within penile tissue, attributed to dysregulated fibrogenesis, is pathognomonic for this condition. The onset of fibrosis hinges on the perturbation of the equilibrium between matrix metalloproteinases (MMPs), crucial enzymes governing the extracellular matrix, and tissue inhibitors of MMPs (TIMPs). In the context of Peyronie's disease, there is an elevation in TIMP levels coupled with a decline in MMP levels, culminating in fibrogenesis. Despite the scant molecular insights into fibrotic pathologies, particularly in the context of Peyronie's disease, a comprehensive literature search spanning 1995 to 2023, utilizing PubMed Library, was conducted to elucidate these mechanisms. The findings underscore the involvement of growth factors such as FGF and PDGF, and cytokines like IL-1 and IL-6, alongside PAI-1, PTX-3, HIF, and IgG4 in the fibrotic cascade. Given the tissue-specific modulation of fibrosis, comprehending the molecular underpinnings of penile fibrosis becomes imperative for the innovation of novel and efficacious therapies targeting Peyronie's disease. This review stands as a valuable resource for researchers and clinicians engaged in investigating the molecular basis of fibrotic diseases, offering guidance for advancements in understanding Peyronie's disease.
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Affiliation(s)
- Ali Şahin
- Selcuk University School of Medicine, 42250, Konya, Turkey
| | - Huseyn Babayev
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, 7265, Davos, Switzerland
| | - Lorenzo Cirigliano
- Department of Urology, Molinette Hospital, University of Torino, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Mirko Preto
- Department of Urology, Molinette Hospital, University of Torino, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Marco Falcone
- Department of Urology, Molinette Hospital, University of Torino, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Emre Altıntas
- Department of Urology, Selcuk University School of Medicine, 42250, Konya, Turkey
| | - Murat Gül
- Department of Urology, Molinette Hospital, University of Torino, AOU Città della Salute e della Scienza di Torino, Turin, Italy.
- Department of Urology, Selcuk University School of Medicine, 42250, Konya, Turkey.
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Sharqawi A, Mansour MF, Elatrash GA, Ismail EA, Ralph D, El-Sakka AI. Role of adipose-derived stem cells in healing surgically induced trauma of the rat's tunica albuginea. Sex Med 2023; 11:qfad058. [PMID: 38028732 PMCID: PMC10661659 DOI: 10.1093/sexmed/qfad058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 10/18/2023] [Accepted: 10/24/2023] [Indexed: 12/01/2023] Open
Abstract
Background Injection of adipose-derived stem cells (ADSCs) into the injured tunica albuginea (TA) may prevent fibrosis, restore the balance between pro- and antifibrotic pathways, and potentially mitigate erectile dysfunction caused by abnormal TA healing. Aim To assess the potential role of ADSC injection on structural, ultrastructural, functional, and molecular changes in surgically induced trauma of the rat's TA. Methods Forty adult male albino Wistar rats were divided into 5 groups of 8 rats each: group 1, sham; group 2, injury to TA without treatment; group 3, injury to TA and suture repair; group 4, injury to TA and injection of ADSCs without suture repair; group 5, injury to TA followed by injection of ADSCs and suture repair. Outcomes After 6 weeks, all groups were subjected to functional, histologic, and ultrastructural examination and molecular expression of healing growth factors. Results The intracavernous pressure (ICP; mean ± SD) was 114 ± 2, 32 ± 2, 65 ± 2, 68 ± 2, and 111 ± 2 mm Hg in groups 1 to 5, respectively. There were significant differences in ICP between each of groups 3 to 5 and group 2 (P < .05), and groups 3 and 4 each had significant differences with group 1 (P < .05). No significant difference in ICP occurred between groups 3 and 4 (P > .05). There were significant histologic and ultrastructural alterations in tunical tissues from group 2; however, these changes were markedly less in group 5 in terms of lower levels of fibrotic changes, elastosis, and superior overall neuroendothelial expression. Groups 3 and 4 showed improved structural and ultrastructural parameters when compared with group 2. Group 5 demonstrated lower levels of transforming growth factor β1 and basic fibroblast growth factor expression. Clinical Implications This experimental model may encourage administration of ADSCs to prevent the deleterious effects of trauma to the TA. Strengths and Limitations Injecting ADSCs can improve the healing process and erectile dysfunction in a rat model following TA injury, and combining ADSC injection with surgical suturing resulted in superior outcomes. The main limitation was the absence of long-term ICP measurements and a longer follow-up period that may provide further insight into the chronic phase of the healing process. Conclusion ADSC injection may prevent structural, ultrastructural, functional, and molecular alterations in surgically induced trauma of the rat's TA and enhance the effect of tunical suturing after trauma.
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Affiliation(s)
| | - Mona F Mansour
- Department of Physiology, Suez Canal University, Ismailia 4111, Egypt
| | - Gamal A Elatrash
- Department of Urology, Suez Canal University, Ismailia 4111, Egypt
| | - Ezzat A Ismail
- Department of Urology, Suez Canal University, Ismailia 4111, Egypt
| | - David Ralph
- Institute of Urology, University College of London Hospital, London W1G 8PH, United Kingdom
| | - Ahmed I El-Sakka
- Department of Urology, Suez Canal University, Ismailia 4111, Egypt
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Castiglione F, Çakır OÖ, Schifano N, Corona G, Reisman Y, Bettocchi C, Cellek S, Ilg MM. European Society of Sexual Medicine consensus statement on the use of animal models for studying Peyronie's disease. Sex Med 2023; 11:qfad046. [PMID: 37547872 PMCID: PMC10397421 DOI: 10.1093/sexmed/qfad046] [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: 04/12/2023] [Revised: 07/10/2023] [Accepted: 07/10/2023] [Indexed: 08/08/2023] Open
Abstract
Introduction Animal models are frequently used for translational research in Peyronie's disease (PD). However, due to lack of availability of guidelines, there is some heterogeneity in study design, data reporting, and outcome measures. Aim This European Society for Sexual Medicine consensus statement aims to provide guidance in utilization of animal models in PD research in a standardized and uniform fashion. Methods PubMed was searched for studies using animal models for PD. The following search terms were used: ("Peyronie's disease" OR "penile fibrosis" OR "penile curvature" OR "induration penis plastica" OR "erectile dysfunction") AND ("rodent" OR "mouse" OR "mice" OR "rat" OR "rabbit"). Outcomes This European Society for Sexual Medicine statement describes best practice guidelines for utilization of animals in PD research: power calculation, details of available models, surgical procedures, and measurement techniques, while highlighting possible pitfalls and translational limitations of the models. Results In total, 2490 studies were retrieved and 2446 articles were excluded. A total of 44 studies were included, of which 40 studies used rats, 1 study used both rats and mice, 1 study used a genetic mouse model, and 2 studies used rabbits. A significant number of the studies (70.5%) used transforming growth factor β 1 for induction of fibrosis. Oxford 2011 Levels of Evidence criteria could not be applied due to the nature of the studies. Conclusion Despite certain limitations of PD animal models presented, we aimed to provide guidance for their appropriate use in translational research, with the purpose of improving study quality and reproducibility as well as facilitating interpretation of reported results and conclusions.
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Affiliation(s)
| | - Onur Ö Çakır
- King's College London Hospital, London SE5 9RS, United Kingdom
| | - Nicolò Schifano
- King's College London Hospital, London SE5 9RS, United Kingdom
| | - Giovanni Corona
- Endocrinology Unit, Medical Department, Maggiore-Bellaria Hospital, Azienda USL, Bologna 40139, Italy
| | | | - Carlo Bettocchi
- Department of Urology, University of Bari, Bari 70121, Italy
| | - Selim Cellek
- Fibrosis Research Group, Medical Technology Research Centre, Anglia Ruskin University, Chelmsford, Essex CM1 1SQ, United Kingdom
| | - Marcus M Ilg
- Fibrosis Research Group, Medical Technology Research Centre, Anglia Ruskin University, Chelmsford, Essex CM1 1SQ, United Kingdom
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Rahardjo HE, Märker V, Tsikas D, Kuczyk MA, Ückert S, Bannowsky A. Fibrotic Diseases of the Human Urinary and Genital Tract: Current Understanding and Potential Strategies for Treatment. J Clin Med 2023; 12:4770. [PMID: 37510885 PMCID: PMC10381287 DOI: 10.3390/jcm12144770] [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: 04/25/2023] [Revised: 07/05/2023] [Accepted: 07/13/2023] [Indexed: 07/30/2023] Open
Abstract
Fibrosis is a disease condition characterized by abnormalities of the extracellular matrix, such as accumulation of the transforming growth factor β, infiltration by myofibroblasts, deposition of collagen, and a generalized dysregulation of collagen maturation. It can severely impair the function of organs by replacing normal tissue with a highly collagenized matrix, thereby reducing the elasticity and compliance of tissues. Fibrotic diseases of the genitourinary tract present relevant problems in healthcare, and their principles of pathophysiology remain unclarified; hence, the armamentarium for prevention and treatment is limited. These diseases include renal fibrosis, Peyronie's disease and ureteral and urethral strictures due to perturbations in the process of wound healing in response to injuries. Such deteriorations may contribute to obstructive uropathies or sexual dysfunction. This review provides a brief overview of the most frequent fibrotic diseases of the genitourinary system and of how the pathophysiology is related to symptoms, and also highlights potential therapeutic strategies to address the abnormal deposition of collagen. Although the understanding of factors associated with fibrotic conditions of the urinary and genital tract is still limited, some beneficial advances have been made. Further research will serve to provide a more comprehensive insight into factors responsible for the development of fibrotic tissue deposition.
