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Yazdani A, Nasri P, Baradaran Mahdavi S. The Effects of Shock Wave Therapy on the Symptoms and Function of Individuals With Dupuytren Disease: A Systematic Review. Arch Phys Med Rehabil 2024:S0003-9993(24)01050-5. [PMID: 38866227 DOI: 10.1016/j.apmr.2024.05.030] [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: 09/06/2023] [Revised: 02/20/2024] [Accepted: 05/27/2024] [Indexed: 06/14/2024]
Abstract
OBJECTIVE To systematically evaluate the effects of extracorporeal shockwave therapy (ESWT) on pain, clinical and functional outcomes, and satisfaction of patients with Dupuytren disease. DATA SOURCES A thorough search for all the study types published in English was conducted in PubMed, Scopus, Web of Science, and Embase from inception to August 31, 2022. STUDY SELECTION Title and abstract and then full-text screening against eligibility criteria was performed independently by 2 reviewers, and a third reviewer achieved consensus. DATA EXTRACTION Reviewers identified 26 studies, of which 6 were included in the analysis (145 cases). The methodological quality was assessed using the National Heart, Lung, and Blood Institute and the Joanna Briggs Institute checklists. The certainty of evidence was evaluated using the Grading of Recommendation Assessment, Development, and Evaluation. DATA SYNTHESIS Assessments represented a remarkable improvement in the pain and function through the measurements including the visual analog scale, the Disabilities of Arm Shoulder and Hand Questionnaire, the Michigan Hand Outcome Questionnaire, and Mayo Wrist Score. Patients' satisfaction was also favorable using the Roles and Maudsley score. The hand grip strength improvement was noted in one study measured via a Jamar dynamometer. In addition, the ultrasonographic assessment of the nodules revealed a decrease in the size of the nodules in a patient with multiple bilateral nodules after the treatment. The quality of the included studies was good for all studies except for one that was fair. The certainty of evidence was moderate for pain and function and was low for patients' satisfaction and ultrasonographic findings. CONCLUSIONS ESWT can lead to significant pain improvement, functional rehabilitation, and patient satisfaction with no adverse effect in the management of Dupuytren disease. Pain may return over time, but not to that severity before the intervention. ESWT-related characteristics and the need for continuation of treatment remain to be fully elucidated in future large clinical trials.
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Affiliation(s)
- Amid Yazdani
- Department of Physical Medicine and Rehabilitation, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran; Ordibehesht Health Center, Isfahan, Iran; Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA.
| | - Parsa Nasri
- Student Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Sadegh Baradaran Mahdavi
- Department of Physical Medicine and Rehabilitation, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran; Student Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran; Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran.
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Spirito L, Manfredi C, La Rocca R, Napolitano L, Preto M, Di Girolamo A, Arcaniolo D, De Sio M, Creta M, Longo N. Long-term outcomes of extracorporeal shock wave therapy for acute Peyronie's disease: a 10-year retrospective analysis. Int J Impot Res 2024; 36:135-139. [PMID: 36788352 DOI: 10.1038/s41443-023-00673-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 01/27/2023] [Accepted: 01/31/2023] [Indexed: 02/16/2023]
Abstract
The aim of this paper was to describe the long-term outcomes of extracorporeal shock wave therapy (ESWT) in patients with acute Peyronie'disease (PD). An observational retrospective study was conducted in men with acute PD who underwent ESWT between 2009-2013 at a single institution. ESWT protocol consisted of 1 session (3000 shock waves, 0.10-0.25 mJ/mm^2, 4-6 Hz) per week for 4 weeks. Penile pain was chosen as the primary outcome. Penile curvature angle, erectile function, and satisfaction with ESWT were selected as secondary long-term outcomes. A total of 194 patients were included. The mean follow-up duration after ESWT was 125.6 months. Mean penile curvature worsened significantly at 3 months (18.3 vs. 21.5 degrees; p = 0.023) and 12 months (21.5 vs. 28.6 degrees; p = 0.001) and stabilized over the long-term (28.6 vs. 28.8 degrees; p = 0.335). Mean penile pain improved significantly at 3 months (6.5 vs. 3.1 points; p < 0.001) and 12 months (3.1 vs. 1.0 points; p = 0.001), remaining stable over time (1.0 vs. 1.0 points; p = 0.074). The mean five-item version of the International Index of Erectile Function (IIEF-5) increased significantly at 3 months (14.5 vs. 17.9 points; p = 0.001), remaining stable at 12 months (17.9 vs. 18.5 points; p = 0.082), and deteriorating in the long-term (18.5 vs. 15.8 points; p = 0.003). A high satisfaction rate with ESWT was recorded at 3 months (92.3%), remaining similar at 12 months (91.2%) and over the long-term (90.2%). No new acute phase and low rate of PD surgery (4.1%) were recorded in the long-term analysis. In patients with acute PD, ESWT seems to be associated with early and persistent relief of penile pain, transient improvement in erectile function, no significant effect on penile curvature, and a high rate of patient satisfaction constant over time.
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Affiliation(s)
- Lorenzo Spirito
- Unit of Urology, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", 80131, Naples, Italy
| | - Celeste Manfredi
- Unit of Urology, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", 80131, Naples, Italy
| | - Roberto La Rocca
- Unit of Urology, Department of Neurosciences, Reproductive Sciences, and Odontostomatology, University of, Naples, "Federico II", 80131Naples, Italy
| | - Luigi Napolitano
- Unit of Urology, Department of Neurosciences, Reproductive Sciences, and Odontostomatology, University of, Naples, "Federico II", 80131Naples, Italy.
| | - Mirko Preto
- Urology Clinic-A.O.U. "Città della Salute e della Scienza"-Molinette Hospital, University of Turin, 10126, Turin, Italy
| | | | - Davide Arcaniolo
- Unit of Urology, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", 80131, Naples, Italy
| | - Marco De Sio
- Unit of Urology, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", 80131, Naples, Italy
| | - Massimiliano Creta
- Unit of Urology, Department of Neurosciences, Reproductive Sciences, and Odontostomatology, University of, Naples, "Federico II", 80131Naples, Italy
| | - Nicola Longo
- Unit of Urology, Department of Neurosciences, Reproductive Sciences, and Odontostomatology, University of, Naples, "Federico II", 80131Naples, Italy
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Kozub A, Suleja A, Chłosta M, Kupilas A, Pradere B, Rivas JG, Rajwa P, Miszczyk M. Current trends in non-surgical management of Peyronie's disease-A narrative review. Andrology 2024; 12:505-517. [PMID: 37593783 DOI: 10.1111/andr.13512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 07/21/2023] [Accepted: 07/25/2023] [Indexed: 08/19/2023]
Abstract
Peyronie's disease (PD) is a connective tissue disorder affecting the tunica albuginea. It can cause pain and penile deformation, and its prevalence increases with age. Although surgery is the gold standard for the chronic phase of the disease, there are several conservative treatment methods available, and the optimal management of the acute phase of the disease remains a matter of debate. In this article, we aim to summarize the recent trends in research on the subject of non-surgical treatment of PD. The search was performed in PubMed, Scopus, and Web of Science databases and included studies in English published between 2012 and 2022 investigating the clinical outcomes of non-surgical PD management in humans. We have identified 20 distinct conservative treatment strategies. Among the oral therapeutics, only the use of phosphodiesterase type 5 inhibitors is currently recommended for clinical use in patients with concomitant erectile dysfunction. The use of collagenase from Clostridium histolyticum is supported by the best quality evidence in terms of intralesional injections for patients suffering from significant penile curvature; however, interferon alpha-2b can also be an option in such patients. Among other non-invasive methods, extracorporeal shockwaves can be useful for pain reduction, and penile traction therapy can lead to a reduction in penile curvature and plaque size. Despite a wide range of non-surgical methods available for PD treatment, the majority are not supported by sufficient scientific evidence, and the treatment efficacy is underwhelming. Further research on the subject of non-surgical management of PD is highly warranted.
