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Doersch KM, Barnett D, Chase A, Johnston D, Gabrielsen JS. The contribution of the immune system to genitourinary fibrosis. Exp Biol Med (Maywood) 2022; 247:765-778. [PMID: 35531654 PMCID: PMC9134766 DOI: 10.1177/15353702221090872] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2023] Open
Abstract
Fibrotic diseases of the genitourinary tract are devastating and incompletely understood pathologies. These diseases include urethral and ureteral strictures, retroperitoneal fibrosis, and Peyronie's disease. They can contribute to obstructive uropathy and sexual dysfunction. Poor understanding of the pathophysiology of these diseases severely limits our ability to prevent and treat them. Genitourinary fibrotic diseases likely represent related pathologies that share common underlying mechanisms involving wound healing in response to injury. These diseases share the common feature of extracellular matrix abnormalities-such as collagen deposition, transforming growth factor-β accumulation, and dysregulation of collagen maturation-leading to abnormal tissue stiffness. Given the association of many of these diseases with autoimmunity, a systemic pro-inflammatory state likely contributes to their associated fibrogenesis. Herein, we explore the immunologic contribution to fibrogenesis in several fibrotic diseases of the genitourinary system. Better understanding how the immune system contributes to fibrosis in these diseases may improve prevention and therapeutic strategies and elucidate the functions of immunologic contributors to fibrosis in general.
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Affiliation(s)
- Karen M Doersch
- Department of Urology, University of
Rochester Medical Center, Rochester, NY 14642, USA
| | - Daniel Barnett
- Department of Pediatrics, University of
Toledo, Toledo, OH 43614, USA
| | - Abbie Chase
- Department of Urology, University of
Rochester Medical Center, Rochester, NY 14642, USA
| | - Daniel Johnston
- Department of Urology, University of
Rochester Medical Center, Rochester, NY 14642, USA
| | - J Scott Gabrielsen
- Department of Urology, University of
Rochester Medical Center, Rochester, NY 14642, USA
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Can O, Özbir S, Atalay HA, Çakır SS, Culha MG, Canat HL. The relationship between testosterone levels and Peyronie's disease. Andrologia 2020; 52:e13727. [PMID: 32589321 DOI: 10.1111/and.13727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 05/06/2020] [Accepted: 05/31/2020] [Indexed: 12/23/2022] Open
Abstract
Aetiologic and predisposing factors are still controversial about Peyronie's disease (PD). However, it is thought to be the result of connective tissue disorder or healing defect. Androgens are known to affect collagen metabolism and wound healing in the body. The aim of this study was to investigate the relationship between PD and low testosterone levels. One hundred and forty-seven Peyronie patients and 137 healthy volunteers were included in the study. In both groups, demographic data, medical history, physical examination and erectile capacity were recorded. Blood samples were collected from all subjects in the early morning hours after an overnight fast. The mean level of serum total testosterone was lower in men with PD compared with the controls (3.9 ± 1.1 vs. 4.2 ± 1.7 ng/ml respectively) (p = .062). However, statistically significant relationship was not found between PD and low serum testosterone levels. There was no significant correlation between penile plaque dimension or penile curvature degree and testosterone levels. Large randomised-controlled prospective studies are needed to reveal this possible association.
