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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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2
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Conlon WJ, Herzog BJ, Hellstrom WJG. Residual penile curvature correction by modeling during penile prosthesis implantation in Peyronie's disease patients. Int J Impot Res 2023; 35:639-642. [PMID: 37055523 DOI: 10.1038/s41443-023-00694-5] [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: 11/30/2022] [Revised: 03/27/2023] [Accepted: 03/29/2023] [Indexed: 04/15/2023]
Abstract
With the advent of new surgical techniques to treat Peyronie's disease with concomitant erectile dysfunction, there remains a question of whether manual modeling (MM), an older technique, still has a place in the treatment algorithm within penile prosthesis (PP) surgery. While the implantation of a PP often corrects moderate to severe curvature, penile curvature can remain greater than 30°, even when concurrent MM is performed during prothesis implantation. There are new variations of the MM technique that have been recently utilized in the intraoperative and postoperative setting to achieve penile curvature less than 30° when the implant is fully inflated. The inflatable PP, regardless of the specific model of choice, is preferred over the noninflatable PP when utilizing the MM technique. MM should be the first line of treatment for persisting intraoperative penile curvature after the placement of a PP due to its long-term efficacy, noninvasive approach, and significantly low risk of adverse effects.
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Affiliation(s)
- William J Conlon
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Bryan J Herzog
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Wayne J G Hellstrom
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA.
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Rossi A, Alei G, Viscuso P, Tufano A, Frisenda M, Mantica G, Bove P, Leonardi R, De Dominicis M, Calarco A. An original mininvasive corporoplasty technique for penile curvature without circumcision. Arch Ital Urol Androl 2022; 94:334-338. [DOI: 10.4081/aiua.2022.3.334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 09/12/2022] [Indexed: 11/23/2022] Open
Abstract
Objective: We describe an original minimally invasive penile plication technique with scrotal or infrapubic access, not requiring circumcision, for penile curvature of different severity and types. This technique can be used to correct both congenital and acquired curvatures, mono or bidirectional deformities. Materials and methods: Between 2012 and 2018 we treated 134 patients suffering from congenital curvature (33) and acquired curvature from Peyronie's disease (101). The average curvature was 62.2° (± 30.4°). Preoperative evaluation included prostaglandin E1 injection with photographic documentation and measurement of penile angulation, administration of IIEF- 15, vasoactive penile Doppler ultrasound, analysis of thermal and vibratory sensitivity with Genito-Sensory-Analyzer (GSA) and assessment of nocturnal penile stiffness with Rigiscan, performed twice, for a detailed evaluation of patient’s erectile function. Scrotal access was performed in patients with dorsal and/or lateral penile curvature; the infrapubic access was performed in patients with ventral curvature. After preparation and incision of Colles’ fascia, penis was partially degloved and an original plication technique called "binary corporoplasty" was performed at the site or sites established at preoperative assessment, with non-resorbable synthetic multifilament (Premicron®) suture. Results: Complete correction of penile curvature was achieved in 96.8 % of patients. No major complications were reported, and no patients suffered worsening in erectile function or in penile sensitivity. The average shortening of convex side was 1.65 cm (± 0.7 cm) and all patients report easy intercourse after correction. The average time of surgery was 46 minutes (± 11 min) and all procedures were performed as a day-hospital or ambulatory settings, with local anesthesia and light sedation. Overall satisfaction rate is 96%. Conclusions: This is a simple and rapid technique that perfectly corrects even the most severe and complex penile curvatures. In comparison to traditional techniques, such as Nesbit procedure, this technique is associated with low morbidity, a very low recurrence rate and a great aesthetic results. Aesthetic and functional patients’ satisfaction was excellent.