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Affiliation(s)
- Harrina E Rahardjo
- Department of Urology, Cipto Mangunkusumo Hospital, School of Medicine, University of Indonesia, Jakarta 10430, Indonesia
- Department of Urology & Urological Oncology, Division of Surgery, Hannover Medical School, 30625 Hannover, Germany
| | - Viktoria Märker
- Department of Forensic Psychiatry, University Hospital Hamburg-Eppendorf (UKE), 20251 Hamburg, Germany
| | - Dimitrios Tsikas
- Core Unit Proteomics, Center of Pharmacology & Toxicology, Hannover Medical School, 30625 Hannover, Germany
| | - Markus A Kuczyk
- Department of Urology & Urological Oncology, Division of Surgery, Hannover Medical School, 30625 Hannover, Germany
| | - Stefan Ückert
- Department of Urology & Urological Oncology, Division of Surgery, Hannover Medical School, 30625 Hannover, Germany
| | - Andreas Bannowsky
- Department of Urology, Imland Hospital gGmbH, 24768 Rendsburg, Germany
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Ilg MM, Ralph DJ, Cellek S. Statins synergize with phosphodiesterase type 5 inhibitors but not with selective estrogen receptor modulators to prevent myofibroblast transformation in an in vitro model of Peyronie's disease. J Sex Med 2023:7131119. [PMID: 37082866 DOI: 10.1093/jsxmed/qdad051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 02/22/2023] [Accepted: 03/10/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND Peyronie's disease (PD) is a fibrotic disorder characterized by plaque formation in the tunica albuginea (TA) of the penis, and we have previously shown that inhibition of transformation of TA-derived fibroblasts to myofibroblasts using a combination phosphodiesterase type 5 (PDE5) inhibitors and selective estrogen receptor modulators (SERMs) is effective in slowing the progression of early PD. AIM The study sought to investigate whether combinations of statins with PDE5 inhibitors or SERMs would affect myofibroblast transformation in vitro. METHODS Primary fibroblasts were isolated from TA of patients with PD and stimulated with transforming growth factor β1 in the absence and presence of a range of concentrations of statins, PDE5 inhibitors, SERMs, and their combinations for 72 hours before quantifying α-smooth muscle actin using in-cell enzyme-linked immunosorbent assay. OUTCOMES The prevention of transforming growth factor β1-induced transformation of TA-derived fibroblasts to myofibroblasts was measured in vitro. RESULTS Statins (simvastatin, lovastatin) inhibited myofibroblast transformation in a concentration-dependent manner with half maximal inhibitory concentration values of 0.77 ± 0.07 μM and 0.8 ± 0.13 μM, respectively. Simvastatin inhibited myofibroblast transformation in a synergistic fashion when combined with vardenafil (a PDE5 inhibitor; log alpha >0). Combination of tamoxifen (a SERM) and simvastatin did not show synergy (log alpha <0). When 3 drugs (simvastatin, vardenafil, and tamoxifen) were combined, the effect was not synergistic, but rather was additive. CLINICAL IMPLICATIONS A combination of a statin with a PDE5 inhibitor might be useful in the clinic to slow the progression of the disease in patients with early PD; however, caution should be taken with such a combination because of the reported myopathy as a side effect. STRENGTHS AND LIMITATIONS The use of primary human cells from patients with PD is a strength of this study. The mechanisms by which these drug classes exert synergy when used in combination was not investigated. CONCLUSION This is the first demonstration of an antifibrotic synergy between statins and PDE5 inhibitors.
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Affiliation(s)
- Marcus M Ilg
- Medical Technology Research Centre, School of Allied Health, Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin University, Chelmsford CM1 1SQ, United Kingdom
| | - David J Ralph
- Medical Technology Research Centre, School of Allied Health, Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin University, Chelmsford CM1 1SQ, United Kingdom
- Urology Department, University College Hospital, London W1G 8PH, United Kingdom
| | - Selim Cellek
- Medical Technology Research Centre, School of Allied Health, Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin University, Chelmsford CM1 1SQ, United Kingdom
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Gianazza S, Belladelli F, Leni R, Masci F, Rossi P, Gianesini G, Maggio P, Zaffuto E, Salonia A, Carcano G, Dehò F, Capogrosso P. Peyronie's disease development and management in diabetic men. Andrology 2023; 11:372-378. [PMID: 35771713 DOI: 10.1111/andr.13224] [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: 03/31/2022] [Revised: 06/15/2022] [Accepted: 06/24/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND Peyronie's disease (PD) is a fibrosing disorder of the penis resulting in plaque formation and penile deformity that negatively affect sexual and psychosocial function of patients. A multifactorial etiology of PD is assumed with diabetes mellitus (DM) being a potential risk factor. OBJECTIVES The aim of this narrative review was to investigate diabetes role in PD pathophysiology, diagnosis, and treatment. MATERIALS AND METHODS A non-systematic narrative review of original articles, meta-analyses, and randomized trials was conducted, including articles in the pre-clinical setting to support relevant findings. RESULTS Diabetes is one of the most common comorbidity observed in PD patients, with a prevalence of about 11% and a strong association with erectile dysfunction (ED). DM is associated with both a higher risk of developing PD and has also an impact on the outcomes of PD's treatments. DISCUSSION Evidence from literature underlines that metabolic alterations typical of DM are pivotal factors in the development of PD and resistance to its medical treatment. CONCLUSION The role of DM in development of PD is still debated, while its role in PD development is not completely clear, there is a clear impact of DM on PD treatment outcomes.
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Affiliation(s)
- Simone Gianazza
- Department of Urology, University of Insubria, Varese, Italy.,Department of Surgery, Circolo & Fondazione Macchi Hospital-ASST Sette Laghi, Varese, Italy
| | - Federico Belladelli
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.,Department of Urology, University Vita-Salute San Raffaele, Milan, Italy
| | - Riccardo Leni
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.,Department of Urology, University Vita-Salute San Raffaele, Milan, Italy
| | - Federica Masci
- Department of Urology, University of Insubria, Varese, Italy.,Department of Surgery, Circolo & Fondazione Macchi Hospital-ASST Sette Laghi, Varese, Italy
| | - Piercarlo Rossi
- Department of Urology, Circolo & Fondazione Macchi Hospital-ASST Sette Laghi, Varese, Italy
| | - Giuseppe Gianesini
- Department of Urology, Circolo & Fondazione Macchi Hospital-ASST Sette Laghi, Varese, Italy
| | - Paolo Maggio
- Department of Urology, Circolo & Fondazione Macchi Hospital-ASST Sette Laghi, Varese, Italy
| | - Emanuele Zaffuto
- Department of Urology, University of Insubria, Varese, Italy.,Department of Urology, Circolo & Fondazione Macchi Hospital-ASST Sette Laghi, Varese, Italy
| | - Andrea Salonia
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.,Department of Urology, University Vita-Salute San Raffaele, Milan, Italy
| | - Giulio Carcano
- Department of Urology, University of Insubria, Varese, Italy.,Department of Surgery, Circolo & Fondazione Macchi Hospital-ASST Sette Laghi, Varese, Italy
| | - Federico Dehò
- Department of Urology, University of Insubria, Varese, Italy.,Department of Urology, Circolo & Fondazione Macchi Hospital-ASST Sette Laghi, Varese, Italy
| | - Paolo Capogrosso
- Department of Urology, University of Insubria, Varese, Italy.,Department of Urology, Circolo & Fondazione Macchi Hospital-ASST Sette Laghi, Varese, Italy
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11
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Topcuoglu M, Çakan M. Effects of long term sildenafil on the acute phase of Peyronie’s disease in a combination treatment. Arch Ital Urol Androl 2022; 94:319-322. [DOI: 10.4081/aiua.2022.3.319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 07/02/2022] [Indexed: 11/23/2022] Open
Abstract
Objectives: The aim of this study was to investigate the impact of the addition of 50 mg daily sildenafil to pentoxifylline-colchicine combination ther-apy on the Peyronie's plaque features in patients with the acute phase of Peyronie's disease (PD). Methods: In this retrospective and non-randomized clinical study, patients were divided into 2 groups as group 1; (n = 107) who received colchicine and pentoxyfillin plus 50 mg daily oral sildenafil, and as group 2; (n = 79) who received only colchicine and pentoxyfillin. Patients were compared in terms of degree of curvature, pain in erection and erectile function at the baseline and at 6-month follow up. Pain in erection and erectile func-tion were evaluated by visual Analogue Scale (EF-VAS), and the shortened version of the International Index of Erectile Function (IIEF-5). Improvement in the degree of curvature and change in EF-VAS scores were primary endpoints of the study. Change in IIEF-5 score was the secondary endpoint of the study.
Results: The two groups were statistically similar in terms of demographics and baseline features of PD. A statistically signifi-cant reduction in degree of curvature and EF-VAS scores was shown in group 1 compared to group 2.There was also a signifi-cantly higher IIEF-5 score in group 1 compared to group 2. No significant side effects were detected in both groups during treatment period.Conclusions: Adding sildenafil to pentoxifylline-colchicine com-bination treatment seems to improve PD related symptoms in the acute phase PD. PDE5i may contribute to relieve the Peyronie's symptoms in ED patients through their antifibrotic effects.
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12
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Dullea A, Efimenko I, Firdaus F, Griswold A, Arora H, Masterson T, Ramasamy R. Whole-Genome Sequencing Identifies Novel Heterozygous Mutation in ALMS1 in Three Men with Both Peyronie's and Dupuytren's Disease. Urology 2022; 166:76-78. [PMID: 35292292 PMCID: PMC9356975 DOI: 10.1016/j.urology.2022.02.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 02/21/2022] [Accepted: 02/27/2022] [Indexed: 11/30/2022]
Abstract
Peyronie's Disease (PD) is estimated to occur in up to 13% of males and has been associated with Dupuytren's Disease (DD). We identified 3 men with PD/DD and hypothesized that there may be a genetic association between the 2 diseases. Blood samples were collected from the participants and sent for whole genome sequencing. A rare non-synonymous mutation in the ALMS1 gene was identified in 3 men. Interestingly, ALMS1 is associated with TGF-b, and aberrant fibrosis. This pilot study generates the hypothesis that mutations in ALMS1 may predispose patients to development of PD/DD.
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13
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Paulis G, Pisano F, Palmieri A, Cai T, Palumbo F, Giammusso B. Urologists' knowledge base and practice patterns in Peyronie's disease. A national survey of members of the italian andrology society. Arch Ital Urol Androl 2021; 93:348-355. [PMID: 34839643 DOI: 10.4081/aiua.2021.3.348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 08/09/2021] [Indexed: 11/23/2022] Open
Abstract
Peyronie's disease is a chronic inflammatory disease involving the formation of plaque in the tunica albuginea of the corpora cavernosa, resulting in penis deformity. It is often associated with penile pain, especially in younger patients, but it is not rare for pain to be absent; the disease is also associated with erectile dysfunction and a depressive state in a large percentage of cases. OBJECTIVE Aim of our study was to explore the basic knowledge base and diagnostic and therapeutic practice patterns in Peyronie's disease (PD) of a large number of physicians belonging to the Italian Andrology Society (SIA). METHODS Our survey is based on two questionnaires which were e-mailed to the members of the SIA. The first questionnaire explored diagnostic and therapeutic practice patterns of SIA physicians, while the second questionnaire focused on their knowledge of the disease, as well as their training and level of experience in the specific field. We then planned to compare our outcomes with similar PD surveys from other countries. RESULTS The first questionnaire was answered by 142 SIA physicians. The second questionnaire was answered by 83 SIA physicians. Most respondents (74.6%) chose penile ultrasonography as first-line diagnostic approach and 47.1% prefer to perform a color Doppler ultrasound after pharmaco-induced erection. Concerning the therapeutic practice patterns in active stage of the disease, most respondents (99.29%) prefer conservative medical therapy. Additionally, most respondents (64.78%), when failure of conservative treatment had been established, considered surgical treatment necessary, specifically corporoplasty, which may be associated with other techniques. CONCLUSIONS The results of our survey show that, in comparison to their foreign counterparts, Italian SIA uro-andrologists have a more proactive diagnostic approach right from when patients first present. When PD is still in its active stage, SIA uro-andrologists mostly opt for medical therapy. In advanced disease or if conservative treatment fails, our survey indicates a greater preference for surgical treatment. Answers to the theoretical knowledge questions showed that SIA physicians have a good understanding of the disease's etiology, epidemiology, and clinical picture, and of the appropriate indications for treatment.