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Affiliation(s)
- Osman Can
- Department of Urology, Basaksehir City Hospital, Istanbul, Turkey
| | - Sait Özbir
- Department of Urology, Cemil Taşcıoglu City Hospital, Istanbul, Turkey
| | | | - Süleyman Sami Çakır
- Department of Urology, Atlas University, Medicine Hospital, Istanbul, Turkey
| | | | - Halil Lütfi Canat
- Department of Urology, Cemil Taşcıoglu City Hospital, Istanbul, Turkey
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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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Shiraishi K, Shimabukuro T, Matsuyama H. The prevalence of Peyronie's disease in Japan: a study in men undergoing maintenance hemodialysis and routine health checks. J Sex Med 2012; 9:2716-23. [PMID: 22897619 DOI: 10.1111/j.1743-6109.2012.02868.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION The incidence of Peyronie's disease (PD) in the general population is believed to be as high as 20%. However, most of the data concerning the prevalence of PD have been obtained from Caucasian populations. AIM The aim of this study was to examine the prevalence of PD in Asia and among men undergoing hemodialysis and discuss the pathophysiology of PD. METHODS A total of 1,090 men who received a routine health check at our hospital (control group) as well as 130 male patients undergoing maintenance hemodialysis were enrolled. The diagnosis of PD was based on a palpable penile plaque. MAIN OUTCOME MEASURES Hemodialysis patients were asked about their sexual activity and completed the International Index of Erectile Function-5 questionnaires. The differences between patients' and hemodialysis-associated factors, comorbidities, and medications were statistically assessed for patients with and without PD. RESULTS The prevalence of PD was significantly increased among hemodialysis patients (12 patients: 9.2%) relative the control group (six men: 0.6%) (P<0.0001, odds ratio: 18.4). In both groups, the plaques were primarily allocated dorsally. In the hemodialysis patients with PD, the frequency of masturbation (P<0.05) and the incidence of moderate or severe erectile dysfunction (P<0.01) were significantly higher than those among hemodialysis patients without PD. In comparison with patients without PD, the number of acetate dialysate users was significantly higher among patients with PD (P<0.05), and none of the PD patients used angiotensin-related antihypertensive drugs (P<0.05). CONCLUSIONS The prevalence of PD in healthy Japanese men is low (0.6%), which suggests the existence of racial differences in the prevalence of PD. Moreover, these results indicate that hemodialysis increases the incidence of PD. The differences in the characteristics between male hemodialysis patients with and without PD provide new insights into the pathophysiology and therapeutic window of PD.
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Affiliation(s)
- Koji Shiraishi
- Department of Urology, Yamaguchi University School of Medicine, Department of Urology, UBE Industries Central Hospital, Ube, Yamaguchi, Japan.
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Moreno SA, Morgentaler A. ORIGINAL RESEARCH—PEYRONIE'S DISEASE: Testosterone Deficiency and Peyronie's Disease: Pilot Data Suggesting a Significant Relationship. J Sex Med 2009; 6:1729-1735. [DOI: 10.1111/j.1743-6109.2009.01250.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Zimmermann RP, Feil G, Bock C, Hoeltl L, Stenzl A. Significant alterations of serum cytokine levels in patients with Peyronie's disease. Int Braz J Urol 2008; 34:457-66; discussion 466. [DOI: 10.1590/s1677-55382008000400008] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2008] [Indexed: 01/18/2023] Open
Affiliation(s)
| | | | - Conny Bock
- Eberhard-Karls-University of Tuebingen, Germany
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Affiliation(s)
- Gerald H Jordan
- Department of Urology, Eastern Virginia Medical School, VA, Norfolk 23510, USA
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Abstract
PURPOSE OF REVIEW This review is aimed to summarize the most recent findings about this topic, by reviewing the literature published in 2002 and 2003 regarding the epidemiology, pathophysiology, diagnosis and treatment of Peyronie's disease. RECENT FINDINGS Although many aspects in pathophysiology, diagnosis, medical and surgical treatment of Peyronie's disease still remain under debate, recent interesting advances have been made regarding the different aspects of this condition. Topical and systemic medical therapies have been associated with varying degrees of results, depending on modalities and timing of the treatment itself. A wide range of surgical modalities have been recently developed, although the ideal surgical procedure especially in case of severe and complex curvature does not seem to be reached yet. Furthermore this condition is often associated with psychological distress that could be responsible for performance anxiety, leading to improvement of abnormalities in erectile functioning eventually associated with Peyronie's disease. SUMMARY Peyronie's disease consists of an acquired penile deformity caused by the formation of fibrous plaques within the tunica albuginea, leading to bio-mechanical and vascular abnormalities. In the last decade numerous advances have been made regarding pathophysiology, diagnosis and treatment of this condition, allowing for improved patient clinical prognosis. Nevertheless, although improvements in medical and surgical therapies have substantially increased the successful patients' outcome rate, Peyronie's disease is still not completely understood and its treatment remains often frustrating for the practicing urologist. Clinical presentations of this disease include penile deformities or shortening during erection, painful erection, palpable plaque or induration throughout the length of the penile shaft and erectile dysfunction.