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4
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Goldstein I, Gelbard MK, Lipshultz LI. Clinical Significance of Shortened Penile Length and Alterations in Penile Length Following Treatment for Peyronie's Disease. Sex Med Rev 2022; 10:409-420. [PMID: 35772849 DOI: 10.1016/j.sxmr.2021.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 12/15/2021] [Accepted: 12/20/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Across many cultures, penis size has been associated with virility, and concerns about penile length are commonplace. Peyronie's disease (PD) is a known acquired cause of penile shortening. OBJECTIVES This paper describes the psychosocial impacts of penile length on men and their partners, both generally and in men with PD, and evaluates the effect of PD treatments (eg, collagenase clostridium histolyticum , surgery, mechanical therapy) on this outcome measure. METHODS A PubMed database search was performed for English language articles through July 2021. Main outcome measures were association of penile length with emotional well-being, selfesteem, and relationship satisfaction in men with PD, and change from baseline penile length after treatment. RESULTS Shortened penile length caused by PD can negatively impact patient and partner quality of life, including effects on body image, emotional well-being, sexual function, and interpersonal relationships. In men with PD, studies have demonstrated an association between loss of penile length and emotional problems, reduced satisfaction with sexual performance, poor self-esteem, depression, and relationship difficulties. Loss of penile length can frequently occur after surgery for PD (including plication, plaque incision/excision with grafting, and penile implant). Advanced surgical techniques may preserve/increase penile length, but the increased risks associated with these complex procedures must be carefully considered. Treatment with collagenase clostridium histolyticum does not appear to negatively impact penile length, and 5-year follow-up data suggest potential longterm posttreatment improvements in this outcome measure. Penile traction therapy, either alone or as adjunctive therapy, may increase penile length in men with PD, but nonadherence may limit improvement. CONCLUSION Changes in penile length are important to many men, particularly those with PD, and should be considered during PD treatment selection. Penile length should be measured objectively before and after treatment for PD and should be included as an outcome measure in future studies on treatment effectiveness. Goldstein I, Gelbard MK, Lipshultz LI. Clinical Significance of Shortened Penile Length and Alterations in Penile Length Following Treatment for Peyronie's Disease. Sex Med Rev 2022;10:409-420.
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Autologous testicular tunica vaginalis graft in Peyronie's disease: a prospective evaluation. Int Urol Nephrol 2022; 54:1545-1550. [PMID: 35503401 DOI: 10.1007/s11255-022-03223-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 04/21/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Peyronie's disease (PD) is a two-phase progressive condition characterized by inelastic plaques in the tunica albuginea of the penis, leading to curvature of the penis. Men with PD also suffer from psychological distress, and sexual life and overall quality of life. Although the preferred surgical treatment modality in Peyronie's disease is plaque incision and grafting, there is lack of studies assessing the erectile function and penile vasculature after the treatment. OBJECTIVES We aimed to evaluate the efficiency and safety of plaque incision and tunica vaginalis of testis grafting in PD. METHODS This was a prospective analysis. Erectile dysfunction was assessed via International Index of Erectile Function Questionnaire (IIEF-5). Penile Doppler ultrasound was performed to assess peak systolic velocity (PSV) and end-diastolic velocity (EDV). Postoperative follow-ups were scheduled at 3, 12, and 24 months. RESULTS Twenty patients (mean age 47.2 ± 10.8 years) were included. The mean preoperative penile curvature was 48 ± 6.6°. The technical success rate was 100% at 3 months and 90% at 24 months. At follow-up visits, mean erect penile length was no different from the baseline. The baseline mean IIEF-5 score was 18.4 ± 2.5. The mean IIEF-5 score was 20.6 ± 2.6 at 24-month visit (p < 0.0001). Mean PSV significantly increased, while EDV significantly reduced after surgery. There were no serious complications related to surgery. CONCLUSIONS We conclude that surgical reconstruction of penile curvature with tunica vaginalis grafting was a safe and effective procedure in PD.
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Moghalu OI, Das R, Horns J, Campbell A, Hotaling JM, Pastuszak AW. Trends in treatment of Peyronie's disease in adult men in the United States from 2008 to 2017-results from an encounter and claims database. Int J Impot Res 2022; 34:280-288. [PMID: 33828265 PMCID: PMC8494877 DOI: 10.1038/s41443-021-00430-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/04/2021] [Accepted: 03/24/2021] [Indexed: 12/01/2022]
Abstract
Treatments for Peyronie's Disease (PD) include oral medications, intralesional injections, and surgery. Collagenase Clostridium histolyticum (CCh) is the only FDA-approved treatment for PD. We sought to examine current trends in treatment of PD across the United States. Using data in the MarketScan Database, we conducted a retrospective study of men with PD in the United States. Cases were identified by ICD-9 and 10 codes, and treatments were identified using NDC and CPT codes. Treatment rates were analyzed using a linear regression model, and a Cox proportional hazard function test was performed for time-to-treatment analysis. About 27.8% of men with PD were treated within a year of diagnosis. The annual treatment rate increased from 23.2 to 35.4%, and intralesional injection was the most used treatment. Over the study period, the percentage of men receiving treatment with oral medication increased from 0.66 to 20.5%, while the use of intralesional injection and surgery decreased. Increased odds of treatment were observed in men 45-54 years (odds ratio [OR] 1.35; 95% confidence interval [CI], 1.21-1.50; p = 0) and in the southern region (OR 1.48; 95% CI, 1.39-1.56; p = 0). Trends in treatment of PD have changed over time. Intralesional injection remains the most used treatment option for men with PD.