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Affiliation(s)
- Gianni Paulis
- Peyronie's Care Center, Department of Uro-Andrology, Castelfidardo Medical Team, Rome.
| | - Francesca Pisano
- Peyronie's Care Center, Department of Uro-Andrology, Castelfidardo Medical Team, Rome.
| | - Alessandro Palmieri
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples.
| | - Tommaso Cai
- Department of Urology, Santa Chiara Regional Hospital, Trento.
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14
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Cohen DJ, Reynaldo WV, Borba VB, Theodoro TR, Petri G, Cavalheiro RP, Mader AM, Han SW, Pinhal MA, Glina S. New in vivo model to assess macroscopic, histological, and molecular changes in Peyronie's disease. Andrology 2021; 10:154-165. [PMID: 34464514 DOI: 10.1111/andr.13092] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 06/21/2021] [Accepted: 08/01/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Peyronie's Disease (PD) is a connective tissue disorder that affects the tunica albuginea (TA) of the penis causing curvature and erectile dysfunction. The pathophysiology is not well understood and, for this reason, treatment options are limited. OBJECTIVE The aim of the present study is to analyze and compare whether single or multiple instillations of plasma in the TA of rats is capable of triggering macroscopic, histopathological, and molecular changes consistent with PD. MATERIAL/METHODS Fifty male Wistar rats were divided into four groups: Group 1: a single instillation of plasma in the TA; Group 2: a single instillation of distilled water in the TA; Group 3: four instillations of plasma in the TA (1x per week); and Group 4: four instillations of distilled water in the TA (1× per week). Forty-five days after the last instillation a manual inspection of the corpus cavernosum, a penile erection test and a penectomy were performed to obtain material for histopathological and molecular analysis. RESULTS It was observed that 31.25% of the rats that received repeated instillations of plasma presented penile curvature according to the erection test, while none of the rats from the control group or group with one instillation of plasma presented curvature. In the animals that received four instillations of plasma, the following differences were observed in relation to the control group: increase in fibrosis and the deposition of collagen I. The protein expression of heparanase (HPSE) and TGF-β increased in the groups that received a single or four instillations of plasma, and the protein expression of heparanase-2 (HPSE-2), metalloproteinases (MMP-2, MMP-9) and metalloproteinase inhibitor (TIMP-2) showed an increase in the group that received four instillations of plasma. There was a significant increase in the gene expression of HPSE, MMP-9, and TGF-β in the group that received four instillations of plasma. In the analysis of the glycosaminoglycans, an increase was observed in the secretion of galactosaminoglycans chondroitin sulfate and dermatan sulfate (CS/DS) in the group that received four instillations of plasma. DISCUSSION Previous studies have demonstrated increased protein expression. of HPSE, MMP-9 and TGF-β with instillation of blood in the TA; however, there was no increase in gene expression. In the present study, the increase in the expression of TGF-β with plasma instillations, proved to be more reliable. The two models with plasma (one or four instillations) demonstrated significant histopathological and molecular changes when compared to the control group. However, only in the group with four plasma instillations there was a macroscopic change. The idea is that repeatedly extravasation of TGF-β present in plasma of predisposed individuals acts as a trigger for the development and maintenance of changes in the extracellular matrix that perpetuate an anomalous inflammatory process present in PD. CONCLUSION The present study shows that the repeated instillation of plasma is a low cost in vivo model for the study of PD.
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Affiliation(s)
- David J Cohen
- ABC Medical School, Urologic Department, Santo Andre, Brazil
| | | | - Vivian B Borba
- ABC Medical School, Urologic Department, Santo Andre, Brazil
| | | | - Giuliana Petri
- ABC Medical School, Experimental Surgery Department, Santo André, Brazil
| | | | - Ana M Mader
- ABC Medical school, Pathology Department, Santo André, Brazil
| | - Sang W Han
- Paulista Medical School, Biochemistry Department, São Paulo, Brazil
| | - Maria A Pinhal
- ABC Medical School, Biochemistry Department, Santo André, Brazil.,Paulista Medical School, Biochemistry Department, São Paulo, Brazil
| | - Sidney Glina
- ABC Medical School, Urologic Department, Santo Andre, Brazil
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15
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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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16
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DiNicolantonio JJ, McCarty MF, Barroso-Aranda J, Assanga S, Lujan LML, O'Keefe JH. A nutraceutical strategy for downregulating TGFβ signalling: prospects for prevention of fibrotic disorders, including post-COVID-19 pulmonary fibrosis. Open Heart 2021; 8:openhrt-2021-001663. [PMID: 33879509 PMCID: PMC8061562 DOI: 10.1136/openhrt-2021-001663] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/30/2021] [Indexed: 12/14/2022] Open
Affiliation(s)
- James J DiNicolantonio
- Preventive Cardiology, Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA
| | | | | | - Simon Assanga
- Department of Research and Postgraduate Studies in Food, University of Sonora, Sonora, Mexico
| | | | - James H O'Keefe
- University of Missouri-Kansas City, Saint Lukes Mid America Heart Institute, Kansas City, Missouri, USA
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17
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Ferretti L, Madec FX, Akakpo W, Methorst C, Carnicelli D, Terrier JE, Morel Journel N, Beley S, Graziana JP, Marcelli F, Hupertan V, Yiou R, Ben-Naoum K, Savareux L, Huyghe E, Faix A. [French Urological Association (AFU) guidelines for Peyronie's disease assessment and treatment]. Prog Urol 2021; 31:477-494. [PMID: 33941460 DOI: 10.1016/j.purol.2020.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 10/31/2020] [Accepted: 11/09/2020] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Peyronie's disease is a common cause for consultation in urology. Many controversies surround its treatment. No French Guidelines have been published so far. The Committee of Andrology and Sexual Medicine of the French Association of Urology therefore offers a series of evidence-based recommendations. MATERIALS AND METHODS These recommendations are made according to the ADAPTE method, based on European (EAU, ESSM), American (AUA, ISSM) and Canadian (CAU) recommendations, integrating French specificities due to the availability of treatments, and an update of the recent bibliography. RESULTS The assessment of the disease is clinical. Patients with functional impairment or significant psychological repercussions may be offered treatment. The benefits and drawbacks of each treatment should be explained to the patient. Regarding non-surgical treatments, no available treatment has market authorization in France. Vitamin E is not recommended. Analgesic (oral or low-intensity shock waves) or proerectile treatments may be offered as needed, as well as traction therapy. Due to the unavailability of collagenase injections, verapamil injections may be offered. Surgical treatments are to be considered in the stabilized phase of the disease, and consist of performing a plication, an incision-graft or the placement of a penile implant according to the patient's wishes, the curvature and the penis size, as well as erectile function. Combination treatments can be offered. CONCLUSION The management of Peyronie's disease is complex, and the levels of evidence for treatments are generally low. The success of treatment will depend on the quality of the initial assessment, the patient's information and understanding of the expected effects, and the practitioner's experience.
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Affiliation(s)
- L Ferretti
- Service d'urologie, MSP Bordeaux Bagatelle, Talence.
| | - F-X Madec
- Service d'urologie, hôpital Foch, Suresnes
| | - W Akakpo
- Département d'urologie, Hôpital Pitié-Salpétrière, Paris
| | - C Methorst
- Service d'urologie, hôpital des 4 Villes, Saint-Cloud
| | - D Carnicelli
- Service d'urologie, hôpital Privé Jean Mermoz, Lyon
| | - J-E Terrier
- Service d'urologie, Hôpital Lyon Sud, Pierre-Bénite
| | | | | | - J-P Graziana
- Clinique Mutualiste de la Porte de l'Orient, Lorient
| | - F Marcelli
- Service d'urologie, andrologie et transplantation rénale, hôpital Huriez CHU Lille, France
| | | | - R Yiou
- Département d'urologie, CHU Henri Mondor, Créteil
| | | | - L Savareux
- Service d'urologie, Hôpital Privé la Chataigneraie, Beaumont
| | - E Huyghe
- Département d'urologie, CHU Rangueil, Toulouse
| | - A Faix
- Centre d'urologie du Polygone, Montpellier
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18
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Beano H, Morgan JT, Ortiz NM. Penile Plication in Peyronie’s Disease: Technique Evolution and Recent Advances. CURRENT SEXUAL HEALTH REPORTS 2021. [DOI: 10.1007/s11930-021-00303-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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19
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Wang CX, Flick TR, Patel AH, Sanchez F, Sherman WF. Patients with Dupuytren's Contracture, Ledderhose Disease, and Peyronie's Disease are at higher risk of arthrofibrosis following total knee arthroplasty. Knee 2021; 29:190-200. [PMID: 33640618 DOI: 10.1016/j.knee.2021.02.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 11/05/2020] [Accepted: 02/05/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Total knee arthroplasty (TKA) is a successful treatment for patients with late stage osteoarthritis, yet arthrofibrosis remains a consistent cause of TKA failure. Dupuytren's, Ledderhose and Peyronie's Diseases are related conditions of increased fibroblast proliferation. The aim of this study was to identify whether an association exists between these conditions and arthrofibrosis following TKA. METHODS Patient records were queried from 2010 to 2016 using an administrative claims database to compare the rates of arthrofibrosis, manipulation under anesthesia (MUA), lysis of adhesions (LOA), and revision TKA in patients with independent chart diagnoses of Dupuytren's Contracture, Ledderhose, or Peyronie's Diseases versus those without. Complications were queried and compared using multivariate logistic regression. RESULTS Patients with Dupuytren's (n = 5,232) and Ledderhose (n = 50,716) had a significantly higher rate of ankylosis following TKA: 30-days (OR, 1.54; OR, 1.23), 90-days (OR, 1.20; OR, 1.24), 6-months (OR, 1.23; OR, 1.23), and 1-year (OR, 1.28; OR, 1.23), while patients with Peyronie's (n = 1,186) had a higher rate of diagnosis at 6-months (OR, 1.37) and 1-year (OR, 1.35). Patients with diagnoses of any of the fibroproliferative diseases had a statistically higher risk of MUA at 90-days, 6-month, and 1-year following primary TKA. These cohorts did not have a significantly higher rate of revision TKA. CONCLUSION There is an increased odds risk of arthrofibrosis and MUA in patients who have undergone TKA and have a diagnosis of Dupuytren's Contracture, Ledderhose, or Peyronie's Diseases. Improvements to frequency and application of post-operative treatment should be considered in these cohorts to improve outcomes.
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Affiliation(s)
- Cindy X Wang
- Department of Orthopedic Surgery, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA 70112, USA.
| | - Travis R Flick
- Department of Orthopedic Surgery, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA 70112, USA.
| | - Akshar H Patel
- Department of Orthopedic Surgery, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA 70112, USA.
| | - Fernando Sanchez
- Department of Orthopedic Surgery, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA 70112, USA.
| | - William F Sherman
- Department of Orthopedic Surgery, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA 70112, USA.