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Affiliation(s)
- Anna Kozub
- IIIrd Department of Radiotherapy and Chemotherapy, Maria Sklodowska-Curie National Research Institute of Oncology (MSCNRIO), Gliwice, Poland
| | - Agata Suleja
- IIIrd Department of Radiotherapy and Chemotherapy, Maria Sklodowska-Curie National Research Institute of Oncology (MSCNRIO), Gliwice, Poland
| | - Marcin Chłosta
- Department of Urology, Jagiellonian University, Collegium Medicum, Krakow, Poland
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Andrzej Kupilas
- Department of Urology and Urooncology, City Hospital, Gliwice, Poland
| | - Benjamin Pradere
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Urology, University of Tours, Tours, France
| | - Juan Gómez Rivas
- Department of Urology, Hospital Clínico San Carlos, Madrid, Spain
| | - Paweł Rajwa
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Urology, Medical University of Silesia, Zabrze, Poland
| | - Marcin Miszczyk
- IIIrd Department of Radiotherapy and Chemotherapy, Maria Sklodowska-Curie National Research Institute of Oncology (MSCNRIO), Gliwice, Poland
- Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
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Wang X, Liu H, Tang G, Wu G, Chu Y, Wu J, Cui Y. Updated recommendations on the therapeutic role of extracorporeal shock wave therapy for peyronie's disease: systematic review and meta-analysis. BMC Urol 2023; 23:145. [PMID: 37700253 PMCID: PMC10498627 DOI: 10.1186/s12894-023-01320-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 09/08/2023] [Indexed: 09/14/2023] Open
Abstract
BACKGROUND The therapeutic role of extracorporeal shockwave therapy (ESWT) for Peyronie's disease (PD) has been controversial in a long term. We aimed to further evaluate the therapeutic effect of ESWT for PD on the basis of available high-quality studies. METHODS The PubMed, CENTRAL and Embase databases were searched for articles published from January 1st, 2000 to December 31, 2022. Only randomized controlled trials (RCTs) using ESWT to treat PD were included. Meta-analysis and forest plots were carried out using Review Manager 5.4.1 software, and outcomes were reviewed by 2 authors independently. Using the Risk of Bias assessment form (ROB-2) by Cochrane Collaboration for quality assessment. PRISMA 2020 guidelines were used in this article to achieve the quantitative and qualitative synthesis of data. RESULTS A total of four RCTs were included. 151 patients in the ESWT group and 150 patients in the control group. The meta-analysis results showed that ESWT could significantly reduce plaque size (OR 2.59, 95%CI 1.15 to 5.85, P = 0.02) and relieve pain (MD -1.55, 95%CI -2.46 to -0.64, P = 0.0008); but it has no significant effect on reducing the penile curvature (OR 1.93, 95%CI 0.87-4.26, P = 0.11) and improving sexual function (MD 2.6, 95%CI -1.63 to 6.83, P = 0.23), there is also no significant difference in complication rates between groups (OR 2.94, 95%CI 0.66 to 13.03, P = 0.16). The risk of bias of results is low. The limitations of this study are that the number of included studies is too small, some experimental outcomes are missing, and the expression of outcomes is not unified. CONCLUSIONS For PD, ESWT can be considered as a safe short-term treatment, which can reduce plaque size and relieve pain, but cannot improve penile curvature and sexual function. Its long-term efficacy remains to be discussed. REGISTRATION NUMBER PROSPERO (ID: CRD42023436744).
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Affiliation(s)
- Xiaofeng Wang
- Department of Urology, Qindao University Medical College Affiliated Yantai Yuhuangding Hospital, No. 20 East Yuhuangding Road, Yantai, Shandong, 264000, China
| | - Hongquan Liu
- Department of Urology, Qindao University Medical College Affiliated Yantai Yuhuangding Hospital, No. 20 East Yuhuangding Road, Yantai, Shandong, 264000, China
| | - Gonglin Tang
- Department of Urology, Qindao University Medical College Affiliated Yantai Yuhuangding Hospital, No. 20 East Yuhuangding Road, Yantai, Shandong, 264000, China
| | - Gang Wu
- Department of Urology, Qindao University Medical College Affiliated Yantai Yuhuangding Hospital, No. 20 East Yuhuangding Road, Yantai, Shandong, 264000, China
| | - Yongli Chu
- Department of Urology, Qindao University Medical College Affiliated Yantai Yuhuangding Hospital, No. 20 East Yuhuangding Road, Yantai, Shandong, 264000, China
| | - Jitao Wu
- Department of Urology, Qindao University Medical College Affiliated Yantai Yuhuangding Hospital, No. 20 East Yuhuangding Road, Yantai, Shandong, 264000, China.
| | - Yuanshan Cui
- Department of Urology, Qindao University Medical College Affiliated Yantai Yuhuangding Hospital, No. 20 East Yuhuangding Road, Yantai, Shandong, 264000, China.
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Hayat S, Brunckhorst O, Alnajjar HM, Cakir OO, Muneer A, Ahmed K. A systematic review of non-surgical management in Peyronie's disease. Int J Impot Res 2023; 35:523-532. [PMID: 36289392 PMCID: PMC10499596 DOI: 10.1038/s41443-022-00633-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 09/21/2022] [Accepted: 10/03/2022] [Indexed: 11/08/2022]
Abstract
The efficacy of many non-surgical treatments for Peyronie's disease is unclear. This systematic review aims to critically assess the currently available options and provide a recommendation for treatment based on this. A systematic literature search utilising the Medline (Pubmed), Embase, global health and Cochrane library databases was conducted up to May 2021. All randomised controlled trials assessing non-surgical treatment modalities for Peyronie's Disease were included. Individual study risk of bias was evaluated using the Cochrane tool and GRADE was used to assess evidence strength. Outcome measures were the change in penile curvature (degrees), plaque size (volume or size), International Index of Erectile Function score, pain scores and change in penile length. Prospero registration number: CRD42017064618. Amongst the 5549 articles identified, 41 studies (42 reports) were included. Seven different oral treatment options including vitamin E supplementation showed evidence for improving outcomes such as penile curvature and plaque size. Of the intralesional treatments, Collagenase Clostridium Histolyticum showed evidence for improving penile curvature (Range: 16.3-17 degrees, moderate level certainty of evidence). Intralesional Interferon demonstrated some improvement in curvature (Range: 12-13.5 degrees), plaque size (Range: 1.67-2.2 cm2) and pain, whilst intralesional calcium channel blockers such as Verapamil showed variable evidence for changes in the plaque size and pain. Extracorporeal Shockwave Therapy consistently demonstrated evidence for improving penile pain in stable disease, and two mechanical traction devices improved curvature. Iontophoresis, topical medications, and combination therapies did not demonstrate any consistent improvements in outcome measures. Intralesional options demonstrate the best potential. Overall, results varied with few high-quality randomised trials present.
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Affiliation(s)
- Sulaiman Hayat
- MRC Centre for Transplantation, Guy's Hospital Campus, King's College London, King's Health Partners, London, United Kingdom
| | - Oliver Brunckhorst
- MRC Centre for Transplantation, Guy's Hospital Campus, King's College London, King's Health Partners, London, United Kingdom
| | - Hussain M Alnajjar
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Onur Omer Cakir
- Department of Urology, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Asif Muneer
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
- Division of Surgery and Interventional Science, University College London, London, United Kingdom
- NIHR Biomedical Research Centre, University College London Hospital, London, United Kingdom
- Male Genital Cancer Centre, University College London, London, United Kingdom
| | - Kamran Ahmed
- MRC Centre for Transplantation, Guy's Hospital Campus, King's College London, King's Health Partners, London, United Kingdom.
- Department of Urology, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates.
- Khalifa University, Abu Dhabi, United Arab Emirates.
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Dell'Atti L, Ronchi P. Low-intensity laser diode plus extracorporeal shock wave therapy: a new treatment strategy in the management of Peyronie's disease. World J Urol 2023; 41:2563-2568. [PMID: 37490060 DOI: 10.1007/s00345-023-04533-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 07/07/2023] [Indexed: 07/26/2023] Open
Abstract
PURPOSE To assess the clinical effectiveness of extra corporeal shockwave therapy (ESWT) administration compared with ESWT plus a low-intensity laser diode therapy (LILDT) in the management of Peyronie's disease (PD) stable stage. METHODS In this study, 214 patients affected by PD in stable stage (≥ 12 months), were divided into two groups. Group 1 (G1) counted 111 patients treated only with ESWT; Group 2 (G2) consisted of 103 patients that received ESWT with the same protocol of G1 plus LILDT for six weeks. The patients of both groups were assessed at baseline and follow-up for erectile function, painful erections, penile plaque size and penile curvature. The results were evaluated at baseline and 3, 6, 12 months after the treatment. RESULTS Three months after the treatment in G2 pain in an erection or during intercourse was resolved completely in 78.6% of the patients, whereas in 55.8% cases of G1 (p < 0.003). G2 patients had a reduction of curvature degree after the 3 months treatment (p < 0.002). However, mean plaque size decreased in both groups without statistically differences with baseline values. Mean ± SD IIEF-5 score further improved significantly in the group treated with ESWT plus LILDT (p < 0.001). There were no permanent adverse sequelae after treatments. CONCLUSION This study demonstrates an interesting therapeutic strategy when combined to the synergistic action of a shock wave therapy with low-intensity laser therapy on the stable plaques with significant benefits in terms of pain perception, penile curvature and sexual activity.