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Affiliation(s)
- Odinachi I Moghalu
- Department of Surgery, Division of Urology, University of Utah Health Science Center, Salt Lake City, Utah, United States of America.
| | - Rupam Das
- Department of Surgery, Division of Urology, University of Utah Health Science Center, Salt Lake City, Utah, United States of America
- Surgical Population Analysis Research Core, University of Utah Health Science Center, Salt Lake City, Utah, United States of America
| | - Joshua Horns
- Department of Surgery, Division of Urology, University of Utah Health Science Center, Salt Lake City, Utah, United States of America
- Surgical Population Analysis Research Core, University of Utah Health Science Center, Salt Lake City, Utah, United States of America
| | - Alexander Campbell
- Department of Surgery, Division of Urology, University of Utah Health Science Center, Salt Lake City, Utah, United States of America
- Surgical Population Analysis Research Core, University of Utah Health Science Center, Salt Lake City, Utah, United States of America
| | - James M Hotaling
- Department of Surgery, Division of Urology, University of Utah Health Science Center, Salt Lake City, Utah, United States of America
- Utah Center for Reproductive Medicine, Salt Lake City, Utah, United States of America
| | - Alexander W Pastuszak
- Department of Surgery, Division of Urology, University of Utah Health Science Center, Salt Lake City, Utah, United States of America
- Utah Center for Reproductive Medicine, Salt Lake City, Utah, United States of America
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7
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Edler Zandoná PC, Teixeira NP, Oliveira HE, Soares Garcia JH. The use of a polyglycolic acid polymer graft in Peyronie's disease - preliminary outcomes. Arch Ital Urol Androl 2022; 94:87-90. [PMID: 35352532 DOI: 10.4081/aiua.2022.1.87] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 01/18/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Plaque incision and grafting is indicated for patients with Peyronie's Disease [PD] and severe curvature, complex deformities or for patients with significant penile shortening. To date, no graft studied has been considered ideal. The aim of this study is to conduct a descriptive analysis about functional results with the use of a bioabsorbable graft for PD treatment. MATERIALS AND METHODS A single-center, retrospective evaluation of a cohort of patients who were treated by plaque incision and grafting with a polyglycolic acid polymer graft (Gore® Bio-A®) between 2018 and 2021 was conducted. Correction of penile curvature was the main outcome. Loss of penile sensitivity, de novo erectile dysfunction and any other adverse event were the secondary endpoints. RESULTS 14 patients were included in this study (mean age 59.5 ± 7.2 years). The median follow-up time was 12 months (range 3-12). The curvature correction rate was 78.5%. Glans hypoesthesia was present in one of 14 patients (7.1%) and refractory erectile dysfunction was reported in 64.2%. None of the patients presented any major adverse event based on Clavien-Dindo classification. CONCLUSIONS Curvature correction and changes in penile sensitivity rates were similar to those found in the literature. No major surgical complications, such as graft rejection, infection, and extrusion, occurred in this sample. Although a population with a higher prevalence of erectile dysfunction was included in this sample, higher rates of refractory erectile dysfunction were observed and these findings should be confirmed in further studies.
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8
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Trost L, Huang H, Han X, Burudpakdee C, Hu Y. Penile surgery for patients with Peyronie's disease initially treated with collagenase clostridium histolyticum or surgery: a claims database analysis. Int J Impot Res 2022; 35:147-151. [PMID: 35013566 PMCID: PMC10049921 DOI: 10.1038/s41443-021-00522-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 12/09/2021] [Accepted: 12/20/2021] [Indexed: 11/10/2022]
Abstract
Collagenase clostridium histolyticum (CCH) is an injectable therapy targeting collagen present in penile plaques in Peyronie's disease (PD). Data comparing CCH to penile surgery are limited, and long-term therapeutic outcomes are unknown. This retrospective analysis used a US claims database (January 2014-June 2017) to determine the percentage of men with subsequent penile surgery among those who initially received CCH (n = 1227) or surgery (index treatment; n = 620) for PD. Eligible patients were aged ≥18 years with continuous enrollment ≥6 months before and ≥12 months after index treatment date. During 12 months of post-index treatment follow-up, fewer patients with PD initially treated with CCH (4.6% [56/1227]) had subsequent penile surgery versus those initially treated with penile surgery (10.3% [64/620]; p < 0.0001). Mean ± SD time to first subsequent surgery after initial PD treatment was longer in the CCH versus surgery cohort (7.7 ± 3.0 vs 1.7 ± 3.2 months). The likelihood of subsequent surgery varied by initial surgery type: 18.2% after plaque incision or excision with grafting; 11.6% after penile implant; and 8.2% after tunical plication. Patients with PD who received CCH first were less likely to undergo subsequent surgery compared with those who received surgery first within a 12-month post-treatment follow-up.