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20
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Rainer QC, Rodriguez AA, Bajic P, Galor A, Ramasamy R, Masterson TA. Implications of Calcification in Peyronie's Disease, A Review of the Literature. Urology 2021; 152:52-59. [PMID: 33476600 DOI: 10.1016/j.urology.2021.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 12/14/2020] [Accepted: 01/03/2021] [Indexed: 02/06/2023]
Abstract
A common characteristic of Peyronie's Disease (PD) is plaque calcification, which is associated with decreased response to treatments and higher rates of surgical intervention. Despite its prevalence in the PD population, the literature on plaque calcification is limited. While the diagnosis of PD is mostly clinical, imaging modalities such as ultrasound can be used to identify plaque calcification. The proper identification of plaque calcification is crucial for guiding management and setting therapeutic expectations for patients with PD. Herein we discuss what is known about PD plaque calcification, including epidemiology, etiology, diagnosis, and management.
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Affiliation(s)
| | | | | | - Anat Galor
- University of Miami Miller School of Medicine, Miami FL; Bruce W Carter VA Medical Center, Miami FL
| | | | - Thomas A Masterson
- University of Miami Miller School of Medicine, Miami FL; Bruce W Carter VA Medical Center, Miami FL.
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21
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Choi EJ, Schneider D, Xu P, El-Khatib FM, Yafi FA. Future concepts and therapy approaches for Peyronie’s disease. Expert Opin Orphan Drugs 2020. [DOI: 10.1080/21678707.2020.1804861] [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: 10/23/2022]
Affiliation(s)
- Edward J. Choi
- Department of Urology, University of California, Irvine Health, Orange, CA, USA
| | - Douglas Schneider
- Department of Urology, University of California, Irvine Health, Orange, CA, USA
| | - Perry Xu
- Department of Urology, University of California, Irvine Health, Orange, CA, USA
| | - Farouk M. El-Khatib
- Department of Urology, University of California, Irvine Health, Orange, CA, USA
| | - Faysal A. Yafi
- Department of Urology, University of California, Irvine Health, Orange, CA, USA
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22
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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: 5] [Impact Index Per Article: 1.3] [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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23
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DiGiorgio L, Mendez M, Parker J, Carrion R. Surgical Techniques and Pitfalls for Excision and Grafting. CURRENT SEXUAL HEALTH REPORTS 2019. [DOI: 10.1007/s11930-019-00207-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Song KM, Chung DY, Choi MJ, Ghatak K, Minh NN, Limanjaya A, Kwon MH, Ock J, Yin GN, Kim DK, Ryu JK, Suh JK. Vactosertib, a Novel, Orally Bioavailable Activin Receptor-Like Kinase 5 Inhibitor, Promotes Regression of Fibrotic Plaques in a Rat Model of Peyronie's Disease. World J Mens Health 2019; 38:552-563. [PMID: 31496148 PMCID: PMC7502315 DOI: 10.5534/wjmh.190071] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 07/13/2019] [Accepted: 07/16/2019] [Indexed: 12/16/2022] Open
Abstract
Purpose To examine the therapeutic effect of Vactosertib, a small molecule inhibitor of transforming growth factor-β (TGF-β) type I receptor (activin receptor-like kinase-5, ALK5), in an experimental model of Peyronie's disease (PD) and determining anti-fibrotic mechanisms of Vactosertib in primary fibroblasts derived from human PD plaques. Materials and Methods Male rats were randomly divided into three groups (n=6 per group); control rats without treatment; PD rats receiving vehicle; and PD rats receiving Vactosertib (10 mg/kg). PD-like plaques were induced by administering 100 µL of each of human fibrin and thrombin solutions into the tunica albuginea on days 0 and 5. Vactosertib was given orally five times a week for 2 weeks. On day 30, we performed electrical stimulation of the cavernous nerve to measure erectile function, and the penis was obtained for histological examination. Fibroblasts isolated from human PD plaques were used to determine the anti-fibrotic effects of Vactosertib in vitro. Results Vactosertib induced significant regression of fibrotic plaques in PD rats in vivo through reduced infiltration of inflammatory cells and reduced expression of phospho-Smad2, which recovered erectile function. Vactosertib also abrogated TGF-β1-induced enhancement of extracellular matrix protein production and hydroxyproline content in PD fibroblasts in vitro by hindering the TGF-β1-induced Smad2/3 phosphorylation and nuclear translocation, and fibroblast-to-myofibroblast transdifferentiation. Conclusions In view of the critical role of TGF-β and the Smad pathway in the pathogenesis of PD, inhibition of this pathway with an ALK5 inhibitor may represent a novel, targeted therapy for PD.
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Affiliation(s)
- Kang Moon Song
- National Research Center for Sexual Medicine and Department of Urology, Inha University School of Medicine, Incheon, Korea
| | - Doo Yong Chung
- National Research Center for Sexual Medicine and Department of Urology, Inha University School of Medicine, Incheon, Korea
| | - Min Ji Choi
- National Research Center for Sexual Medicine and Department of Urology, Inha University School of Medicine, Incheon, Korea
| | - Kalyan Ghatak
- National Research Center for Sexual Medicine and Department of Urology, Inha University School of Medicine, Incheon, Korea
| | - Nguyen Nhat Minh
- National Research Center for Sexual Medicine and Department of Urology, Inha University School of Medicine, Incheon, Korea
| | - Anita Limanjaya
- National Research Center for Sexual Medicine and Department of Urology, Inha University School of Medicine, Incheon, Korea
| | - Mi Hye Kwon
- National Research Center for Sexual Medicine and Department of Urology, Inha University School of Medicine, Incheon, Korea
| | - Jiyeon Ock
- National Research Center for Sexual Medicine and Department of Urology, Inha University School of Medicine, Incheon, Korea
| | - Guo Nan Yin
- National Research Center for Sexual Medicine and Department of Urology, Inha University School of Medicine, Incheon, Korea
| | - Dae Kee Kim
- Graduate School of Pharmaceutical Sciences, College of Pharmacy, Ewah Womans University, Seoul, Korea
| | - Ji Kan Ryu
- National Research Center for Sexual Medicine and Department of Urology, Inha University School of Medicine, Incheon, Korea.
| | - Jun Kyu Suh
- National Research Center for Sexual Medicine and Department of Urology, Inha University School of Medicine, Incheon, Korea.
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Patel DP, Christensen MB, Hotaling JM, Pastuszak AW. A review of inflammation and fibrosis: implications for the pathogenesis of Peyronie's disease. World J Urol 2019; 38:253-261. [PMID: 31190155 DOI: 10.1007/s00345-019-02815-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 05/17/2019] [Indexed: 01/07/2023] Open
Abstract
Peyronie's disease (PD) is a superficial fibrosing disorder that causes penile deformity and can interfere with sexual intercourse and reproduction, as well as diminish quality of life. While the exact mechanism of PD is still being investigated, there is likely a genetic component to the predisposition to penile plaque formation. Ultimately, however, perturbations in normal wound healing and aberrant deposition of extracellular matrix components lead to fibrotic tissue deposition. Fibrosis in PD is regulated by a complex pathway of inflammatory and fibrotic mediators. Currently there are no treatments for PD that address an underlying cause or disease progression. In this review, we provide an overview of the known inflammatory and fibrotic mediators of PD and explore the pathophysiology of other human superficial fibrosing disorders to develop further insights into PD.
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Affiliation(s)
- Darshan P Patel
- Division of Urology, Department of Surgery, Center for Reconstructive Urology and Men's Health, University of Utah School of Medicine, 30 N 1900 E, Rm # 3B420, Salt Lake City, UT, 84132, USA
| | - Michael B Christensen
- Division of Urology, Department of Surgery, Center for Reconstructive Urology and Men's Health, University of Utah School of Medicine, 30 N 1900 E, Rm # 3B420, Salt Lake City, UT, 84132, USA
| | - James M Hotaling
- Division of Urology, Department of Surgery, Center for Reconstructive Urology and Men's Health, University of Utah School of Medicine, 30 N 1900 E, Rm # 3B420, Salt Lake City, UT, 84132, USA
| | - Alexander W Pastuszak
- Division of Urology, Department of Surgery, Center for Reconstructive Urology and Men's Health, University of Utah School of Medicine, 30 N 1900 E, Rm # 3B420, Salt Lake City, UT, 84132, USA.
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26
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El-Khatib FM, Towe M, Yafi FA. Management of Peyronie's disease with collagenase Clostridium histolyticum in the acute phase. World J Urol 2019; 38:299-304. [PMID: 31093703 DOI: 10.1007/s00345-019-02791-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 04/26/2019] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Peyronie's disease (PD) can affect men of all ages and is associated with penile pain as well as curvature and erectile dysfunction. Treatment modalities for PD include conservative, less invasive and surgical treatments. Choice of treatment depends on the disease's phase. Injection of collagenase Clostridium histolyticum (CCH) is only the Food and Drug Administration approved treatment for the management of the chronic phase of the disease. Only a few limited studies have evaluated its potential benefits during the acute phase. AIM To evaluate the current evidence on the use of injectable CCH during the acute or active phase of PD. METHODS We performed a PubMed database search for articles published between 2015 and 2018 that investigated the use of CCH for the management of the acute phase of PD. Search keywords included "Peyronie's disease", "collagenase Clostridium histolyticum", and "acute phase". MAIN OUTCOME MEASURES Changes in penile curvature after treatment with injectable CCH. RESULTS Mean curvature decrease ranged between 15.8° and 22.6° corresponding to 27.4-37.4% decrease from baseline after 2.5-4 cycles, corresponding to 5-8 injections, of CCH treatment in patients during the acute phase of PD. CONCLUSIONS Intralesional CCH injection therapy during the acute phase of PD can be both safe and effective and clinically significant improvements in penile curvature may be achieved. Larger multi-institutional studies are, however, still needed to confirm these results and validate this additional indication for CCH.
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Affiliation(s)
- Farouk M El-Khatib
- Department of Urology, University of California Irvine, 333 The City Blvd W, Suite 2100, Orange, CA, 92868, USA
| | - Maxwell Towe
- Department of Urology, University of California Irvine, 333 The City Blvd W, Suite 2100, Orange, CA, 92868, 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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27
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Huang IS, Wren J, Bennett NE, Brannigan RE. Clinical Consultation Guide on Imaging in Male Infertility and Sexual dysfunction. Eur Urol Focus 2018; 4:338-347. [PMID: 30327281 DOI: 10.1016/j.euf.2018.09.018] [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: 07/16/2018] [Revised: 08/23/2018] [Accepted: 09/28/2018] [Indexed: 10/28/2022]
Abstract
Imaging can benefit clinicians in evaluating men with infertility or sexual dysfunction by giving an overview of a patient's overall clinical condition before undertaking an invasive procedure. An understanding of the limitations and advantages of image modalities used in clinical practice will ensure that clinicians can optimize patient care with imaging when necessary. PATIENT SUMMARY: The objective of this article was to review the current literature on imaging modalities used for the diagnosis and management of male infertility and sexual dysfunction. An understanding of the advantages and limitations of these imaging modalities will ensure that clinicians can optimize patient care with imaging when necessary.