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Affiliation(s)
- Lucio Dell'Atti
- Unit of Quality and Risk Management, University-Hospital of Marche, 71 Conca Street, Torrette, 60126, Ancona, Italy.
| | - Piero Ronchi
- Division of Urology, University-Hospital of Marche, 71 Conca Street, Torrette, 60126, Ancona, Italy
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Thomas J, Sencaj M, Ghomeshi A, Zucker IJ, Best JC, Ramasamy R. Stem-Cell, Shockwave, and Platelet Rich Plasma Therapy for the Treatment of Erectile Dysfunction and Peyronie's Disease: A Survey of Clinics Across the USA. Urology 2023; 178:83-90. [PMID: 37076023 DOI: 10.1016/j.urology.2023.01.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 12/12/2022] [Accepted: 01/25/2023] [Indexed: 04/21/2023]
Abstract
OBJECTIVE To identify clinics offering off-label therapies for erectile dysfunction (ED) and Peyronie's disease (Pyd) including stem cell, platelet-rich plasma (PRP), and shockwave therapy and to determine the transparency they provided to patients inquiring about these treatment modalities. METHODS Clinics were identified in different regions in the US using a systematic search on online website directories and were approached by asking a series of standardized questions regarding the cost of treatment, duration of therapy, the medical staff involved, and patient outcome data. A total of 26 clinics were surveyed for stem cell therapy, 26 for PRP treatment, and 27 for shockwave therapy. RESULTS Of the 79 clinics contacted, 93.7% provided some answers to the questions we asked, with a majority offering treatments for both ED and Pyd. The cost of treatment varied widely between clinics. The average cost per stem cell therapy injection was $5291, PRP per injection was $1336, and shockwave therapy per session was $413. A physician was involved in 67% of treatments, and only 6 of 79 clinics reported that a urologist was involved. Over 75% of the clinics reported patient satisfaction following treatment. Durability of benefits to patients ranged from months to years according to the clinics' reports. CONCLUSION Our data not only demonstrate the widespread use of off-label therapies for ED and PyD across the United States but also the lack of scientific data to support the claims made to patients. This study highlights the need for more oversight and standardization in novel regenerative therapies for ED and PyD.
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Affiliation(s)
- Jamie Thomas
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL.
| | - Michael Sencaj
- Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL.
| | - Armin Ghomeshi
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL.
| | - Isaac J Zucker
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL.
| | - Jordan C Best
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL.
| | - Ranjith Ramasamy
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL.
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Zhang X, Ma Y. Global trends in research on extracorporeal shock wave therapy (ESWT) from 2000 to 2021. BMC Musculoskelet Disord 2023; 24:312. [PMID: 37081473 PMCID: PMC10116688 DOI: 10.1186/s12891-023-06407-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 04/07/2023] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND This study intended to analyze the application of extracorporeal shock wave therapy in medicine and to evaluate the quality of related literature. METHODS All publications were extracted from 2000 to 2021 from the Web of Science Core Collection (WoSCC). The literature characteristics were depicted by VOSviewer (version 1.6.15) and the online bibliometric website ( http://bibliometric.com/ ). The future trends and hotspots were conducted by Bibliographic Item Co-occurrence Matrix Builder (version 2.0) and gCLUTO software. RESULTS We analyzed 1774 articles corresponding to the criteria for ESWT publications from 2000 to 2021. Most studies were conducted within the United States and China which besides have the most cooperation. The most published research institutions are Chang Gung University, Kaohsiung Chang Gung Memorial Hospital, and Kaohsiung Medical University. Six research hotspots were identified by keyword clustering analysis: Cluster0: The effects of ESWT on muscle spasticity; Cluster1: The application of ESWT in osteoarthritis (OA); Cluster2: Therapeutic effect of ESWT on tendon diseases; Cluster3: Early application of ESWT/ESWL in urolithiasis; Cluster4: The Role of angiogenesis in ESWT and the efficiency of ESWT for penile disease; Cluster5: The Special value of radial extracorporeal shock wave therapy (rESWT). CONCLUSIONS A comprehensive and systematic bibliometric analysis of ESWT was conducted in our study. We identified six ESWT-related research hotspots and predicted future research trends. With the gradual increase of research on ESWT, we find that ESWT is used more and more extensively, such in musculoskeletal disease, bone delay union, neurological injury, andrology disorders, lymphedema, and so on. In addition, the mechanism is not destructive damage, as initially thought, but a restorative treatment. Furthermore, delayed union, cellulite, burn, and diabetic foot ulcers may be the future direction of scientific study.
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Affiliation(s)
- Xinyu Zhang
- Department of Rehabilitation, The First Affiliated Hospital of China Medical University, 155 Nanjing Street, 110001, Shenyang, P.R. China
| | - Yuewen Ma
- Department of Rehabilitation, The First Affiliated Hospital of China Medical University, 155 Nanjing Street, 110001, Shenyang, P.R. China.
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Assessment of Conservative Combination Therapies for Active and Stable Peyronie's Disease: A Systematic Review and Meta-analysis. Eur Urol Focus 2022; 8:1520-1530. [PMID: 34924336 DOI: 10.1016/j.euf.2021.12.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 11/03/2021] [Accepted: 12/02/2021] [Indexed: 12/16/2022]
Abstract
CONTEXT In patients with Peyronie's disease (PD), oral, injected, or topical agents provide limited efficacy. In this setting, combination of two or more conservative treatments may improve symptoms further. OBJECTIVE To explore the effects of available conservative combination therapies for active and stable PD through a systematic review and meta-analysis. EVIDENCE ACQUISITION We searched multiple databases and sources of gray literature until June 2021. We included randomized or observational comparative studies assessing any conservative combination therapies for PD. We undertook a random-effect meta-analysis when at least two studies employed the same treatment modality (PROSPERO: CRD42021224517). EVIDENCE SYNTHESIS Overall, 13 studies on active PD and ten on stable PD (1962 participants) were included. Most included studies raised methodological concerns. In patients with active or stable PD, the available evidence is inconclusive to support the use of any combination treatment modality, such as intralesional verapamil injections, antioxidants, and other oral, injected, or topical agents. Based on data availability, we performed a meta-analysis to compare the effect of collagenase Clostridium histolyticum (CCH) plus adjunctive mechanical therapies (penile traction or vacuum pump) versus CCH monotherapy on penile curvature and length in patients with stable PD. CCH and adjunctive mechanical therapies resulted in an additional decrease of 0.3° in penile curvature (95% confidence interval [CI]: -3.97 to 4.49, I2 = 0%) and in an increase of 0.5 cm in penile length (95% CI: -0.32 to 1.4, I2 = 70%) compared with CCH monotherapy. CONCLUSIONS The available combination treatment modalities, including the addition of adjunctive mechanical therapies to CCH, do not improve symptoms further compared with monotherapy and should not be implemented in patients with active or stable PD. Further high-quality randomized trials combining only recommended treatments are mandatory. PATIENT SUMMARY Despite the interest in and optimism for combination treatment modalities, the road to an effective conservative therapy for Peyronie's disease still seems long.
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A Critical Analysis of Reporting in Systematic Reviews and Meta-Analyses in the Peyronie's Disease Literature. J Sex Med 2022; 19:629-640. [PMID: 35177375 PMCID: PMC9575169 DOI: 10.1016/j.jsxm.2022.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 12/17/2021] [Accepted: 01/12/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Despite an increasing number of publications on Peyronie's disease (PD), evidence-based clinical decision-making remains challenging due to the small number of well-designed clinical trials. AIM To perform a critical analysis of reporting quality in PD systematic reviews (SR) and meta-analyses (MA). METHODS Study protocol registration was performed on the Open Science Framework platform. In January 2021, a systematic electronic search of the Medline/PubMed, Embase, Ovid, Scopus, Joanne Briggs Institute, and Cochrane databases was performed. Search terms included "Peyronie's disease" and "systematic review OR meta-analysis OR meta-analysis." Eligibility criteria were English-language, relevance to PD and specification of "systematic review" or "meta-analysis" in the title or abstract. Oxford Center for Evidence-Based Medicine levels of evidence were used to classify original studies reviewed within each publication. Risk of bias was assessed using the ROBIS tool. Data were tabulated and reported as means with standard deviation, median with interquartile range and t-testing as appropriate. Strength of association between variables was calculated using Pearson correlation coefficient. Statistical analyses were performed on RStudio (version 1.4.1106). OUTCOMES Outcomes included review type, level of evidence, authorship, journal, publication date, "A MeaSurement Tool to Assess systematic Reviews" (AMSTAR-2) score and "Preferred Reporting Items for Systematic Reviews and Meta-Analyses" (PRISMA) score. RESULTS From 1974 to 2021, 340 articles were identified. After review, 17 full length articles were included. Thirteen were SR, 2 MA and 2 was combined. Significant heterogeneity was seen in evidence level of included studies. There was median 54% adherence to AMSTAR-2 criteria and 74% adherence to PRISMA criteria. Overall AMSTAR-2 confidence rating was Critically Low in 11 of 17 studies. Correlation analysis revealed very high positive association between AMSTAR 2 and PRISMA adherence (+0.95). ROBIS revealed "High" concern regarding methods used to collect data and appraise 12/17 studies (71%), and "High" concern regarding synthesis and findings in 8 of 17 studies (47%). CLINICAL IMPLICATIONS Many SR include markedly heterogenous levels of evidence and fail to meet accepted methodological criteria for reporting. STRENGTHS AND LIMITATIONS Main strengths include extensive literature review and analysis of standardized study reporting. One limitation is that aggregate scoring of AMSTAR-2 and PRISMA is not intended as primary method of quality assessment; however effect was minimized by reporting critical domains, overall quality assessments and specifics on globally poorly reported domains. CONCLUSION More high quality randomized controlled PD trials are necessary; SR and MA should focus on these studies alone. Bole R, Gottlich HC, Ziegelmann MJ, et al. A Critical Analysis of Reporting in Systematic Reviews and Meta-Analyses in the Peyronie's Disease Literature. J Sex Med 2022;19:629-640.