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Affiliation(s)
- Landon Trost
- Mayo Clinic, Rochester, MN, USA. .,Male Fertility and Peyronie's Clinic, Orem, UT, USA.
| | | | - Xu Han
- IQVIA, Falls Church, VA, USA
| | | | - Yiqun Hu
- Endo Pharmaceuticals Inc., Malvern, PA, USA
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Gundogdu G, Okhunov Z, Starek S, Veneri F, Orabi H, Holzman SA, Sullivan MP, Khoury AE, Mauney JR. Evaluation of Bi-Layer Silk Fibroin Grafts for Penile Tunica Albuginea Repair in a Rabbit Corporoplasty Model. Front Bioeng Biotechnol 2021; 9:791119. [PMID: 34950646 PMCID: PMC8688800 DOI: 10.3389/fbioe.2021.791119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 11/23/2021] [Indexed: 02/05/2023] Open
Abstract
The use of autologous tissue grafts for tunica albuginea repair in Peyronie's disease and congenital chordee is often restricted by limited tissue availability and donor site morbidity, therefore new biomaterial options are needed. In this study, bi-layer silk fibroin (BLSF) scaffolds were investigated to support functional tissue regeneration of tunica albuginea in a rabbit corporoplasty model. Eighteen adult male, New Zealand white rabbits were randomized to nonsurgical controls (NSC, N = 3), or subjected to corporoplasty with BLSF grafts (N = 5); decellularized small intestinal submucosa (SIS) matrices (N = 5); or autologous tunica vaginalis (TV) flaps (N = 5). End-point evaluations were cavernosography, cavernosometry, histological, immunohistochemical, and histomorphometric assessments. Maximum intracorporal pressures (ICP) following papaverine-induced erection were similar between all groups. Eighty percent of rabbits repaired with BLSF scaffolds or TV flaps achieved full rigid erections, compared to 40% of SIS reconstructed animals. Five-minute peak erections were maintained in 60% of BLSF rabbits, compared to 20% of SIS and TV flap reconstructed rabbits. Graft perforation occurred in 60% of TV group at maximum ICP compared to 20% of BLSF cohort. Neotissues supported by SIS and BLSF scaffolds were composed of collagen type I and elastin fibers similar to NSC. SIS and TV flaps showed significantly elevated levels of corporal fibrosis relative to NSC with a corresponding decrease in corporal smooth muscle cells expressing contractile proteins. BLSF biomaterials represent emerging platforms for corporoplasty and produce superior functional and histological outcomes in comparison to TV flaps and SIS matrices for tunica albuginea repair.
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Affiliation(s)
- Gokhan Gundogdu
- Department of Urology, University of California, Irvine, Irvine, CA, United States
| | - Zhamshid Okhunov
- Department of Urology, University of California, Irvine, Irvine, CA, United States
| | - Stephanie Starek
- Department of Urology, University of California, Irvine, Irvine, CA, United States
| | - Faith Veneri
- Department of Urology, University of California, Irvine, Irvine, CA, United States
| | - Hazem Orabi
- Department of Urology, University of California, Irvine, Irvine, CA, United States
| | - Sarah A Holzman
- Department of Urology, University of California, Irvine, Irvine, CA, United States.,Department of Urology, Children's Hospital of Orange County (CHOC), Orange, CA, United States
| | - Maryrose P Sullivan
- Department of Surgery and Harvard Medical School, Boston, MA, United States.,Division of Urology, Veterans Affairs Boston Healthcare System, West Roxbury, MA, United States.,Department of Surgery, Brigham and Women's Hospital, Boston, MA, United States
| | - Antoine E Khoury
- Department of Urology, University of California, Irvine, Irvine, CA, United States.,Department of Urology, Children's Hospital of Orange County (CHOC), Orange, CA, United States
| | - Joshua R Mauney
- Department of Urology, University of California, Irvine, Irvine, CA, United States.,Department of Biomedical Engineering, University of California, Irvine, Irvine, CA, United States
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Osmonov D, Ragheb A, Ward S, Blecher G, Falcone M, Soave A, Dahlem R, van Renterghem K, Christopher N, Hatzichristodoulou G, Preto M, Garaffa G, Albersen M, Bettocchi C, Corona G, Reisman Y. ESSM Position Statement on Surgical Treatment of Peyronie's Disease. Sex Med 2021; 10:100459. [PMID: 34823053 PMCID: PMC8847818 DOI: 10.1016/j.esxm.2021.100459] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 10/06/2021] [Accepted: 10/09/2021] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Patients with Peyronie's disease may experience significat distress. The choice of treatment depends on a variety of factors, including the stage of the disease, the presence of pain, severity and direction of the curvature, penile length and the quality of erectile function. AIM To review the evidence associated with surgical treatment of Peyronie`s Disease and provide clinical recommendations on behalf of the European Society for Sexual Medicine. 