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Affiliation(s)
- I-Shen Huang
- Department of Physiology, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Urology, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Urology, School of Medicine, Shu-Tien Urological Research Center, National Yang-Ming University, Taipei, Taiwan; Division of Male Reproductive Surgery and Men's Health, Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - James Wren
- Division of Male Reproductive Surgery and Men's Health, Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Nelson E Bennett
- Division of Male Reproductive Surgery and Men's Health, Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Robert E Brannigan
- Division of Male Reproductive Surgery and Men's Health, Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
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Huang S, Yang C, Li M, Wang B, Chen H, Fu D, Chong T. Effect of dual mTOR inhibitor on TGFβ1-induced fibrosis in primary human urethral scar fibroblasts. Biomed Pharmacother 2018; 106:1182-1187. [DOI: 10.1016/j.biopha.2018.07.070] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 07/12/2018] [Accepted: 07/13/2018] [Indexed: 11/17/2022] Open
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Setia SA, Levine LA. Devices for penile traction: the long and winding road to treating Peyronie's disease. Expert Rev Med Devices 2018; 15:517-526. [PMID: 30016597 DOI: 10.1080/17434440.2018.1502083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Penile traction therapy (PTT) is increasingly being recognized as a viable nonsurgical approach to Peyronie's disease (PD). The goal of this article is to review the current literature on PTT with attention to traction protocols, devices, and outcomes. AREAS COVERED Literature on the pathophysiology of PD, PTT as primary and adjunctive treatment for PD, perioperative use of PTT, and vacuum erection devices are all reviewed. Pertinent literature was obtained from the PubMed database. The key words 'penile traction,' 'mechanotransduction,' and 'Peyronie's disease' were searched and results were narrowed down based on relevance to the review. EXPERT COMMENTARY PTT appears beneficial but the true magnitude of effect is difficult to discern. Most studies are not randomized, have small sample sizes, lack control arms, or have varying traction protocols. Patient compliance is critical and new devices and traction protocols are needed to maximize the benefit of PTT.
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Affiliation(s)
- Shaan A Setia
- a Rush University Medical Center - Urology , Chicago , Illinois , USA
| | - Laurence A Levine
- a Rush University Medical Center - Urology , Chicago , Illinois , USA
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30
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Wang JP, Yu HHM, Chiang ER, Wang JY, Chou PH, Hung SC. Corticosteroid inhibits differentiation of palmar fibromatosis-derived stem cells (FSCs) through downregulation of transforming growth factor-β1 (TGF-β1). PLoS One 2018; 13:e0198326. [PMID: 29944666 PMCID: PMC6019676 DOI: 10.1371/journal.pone.0198326] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Accepted: 05/17/2018] [Indexed: 01/16/2023] Open
Abstract
Treatment for musculoskeletal fibromatosis remains challenging. Surgical excision for fibromatosis is the standard therapy but recurrence remains high. Corticosteroids, an anti-fibrogenic compound, have been used to treat early stage palmar fibromatosis, but the mechanism is unknown. We investigated the inhibitory mechanism effect of corticosteroids in the murine model of fibromatosis nodule as well as in cultured FSCs. Quantitative reverse transcription/polymerase chain reaction (PCR) analysis and immunofluorescence (IF) staining for markers of myofibroblasts (α-smooth muscle actin and type III collagen) were used to examine the effect of dexamethasone on myofibroblasic differentiation of FSCs both in vitro and in vivo. Transforming growth factor-β1 (TGF-β1) signaling and its downstream targets were examined using western blot analysis. TGF-β1 expression in FSCs before and after dexamethasone treatment was compared. In addition, inhibition of TGF-β1 expression was examined using RNA interference (RNAi) on FSCs, both in vitro and in vivo. Treating FSCs with dexamethasone inhibited FSCs’ myofibroblastic differentiation in vitro. Treating FSCs with dexamethasone before or after implantation further inhibited formation of fibromatosis nodules. Dexamethasone suppressed expression of TGF-β1 and pSmad2/3 by FSCs in vitro. TGF-β1 knockdown FSCs showed reducing myofibroblastic differentiation both in vitro and in vivo. Finally, addition of TGF-β1 abolished dexamethasone-mediated inhibition of myofibroblastic differentiation. Dexamethasone inhibits the myofibroblastic differentiated potential of FSCs both in vitro and in vivo through inhibition of TGF-β1 expression in FSCs. TGF-β1 plays a key role in myofibroblastic differentiation.
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Affiliation(s)
- Jung-Pan Wang
- Department of Surgery, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Orthopedics & Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan
- * E-mail:
| | - Hsiang-Hsuan Michael Yu
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, United States of America
| | - En-Rung Chiang
- Department of Surgery, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Orthopedics & Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jir-You Wang
- Department of Surgery, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Orthopedics & Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Po- Hsin Chou
- Department of Surgery, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Orthopedics & Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shih-Chieh Hung
- Department of Surgery, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Orthopedics & Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan
- Integrative Stem Cell Center, China Medical University Hospital, Taichung, Taiwan
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31
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Kang DH, Yin GN, Choi MJ, Song KM, Ghatak K, Minh NN, Kwon MH, Seong DH, Ryu JK, Suh JK. Silencing Histone Deacetylase 7 Alleviates Transforming Growth Factor-β1-Induced Profibrotic Responses in Fibroblasts Derived from Peyronie's Plaque. World J Mens Health 2018; 36:139-146. [PMID: 29706035 PMCID: PMC5924955 DOI: 10.5534/wjmh.170005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 01/23/2018] [Accepted: 02/03/2018] [Indexed: 12/19/2022] Open
Abstract
Purpose Epigenetic modifications, such as histone acetylation/deacetylation and DNA methylation, play a crucial role in the pathogenesis of inflammatory disorders and fibrotic diseases. The aim of this study was to study the differential gene expression of histone deacetylases (HDACs) in fibroblasts isolated from plaque tissue of Peyronie's disease (PD) or normal tunica albuginea (TA) and to examine the anti-fibrotic effect of small interfering RNA (siRNA)-mediated silencing of HDAC7 in fibroblasts derived from human PD plaque. Materials and Methods For differential gene expression study, we performed reverse-transcriptase polymerase chain reaction for HDAC isoforms (1–11) in fibroblasts isolated from PD plaque or normal TA. Fibroblasts isolated from PD plaque were pretreated with HDAC7 siRNA (100 pmol) and then stimulated with transforming growth factor-β1 (TGF-β1, 10 ng/mL). Protein was extracted from treated fibroblasts for Western blotting. We also performed immunocytochemistry to detect the expression of extracellular matrix proteins and to examine the effect of HDAC2 siRNA on the TGF-β1-induced nuclear translocation of Smad2/3 and myofibroblastic differentiation. Results The mRNA expression of HDAC2, 3, 4, 5, 7, 8, 10, and 11 was higher in fibroblasts isolated from PD plaque than in fibroblasts isolated from normal TA tissue. Knockdown of HDAC7 in PD fibroblasts inhibited TGF-β1-induced nuclear shuttle of Smad2 and Smad3, transdifferentiation of fibroblasts into myofibroblasts, and abrogated TGF-β1-induced production of extracellular matrix protein. Conclusions These findings suggest that specific inhibition of HDAC7 with RNA interference may represent a promising epigenetic therapy for PD.
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Affiliation(s)
- Dong Hyuk Kang
- National Research Center for Sexual Medicine, Inha University School of Medicine, Incheon, Korea.,Department of Urology, Inha University School of Medicine, Incheon, Korea
| | - Guo Nan Yin
- National Research Center for Sexual Medicine, Inha University School of Medicine, Incheon, Korea.,Department of Urology, Inha University School of Medicine, Incheon, Korea
| | - Min Ji Choi
- National Research Center for Sexual Medicine, Inha University School of Medicine, Incheon, Korea.,Department of Urology, Inha University School of Medicine, Incheon, Korea
| | - Kang Moon Song
- National Research Center for Sexual Medicine, Inha University School of Medicine, Incheon, Korea.,Department of Urology, Inha University School of Medicine, Incheon, Korea
| | - Kalyan Ghatak
- National Research Center for Sexual Medicine, Inha University School of Medicine, Incheon, Korea.,Department of Urology, Inha University School of Medicine, Incheon, Korea
| | - Nguyen Nhat Minh
- National Research Center for Sexual Medicine, Inha University School of Medicine, Incheon, Korea.,Department of Urology, Inha University School of Medicine, Incheon, Korea
| | - Mi Hye Kwon
- National Research Center for Sexual Medicine, Inha University School of Medicine, Incheon, Korea.,Department of Urology, Inha University School of Medicine, Incheon, Korea
| | - Do Hwan Seong
- National Research Center for Sexual Medicine, Inha University School of Medicine, Incheon, Korea.,Department of Urology, Inha University School of Medicine, Incheon, Korea
| | - Ji Kan Ryu
- National Research Center for Sexual Medicine, Inha University School of Medicine, Incheon, Korea.,Department of Urology, Inha University School of Medicine, Incheon, Korea.,Inha Research Institute for Medical Sciences, Inha University School of Medicine, Incheon, Korea.
| | - Jun Kyu Suh
- National Research Center for Sexual Medicine, Inha University School of Medicine, Incheon, Korea.,Department of Urology, Inha University School of Medicine, Incheon, Korea.
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Zhao J, Ren L, Liu M, Xi T, Zhang B, Yang K. Anti-fibrotic function of Cu-bearing stainless steel for reducing recurrence of urethral stricture after stent implantation. J Biomed Mater Res B Appl Biomater 2017; 106:2019-2028. [PMID: 29068537 DOI: 10.1002/jbm.b.34005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Revised: 08/23/2017] [Accepted: 09/11/2017] [Indexed: 11/07/2022]
Abstract
Recurrent stenosis is the main reason inducing the failure of urethral stricture treatment. Our previous study has found that the 316L type Cu bearing stainless steel (316L-Cu SS) showed antimicrobial activity and anti-encrustation performance when it was used for relieving urethral obstructer. However, whether it can reduce the occurrence of fibrosis or not, we need further investigation to compare the cellular and molecular responses of human urethral scar fibroblast cells (USFCs) on 316L-Cu SS and medical grade 316L stainless (316L SS, as a control). [3-(4,5-dimethylthiazol-2-yl)-5-(3-carboxymethoxyphenyl)-2-(4- sulfophenyl)- 2H-tetrazolium (MTS) and Transwell were used to assess the cellular responses, which confirmed that 316L-Cu SS could inhibit proliferation and migration of USFCs. Molecular expressions of fibrosis were evaluated by western blot, real-time quantitative polymerase chain reaction (qPCR), and Cu/Zn superoxide dismutase (CuZnSOD) measurement. The results indicated that up-regulating of CuZnSOD attenuated the transforming growth factor-β1 expression and phosphorylation of Smad3 after exposure to 316L-Cu SS. Besides, the content of collagen type I (COL1) and collagen type III (COL3) secreting into the culture medium measured by enzyme-linked immunosorbent assay were in accord with the results of messenger ribonucleic acids. Both of them exhibited lower levels of COL1/COL3 exposure to 316L-Cu SS, demonstrating the inhibitory performance of 316L-Cu SS against fibrosis. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 106B: 2019-2028, 2018.