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Dekalo S, Brock GB. Shock Wave Therapy for Peyronie's Disease—Learning From the Past and Looking Into the Future. J Sex Med 2022; 19:404-407. [DOI: 10.1016/j.jsxm.2021.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 12/13/2021] [Accepted: 12/29/2021] [Indexed: 11/29/2022]
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Extracorporeal Shockwave Therapy in Peyronie's Disease: Systematic Review and Meta-Analysis. J Sex Med 2021; 18:1705-1714. [PMID: 37057504 DOI: 10.1016/j.jsxm.2021.06.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 06/16/2021] [Accepted: 06/21/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Peyronie's disease (PD) is associated with penile pain, deviation, and sexual dysfunction. Up till now, there is no conservative standard treatment for PD. However, the role of Extracorporeal Shock Wave Therapy (ESWT) is gaining increasing interest. AIM To evaluate the effect of ESWT on penile deviation, plaque size, erectile function, pain scale, and the rate of complications in PD patients. METHODS PubMed database was searched for articles published from January 2000 to November 2020, using related keywords and including randomized controlled trials (RCTs) only. Meta-analysis and forest plots were carried out using RevMan, and outcomes were reviewed by 2 authors independently. PRISMA guidelines were used in this article to achieve the quantitative and qualitative synthesis of data. OUTCOMES Changes in penile deviation, plaque size, erectile function, pain scale, and the rate of ESWT related complications. RESULTS The search yielded 73 articles. Three RCTs, including 117 patients in the ESWT group and 121 patients in the placebo group, were reviewed. ESWT is associated with reduction in plaque size (OR = 2.59, 95% CI (1.15-5.85), P= .02). No significant difference in reduction of penile deviation angle or rate of bruises were detected in post ESWT group when compared to placebo. No evidence was found to show an effect of ESWT on erectile function or pain scale. CLINICAL IMPLICATIONS Based on the available RCTs, ESWT fails to improve penile curvature or pain in men with PD. Although ESWT may reduce plaque size, this remains of questionable clinical significance. STRENGTHS & LIMITATIONS RCTs used different metrics to report the same outcome. Missed data were imputed to match the requirements of meta-analysis. However, there is still much data that cannot be estimated. CONCLUSION The current data suggest that ESWT fails to improve penile curvature or pain in men with PD. Although ESWT may reduce plaque size, this remains of questionable clinical significance, and further studies are required to confirm findings. Bakr AM, El-Sakka A. Extracorporeal Shockwave Therapy in Peyronie's Disease: Systematic Review and Meta-Analysis. J Sex Med 2021;18:1705-1714.
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Low-intensity shockwave therapy in Peyronie's disease: long-term results from a prospective, randomized, sham-controlled trial. Int J Impot Res 2021; 34:487-494. [PMID: 34007066 DOI: 10.1038/s41443-021-00447-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 04/23/2021] [Accepted: 05/04/2021] [Indexed: 11/09/2022]
Abstract
Low-intensity shockwave therapy (LiST) is an effective treatment for pain reduction in patients with Peyronie's disease (PD). We aimed to report the long-term results of a previously published randomized, sham-controlled trial on LiST for PD management. For the initial study, 102 patients with stable PD were randomly assigned to six sessions of LiST (n = 51) or sham (n = 51) therapy. All participants were subsequently contacted for an additional evaluation at 3 years after completion of the initial treatment and 63 of them (LiST = 34 and sham therapy = 29) presented for the evaluation. Among them, improvement of pain was reported in 23 participants (LiST = 16, sham = 7, p = 0.005) at 4 weeks and in 22 (LiST = 15, sham = 7, p = 0.031) at 3 years. We detected a mean difference of 2.2 points (95%CI: 0.9-3.5, p = 0.002) in the visual analog pain scale at 4 weeks and a mean difference of 2.5 points (95%CI: 1-4, p = 0.002) at 3 years between the two groups. No treatment-related complications occurred during the sessions or the follow-up period. Regarding the improvement of penile curvature or sexual function, no significant differences between the two groups were observed. Overall, LiST constitutes a safe and effective therapeutic approach for pain management both in the short- and long term.
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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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Li EV, Esterquest R, Pham MN, Panken EJ, Amarasekera C, Siebert A, Bajic P, Levine LA. Peyronie's disease: pharmacological treatments and limitations. Expert Rev Clin Pharmacol 2021; 14:703-713. [PMID: 33719851 DOI: 10.1080/17512433.2021.1903873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Introduction: Peyronie's disease (PD) is a disorder of the tunica albuginea from disordered and excessive deposition of collagen resulting in a palpable scar, pain, erect penile deformity and erectile dysfunction that significantly impacts patients both physically and emotionally.Areas Covered: Several treatment options have been described for PD, including shockwave therapy, traction therapy, both oral and intralesional pharmacological options, and surgery. This review seeks to examine the data for different types of non-surgical treatments for PD. We review how various treatment modalities impact several relevant clinical endpoints for Peyronie's disease, including effects on pain, penile curvature, plaque formation, and erectile function. We performed a literature search using PubMed and SCOPUS while referencing AUA, EAU, and CUA guidelines for management of Peyronie's Disease for studies published 1980-2020.Expert opinion: Intralesional collagenase injections have the strongest evidence and are the only FDA approved intralesional treatment for PD. Penile traction therapy (PTT) is low risk and may be beneficial in patients willing to invest significant time using the devices. Furthermore, oral combination therapy with other modalities may provide some benefit. Further investigation is required to better understand pathophysiology of PD and clarify the therapeutic utility of existing treatments, potentially with a multimodal strategy.
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Affiliation(s)
- Eric V Li
- Department of Urology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Robert Esterquest
- Division of Urology, Rush University Medical Center, Chicago, Illinois, USA
| | - Minh N Pham
- Department of Urology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Evan J Panken
- Department of Urology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Channa Amarasekera
- Division of Urology, Rush University Medical Center, Chicago, Illinois, USA
| | - Aisha Siebert
- Department of Urology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Petar Bajic
- Cleveland Clinic, Center for Men's Health, Glickman Urological and Kidney Institute, Cleveland, Ohio, USA
| | - Laurence A Levine
- Division of Urology, Rush University Medical Center, Chicago, Illinois, USA
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Illiano E, Trama F, Mancini V, Ruffo A, Romeo G, Riccardo F, Fabi C, Carrieri G, Crocetto F, Iacono F, Costantini E. Peyronie's disease may negatively impact the sexual experience of a couple and female sexual function: a single center study. Transl Androl Urol 2021; 10:555-562. [PMID: 33718058 PMCID: PMC7947445 DOI: 10.21037/tau-20-1067] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background Peyonie’s disease (PD) mostly affects males in the fifth decade of life, with a prevalence in the general population ranging between 0.5% and 20.3%. The pathology of PD is characterized by fibrosis of the tunic albuginea of the cavernous bodies of the penis, with the presence of pain in the erection and penile deformity. This is associated with decreased sexual function for both participants. The objective of the study was to investigate the influence of PD pathology on both male patients’ and their female partners’ sexual spheres, and analyze changes in sexual function and perception following penile correction surgery. Methods Prospective study, we included male patients with PD and their female partner sexually active. Patients underwent corporoplasty with multiple plications. The male and female sexuality was evaluated before surgery and three months after male treatment by the Female sexual Function Index (FSFI); International Index of Erectile Function (IIEF); Visual Analogical Scale (VAS). Results From January 2018 to November 2019 we included 35 couple. The female subjects before partner’s surgery presented dyspareunia, loss of sexual desire, inability to achieve orgasm, and sexual dissatisfaction. At three months after surgical treatment there was an improvement of sexual function in both male patients and female partners (desire P<0.0001, arousal P<0.0001, lubrification P<0.0001, orgasm P<0.0001, satisfaction P<0.0001, pain P<0.0001). As regarding male patients the pain decreased significantly (VAS score from 6 to 2.5), while there was no statistically significant improvement in erectile function (P=0.05). Conclusions Our findings suggest that a viable approach to treatment of PD patients that involves their partners could lead to better functional and psychological results.