131 peer-reviewed studies and systematic reviews, which were published from 2009 to 2019 in the English language, were included. METHODS MEDLINE, Google Scholar and EMBASE were searched for randomized clinical trials, meta-analyses, open-label prospective and retrospective studies. MAIN OUTCOME MEASURE The panel provided statements on clinically relevant questions including patient involvement in the decision process, indications for surgery, choice of the approach, and the management of patient expectations. A comparison of the different grafts used in patients who have undergone plaque incision/excision and grafting in order to identify an ideal graft, has been carried out. The prevalence of postoperative complications has been summarized. Levels of evidence were provided according to the Oxford 2011 criteria and Oxford Centre for Evidence-Based Medicine recommendations. RESULTS In order to allow shared decision making, a patient preoperative counselling regarding the pros and cons of each intervention is recommended. In particular, adverse effects of surgical treatments should be discussed to set realistic understanding and expectations of surgical outcomes and ultimately improve postoperative satisfaction rates. Surgical treatment should be only offered in the chronic phase of the condition, when the deformity and/or degree of erectile dysfunction, prevent patients from engaging in satisfying sexual interaction, or if the deformity is the cause of severe bother. CONCLUSIONS Current European Society for Sexual Medicine recommendations cover several aspects of Peyronie's disease treatment. These recommendations aim both to ensure patients and partners have accurate and realistic expectations of their treatment options, as well as to formulate algorithms to guide clinician management pathways. Osmonov D. et al., ESSM Position Statement on Surgical Treatment of Peyronie's Disease. Sex Med 2022;10:100459.
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Affiliation(s)
- Daniar Osmonov
- Department of Urology and Pediatric Urology, University Hospital Schleswig-Holstein, Kiel, Germany.
| | - Ahmed Ragheb
- Department of Urology, Beni-Suef University, Bedaya Fertility & IVF Hospitals, Kairo, Egypt
| | - Sam Ward
- Department of Urology, Clinique Saint Jean, Brussels; Medicis Medical Center, Woluwe, Belgium
| | - Gideon Blecher
- Department of Surgery, Monash University, Melbourne; Department of Urology, The Alfred Hospital, Melbourne, Australia
| | - Marco Falcone
- Department of Urology, University of Turin - Cittàdella Salute e dellaScienza, Turin, Italy
| | - Armin Soave
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Roland Dahlem
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Nim Christopher
- The Institute of Urology, University College London Hospitals, London, UK
| | | | - Mirko Preto
- Department of Urology, University of Turin - Cittàdella Salute e dellaScienza, Turin, Italy
| | - Giulio Garaffa
- The Institute of Urology, University College London Hospitals, London, UK
| | - Maarten Albersen
- Department of Urology, UZ Leuven Gasthuisberg Campus, Leuven, Belgium
| | | | - Giovanni Corona
- Endocrinology Unit, Medical Department, AziendaUsl Bologna Maggiore-Bellaria Hospital, Bologna, Italy
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11
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Colombo F, Franceschelli A, Gentile G, Droghetti M, Fiorillo A, Palmisano F. The evolution in the surgical management of Peyronie's disease. Urologia 2021; 88:79-89. [PMID: 33781136 DOI: 10.1177/03915603211005326] [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: 11/15/2022]
Abstract
Peyronie's disease (PD) is due to a fibrotic alteration of the tunica albuginea of the penis. It is responsible of penile pain, angulation, and possible erectile dysfunction (ED). Despite almost three centuries have passed since the first description of the disease, etiology still remains uncertain. This fact has led to the lack of a truly effective medical therapy and to date the surgical treatment, although not yet standardized, is the only one that offers acceptable outcomes in terms of function and overall patient's satisfaction. Since the beginning of the surgical experience in this field, two different currents of thought have developed: the first, involved the proposal of a number of different plication techniques, applied on the healthy side of the penis, opposite to the sick side, with the sole purpose of correcting the curvature; on the other side, efforts have focused on treating the "focus" of the disease, thus developing the so called "plaque surgery." If with the passing of the decades neither of the two "philosophical" currents has prevailed, this probably depends on the fact that is still not clear which is the lesser of evils: the frequent onset of ED which may follows the plaque surgery or rather the penis shortening that inevitably occurs if any technique of plication has been applied. Our contribution aims to offer an historical retrospective of the surgical treatment of this disease as well as to discuss the latest international guidelines on this topic. The reader will also find some notes about our personal experience in this field.