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Affiliation(s)
- Alberto Briganti
- Department of Urology, Universita Vita Salute Raffaele, Milan, Italy
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Abstract
Peyronie's disease is an inflammatory condition characterized by the formation of fibrous, noncompliant nodules in the tunica albuginea which can impede tunical expansion during penile erection, leading to deformity and bending. While the cause of this disease is thought to be due to microvascular trauma and abnormal wound healing, other hypotheses include genetic predisposition. In this review the pathophysiology of Peyronie's disease is discussed as well as current hypotheses regarding its origin.
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Affiliation(s)
- R B Moreland
- Department of Urology and Physiology, Boston University School of Medicine, Boston, Massachusetts, USA
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Abstract
Peyronie's disease (PD) remains a therapeutic dilemma for the urologist. Despite a myriad of medical therapies proposed for PD there have been limited advances in oral medical treatment. Several new approaches are presented which hold promise of success, although a definitive medical therapy for PD has yet to be established. Since early stage disease is reputed to respond better than well-established plaques, an early trial of inexpensive, safe and well-tolerated oral therapy is often initially recommended. This review discusses the historical aspects as well as contemporary oral medical therapy for PD. With advances in the molecular biology of inflammation and wound healing, the management and understanding of this frustrating disease will no doubt improve.
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Affiliation(s)
- L A Mynderse
- Department of Urology, Mayo Clinic, Rochester, Minnesota 55905, USA.
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Abstract
The formation of Peyronie's disease plaques is a process that seems to involve a cascade of genetic, structural and immunologic events. Clinical manifestations include penile deformity and possible erectile dysfunction. Rational strategies have been forthcoming, with both minimally invasive and surgical treatments of Peyronie's disease available. This article reviews and updates current scientific and clinical advances in Peyronie's disease.
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Affiliation(s)
- G H Lischer
- Department of Urology, Mayo Clinic Foundation, Rochester, Minnesota 55905, USA
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Rhoden EL, Teloken C, Ting HY, Lucas ML, Teodósio da Ros C, Ary Vargas Souto C. Prevalence of Peyronie's disease in men over 50-y-old from Southern Brazil. Int J Impot Res 2001; 13:291-3. [PMID: 11890516 DOI: 10.1038/sj.ijir.3900727] [Citation(s) in RCA: 66] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The pathogenesis of Peyronie's disease still remains an enigma and few epidemiological studies are available. The purpose of this study was to determine the prevalence of Peyronie's disease in males older than 50 y. From 26 to 30 July 1998, 1071 men attended the 'Prostate Cancer Awareness Week of Santa Casa Hospital, Porto Alegre, Brazil'. In the prostate exam they also consented to be screened for Peyronie's disease. They underwent the 5-item International Index of Erectile Function (IIEF-5) questionnaire for evaluation of the erectile condition. The presence of a well-defined plaque in the penis was the diagnostic criterion for Peyronie's disease. The men were examined by five senior residents, under supervision by the staff Urologist. Men younger than 50 y as well as patients under intracavernous injection therapy for erectile dysfunction were excluded from the study. Chi2 test was used for statistical analysis. Nine hundred and fifty-four (89.1%) out of the 1071 men with a mean age of 62 y (ranging from 52 to 77) were included in the study. Peyronie's disease plaques were found in 35 men (3.67%). Eight hundred and forty-five (88.6%) were Caucasians. There was no significant statistical difference regarding age (P > 0.05). The presence of erectile dysfunction in the men with Peyronie's disease and without this condition, was 68.6% and 53.5%, respectively (P > 0.05). From this data we can conclude that the prevalence of Peyronie's disease is higher than in formerly reported studies. Further observations should be carried out in different communities and in other groups of patients in order to confirm our results.
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Affiliation(s)
- E L Rhoden
- Department of Urology, Santa Casa Hospital/Federal Faculty Foundation of Medical Sciences of Porto Alegre, Brazil.
