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Al Hashimi M, Pinggera GM, Mostafa T, Rambhatla A, Hamoda T, Shah R, Chung E, Harraz A, Arafa M, Toprak T, Raheem O, Giulioni C, Birowo P, Boeri L, Jassim Y, Kothari P, Vishwakarma R, Sahin B, Atmoko W, Gamidov S, Rojas-Cruz C, Katz D, Fregonesi A, Gherabi N, Zini A, Ho CCK, Al-Marhoon MS, Martinez M, Russo GI, Rashed A, Busetto GM, Ko E, Park HJ, Cayan S, Saleh R, Rajmil O, Kim DS, Colpi G, Smith R, Ragab M, Kadioglu A, Nguyen Q, Bocu K, El-Sakka A, Thomas C, Alnajjar HM, Alipour H, Agarwal A. Regenerative Therapy in Erectile Dysfunction: A Survey on Current Global Practice Trends and GAF Expert Recommendations. World J Mens Health 2024; 42:42.e67. [PMID: 39028131 DOI: 10.5534/wjmh.240086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 04/09/2024] [Accepted: 04/22/2024] [Indexed: 07/20/2024] Open
Abstract
PURPOSE This study aimed to examine current global practices in regenerative therapy (RT) for erectile dysfunction (ED) and to establish expert recommendations for its use, addressing the current lack of solid evidence and standardized guidelines. MATERIALS AND METHODS A 39-question survey was developed by senior Global Andrology Forum (GAF) experts to comprehensively cover clinical aspects of RT. This was distributed globally via a secure online Google Form to ED specialists through the GAF website, international professional societies, and social media, the responses were analyzed and presented for frequencies as percentages. Consensus on expert recommendations for RT use was achieved using the Delphi method. RESULTS Out of 479 respondents from 62 countries, a third reported using RT for ED. The most popular treatment was low-intensity shock wave therapy (54.6%), followed by platelet-rich plasma (24.5%) and their combination (14.7%), with stem cell therapy being the least used (3.7%). The primary indication for RT was the refractory or adverse effects of PDE5 inhibitors, with the best effectiveness reported in middle-aged and mild-to-moderate ED patients. Respondents were confident about its overall safety, with a significant number expressing interest in RT's future use, despite pending guidelines support. CONCLUSIONS This inaugural global survey reveals a growing use of RT in ED treatment, showcasing its diverse clinical applications and potential for future widespread adoption. However, the lack of comprehensive evidence and clear guidelines requires further research to standardize RT practices in ED treatment.
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Affiliation(s)
- Manaf Al Hashimi
- Department of Urology, Burjeel Hospital, Abu Dhabi, UAE
- Department of Clinical Urology, College of Medicine and Health Science, Khalifa University, Abu Dhabi, UAE
- Global Andrology Forum, Moreland Hills, OH, USA
| | - Germar-M Pinggera
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Innsbruck Medical University, Innsbruck, Austria
| | - Taymour Mostafa
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Andrology, Sexology & STIs, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Amarnath Rambhatla
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Henry Ford Health System, Vattikuti Urology Institute, Detroit, MI, USA
| | - Taha Hamoda
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, King Abdulaziz University, Jeddah, Saudi Arabia
- Department of Urology, Faculty of Medicine, Minia University, Minia, Egypt
| | - Rupin Shah
- Global Andrology Forum, Moreland Hills, OH, USA
- Division of Andrology, Department of Urology, Lilavati Hospital and Research Centre, Mumbai, India
| | - Eric Chung
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Princess Alexandra Hospital, University of Queensland, Brisbane, Australia
| | - Ahmed Harraz
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Mansoura University Urology and Nephrology Center, Mansoura, Egypt
- Department of Surgery, Urology Unit, Farwaniya Hospital, Farwaniya, Kuwait
- Department of Urology, Sabah Al Ahmad Urology Center, Kuwait City, Kuwait
| | - Mohamed Arafa
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Andrology, Sexology & STIs, Faculty of Medicine, Cairo University, Cairo, Egypt
- Department of Urology, Hamad Medical Corporation, Doha, Qatar
- Department of Urology, Weill Cornell Medical-Qatar, Doha, Qatar
| | - Tuncay Toprak
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Fatih Sultan Mehmet Training and Research Hospital, University of Health Sciences, Istanbul, Türkiye
| | - Omer Raheem
- Global Andrology Forum, Moreland Hills, OH, USA
- Section of Urology, University of Chicago, Chicago, IL, USA
| | - Carlo Giulioni
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Polytechnic University of Marche Region, Ancona, Italy
| | - Ponco Birowo
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Dr. Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Luca Boeri