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Affiliation(s)
- Jing Zhao
- Institute of Metal Research, Chinese Academy of Sciences, Shenyang, 110016, China
| | - Ling Ren
- Institute of Metal Research, Chinese Academy of Sciences, Shenyang, 110016, China
| | - Meixia Liu
- Institute of Metal Research, Chinese Academy of Sciences, Shenyang, 110016, China
| | - Tong Xi
- Institute of Metal Research, Chinese Academy of Sciences, Shenyang, 110016, China
| | - Bingchun Zhang
- Institute of Metal Research, Chinese Academy of Sciences, Shenyang, 110016, China
| | - Ke Yang
- Institute of Metal Research, Chinese Academy of Sciences, Shenyang, 110016, China
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Gabrielson AT, Alzweri LM, Hellstrom WJ. Collagenase Clostridium Histolyticum in the Treatment of Peyronie's Disease: Review of a Minimally Invasive Treatment Option. World J Mens Health 2017; 35:134-145. [PMID: 28879693 PMCID: PMC5746484 DOI: 10.5534/wjmh.17033] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 09/01/2017] [Indexed: 12/23/2022] Open
Abstract
Peyronie's disease (PD) is an inflammatory disorder characterized by an abnormal collagen deposition in the tunica albuginea of the penis, leading to fibrous and non-compliant plaques that can impede normal erection. Although pharmacological treatments are available, only intralesional injection therapy and surgical reconstruction have demonstrated tangible clinical efficacy in the management of this condition. Intralesional injection of collagenase clostridium histolyticum (CCH) has come to the forefront of minimally invasive treatment of PD. In this review, the authors provide an update on the safety, efficacy, and indications for CCH. The efficacy of CCH will be assessed on the basis of improvement in the severity of penile fibrosis, curvature, and pain. Numerous well-designed clinical trials and post-approval studies involving more than 1,500 patients have consistently demonstrated the efficacy and tolerability of CCH in the treatment of PD. CCH significantly decreases penile curvature and plaque consistency, as well as improves quality of life. Post-approval studies continue to demonstrate the efficacy of CCH despite broader inclusion criteria for treatment, such as the case with acute phase disease and atypical plaque deformities (i.e., ventral plaques, hourglass narrowing). CCH continues to be the gold standard for non-surgical management of stable phase PD, in the absence of strong evidence supporting oral therapy agents and ongoing evaluation of extracorporeal shockwave therapy. However, recent studies are beginning to provide precedent for the use of CCH in the management of acute phase and atypical PD.
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Affiliation(s)
- Andrew T Gabrielson
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Laith M Alzweri
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Wayne Jg Hellstrom
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA.
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Abstract
INTRODUCTION Like other fibrotic diseases, the cause of Peyronie's disease (PD) is still obscure. Since there is now increasing evidence for the role of Mesenchymal Stem Cells (MSCs) as potential treatment to fibrosis, it is crucial to determine their possible efficacy in the treatment of PD. Areas covered: In this review, the authors summarize the emerging data and published studies regarding the use of SCs for the treatment of PD. The authors provide particular focus on the three-first experimental studies for the use of SCs in rat models as well as the sole two studies undertaken in humans. Expert opinion: It seems evident in experimental settings that SCs in general (Adipose Derived SCs in particular) provide a feasible, safe and effective therapy for PD. The potential limits of the rat models used initially have been somewhat overcome with the inception of studies in men. However, further prospective studies are needed in humans to further elucidate the therapeutic potential of stem cell therapy in PD.
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Affiliation(s)
- Athanasios Dellis
- a University Department of Urology , Sismanoglio General Hospital , Athens , Greece
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35
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Aliperti LA, Mehta A. Peyronie’s Disease: Intralesional Therapy and Surgical Intervention. Curr Urol Rep 2016; 17:60. [DOI: 10.1007/s11934-016-0622-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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36
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Traore EJ, Wang W, Yafi FA, Hellstrom WJG. Collagenase Clostridium histolyticum in the management of Peyronie's disease: a review of the evidence. Ther Adv Urol 2016; 8:192-202. [PMID: 27247629 DOI: 10.1177/1756287216637569] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVES Peyronie's disease (PD) is a connective tissue disorder resulting in the abnormal accumulation of scar or plaques in the tunica albuginea of the penis. The condition is characterized by two phases: an active, inflammatory phase, and a stable, chronic phase. Collagenase Clostridium histolyticum (CCH) was isolated in the mid-1900s and postulated as a potential pharmacologic strategy for breaking down the abnormal connective tissue plaques of PD. Prior to the introduction of CCH, a wide variety of treatment modalities for PD were used in clinical practice, including oral and topical medications, intralesional injections, electromotive drug administration, extracorporeal shockwave therapy, traction, and invasive surgery, all with variable results. This review aims to examine the known data surrounding the use of intralesional CCH injections in the treatment of PD. METHODS CCH is a recently US Food and Drug Administration approved pharmacologic treatment for PD. Clinical trials using intralesional CCH injection therapy for the treatment of PD were reviewed for clinical safety and efficacy of treatment. RESULTS Studies demonstrated that CCH treatment administered in multiple cycles led to significant benefit in both the psychological and physical aspects of PD. The strongest evidence for CCH's effectiveness was revealed in large, multicenter randomized controlled trials (Investigation for Maximal Peyronie's Reduction Efficacy and Safety Studies I and II) in which intralesional CCH was combined with manual modeling of the penis. Although adverse events from treatment are relatively common, the majority are mild to moderate in degree, including penile pain, swelling, and bruising, which all resolve spontaneously. CONCLUSION Overall, evidence indicates that CCH is a valuable, effective, and safe minimally invasive treatment option for men with PD.
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Affiliation(s)
- Elizabeth J Traore
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA
| | - William Wang
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Faysal A Yafi
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Wayne J G Hellstrom
- Department of Urology, Tulane University Health Sciences Center, 1430 Tulane Avenue SL-42, New Orleans, LA 70112, USA
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Stuntz M, Perlaky A, des Vignes F, Kyriakides T, Glass D. The Prevalence of Peyronie's Disease in the United States: A Population-Based Study. PLoS One 2016; 11:e0150157. [PMID: 26907743 PMCID: PMC4764365 DOI: 10.1371/journal.pone.0150157] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 02/10/2016] [Indexed: 11/22/2022] Open
Abstract
Peyronie's disease (PD) is a connective tissue disorder which can result in penile deformity. The prevalence of diagnosed PD in the United States (US) has been estimated to be 0.5% in adult males, but there is limited additional information comparing definitive and probable PD cases. We conducted a population-based survey to assess PD prevalence using a convenience-sample of adult men participating in the ResearchNow general population panel. Respondents were categorized according to PD status (definitive, probable, no PD) and segmented by US geographic region, education, and income levels. Of the 7,711 respondents, 57 (0.7%) had definitive PD while 850 (11.0%) had probable PD. Using univariate logistic regression modeling, older age (18-24 vs 24+) (OR = 0.721; 95% CI = 0.570,0.913), Midwest/Northeast/West geographic region (South vs Midwest/Northeast/West) (OR = 0.747; 95% CI = 0.646,0.864), and higher income level (<25K vs 25K+) (OR = 0.820; 95% CI = 0.673,0.997) were each significantly associated with reduced odds of having a definitive/probable PD diagnosis compared with no PD diagnosis. When all three variables were entered in a stepwise multivariable logistic regression, only age (OR = 0.642; 95% CI = 0.497, 0.828) and region (OR = 0.752; 95% CI = 0.647, 0.872) remained significant. This study is the first to report PD prevalence by geographic region and income, and it advocates that the prevalence of PD in the US may be higher than previously cited. Further, given the large discrepancy between definitive PD cases diagnosed by a physician and probable cases not diagnosed by a physician, much more needs to be done to raise awareness of this disease.
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Affiliation(s)
- Mark Stuntz
- Deerfield Institute, New York, New York, United States of America
| | - Anna Perlaky
- Deerfield Institute, New York, New York, United States of America
| | - Franka des Vignes
- Formerly at Deerfield Institute, New York, New York, United States of America
| | - Tassos Kyriakides
- Yale Center for Analytical Services, Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Dan Glass
- Deerfield Institute, New York, New York, United States of America
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Yafi FA, Hatzichristodoulou G, Wang J, Anaissie J, Sikka SC, Hellstrom WJG. Outcomes of Surgical Management of Men With Peyronie's Disease With Hourglass Deformity. Urology 2016; 91:119-23. [PMID: 26876465 DOI: 10.1016/j.urology.2016.01.032] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 01/22/2016] [Accepted: 01/27/2016] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To investigate the outcomes of two surgical interventions for Peyronie's disease (PD) with hourglass deformity: partial excision and grafting (PEG) or inflatable penile prosthesis (IPP) implantation. MATERIALS AND METHODS Retrospective data were collected from two centers: Technical University of Munich (PEG) and Tulane University Medical Center (IPP). Collected variables included patient demographics, sexual function, penile vascular measurements, and treatment outcomes. RESULTS A total of 50 PD patients with hourglass deformity (26 PEG [group 1] and 24 IPP [group 2]) were included in this study. Patients in group 1 had higher mean preoperative Sexual Health Inventory for Men scores (22.2 vs 10.3, P < 0001), required less erectile dysfunction treatment (35% vs 79%, P = .005), and had more nonvascular etiology (77% vs 21%, P < .0001). There were no intraoperative complications, 2 patients in group 1 had postoperative glans hypoesthesia, and 1 patient in group 2 required surgical revision. All patients in both groups had significant ≥20% improvements in penile curvature with mean changes of 68.1 degrees (12.7) in group 1 and 49.6 degrees (13.5) in group 2, P < .0001. Resolution of hourglass deformity was achieved in 85% of patients in group 1 and 100% of patients in group 2, P = .045. The mean postoperative change in Sexual Health Inventory for Men score was -0.3 (1.3) in group 1 and 16.7 (4.7) in group 2, P < .0001. CONCLUSION Both options provide excellent outcomes for well-selected patients with PD and an hourglass deformity. PEG can be offered to patients with good erectile function, whereas the IPP remains the preferred option for patients with poor erections.
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Affiliation(s)
- Faysal A Yafi
- Department of Urology, Tulane University School of Medicine, New Orleans, LA
| | | | - Julie Wang
- Department of Urology, Tulane University School of Medicine, New Orleans, LA
| | - James Anaissie
- Department of Urology, Tulane University School of Medicine, New Orleans, LA
| | - Suresh C Sikka
- Department of Urology, Tulane University School of Medicine, New Orleans, LA
| | - Wayne J G Hellstrom
- Department of Urology, Tulane University School of Medicine, New Orleans, LA.