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CHUN JUDYL, McGREGOR ANDY, KRISHNAN RAMESH, CARSON CULLEYC. A COMPARISON OF DERMAL AND CADAVERIC PERICARDIAL GRAFTS IN THE MODIFIED HORTON-DEVINE PROCEDURE FOR PEYRONIE’S DISEASE. J Urol 2001. [DOI: 10.1016/s0022-5347(05)66106-x] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- JUDY L. CHUN
- From the University of North Carolina, Chapel Hill, North Carolina
| | - ANDY McGREGOR
- From the University of North Carolina, Chapel Hill, North Carolina
| | - RAMESH KRISHNAN
- From the University of North Carolina, Chapel Hill, North Carolina
| | - CULLEY C. CARSON
- From the University of North Carolina, Chapel Hill, North Carolina
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A COMPARISON OF DERMAL AND CADAVERIC PERICARDIAL GRAFTS IN THE MODIFIED HORTON-DEVINE PROCEDURE FOR PEYRONIE???S DISEASE. J Urol 2001. [DOI: 10.1097/00005392-200107000-00044] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
Peyronie's disease remains one of the most perplexing diseases in urology. With continued basic research in wound healing and scarring, the understanding and management of this frustrating disease will improve. Initial treatment of Peyronie's disease should be conservative, with expectant therapy and medical management. Once the penile curvature and plaque have stabilized, patients with severe deformity can be offered surgery depending on their symptoms and complaints. Patient selection is the key to proper treatment. Less experienced surgeons should limit themselves to medical management or simple surgical management of the disease, including plication or Nesbit procedures. Penile-lengthening procedures or the placement of complicated penile prosthesis should be reserved for surgeons with familiarity and expertise in this type of reconstruction. Education on the pathogenesis and natural history of the disease will allow the patient and his partner to make an informed decision in regards to treatment options and expected outcomes.
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Affiliation(s)
- S S Gholami
- Department of Urology, University of California San Francisco, San Francisco, California, USA
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Teloken C, Rhoden EL, Grazziotin TM, Ros CT, Sogari PR, Souto CA. Tamoxifen versus placebo in the treatment of Peyronie's disease. J Urol 1999; 162:2003-5. [PMID: 10569556 DOI: 10.1016/s0022-5347(05)68087-1] [Citation(s) in RCA: 130] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE We evaluated the effects of oral tamoxifen and placebo in patients with Peyronie's disease. MATERIALS AND METHODS We selected 25 patients with Peyronie's disease who did not have calcified plaque for treatment in the andrology outpatient clinic. A medical history was obtained, and physical examination, penile x-ray, penile ultrasound and pharmacologically induced erection with prostaglandin E1 were performed. Patients were randomly divided into group 1--those who received 20 mg. tamoxifen twice daily for 3 months and group 2--those who received placebo for the same period. The same evaluations were done 4 months later and results were compared. Qualitative (chi-square test) and quantitative (Student's t test) results were analyzed using the Yates correction factor with p <0.05 considered significant. RESULTS Pain subsided in 66.6 and 75% of the patients treated with tamoxifen and placebo, respectively (p >0.05). In groups 1 and 2 a reduction in the penile deformity was noticed by 46.1 and 41.7% of the patients (p >0.05), and a decrease in plaque size was noticed by 30.7 and 25%, respectively. On the other hand, objective measurements did not reveal any difference in plaque area or curvature angle. CONCLUSIONS This study did not show significant improvement in pain, curvature or plaque size in patients with Peyronie's disease who were treated with tamoxifen compared with those treated with placebo.
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Affiliation(s)
- C Teloken
- Department of Urology, Santa Casa Hospital and Fundação Faculdade Federal de Ciências Médicas, Porto Alegre, Brazil
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Abstract
The pathogenesis of Peyronie's disease is still not well understood. As a result, the treatment of Peyronie's disease remains a dilemma and new therapies continue to evolve. This article discusses present understanding, controversy and new discoveries related to this condition.
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Affiliation(s)
- A I El-Sakka
- Department of Urology, University of California, San Francisco, California 94143, USA
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