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, IRCCS Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Yassir Jassim
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Canadian Specialist Hospital, Dubai, UAE
| | - Priyank Kothari
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, B.Y.L Nair Ch Hospital, Topiwala National Medical College, Mumbai, India
| | - Ranjit Vishwakarma
- Global Andrology Forum, Moreland Hills, OH, USA
- Division of Andrology, Department of Urology, Lilavati Hospital and Research Centre, Mumbai, India
| | - Bahadir Sahin
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Marmara University School of Medicine, Istanbul, Türkiye
| | - Widi Atmoko
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Dr. Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Safar Gamidov
- Global Andrology Forum, Moreland Hills, OH, USA
- Deparment of Urology, Kulakov National Medical Research, Moscow, Russia
| | - Cesar Rojas-Cruz
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, University Hospital of Rostock, Rostock, Germany
| | - Darren Katz
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Men's Health Melbourne, Victoria, Australia
- Department of Surgery, Western Precinct, University of Melbourne, Victoria, Australia
- Department of Urology, Western Health, Victoria, Australia
| | - Adriano Fregonesi
- Global Andrology Forum, Moreland Hills, OH, USA
- Discipline of Urology, Department of Surgery, School of Medicine, Universida de Estadual de Campina, Sao Paolo, Brazil
| | - Nazim Gherabi
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Medicine, University of Algiers 1, Algiers, Algeria
| | - Armand Zini
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Surgery, McGill University, Montreal, QC, Canada
| | - Christopher Chee Kong Ho
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Surgery, School of Medicine, Taylor's University, Selangor, Malaysia
| | - Mohamed S Al-Marhoon
- Global Andrology Forum, Moreland Hills, OH, USA
- Division of Urology, Department of Surgery, Sultan Qaboos University, Muscat, Oman
| | - Marlon Martinez
- Global Andrology Forum, Moreland Hills, OH, USA
- Section of Urology, Department of Surgery, University of Santo Tomas Hospital, Manila, Philippines
| | - Giorgio Ivan Russo
- Global Andrology Forum, Moreland Hills, OH, USA
- Urology Section, University of Catania, Catania, Italy
| | - Ayman Rashed
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology and Andrology, October 6th University, Cairo, Egypt
| | - Gian Maria Busetto
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology and Renal Transplantation, University of Foggia, Foggia, Italy
| | - Edmund Ko
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Kaiser Permanente, Fontana, CA, USA
| | - Hyun Jun Park
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Pusan National University School of Medicine, Busan, Korea
- Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Selahittin Cayan
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, University of Mersin School of Medicine, Mersin, Türkiye
| | - Ramadan Saleh
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Osvaldo Rajmil
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Andrology, Fundacio Puigvert, Barcelona, Spain
| | - Dong Suk Kim
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, CHA Gangnam Medical Center, CHA University, Seoul, Korea
| | - Giovanni Colpi
- Global Andrology Forum, Moreland Hills, OH, USA
- Andrology and IVF Center, Next Fertility Procrea, Lugano, Switzerland
| | - Ryan Smith
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Maged Ragab
- Global Andrology Forum, Moreland Hills, OH, USA
- Urology Department, Tanta University, Tanta, Egypt
| | - Ates Kadioglu
- Global Andrology Forum, Moreland Hills, OH, USA
- Section of Andrology, Department of Urology, Istanbul School of Medicine, Istanbul, Türkiye
| | - Quang Nguyen
- Global Andrology Forum, Moreland Hills, OH, USA
- Center for Andrology and Sexual Medicine, Viet Duc University Hospital, Hanoi, Vietnam
- Department of Urology, Andrology and Sexual Medicine, University of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam
| | - Kadir Bocu
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Niğde Omer Halisdemir University, Niğde, Türkiye
| | - Ahmed El-Sakka
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Charalampos Thomas
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, General Hospital of Corinth, Corinthia, Greece
| | - Hussain M Alnajjar
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, University College London Hospital, London, UK
| | - Hiva Alipour
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Ashok Agarwal
- Global Andrology Forum, Moreland Hills, OH, USA
- Cleveland Clinic Foundation, Cleveland, OH, USA.