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Sangkum P, Gokce A, Tan RB, Bouljihad M, Kim H, Mandava SH, Saleem SN, Lasker GF, Yafi FA, Abd Elmageed ZY, Moparty K, Sikka SC, Abdel-Mageed AB, Hellstrom WJ. Transforming Growth Factor-β1 Induced Urethral Fibrosis in a Rat Model. J Urol 2015; 194:820-7. [DOI: 10.1016/j.juro.2015.02.014] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Premsant Sangkum
- Department of Urology, Tulane University School of Medicine, New Orleans, Louisiana
- Division of Comparative Pathology, Tulane National Primate Research Center, Covington, Louisiana
- Department of Urology, Sakarya University School of Medicine, Sakarya, Turkey
| | - Ahmet Gokce
- Department of Urology, Tulane University School of Medicine, New Orleans, Louisiana
- Division of Comparative Pathology, Tulane National Primate Research Center, Covington, Louisiana
- Department of Urology, Sakarya University School of Medicine, Sakarya, Turkey
| | - Ronny B.W. Tan
- Department of Urology, Tulane University School of Medicine, New Orleans, Louisiana
- Division of Comparative Pathology, Tulane National Primate Research Center, Covington, Louisiana
- Department of Urology, Sakarya University School of Medicine, Sakarya, Turkey
| | - Mostafa Bouljihad
- Department of Urology, Tulane University School of Medicine, New Orleans, Louisiana
- Division of Comparative Pathology, Tulane National Primate Research Center, Covington, Louisiana
- Department of Urology, Sakarya University School of Medicine, Sakarya, Turkey
| | - Hogyoung Kim
- Department of Urology, Tulane University School of Medicine, New Orleans, Louisiana
- Division of Comparative Pathology, Tulane National Primate Research Center, Covington, Louisiana
- Department of Urology, Sakarya University School of Medicine, Sakarya, Turkey
| | - Sree Harsha Mandava
- Department of Urology, Tulane University School of Medicine, New Orleans, Louisiana
- Division of Comparative Pathology, Tulane National Primate Research Center, Covington, Louisiana
- Department of Urology, Sakarya University School of Medicine, Sakarya, Turkey
| | - Sarmad N. Saleem
- Department of Urology, Tulane University School of Medicine, New Orleans, Louisiana
- Division of Comparative Pathology, Tulane National Primate Research Center, Covington, Louisiana
- Department of Urology, Sakarya University School of Medicine, Sakarya, Turkey
| | - George F. Lasker
- Department of Urology, Tulane University School of Medicine, New Orleans, Louisiana
- Division of Comparative Pathology, Tulane National Primate Research Center, Covington, Louisiana
- Department of Urology, Sakarya University School of Medicine, Sakarya, Turkey
| | - Faysal A. Yafi
- Department of Urology, Tulane University School of Medicine, New Orleans, Louisiana
- Division of Comparative Pathology, Tulane National Primate Research Center, Covington, Louisiana
- Department of Urology, Sakarya University School of Medicine, Sakarya, Turkey
| | - Zakaria Y. Abd Elmageed
- Department of Urology, Tulane University School of Medicine, New Orleans, Louisiana
- Division of Comparative Pathology, Tulane National Primate Research Center, Covington, Louisiana
- Department of Urology, Sakarya University School of Medicine, Sakarya, Turkey
| | - Krishnarao Moparty
- Department of Urology, Tulane University School of Medicine, New Orleans, Louisiana
- Division of Comparative Pathology, Tulane National Primate Research Center, Covington, Louisiana
- Department of Urology, Sakarya University School of Medicine, Sakarya, Turkey
| | - Suresh C. Sikka
- Department of Urology, Tulane University School of Medicine, New Orleans, Louisiana
- Division of Comparative Pathology, Tulane National Primate Research Center, Covington, Louisiana
- Department of Urology, Sakarya University School of Medicine, Sakarya, Turkey
| | - Asim B. Abdel-Mageed
- Department of Urology, Tulane University School of Medicine, New Orleans, Louisiana
- Division of Comparative Pathology, Tulane National Primate Research Center, Covington, Louisiana
- Department of Urology, Sakarya University School of Medicine, Sakarya, Turkey
| | - Wayne J.G. Hellstrom
- Department of Urology, Tulane University School of Medicine, New Orleans, Louisiana
- Division of Comparative Pathology, Tulane National Primate Research Center, Covington, Louisiana
- Department of Urology, Sakarya University School of Medicine, Sakarya, Turkey
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Gokce A, Abd Elmageed ZY, Lasker GF, Bouljihad M, Braun SE, Kim H, Kadowitz PJ, Abdel-Mageed AB, Sikka SC, Hellstrom WJ. Intratunical Injection of Genetically Modified Adipose Tissue-Derived Stem Cells with Human Interferon α-2b for Treatment of Erectile Dysfunction in a Rat Model of Tunica Albugineal Fibrosis. J Sex Med 2015; 12:1533-44. [PMID: 26062100 DOI: 10.1111/jsm.12916] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Peyronie's disease (PD) has frequently been associated with erectile dysfunction (ED) and may further compromise coitus. AIM To investigate the efficacy of intratunical injection of genetically modified rat adipose tissue-derived stem cells (ADSCs) expressing human interferon α-2b (ADSCs-IFN) in decreasing fibrosis and restoring erectile function in a rat model of tunica albugineal fibrosis (TAF). METHODS A total of 36 Sprague-Dawley rats (12 weeks old; 300-350 g) were randomly divided in six equal groups: (i) sham group (50 μL saline-injected into the tunica albuginea [TA]); (ii) TAF group (transforming growth factor [TGF]-β1 [0.5 μg/50 μL] injected into the TA); (iii) TGF-β1 plus 5 × 10(5) control ADSCs injected same day; (iv) TGF-β1 plus 5 × 10(5) ADSCs-IFN injected same day; (v) TGF-β1 plus 5 × 10(5) control ADSCs injected after 30 days; and (vi) TGF-β1 plus 5 × 10(5) ADSCs-IFN injected after 30 days. Rat allogeneic ADSCs were harvested from inguinal fat tissue. MAIN OUTCOME MEASURES Forty-five days following the TGF-β1 injection, erectile function was assessed, and penile tissues were harvested for further evaluations. RESULTS In the same-day injection groups, intratunical injection of ADSCs and ADSC-IFN improved erectile response observed upon stimulation of cavernous nerve compared with TAF group. Intratunical ADSC-IFN injection at day 30 improved erectile responses 3.1, 1.8, and 1.3 fold at voltages of 2.5, 5.0, and 7.0, respectively, when compared with TAF group. Furthermore, at voltages of 2.5 and 5.0, treatment on day 30 with ADSCs-IFN improved erectile responses 1.6- and 1.3-fold over treatment with ADSCs alone. Local injection of ADSCs or ADSCs-IFN reduced Peyronie's-like manifestations, and these effects might be associated with a decrease in the expression of tissue inhibitors of metalloproteinases. CONCLUSION This study documents that transplantation of genetically modified ADSCs, with or without human IFN α-2b, attenuated Peyronie's-like changes and enhanced erectile function in a rat model of TAF.
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Affiliation(s)
- Ahmet Gokce
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA.,Department of Urology, Sakarya University School of Medicine, Sakarya, Turkey
| | | | - George F Lasker
- Department of Pharmacology, Tulane University School of Medicine, New Orleans, LA, USA
| | | | - Stephen E Braun
- Tulane National Primate Research Center, New Orleans, LA, USA
| | - Hogyoung Kim
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Philip J Kadowitz
- Department of Pharmacology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Asim B Abdel-Mageed
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Suresh C Sikka
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Wayne J Hellstrom
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA
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Abstract
Peyronie's disease (PD) has a significant impact on the quality of life of both patients and their partners due to the compromised sexual function and physical deformation resulting from the condition. PD is a connective tissue disorder marked by fibrotic healing of the tunica albuginea, leading to penile deformities including curvature, shortening, loss of girth, hourglass appearance, and hinging. Despite the multiple medical therapies available, surgery is the gold standard of treatment once the plaque has stabilized. We present a review of the disease process, preoperative evaluation, operative planning, surgical treatments with outcomes and complications, and nascent developments in surgical management and graft development. Options include tunical lengthening procedures, tunical shortening procedures, and penile prosthesis. Decision-making is governed by degree of curvature, erectile function, and associated penile deformities. In cases with curvature of less than 60-70 degrees, adequate penile length, and no hourglass deformity, patients are candidates for tunical shortening procedures. Patients with curvature greater than 60-70 degrees, penile hourglass or hinge-destabilizing deformities, and adequate erectile function should be counseled with regard to tunical lengthening procedures. Patients with poor preoperative erectile function should undergo inflatable penile prosthesis placement, with possible secondary straightening procedures. Technique selection should be based upon surgeon preference, expertise, and experience, as evidence does not necessarily support one procedure over another.
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Affiliation(s)
- Uwais B Zaid
- Department of Urology, UCSF School of Medicine, 400 Parnassus Ave, UC Clinics, San Francisco, CA, 94143, USA,
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Hussein AA, Alwaal A, Lue TF. All about Peyronie's disease. Asian J Urol 2015; 2:70-78. [PMID: 29264123 PMCID: PMC5730743 DOI: 10.1016/j.ajur.2015.04.019] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Revised: 01/31/2015] [Accepted: 02/10/2015] [Indexed: 12/27/2022] Open
Abstract
Peyronie's disease (PD) is an acquired connective tissue disorder of the tunica albuginea of the corpus cavernosum, characterized by excessive fibrosis and plaque formation. PD can result in significant physical and psychological morbidity; as it may prevent intercourse and cause adverse impacts on partner relationships. The exact etiology and pathophysiology remain unclear, and many misconceptions about the disease associations, course and treatment exist. The disease has two distinct stages. The acute stage is characterized by pain, and disease may progress during this stage. Non-surgical managements at this stage aim to alleviate pain and stabilize the disease. Results for non-surgical treatment are often conflicting. The chronic stage occurs 6–12 months later, where pain disappears and the deformity stabilizes. Surgical treatment is reserved for significant deformity or with inability to penetrative intercourse. The choice of the surgical technique depends on the length of the penis, degree of deformity, erectile function, patients' expectations and surgeon's preference.
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Affiliation(s)
- Ahmed A Hussein
- Department of Urology, University of California, San Francisco, CA, USA.,Department of Urology, Cairo University, Egypt
| | - Amjad Alwaal
- Department of Urology, University of California, San Francisco, CA, USA.,Department of Urology, King Abdul Aziz University, Saudi Arabia
| | - Tom F Lue
- Department of Urology, University of California, San Francisco, CA, USA
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43
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Hussein AA, Alwaal A, Lue TF. WITHDRAWN: All about Peyronie’s disease. Asian J Urol 2015. [DOI: 10.1016/j.ajur.2015.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Ventimiglia E, Capogrosso P, Colicchia M, Boeri L, Serino A, La Croce G, Russo A, Capitanio U, Briganti A, Cantiello F, Mirone V, Damiano R, Montorsi F, Salonia A. Peyronie's disease and autoimmunity—a real-life clinical study and comprehensive review. J Sex Med 2015; 12:1062-9. [PMID: 25630575 DOI: 10.1111/jsm.12825] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Although heavily investigated over the last decades, Peyronie's disease (PD) pathogenesis remains unclear. AIM We sought to investigate the association between PD and autoimmune diseases (ADs) in men seeking medical help for sexual dysfunction in the real-life setting. METHODS Complete sociodemographic and clinical data from a homogenous cohort of 1,140 consecutive Caucasian-European men were analyzed. Health-significant comorbidities were scored with the Charlson Comorbidity Index and ADs were stratified according to International Classification of Diseases, Ninth Revision classification. MAIN OUTCOME MEASURES Descriptive statistics and multivariate logistic regression models tested the association between ADs and PD. RESULTS PD was diagnosed in 148 (13%) of the 1,140 men; of PD patients, 14 (9.5%) had a comorbid AD; conversely, the rate of ADs in non-PD patients was significantly lower (χ(2) = 24.7; P < 0.01). Both patient age and AD comorbidity achieved multivariable independent predictor status for PD (odds ratio [OR]: 1.05; P < 0.01 and OR: 4.90; P < 0.01, respectively). CONCLUSIONS Our observational findings showed that ADs are highly comorbid with PD in a large cohort of same-race individuals seeking medical help for sexual dysfunction in the real-life setting.