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Affiliation(s)
- Ester Illiano
- Andrology and Urogynecology Clinic, Santa Maria Terni Hospital, University of Perugia, Terni, Italy
| | - Francesco Trama
- Andrology and Urogynecology Clinic, Santa Maria Terni Hospital, University of Perugia, Terni, Italy
| | - Vito Mancini
- Urology and Kidney Transplantation Unit Ospedali Riuniti, University of Foggia, Foggia, Italy
| | - Antonio Ruffo
- Andrea Grimaldi Hospital, San Giorgio a Cremano (NA), Italy
| | - Giuseppe Romeo
- Urology Department, A.O.R.N. A. Cardarelli, Naples, Italy
| | - Filippo Riccardo
- Department of General and Specialized Surgeries, Renal Transplantation, Nephrology, Intensive Care and Pain Management, University of Naples "Federico II", Napoli, Italy
| | - Consuelo Fabi
- Andrology and Urogynecology Clinic, Santa Maria Terni Hospital, University of Perugia, Terni, Italy
| | - Giuseppe Carrieri
- Urology and Kidney Transplantation Unit Ospedali Riuniti, University of Foggia, Foggia, Italy
| | - Felice Crocetto
- Department of General and Specialized Surgeries, Renal Transplantation, Nephrology, Intensive Care and Pain Management, University of Naples "Federico II", Napoli, Italy
| | - Fabrizio Iacono
- Department of General and Specialized Surgeries, Renal Transplantation, Nephrology, Intensive Care and Pain Management, University of Naples "Federico II", Napoli, Italy
| | - Elisabetta Costantini
- Andrology and Urogynecology Clinic, Santa Maria Terni Hospital, University of Perugia, Terni, Italy
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Focused electromagnetic high-energetic extracorporeal shockwave (ESWT) reduces pain levels in the nodular state of Dupuytren's disease-a randomized controlled trial (DupuyShock). Lasers Med Sci 2021; 37:323-333. [PMID: 33483776 PMCID: PMC8803781 DOI: 10.1007/s10103-021-03254-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 01/14/2021] [Indexed: 11/04/2022]
Abstract
Dupuytren’s disease is a progressive fibroproliferative disorder of the hand. In the nodular stage of Dupuytren’s disease, pain might limit daily hand activities and progress to finger contractures. Focused electromagnetic high-energetic extracorporeal shockwave therapy (ESWT) may reduce pain in Dupuytren’s nodules (Tubiana N). In this prospective, randomized, blinded, placebo-controlled single center trial, we enrolled 52 patients (mean age, 58.2 ± 9.2) with painful nodular Dupuytren disease Tubiana N. Randomization was done to either (group A) 3 treatments with focused electromagnetic high-energetic ESWT (2000 shots, 3 Hz, 0.35 mmJ/mm2/hand, Storz Duolith SD1, n = 27) or (group B) placebo ESWT (2000 shots, 3 Hz, 0.01 mJ/mm2/hand, n = 25) in a weekly interval. Primary outcome was the level of pain on a visual analogue scale (VAS 0–10) at 3/6/12/18 months, secondary outcomes were patient-related outcome measures (DASH score, MHQ score, URAM scale), grip strength, patient’s satisfaction, and Dupuytren’s disease progression over 18 months follow-up. Focused ESWT significantly improved outcomes. Pain was reduced from 3.6 ± 1.8 to 1.9 ± 1.2 at three, to 1.4 ± 0.7 at six, to 1.7 ± 1.6 after 12 months and 1.9 ± 0.8 after 18 months in the intervention group (47% reduction, p < 0.05). In the placebo group, pain on VAS increased from 2.2 ± 1.4 to 3.4 ± 1.7 at three, to 3.4 ± 1.8 at six, to 3.4 ± 1.4 at 12 and 3.1 ± 1.1 at 18 months (35% increase, p < 0.05). Quality-of-life score tended to improve in the intervention group (MHQ, 77 ± 19 to 83 ± 12; DASH, 12 ± 18 to 10 ± 9) while it deteriorated in the placebo group as Dupuytren’s disease was progressing (MHQ, 79 ± 15 to 73 ± 17; DASH, 6 ± 10 to 14 ± 13). The strength of the affected hand and fingers did not change significantly in either of the groups. Patients’ satisfaction was higher in the intervention group for symptom improvement (56% vs. 12%) and reduction of disease progression (59% vs. 24%). Any Dupuytren-related intervention was performed in 26% in the intervention group and in 36% in the placebo group within 18 months of follow-up (n.s.). Focused electromagnetic high-energetic ESWT can significantly reduce pain in painful nodules in Dupuytren’s disease in an 18-month perspective. (ClinicalTrials.gov Identifier: NCT01184586).
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El-Sakka AI. Medical, non-invasive, and minimally invasive treatment for Peyronie's disease: A systematic review. Andrology 2020; 9:511-528. [PMID: 33098745 DOI: 10.1111/andr.12927] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 09/29/2020] [Accepted: 10/20/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND The treatment of Peyronie's disease (PD) remains a dilemma as the true pathogenesis of PD remains an enigma. Consequently, new molecules and therapies continue to evolve. The safety and efficacy of conservative treatment for PD have not yet established. OBJECTIVES To provide the available information of the status of conservative therapy for PD. METHODS A systematic literature search was conducted using PubMed, EMBASE, and the Cochrane Library for English-language journal articles between January 2000 and July 2019, using the terms "Conservative treatment for PD", "medical treatment for PD", "non-invasive therapies for PD" and "minimally invasive therapies for PD". This systematic review was conducted in agreement with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) system. We also manually reviewed references from selected articles. The risk of bias in the included RCTs was assessed using the Cochrane Risk of Bias Assessment tool (RoB 2). RESULTS Conservative treatment is accepted as the initial treatment step in most of the cases. This kind of therapy includes various methods of treatment such as medical, non-invasive, and minimally invasive therapies. Ideal management of PD is not yet available. It is not possible to assess the value of treatment without well-designed, randomized, placebo-controlled, large-scale clinical studies. CONCLUSION Optimistically, in the near future, we may witness emergence of efficacious new agents and modalities to revolutionize medical, non-invasive, and minimally invasive treatment of this devastating condition.
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Ochoa A, Guillot-Tantay C, Faix A, Misrai V, Rouprêt M. Traitement de la maladie de Lapeyronie par ondes de choc extracorporelles. Prog Urol 2020; 30:488-499. [DOI: 10.1016/j.purol.2020.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 03/31/2020] [Accepted: 04/03/2020] [Indexed: 12/01/2022]
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Review of the Current Status of Low Intensity Extracorporeal Shockwave Therapy (Li-ESWT) in Erectile Dysfunction (ED), Peyronie's Disease (PD), and Sexual Rehabilitation After Radical Prostatectomy With Special Focus on Technical Aspects of the Different Marketed ESWT Devices Including Personal Experiences in 350 Patients. Sex Med Rev 2020; 9:93-122. [PMID: 32499189 DOI: 10.1016/j.sxmr.2020.01.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Revised: 01/02/2020] [Accepted: 01/13/2020] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Although the literature of the positive effects of penile low intensity extracorporeal shockwave therapy is meanwhile substantial, there are substantial differences regarding both the sources of energies and extracorporeal shockwave therapy (ESWT) devices. OBJECTIVES To provide an overview on the energy range and energy differences of the 6 currently marketed ESWT devices along with personal ESWT experiences in 350 patients. METHODS This review includes all published preclinical and clinical penile ESWT studies with evaluation of the technical differences of the 6 ESWT devices and the personal experiences with these 6 devices in ED and PD. The main outcomes measures were success rates in ED (International Index of Erectile Function-erectile function change, conversion of phosphodiesterase type 5 inhibitors non-responders) and PD (change in deviation and plaque size), differences of used sources of energy, and energy flux densities (EFDs). RESULTS 3 different sources of energies are used, that is electromagnetic, electrohydraulic, and piezoelectric .The devices markedly distinguish in the available spectrum of the EFD ranging between 0.09 and 0.55 mJ/mm². In terms of the biological effects, the relevant energy parameters are -6 dB and the 5 MPa focus, which differ substantially between the ESWT devices. In addition, a great variability in the treatment protocols and applied energy is obvious. The preliminary own experiences with low intensity extracorporeal shockwave therapy in 160 ED non-responders and 190 patients with PD with success rates of 45% and 47%, respectively, are reported. CONCLUSION Positive results were published with all 6 ESWT devices in question in patients with organic ED but with huge differences regarding the EFD and the total energies applied. There is growing evidence that concentrated treatment protocols and increasing energies may yield better results. In this context, it may be argued that at least some of the published studies were markedly underpowered .Owing to the paucity of published studies, the literature of the effects of ESWT in PD and for penile rehabilitation after pelvic surgery is currently not conclusive. Porst H. Review of the Current Status of Low Intensity Extracorporeal Shockwave Therapy (Li-ESWT) in Erectile Dysfunction (ED), Peyronie's Disease (PD), and Sexual Rehabilitation After Radical Prostatectomy With Special Focus on Technical Aspects of the Different Marketed ESWT Devices Including Personal Experiences in 350 Patients. Sex Med 2021;9:93-122.
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Abstract
Treating men with Peyronie's disease remains a challenging problem facing clinicians working across urology and sexual medicine fields. Patients can often be left disappointed by current treatment paradigms, and an overall lack of suitable molecular targets has limited the options for novel, effective medical therapy. Managing men with Peyronie's disease often involves careful counselling alongside multifaceted and possible combination treatments to help improve symptoms whilst ameliorating potential side effects of therapy. We review the latest medical literature and evidence in the contemporary management of Peyronie's disease.