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Affiliation(s)
- Fulvio Colombo
- Sant'Orsola University Hospital, Andrology Unit, University of Bologna, Bologna, Emilia-Romagna, Italy
| | - Alessandro Franceschelli
- Sant'Orsola University Hospital, Andrology Unit, University of Bologna, Bologna, Emilia-Romagna, Italy
| | - Giorgio Gentile
- Sant'Orsola University Hospital, Andrology Unit, University of Bologna, Bologna, Emilia-Romagna, Italy
| | - Matteo Droghetti
- Sant'Orsola University Hospital, Andrology Unit, University of Bologna, Bologna, Emilia-Romagna, Italy
| | - Alessandro Fiorillo
- Sant'Orsola University Hospital, Andrology Unit, University of Bologna, Bologna, Emilia-Romagna, Italy
| | - Franco Palmisano
- Department of Urology, ASST Fatebenefratelli-Sacco, Luigi Sacco University Hospital, Milan, Italy
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12
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Topical Treatment of Premature Ejaculation: The Rise of Anesthetic Spray Formulations? URO 2021. [DOI: 10.3390/uro1010005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Topical anesthetics are one of the first line therapeutical options for men with premature ejaculation (PE). Real-life PE management often involves a range of interventions including systemic drug treatments (such as off-label and on-label selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants, phosphodiesterase-5 inhibitors (PDE5Is)), topical anesthetic creams and sprays, and behavioral approaches. Among them, on-demand dapoxetine and lidocaine/prilocaine spray formulations are the only approved treatment options for lifelong PE. The earliest strategy to treat PE was based on the use of topical anesthetic agents. The rationale behind the use of anesthetics is that by reducing the glans penis sensitivity, the spinal and cerebral input of sexual arousal impulses may also be reduced. Oral SSRI proved to be effective to treat PE, but their high rate of side effects limit treatment adherence and both short and long term follow up data are lacking. Conversely, topical anesthetics have proved to increase ejaculatory latency, control, and sexual satisfaction in couple affected by PE with limited rates of adverse events. In this context, we aimed to perform a narrative review to summarize the most recent findings regarding the use of topical treatments for PE.
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13
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Trost L, Huang H, Han X, Burudpakdee C, Hu Y. Treatment Patterns and Healthcare Outcomes with Collagenase Clostridium Histolyticum vs Surgery in Peyronie's Disease: A Retrospective Claims Database Analysis. Sex Med 2021; 9:100321. [PMID: 33684795 PMCID: PMC8072160 DOI: 10.1016/j.esxm.2021.100321] [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: 12/23/2020] [Accepted: 01/04/2021] [Indexed: 11/05/2022] Open
Abstract
Introduction Treatments for Peyronie's disease (PD) include surgical management and collagenase clostridium histolyticum (CCH). Aims To evaluate PD treatment trends after CCH approval and compare clinical outcomes in CCH- and surgery-treated cohorts. Methods Patients newly diagnosed with PD between January 2011 and December 2017 were identified in a U.S. claims database. Cohorts initiating treatment with CCH or surgery between January 2014 and June 2017 were included. Patients were continuously enrolled ≥6 months before and ≥12 months after index date. Post-treatment penile complications and analgesic use were compared 1 year after procedure in propensity score-matched cohorts. Main outcome measures The main outcome measures of this study were treatment patterns, penile complications, and analgesic use. Results In the newly diagnosed PD cohort, 1,609 patients received CCH and 1,555 patients had surgery. Overall CCH or surgery treatment rate/year increased from 9.8% in 2014 to 15.5% in 2017, with <1% receiving verapamil or interferon. Initial treatment ratios of CCH to surgery increased from approximately 1:1 (2014) to 2:1 (2017). In the unmatched CCH (n = 1,227) and surgery (n = 620) cohorts, more (P < .05) surgery-treated patients received analgesics (particularly opioids), oral PD therapies, vacuum erection devices, and phosphodiesterase-5 inhibitors before the index date. After propensity score matching (n = 620/cohort), newly occurring postprocedural complications during the follow-up period were higher in the surgery cohort (25.3% vs 18.4%, P = .003). The surgery cohort had significantly (P < .05) higher rates of erectile dysfunction (65.0% vs 44.8%), penile pain (17.9% vs 8.9%), and penile swelling (8.1% vs 5.2%) and was more likely to be prescribed opioids (93.3% vs 38.9%; P < .0001) or non-steroidal anti-inflammatory drugs (27.0% vs 20.3%; P = .006). Conclusion CCH demonstrated fewer complications and less analgesic use than surgery and was used as the initial therapy for PD twice as often as surgery. L Trost, H Huang, X Han, et al. Treatment Patterns and Healthcare Outcomes with Collagenase Clostridium Histolyticum vs Surgery in Peyronie's Disease: A Retrospective Claims Database Analysis. Sex Med 2021;9:100321.