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Affiliation(s)
- Eugenio Ventimiglia
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
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Kwon KD, Choi MJ, Park JM, Song KM, Kwon MH, Batbold D, Yin GN, Kim WJ, Ryu JK, Suh JK. Silencing histone deacetylase 2 using small hairpin RNA induces regression of fibrotic plaque in a rat model of Peyronie's disease. BJU Int 2014; 114:926-36. [DOI: 10.1111/bju.12812] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Ki-Dong Kwon
- National Research Center for Sexual Medicine; Department of Urology; Inha University School of Medicine; Incheon 400-711 Korea
| | - Min Ji Choi
- National Research Center for Sexual Medicine; Department of Urology; Inha University School of Medicine; Incheon 400-711 Korea
| | - Jin-Mi Park
- National Research Center for Sexual Medicine; Department of Urology; Inha University School of Medicine; Incheon 400-711 Korea
| | - Kang-Moon Song
- National Research Center for Sexual Medicine; Department of Urology; Inha University School of Medicine; Incheon 400-711 Korea
| | - Mi-Hye Kwon
- National Research Center for Sexual Medicine; Department of Urology; Inha University School of Medicine; Incheon 400-711 Korea
| | - Dulguun Batbold
- National Research Center for Sexual Medicine; Department of Urology; Inha University School of Medicine; Incheon 400-711 Korea
| | - Guo Nan Yin
- National Research Center for Sexual Medicine; Department of Urology; Inha University School of Medicine; Incheon 400-711 Korea
| | - Woo Jean Kim
- National Research Center for Sexual Medicine; Department of Urology; Inha University School of Medicine; Incheon 400-711 Korea
| | - Ji-Kan Ryu
- National Research Center for Sexual Medicine; Department of Urology; Inha University School of Medicine; Incheon 400-711 Korea
| | - Jun-Kyu Suh
- National Research Center for Sexual Medicine; Department of Urology; Inha University School of Medicine; Incheon 400-711 Korea
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Abstract
Peyronie’s disease (PD), more commonly known as penile curvature, is caused by plaque formation in the connective tissue of the penis. PD affects 0.3% to 8.9% of men, most commonly between ages 40 and 60 years and can cause significant psychological distress, regardless of severity. There is a rich history behind the initial reports of PD, initial beliefs about pathogenesis, and initial treatment. This article aims to discuss the history of PD as well as the evolution of causes and treatments throughout time up to present-day theories of pathogenesis and treatment.
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Affiliation(s)
- Stephen P. Carriere
- Louisiana State University Health Sciences Center, Department of Urology, New Orleans, LA, USA
| | - Jarratt D. Pytell
- Louisiana State University Health Sciences Center, Department of Urology, New Orleans, LA, USA
| | - Amanda F. Saltzman
- Louisiana State University Health Sciences Center, Department of Urology, New Orleans, LA, USA
| | - Harold A. Fuselier
- Louisiana State University Health Sciences Center, Department of Urology, New Orleans, LA, USA
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Is transforming growth factor-β signaling activated in human hypertrophied prostate treated by 5-alpha reductase inhibitor? DISEASE MARKERS 2013; 35:679-85. [PMID: 24311892 PMCID: PMC3838824 DOI: 10.1155/2013/783287] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Revised: 09/27/2013] [Accepted: 10/08/2013] [Indexed: 01/29/2023]
Abstract
Background and Aim. It is well known that androgen deprivation relates to penile fibrosis, so we hypothesize that long-term treatment with 5-alphareductase inhibitors (5ARIs) may increase the risk of fibrosis of prostate. Patients and Methods. Thirty-two BPH patients who underwent transurethral resection of the prostate were enrolled. The patients were divided into two groups: group one, 16 patients underwent TURP who had been treated with tamsulosin for 2 years; group two, 16 patients underwent TURP who had been treated with combination of tamsulosin and dutasteride for at least 1 year. We evaluated the expressions of nNOS, iNOS, eNOS, TGF-β1, TGF-β2, phosphorylated-Smad2/3 (p-Smad2/3), E-cadherin, N-cadherin, and α-smooth muscle actin in the resected prostate tissues by western blotting, and the TGF-β concentration was determined by ELISA kit. Results. The expressions of 3 isoforms of NOS were significantly increased in group 2 except of eNOS in lateral prostate, and the expressions of TGF-β1, TGF-β2, and p-Smad2/3 increased about 2-fold compared with group 1. In group 2, the E-cadherin expression decreased while N-cadherin expression increased significantly. Conclusions. The overexpression of nNOS may contribute to prostate smooth muscle relaxation; however, long-time treatment with 5 ARI increases the risk of fibrosis of prostate.
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Favilla V, Russo GI, Privitera S, Castelli T, Madonia M, La Vignera S, Condorelli R, Calogero AE, Farina FP, Cimino S, Morgia G. Combination of intralesional verapamil and oral antioxidants for Peyronie's disease: a prospective, randomised controlled study. Andrologia 2013; 46:936-42. [DOI: 10.1111/and.12178] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2013] [Indexed: 12/13/2022] Open
Affiliation(s)
- V. Favilla
- Department of Urology; University of Catania; Catania Italy
| | - G. I. Russo
- Department of Urology; University of Catania; Catania Italy
| | - S. Privitera
- Department of Urology; University of Catania; Catania Italy
| | - T. Castelli
- Department of Urology; University of Catania; Catania Italy
| | - M. Madonia
- Department of Urology; University of Sassari; Sassari Italy
| | - S. La Vignera
- Department of Internal Medicine and Systemic Diseases; Section of Endocrinology, Andrology and Internal Medicine; University of Catania; Catania Italy
| | - R. Condorelli
- Department of Internal Medicine and Systemic Diseases; Section of Endocrinology, Andrology and Internal Medicine; University of Catania; Catania Italy
| | - A. E. Calogero
- Department of Internal Medicine and Systemic Diseases; Section of Endocrinology, Andrology and Internal Medicine; University of Catania; Catania Italy
| | - F. P. Farina
- Department of Urology; University of Sassari; Sassari Italy
| | - S. Cimino
- Department of Urology; University of Catania; Catania Italy
| | - G. Morgia
- Department of Urology; University of Catania; Catania Italy
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El-Sakka AI, Salabas E, Dinçer M, Kadioglu A. The pathophysiology of Peyronie's disease. Arab J Urol 2013; 11:272-7. [PMID: 26558092 PMCID: PMC4442979 DOI: 10.1016/j.aju.2013.06.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2013] [Revised: 06/09/2013] [Accepted: 06/09/2013] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE To review the contemporary knowledge of the pathophysiology of Peyronie's disease (PD). METHODS Medline was searched for papers published in English from 2000 to March 2013, using the keywords 'Peyronie's disease' and 'pathophysiology'. RESULTS More than 300 relevant articles were identified for the purpose of this review. Unfortunately only a few studies had a high level of evidence, and the remaining studies were not controlled in their design. Many theories have been proposed to explain the cause of PD, but the true pathogenesis of PD remains an enigma. Identifying particular growth factors and the specific genes responsible for the induction of PD have been the ultimate goal of research over the past several decades. This would provide the means to devise a possible gene therapy for this devastating condition. We discuss present controversies and new discoveries related to the pathophysiology of this condition. CONCLUSION PD is one of the most puzzling diseases in urology. The pathogenesis remains uncertain and there is still controversy about the best management. The pathogenesis of PD has been explored in animal models, cell cultures and clinical trials, but the results have led to further questions. New research on the aetiology and pathogenesis of PD is needed, and which will hopefully improve the understanding and management for patients with this frustrating disease.
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Key Words
- (i)NOS, (inducible) nitric oxide synthase
- DM, diabetes mellitus
- ED, erectile dysfunction
- EF, erectile function (domain)
- FGF, fibroblast GF
- Fibrosis
- GF, growth factor
- MMP, matrix metalloproteinase
- PD, Peyronie’s disease
- Pathophysiology
- Peyronie’s disease
- ROS, reactive oxygen species
- TA, tunica albuginea
- Tunica albuginea
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Affiliation(s)
| | - Emre Salabas
- Department of Urology, Faculty of Medicine, Istanbul University, Turkey
| | - Murat Dinçer
- Department of Urology, Faculty of Medicine, Istanbul University, Turkey
| | - Ates Kadioglu
- Department of Urology, Faculty of Medicine, Istanbul University, Turkey
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50
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Garaffa G, Trost LW, Serefoglu EC, Ralph D, Hellstrom WJG. Understanding the course of Peyronie's disease. Int J Clin Pract 2013; 67:781-8. [PMID: 23869679 DOI: 10.1111/ijcp.12129] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Accepted: 01/07/2013] [Indexed: 12/18/2022] Open
Abstract
AIMS To correct common misconceptions about Peyronie's disease (PD) that present obstacles to early recognition and treatment. METHODS The prevalence, natural disease course, psychosocial effects and treatment considerations for patients with PD were reviewed. RESULTS Studies over the past decade have shown that the prevalence of PD may be higher (up to 20%) than previously thought. PD can lead to emotional and relationship distress. Nearly 10% of men who present with PD are younger than 40. Both younger age and comorbid vascular disease have been associated with more severe and progressive PD. In the majority of patients, symptoms will either deteriorate or remain stable. PD is often associated with erectile dysfunction (ED). Effective, minimally invasive treatments used early in the disease course include unapproved and/or investigational intralesional injection therapy with verapamil, interferon (IFN) α-2b, or collagenase clostridium histolyticum (CCH). Surgical intervention is considered in patients with ED and/or penile deformity that impairs sexual functioning; however, preoperative discussion of appropriate expectations is important. DISCUSSION The availability of effective minimally invasive and surgical therapies for PD suggests that active management should be considered over a 'wait-and-see' approach. CONCLUSION Providing early intervention and improved education/awareness of PD as a chronic and progressive disorder may result in improved physical and psychosocial outcomes for PD patients. As general practitioners are often the first contact for men with PD, they are well positioned to recognise symptoms early and promptly refer patients for further evaluation and treatment.
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Affiliation(s)
- G Garaffa
- St Peter's Andrology Centre, UCL, London, UK
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