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Affiliation(s)
- Asrit Babu
- Department of Urology, Leeds Teaching Hospitals, Leeds, UK
| | - Oliver Kayes
- Department of Urology, Leeds Teaching Hospitals, Leeds, UK
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Ziegelmann MJ, Bajic P, Levine LA. Peyronie's disease: Contemporary evaluation and management. Int J Urol 2020; 27:504-516. [PMID: 32253786 DOI: 10.1111/iju.14230] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 02/27/2020] [Indexed: 01/02/2023]
Abstract
Peyronie's disease is a common yet poorly understood condition characterized by penile pain, curvature, sexual dysfunction and psychological bother. Peyronie's disease represents a penile wound healing disorder, and is thought to arise from exuberant scarring in response to penile trauma in genetically predisposed men. In the absence of active treatment, the majority of men experience stable or worsening symptoms, with few reporting spontaneous resolution in penile curvature or other deformity. In contrast, penile pain improves or resolves in the majority of men. Treatment options vary based on symptom severity and stability. Several oral therapies are commonly prescribed, although to date there are no strong data to support any oral agents as monotherapy for Peyronie's disease. Other options including penile traction therapy and intralesional injections result in modest improvements for many patients, particularly when used early after symptom onset. Penile straightening through approaches, such as penile plication and plaque incision or partial excision and grafting, represent the most rapid and reliable approach to correct penile curvature once the symptoms have stabilized. Side-effects vary based on the type of surgery carried out, and include penile shortening, sensation changes and erectile dysfunction in the minority of men. In patients with drug refractory erectile dysfunction and Peyronie's disease, placement of a penile prosthesis will address both issues, and is associated with high levels of patient satisfaction. The current review provides a practical approach to the modern evaluation and management of patients presenting with Peyronie's disease.
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Affiliation(s)
- Matthew J Ziegelmann
- Division of Urology, Rush University Medical Center, Chicago, Illinois, USA.,Department of Urology, Mayo Clinic, Rochester, Minnesota, USA
| | - Petar Bajic
- Division of Urology, Rush University Medical Center, Chicago, Illinois, USA
| | - Laurence A Levine
- Division of Urology, Rush University Medical Center, Chicago, Illinois, USA
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Allameh F, Razzaghi M, Rayegani SM, Fallah-Karkan M, Ranjbar A, Rahavian A, Javadi A, Ghiasy S, Razzaghi Z. Laser Therapy for Peyronie's Disease: A Randomized Control Double-Blind Pilot Study. J Lasers Med Sci 2020; 10:S37-S42. [PMID: 32021671 DOI: 10.15171/jlms.2019.s7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Introduction: The management of Peyronie's disease (PD) has remained a therapeutic dilemma for physicians and there is no gold standard treatment. In this paper, we decided to investigate the beneficial effect of the intralesional administration of verapamil compared with the intralesional administration of verapamil plus a low-intensity laser (LIL). Methods: Research was activated from May 2016 to May 2018 and a total of 38 men aged 18 years and older completed the investigation. The subjects were randomly divided into 2 groups. Group 1 was composed of 22 patients that were treated only by verapamil (5 mg) plus a sham laser weekly for 6 weeks, and group 2 consisted of 22 patients that received a laser, using the BTL-6000 HIGH-INTENSITY LASER 12 W machine and the same protocol of intralesional verapamil injection. The visual analogue scale (VAS) was used to evaluate pain during an erection, penile ultrasonography was used to measure plaque size, the penile curvature angle degree was measured using the photographs taken during an erection, and the International Index of Erectile Function questionnaire was used to assess erectile function. The follow-up treatment lasted for nine months, with visits performed in the 3rd and 9th months. Results: All study parameters decreased significantly after treatment in both arms, but the reduction in pain and penile curvature improvements in combination therapy revealed more significant changes in 3 months (p = .035, p=.032). Nevertheless, these improvements were not seen in the follow-up session after 9 months. Conclusion: A laser appears to be safe treatment modality in carefully-selected patients with PD. It has moderate efficacy in the short term.
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Affiliation(s)
- Farzad Allameh
- Center of Excellence in Training Laser Application in Medicine, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Razzaghi
- Laser Application in Medical Sciences Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Mansoor Rayegani
- Physical Medicine and Rehabilitation Research Center, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Morteza Fallah-Karkan
- Laser Application in Medical Sciences Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Urology, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Arash Ranjbar
- Department of Urology, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amirhosein Rahavian
- Department of Urology, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Atefeh Javadi
- Physical Medicine and Rehabilitation Research Center, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Saleh Ghiasy
- Department of Urology, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zahra Razzaghi
- Laser Application in Medical Sciences Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Fode M, Østergren PB. Contemporary Thoughts on the Role of Shockwave Therapy in Peyronie's Disease. J Sex Med 2020; 17:174-179. [DOI: 10.1016/j.jsxm.2019.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 09/30/2019] [Accepted: 10/07/2019] [Indexed: 12/21/2022]
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Ory J, MacDonald L, Langille G. Noninvasive Treatment Options for Peyronie's Disease. Sex Med Rev 2020; 8:603-614. [PMID: 31983573 DOI: 10.1016/j.sxmr.2019.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 12/04/2019] [Accepted: 12/08/2019] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Evidence for noninvasive management of Peyronie's disease contains many options with varying levels of evidence for each. Many first-line treatments recommended by urologists lack strong evidence for their use. AIM We summarize the noninvasive (oral medications, topical medications, traction, vacuum erection devices, extracorporeal shock wave therapy, intracavernosal injections and electromotive therapy) treatment options for Peyronie's disease and provide the levels of evidence for each. METHODS A literature search of PubMed, EMBASE, Cochrane Library, and ClinicalKey databases was conducted, current up to April 2019. MAIN OUTCOME MEASURE For each treatment modality, we measured level of evidence, change in penile curvature, change in erectile function, the percentage of patients with improved angulation, and pain scores. RESULTS There is weak evidence to support the use of oral or topical medications. Higher levels of evidence exist for intracavernosal injections and extracorporeal shock wave therapy and may be helpful in certain patient populations. CONCLUSION The mechanisms behind Peyronie's disease are not fully understood. Penile injections provide the highest quality of evidence for noninvasive treatment. Ory J, MacDonald L, Langille G. Noninvasive Treatment Options for Peyronie's Disease. Sex Med Rev 2020;8:603-614.
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Affiliation(s)
- Jesse Ory
- Department of Urology, Dalhousie University, Halifax, NS, Canada.
| | - Landan MacDonald
- Department of Urology, Dalhousie University, Halifax, NS, Canada
| | - Gavin Langille
- Department of Urology, Dalhousie University, Saint John, NB, Canada
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Vieiralves RR. Editorial Comment: Low-Intensity Shock Wave Therapy in Sexual Medicine-Clinical Recommendations. Int Braz J Urol 2019; 46:134-135. [PMID: 31851474 PMCID: PMC6968905 DOI: 10.1590/s1677-5538.ibju.2020.01.09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Aita G, Ros CTD, Silvinato A, Bernardo WM. Peyronie's disease: clinical treatment. ACTA ACUST UNITED AC 2019; 65:1231-1239. [PMID: 31721953 DOI: 10.1590/1806-9282.65.10.1231] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2018] [Indexed: 01/07/2023]
Affiliation(s)
- Giuliano Aita
- Sociedade Brasileira de Urologia, Rio de Janeiro, RJ, Brasil
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Capogrosso P, Frey A, Jensen CFS, Rastrelli G, Russo GI, Torremade J, Albersen M, Gruenwald I, Reisman Y, Corona G. Low-Intensity Shock Wave Therapy in Sexual Medicine-Clinical Recommendations from the European Society of Sexual Medicine (ESSM). J Sex Med 2019; 16:1490-1505. [PMID: 31447380 DOI: 10.1016/j.jsxm.2019.07.016] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 07/05/2019] [Accepted: 07/18/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Low-intensity shockwave therapy (LISWT) has been investigated for the treatment of uroandrological disorders including erectile dysfunction (ED), Peyronie's disease (PD) and chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) with controversial findings. AIM To review the evidence on LISWT for ED, PD, and CP/CPPS and provide clinical recommendations on behalf of the European Society of Sexual Medicine. METHODS Medline and Embase databases were searched for randomized clinical trials (RCTs), meta-analyses and open-label prospective or retrospective studies investigating the effect of LISWT on ED, PD, or CP/CPPS. OUTCOMES The panel provided statements on clinically relevant questions concerning LISWT: (i) treatment efficacy, (ii) treatment protocol, (iii) clinical indications, and (iv) safety. The level of evidence was provided according to the Oxford 2011 criteria and graded using the Oxford Centre for Evidence-Based Medicine recommendations. RESULTS 11 RCTs and 5 meta-analyses investigated LISWT for ED. RCTs provided controversial results on the efficacy of LISWT and were affected by high heterogeneity and the small number of patients included. Pooled-data analysis showed an overall positive effect in terms of erectile function improvement but reported small estimates and included a largely heterogeneous cohort of patients. 4 RCTs and 1 meta-analysis assessed LISWT for PD. All trials showed positive findings in terms of pain relief but no effect on penile curvature and plaque size. Inclusion criteria vary widely among studies, and further investigation is needed. 5 RCTs investigated LISWT for CP/CPPS. Data showed a possible effect on pain relief, although there is no evidence supporting that pain relief was maintained or any improvement in pain over time. CLINICAL IMPLICATIONS LISWT needs to be further investigated in the context of sexual medicine and is almost but not yet ready for clinical practice. STRENGTHS AND LIMITATIONS All studies have been evaluated by a panel of experts providing recommendations for clinical practice. CONCLUSIONS LISWT is a safe and well-tolerated procedure but its efficacy for the treatment of ED is doubtful and deserves more investigation. Patients reporting pain associated with PD may benefit from LISWT, although no effect is expected on disease progression. LISWT is not a primary treatment for CP/CPPS, but it may be considered as an option to relieve pain. Capogrosso P, Frey A, Jensen CFS, et al. Low-Intensity Shock Wave Therapy in Sexual Medicine-Clinical Recommendations from the European Society of Sexual Medicine (ESSM). J Sex Med 2019;16:1490-1505.