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Affiliation(s)
- Landon Trost
- Department of Urology, Mayo Clinic, Rochester, MN, USA; Male Fertility and Peyronie's Clinic, Orem, UT, USA.
| | | | - Xu Han
- IQVIA, Falls Church, VA, USA
| | | | - Yiqun Hu
- Endo Pharmaceuticals Inc, Malvern, PA, USA
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14
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Bole R, Jimbo M, Parikh N, Britton C, Gopalakrishna A, Yang D, Trost L, Helo S, Kohler T, Ziegelmann M. Patient Attitudes Towards Surgical Management of Peyronie's Disease Prior to Men's Health Consultation. Urology 2021; 153:199-203. [PMID: 33676956 DOI: 10.1016/j.urology.2021.02.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 01/28/2021] [Accepted: 02/23/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate clinical characteristics associated with patient attitudes toward surgical treatment of Peyronie's disease (PD) prior to consultation in a high-volume male sexual health clinic. METHODS From 2014-2018 a prospective database was created of patients presenting to the sexual health clinic at our institution. Multivariable regression analysis was conducted to determine factors associated with pre-visit consideration of surgery. RESULTS Of 1359 men presenting to clinic, 342 had a chief complaint of PD. Prior to consultation, 79% of patients (n = 270) stated they were willing to consider surgery to correct their PD symptoms. Factors associated with consideration of surgery included younger patient age (mean 55.8 vs 60.0 years; P = .008), history of depression/anxiety (21% vs 8%, P = .01), greater penile curvature (43.3 vs 34.6 degrees; P = .002), penile shortening (64% vs 44%; P = .003), pain with erections (46% vs 33%; P = .05) and decreased ability to have penetrative intercourse (51.9% vs 65.3%, P = .04). On multivariable analysis, age, history of depression, penile shortening, and mean curvature remained significantly associated. Symptom duration and relationship factors were not associated with a difference in the stated preference to consider surgery prior to consultation (P >.05 for all). CONCLUSION Nearly 4 out of 5 patients reported willingness to consider surgical intervention for their PD-related symptoms prior to urologic consultation. On multivariable analysis, younger age, history of depression/anxiety, penile shortening, and curvature were associated with a greater likelihood of considering surgery. This information provides important insight into patient attitude toward undergoing surgery and will help drive patient counseling for men with PD.
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Affiliation(s)
- Raevti Bole
- Department of Urology, Mayo Clinic, Rochester, MN.