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Capogrosso P, Pozzi E, Russo GI, Hatzichristodoulou G, Cocci A, Falcone M, Martinez-Salamanca JI, Fernández-Pascual E, Candela L, Schifano N, Dehò F, Salonia A. Patients' attitude with surgery for Peyronie's disease: results from a multicentric European study. J Sex Med 2023; 21:54-58. [PMID: 37973410 DOI: 10.1093/jsxmed/qdad145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 09/26/2023] [Accepted: 10/01/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Despite the existence of conservative therapies for Peyronie's disease (PD), surgery is commonly utilized for the treatment of bothersome curvatures due to its potential effectiveness, although it carries intrinsic risks and may not universally lead to satisfactory outcomes. AIM To explore the rate and factors influencing patients' willingness to undergo surgery for PD. METHODS Data were prospectively collected in 5 European academic centers between 2016 and 2020. Data included age, time from PD onset, penile pain, curvature degree, difficulty at penetration, hourglass deformity, erectile dysfunction (ED), and previous treatments. All patients were offered conservative treatments, either medications or injections. Tunical shortening or lengthening procedures were offered as an alternative to conservative treatments, when indicated. Penile prosthesis was offered to those with concomitant ED. Patients' attitudes with surgery were recorded. Logistic regression analyses tested the profile of patients who were more likely to be willing to undergo surgery. OUTCOMES Patients' willingness to undergo surgery for PD. RESULTS This study included 343 patients with a median age of 57.3 years (IQR, 49.8-63.6) and a median penile curvature of 40.0° (IQR, 30.0°-65.0°). Overall, 161 (47%) experienced penetration difficulties and 134 (39%) reported ED. Additionally, hourglass deformity and penile shortening were reported by 48 (14%) and 157 (46%), respectively. As for previous treatments, 128 (37%) received tadalafil once daily; 54 (16%) and 44 (13%), intraplaque verapamil and collagenase injections; and 30 (9%), low-intensity shock wave therapy. Significant curvature reduction (≥20°) was observed in 69 (20%) cases. Only 126 (37%) patients were open to surgery for PD when suggested. At logistic regression analysis after adjusting for confounders, younger age (odds ratio [OR], 0.97; 95% CI, 0.95-1.00; P = .02), more severe curvatures (OR, 1.04; 95% CI, 1.03-1.06; P < .0001), and difficulty in penetration (OR, 1.88; 95% CI, 1.04-3.41; P = .03) were associated with a greater attitude to consider surgical treatment. CLINICAL IMPLICATIONS The need for effective nonsurgical treatments for PD is crucial, as is comprehensive patient counseling regarding surgical risks and benefits, particularly to younger males with severe curvatures. STRENGTHS AND LIMITATIONS Main limitations are the cross-sectional design and the potential neglect of confounding factors. CONCLUSIONS Patients with PD, having a lower inclination toward surgery, emphasize the need for effective nonsurgical alternatives and accurate counseling on the risks and benefits of PD surgery, particularly for younger men with severe curvatures.
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Affiliation(s)
- Paolo Capogrosso
- Department of Urology, Circolo & Fondazione Macchi Hospital-ASST Sette Laghi, Varese 28001, Italy
| | - Edoardo Pozzi
- Vita-Salute San Raffaele University, Milan 20151, Italy
- Division of Experimental Oncology, Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan 20151, Italy
| | - Giorgio I Russo
- Urology Section, Department of Surgery, University of Catania, Catania 95100, Italy
| | | | - Andrea Cocci
- Department of Urology, University of Florence, Careggi Hospital, Florence 50100, Italy
| | - Marco Falcone
- Division of Urology, Department of Surgical Sciences, Molinette Hospital, University of Turin, Turin 10024, Italy
| | | | | | - Luigi Candela
- Vita-Salute San Raffaele University, Milan 20151, Italy
- Division of Experimental Oncology, Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan 20151, Italy
| | - Nicolò Schifano
- Department of Urology, Circolo & Fondazione Macchi Hospital-ASST Sette Laghi, Varese 28001, Italy
| | - Federico Dehò
- Department of Urology, Circolo & Fondazione Macchi Hospital-ASST Sette Laghi, Varese 28001, Italy
| | - Andrea Salonia
- Vita-Salute San Raffaele University, Milan 20151, Italy
- Division of Experimental Oncology, Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan 20151, Italy
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