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Affiliation(s)
- Paolo Capogrosso
- Department of Urology; Ospedale San Raffaele, Vita-Salute University, Milano, Italy.
| | - Anders Frey
- Department of Urology, University of Southern Denmark, Esbjerg and Odense, Denmark
| | | | - Giulia Rastrelli
- Andrology, Female Endocrinology and Gender Incongruence Unit, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Florence, Italy
| | | | | | - Maarten Albersen
- Laboratory of Experimental Urology, Department of Development and Regeneration, University of Leuven, Leuven, Belgium; Department of Urology, University Hospitals of Leuven, Leuven, Belgium
| | - Ilan Gruenwald
- Neuro-urology Unit, Rambam Healthcare Campus, Haifa, Israel
| | - Yacov Reisman
- Men's Health Clinic, Amstelland Hospital, Amsterdam, The Netherlands
| | - Giovanni Corona
- Endocrinology Unit, Medical Department, Azienda USL, Maggiore-Bellaria Hospital, Bologna, Italy
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Di Mauro M, Russo GI, Della Camera PA, Di Maida F, Cito G, Mondaini N, Capece M, Falcone M, Sessa F, Mari A, Campi R, Sabini C, Serni S, Gacci M, Minervini A, Carini M, Cimino S, Morelli G, Cocci A. Extracorporeal Shock Wave Therapy in Peyronie's Disease: Clinical Efficacy and Safety from a Single-Arm Observational Study. World J Mens Health 2019; 37:339-346. [PMID: 30929330 PMCID: PMC6704308 DOI: 10.5534/wjmh.180100] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 12/22/2018] [Accepted: 01/17/2019] [Indexed: 12/30/2022] Open
Abstract
Purpose In this study, we aimed to determine the role of extracorporeal shockwave therapy (ESWT) in the management of Peyronie's disease (PD). Materials and Methods A total of 325 patients suffering from PD were enrolled in this single-arm clinical study. All patients were received ESWT using a schedule of 1 treatment/wk. Penile curvature was measured by a goniometer after intracavernosal drug-induced erection using Alprostadil. Plaque size was measured with a ruler and sexual function assessed by the international index of erectile function (IIEF)-15 score. Severity of erectile dysfunction was classified as severe (IIEF-15 ≤10), moderate (IIEF-15 between 11 and 16), or mild (IIEF-15 between 17 and 25). Results were evaluated at baseline and 3 months after the treatment. Results All the patients completed the study protocol. Median age was 59.0 years (55.0–64.0 years). After treatment, the median (interquartile range, IQR) plaque size reduced from 1.78 cm2 (1.43–2.17 cm2) to 1.53 cm2 (1.31–1.96 cm2) (p<0.001); the median (IQR) penile length in erection increased from 13.0 cm (12.0–14.0 cm) to 14 cm (13.0–15.0 cm) (p<0.001) and the median (IQR) penile curvature from 30.4° (22.2°–35.4°) to 25.0° (20.2°–30.4°) (p<0.001). We also observed a decrease in pain assessed by visual analogue scale (7 vs. 3; p<0.001), an improvement in each of the IIEF sub-domains (p<0.001) and an improvement in all three PD questionnaire domains (p<0.001). Conclusions Based on our findings, ESWT could be considered a safe and efficient minimally invasive option for the management of the patients suffering from PD.
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Affiliation(s)
- Marina Di Mauro
- Urology Section, Department of Surgery, University of Catania, Catania, Italy
| | - Giorgio Ivan Russo
- Urology Section, Department of Surgery, University of Catania, Catania, Italy.
| | | | | | - Gianmartin Cito
- Department of Urology, University of Florence, Florence, Italy
| | | | - Marco Capece
- Department of Urology, University of Naples, Naples, Italy
| | - Marco Falcone
- Department of Urology, Molinette Hospital, University of Turin, Turin, Italy
| | - Francesco Sessa
- Department of Urology, University of Florence, Florence, Italy
| | - Andrea Mari
- Department of Urology, University of Florence, Florence, Italy
| | - Riccardo Campi
- Department of Urology, University of Florence, Florence, Italy
| | - Carlotta Sabini
- Department of Urology, University of Florence, Florence, Italy
| | - Sergio Serni
- Department of Urology, University of Florence, Florence, Italy
| | - Mauro Gacci
- Department of Urology, University of Florence, Florence, Italy
| | | | - Marco Carini
- Department of Urology, University of Florence, Florence, Italy
| | - Sebastiano Cimino
- Urology Section, Department of Surgery, University of Catania, Catania, Italy
| | | | - Andrea Cocci
- Department of Urology, University of Florence, Florence, Italy
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Krieger JR, Rizk PJ, Kohn TP, Pastuszak A. Shockwave Therapy in the Treatment of Peyronie's Disease. Sex Med Rev 2019; 7:499-507. [PMID: 30926460 DOI: 10.1016/j.sxmr.2019.02.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 01/28/2019] [Accepted: 02/04/2019] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Peyronie's disease is an acquired condition of the connective tissue of the penis that affects 0.5-20.3% of the male population and is marked by fibrotic plaques in the tunica albuginea. It can result in penile curvature/deviation, painful erections, and sexual dysfunction. Several treatment modalities have been proposed, with studies from the past decade investigating extracorporeal shockwave therapy's (ESWT) potential efficacy in Peyronie's management. AIMS To investigate the effects of ESWT on Peyronie's disease parameters such as penile curvature, plaque size, erectile function, and penile pain. METHODS We reviewed the literature examining the effects of ESWT on Peyronie's disease. MAIN OUTCOME MEASURES The main outcome measures after receiving extracoporeal shockwave therapy included changes in degree of penile curvature, penile plaque size, International Index of Erectile Function-5 questionnaire score, and visual analogue scale score. RESULTS Randomized controlled trials examining the efficacy of ESWT in Peyronie's disease do not show a statistically significant benefit in curvature reduction, plaque size, or erectile function, although a recent meta-analysis demonstrates a benefit in plaque size reduction. A statistically significant reduction in penile pain has been observed across multiple studies. CONCLUSION Extracorporeal shockwave therapy may be beneficial in the management of Peyronie's disease for refractory penile pain and plaque size reduction. However, penile pain typically resolves spontaneously over time, and shockwave therapy can pose a substantial financial burden to patients. A multi-institutional randomized controlled trial with standardization of methods and strict inclusion criteria regarding disease duration would prove beneficial in determining the true efficacy of shockwave therapy in Peyronie's disease. Krieger JR, Rizk PJ, Kohn TP, et al. Shockwave Therapy in the Treatment of Peyronie's Disease. Sex Med Rev 2019;7:499-507.
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Affiliation(s)
- Jordan R Krieger
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Paul J Rizk
- Department of Urology, University of Miami, Miami, FL, USA
| | - Taylor P Kohn
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Alexander Pastuszak
- Division of Urology, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA.
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Therapeutic areas of Li-ESWT in sexual medicine other than erectile dysfunction. Int J Impot Res 2019; 31:223-230. [DOI: 10.1038/s41443-019-0114-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 12/16/2018] [Accepted: 12/20/2018] [Indexed: 12/18/2022]
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Clinical studies on low intensity extracorporeal shockwave therapy for erectile dysfunction: a systematic review and meta-analysis of randomised controlled trials. Int J Impot Res 2019; 31:177-194. [PMID: 30664671 DOI: 10.1038/s41443-019-0117-z] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 01/07/2019] [Accepted: 01/10/2019] [Indexed: 01/25/2023]
Abstract
The efficacy of low intensity extracorporeal shock wave therapy (LI-ESWT) for erectile dysfunction (ED) has received hard criticism and recently published meta-analyses were not able to provide further insights, nor specific recommendations. The aim of this systematic review and meta-analysis is to evaluate the efficacy of LI-ESWT for ED, identify the ideal treatment population and treatment protocol, and provide recommendations for future research in the field. A systematic research for relevant clinical studies published from January 2010 to September 2018 was performed, using the following databases: Medline, Embase, The Cochrane Library, Scopus, and Web of Science. Only clinical studies that investigated the efficacy of LI-ESWT for ED only, and reported primary outcomes using IIEF-EF scores/questionnaires were included. Both, randomised controlled trials (RCTs) and cohort studies were included, but the meta-analysis was performed only for sham-controlled RCTs. Ten RCTs including 873 patients were selected for the meta-analysis. Pooling data of these studies showed that LI-ESWT could significantly improve erectile function in men with ED regarding both patient-subjective outcomes (IIEF-EF: +3.97; 95% CI [2.09-5.84]; p < 0.0001, EHS ≥ 3: OR: 4.35; 95% CI [1.82-10.37]; p = 0.0009) and patient-objective outcomes (peak systolic velocity: +4.12; 95% CI [2.30-5.94]; p < 0.00001). In conclusion, the present meta-analysis provided results showing that LI-ESWT significantly improves erectile function in patients with vasculogenic ED.
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Brimley SC, Yafi FA, Greenberg J, Hellstrom WJG, Tue Nguyen HM, Hatzichristodoulou G. Review of Management Options for Active-Phase Peyronie's Disease. Sex Med Rev 2018; 7:329-337. [PMID: 30503796 DOI: 10.1016/j.sxmr.2018.09.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 09/05/2018] [Accepted: 09/23/2018] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Peyronie's disease (PD) is a fibrotic disorder that leads to plaque formation in ∼3-9% of adult men. Connective tissue buildup results in plaque formation, penile curvature and shortening, and in some cases, pain. In the active phase of PD, penile pain is a common symptom, often accompanied by progression in curvature. Treatment options for PD include oral drugs, topical cream, intralesional injections, traction, and shock wave therapy. This article reviews the different treatment options for active-phase PD. AIM To provide a comprehensive review of the current evidence-based treatments, focusing on active-phase PD. METHODS A PubMed database search was performed for studies on conservative therapy. We reviewed current clinical practices and trials for the treatment of active-phase PD and assessed their applicability as treatment options. MAIN OUTCOME MEASURE Define the most recent and effective therapies for the improvement in penile curvature in men presenting with acute PD. RESULTS A number of trials have resulted in significant benefits in the treatment of PD. Many of the oral therapies studied improved patient outcomes, but the data are insufficient. Similarly, there is no approved topical therapy by guidelines. The best options are intralesional injections of collagenase Clostridium histolyticum (CCh) and interferon-α2b. Shock wave therapy is not recommended for treatment of curvature, but has been shown to improve pain. Traction therapy may have a role in improving PD curve and penile length. CONCLUSION PD remains a challenge for urologists. Evidence suggests that, for oral therapy, a combination of drugs produces better results. Shock wave therapy is still unproven. Intralesional therapy delivers the best evidence for improvement in the active phase. CCh is the only FDA-approved treatment option available. Penile traction therapy may improve patient outcomes. Brimley SC, Yafi FA, Greenberg J, et al. Review of Management Options for Active-Phase Peyronie's Disease. Sex Med Rev 2019;7:329-337.
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Affiliation(s)
- Scott C Brimley
- Department of Urology, Tulane University, New Orleans, LA, USA
| | - Faysal A Yafi
- Department of Urology, University of California, Irvine, CA, USA.
| | - Jacob Greenberg
- Department of Urology, Tulane University, New Orleans, LA, USA
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Li J, Wang S, Qin F, Zhu M, You X, Wu C, Fu F, Yuan J. Reduction in Peyronie's-like plaque size using a vacuum erection device in a rat model of Peyronie's disease via the TGF-β/SMAD signalling pathway. Andrologia 2018; 50:e13051. [PMID: 29806152 DOI: 10.1111/and.13051] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 03/22/2018] [Accepted: 04/15/2018] [Indexed: 02/06/2023] Open
Affiliation(s)
- Jinhong Li
- Andrology Laboratory; West China Hospital; Sichuan University; Chengdu China
- Department of Urology; Institute of Urology; West China Hospital; Sichuan University; Chengdu China
| | - Shuzhen Wang
- Laboratory of Infectious Disease and Vaccine; West China Hospital; Sichuan University; Chengdu China
| | - Feng Qin
- Andrology Laboratory; West China Hospital; Sichuan University; Chengdu China
| | - Mengli Zhu
- Andrology Laboratory; West China Hospital; Sichuan University; Chengdu China
| | - Xuanhe You
- Andrology Laboratory; West China Hospital; Sichuan University; Chengdu China
| | - Changjing Wu
- Andrology Laboratory; West China Hospital; Sichuan University; Chengdu China
| | - Fudong Fu
- Andrology Laboratory; West China Hospital; Sichuan University; Chengdu China
| | - Jiuhong Yuan
- Andrology Laboratory; West China Hospital; Sichuan University; Chengdu China
- Department of Urology; Institute of Urology; West China Hospital; Sichuan University; Chengdu China
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Hackett G, Kirby M, Wylie K, Heald A, Ossei-Gerning N, Edwards D, Muneer A. British Society for Sexual Medicine Guidelines on the Management of Erectile Dysfunction in Men—2017. J Sex Med 2018; 15:430-457. [DOI: 10.1016/j.jsxm.2018.01.023] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 01/05/2018] [Accepted: 01/08/2018] [Indexed: 12/25/2022]
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Zou ZJ, Tang LY, Liu ZH, Liang JY, Zhang RC, Wang YJ, Tang YQ, Gao R, Lu YP. Short-term efficacy and safety of low-intensity extracorporeal shock wave therapy in erectile dysfunction: a systematic review and meta-analysis. Int Braz J Urol 2017; 43:805-821. [PMID: 28379665 PMCID: PMC5678511 DOI: 10.1590/s1677-5538.ibju.2016.0245] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 01/22/2017] [Indexed: 02/05/2023] Open
Abstract
AIM The role of low-intensity extracorporeal shock wave therapy (LI-ESWT) in erectile dysfunction (ED) is not clearly determined. The purpose of this study is to investigate the short-term efficacy and safety of LI-ESWT for ED patients. MATERIALS AND METHODS Relevant studies were searched in Medline, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), WANFANG and VIP databases. Effective rate in terms of International Index of Erectile Function-Erectile Function Domain (IIEF-EF) and Erectile Hardness Score (EHS) at about 1month after LI-ESWT was extracted from eligible studies for meta-analysis to calculate risk ratio (RR) of effective treatment in ED patients treated by LI-ESWT compared to those receiving sham-treatment. RESULTS Overall fifteen studies were included in the review, of which four randomized controlled trials (RCTs) were for meta-analysis. Effective treatment was 8.31 [95% confidence interval (CI): 3.88-17.78] times more effective in the LI-ESWT group (n=176) than in the sham-treatment group (n=101) at about 1 month after the intervention in terms of EHS, while it was 2.50 (95% CI: 0.74-8.45) times more in the treatment group (n=121) than in the control group (n=89) in terms of IIEF-EF. Nine-week protocol with energy density of 0.09mJ/mm2 and 1500 pluses seemed to have better therapeutic effect than five-week protocol. No significant adverse event was reported. CONCLUSION LI-ESWT, as a noninvasive treatment, has potential short-term therapeutic effect on patients with organic ED irrespective of sensitivity to PDE5is. Owing to the limited number and quality of the studies, more large-scale, well-designed and long-term follow-up time studies are needed to confirm our analysis.
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Affiliation(s)
- Zi-jun Zou
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, P.R. China
| | - Liang-you Tang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, P.R. China
| | - Zhi-hong Liu
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, P.R. China
| | - Jia-yu Liang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, P.R. China
| | - Ruo-chen Zhang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, P.R. China
| | - Yu-jie Wang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, P.R. China
| | - Yong-quan Tang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, P.R. China
| | - Rui Gao
- Department of Urology, the First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, P.R. China
| | - Yi-ping Lu
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, P.R. China
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Joice GA, Burnett AL. Nonsurgical Interventions for Peyronie's Disease: Update as of 2016. World J Mens Health 2016; 34:65-72. [PMID: 27574590 PMCID: PMC4999492 DOI: 10.5534/wjmh.2016.34.2.65] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 06/20/2016] [Indexed: 12/19/2022] Open
Abstract
Peyronie's disease (PD) is a debilitating condition of the penis that leads to significant pain, erectile dysfunction, and emotional distress in men. PD is likely underreported due to lack of knowledge of the disease and the absence of well-established available treatments. Surgical treatment can lead to sustained improvements, but is often associated with penile shortening and places the patient at risk for perioperative morbidity. Nonsurgical management has been studied for several years as an alternative to surgery for men with PD. Currently, much of the data on nonsurgical management is conflicting, with only one treatment that has been recently approved by the US Food and Drug Administration. Significant effort has been devoted to advancing non-surgical treatments for PD that can be implemented outside of the operating room. This review aims to describe the research behind current nonsurgical therapies for PD and to highlight the recent advances that have been made within the last three years.
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Affiliation(s)
- Gregory A Joice
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Arthur L Burnett
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Zou ZJ, Liang JY, Lu YP. Re: Zhihua Lu, Guiting Lin, Amanda Reed-Maldonado, Chunxi Wang, Yung-Chin Lee, Tom F. Lue. Low-intensity Extracorporeal Shock Wave Treatment Improves Erectile Function: A Systematic Review and Meta-analysis. Eur Urol 2017;71:223-33. Eur Urol 2016; 71:e57-e58. [PMID: 27544578 DOI: 10.1016/j.eururo.2016.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 08/08/2016] [Indexed: 02/05/2023]
Affiliation(s)
- Zi-Jun Zou
- Institute of Urology, Department of Urology, West China Hospital, Sichuan University, Chengdu, P.R. China
| | - Jia-Yu Liang
- Institute of Urology, Department of Urology, West China Hospital, Sichuan University, Chengdu, P.R. China
| | - Yi-Ping Lu
- Institute of Urology, Department of Urology, West China Hospital, Sichuan University, Chengdu, P.R. China.
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