| | - Masaya Jimbo
- Department of Urology, Mayo Clinic, Rochester, MN
| | - Niki Parikh
- Department of Urology, Mayo Clinic, Rochester, MN
| | | | | | - David Yang
- Department of Urology, Mayo Clinic, Rochester, MN
| | - Landon Trost
- Department of Urology, Mayo Clinic, Rochester, MN
| | - Sevann Helo
- Department of Urology, Mayo Clinic, Rochester, MN
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15
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Manka MG, White LA, Yafi FA, Mulhall JP, Levine LA, Ziegelmann MJ. Comparing and Contrasting Peyronie's Disease Guidelines: Points of Consensus and Deviation. J Sex Med 2021; 18:363-375. [PMID: 33423972 PMCID: PMC8519165 DOI: 10.1016/j.jsxm.2020.11.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 11/16/2020] [Accepted: 11/24/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Peyronie's disease (PD) is a challenging clinical entity. To assist clinicians with diagnosis and management, four separate organizations have published PD guidelines over the past five years, but there remains a lack of consensus and data-driven recommendations for many aspects of diagnosis and treatment. AIM To compare and contrast PD guidelines, highlighting key similarities and differences among the guideline panel recommendations and identify areas for further research. METHODS We performed an extensive review to compare and contrast diagnosis and treatment recommendations from publically available published PD guidelines from four different organizations: American Urological Association, European Association of Urology, Canadian Urologic Association, and the International Society of Sexual Medicine. OUTCOMES Key similarities and differences with regards to definition, evaluation, nonsurgical and surgical treatments were compared. RESULTS Points of general consensus among the guideline panels included: History is adequate for diagnosis of PD, and intracavernosal injection is a gold standard to evaluate penile deformity prior to invasive intervention. Careful counseling with shared decision-making is required prior to treatment. In general, plication and incision and/or grafting surgery is reserved for patients with preserved erectile function whereas penile prosthesis implantation is the only surgical option for PD patients with erectile dysfunction. Overall, nonsurgical treatments have inferior evidence of efficacy with these being the main area of controversy; however, all societies recognize that intralesional injections may be used. 0Further research into the pathophysiology of PD may direct novel treatments targeted towards early intervention and rigorous outcomes research may direct best practices for the surgical treatment of PD in the future. CLINICAL IMPLICATIONS PD is a challenging clinical entity. Direct comparison of the published PD guidelines highlights clear standards of care as well as areas where more research is needed to promote higher levels of evidence-based practice. STRENGTHS & LIMITATIONS To our knowledge this is the first report to directly compare and contrast published guidelines pertaining to the diagnosis and management of PD. Limitations include the lack of evidence-quality review pertaining to individual guideline recommendations, although this was not the aim of this review. CONCLUSION We highlight consensus of major urologic societies on many aspects of work up and management of PD with notable exceptions which may guide further research. Manka MG, White LA, Yafi FA, et al. Comparing and Contrasting Peyronie's Disease Guidelines: Points of Consensus and Deviation. J Sex Med 2021;18:363-375.
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Affiliation(s)
| | | | - Faysal A Yafi
- Department of Urology, University of California, Irvine, CA, USA
| | - John P Mulhall
- Urology Service, Memorial Sloan Kettering Cancer Center, NY, NY, USA
| | - Laurence A Levine
- Division of Urology, Rush University Medical Center, Chicago, IL, USA
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16
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Krakhotkin DV, Ralph DJ, Blecher GA, Chernylovskyi VA, Greco F, Bakurov EE, Bugaev RA. Management of residual penile curvature after penile prosthesis placement. Asian J Androl 2021; 23:129-134. [PMID: 33106463 PMCID: PMC7991822 DOI: 10.4103/aja.aja_62_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Residual penile curvature is a common situation following the implantation of a penile prosthesis in patients with Peyronie's disease. Currently, there is a variety of options for the correction of residual curvature, including penile modeling, plication techniques, as well as tunical incision/excision with or without grafting. A literature search of PubMed and Medline databases was conducted from 1964 until 2020, using search terms for all articles in the English language. In this article, we provide a review of the techniques and the outcomes, according to the published literature.
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Affiliation(s)
- Denis V Krakhotkin
- Central District Hospital, Outpatient Department, Kamenolomni, Rostov Region 346480, Russia
| | - David J Ralph
- University College London St Peter's Andrology Centre and University College London Hospitals, London W1G 6BJ, United Kingdom
| | - Gideon A Blecher
- Monash University, Department of Surgery, Melbourne 3168, Australia.,The Alfred Hospital, Department of Urology, Melbourne 3004, Australia
| | | | - Francesco Greco
- Department of Urology, Humanitas Gavazzeni, Bergamo 24125, Italy
| | - Evgeny E Bakurov
- Department of Surgery No. 1, Rostov Regional Hospital ROKB 1, Rostov-on-Don 344015, Russia
| | - Ruslan A Bugaev
- Central District Hospital, Outpatient Department, Kamenolomni, Rostov Region 346480, Russia
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17
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Ziegelmann MJ, Farrell MR, Levine LA. Modern treatment strategies for penile prosthetics in Peyronie's disease: a contemporary clinical review. Asian J Androl 2020; 22:51-59. [PMID: 31424027 PMCID: PMC6958979 DOI: 10.4103/aja.aja_81_19] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Peyronie's disease is a common condition resulting in penile deformity, psychological bother, and sexual dysfunction. Erectile dysfunction is one common comorbid condition seen in men with Peyronie's disease, and its presence significantly impacts treatment considerations. In a man with Peyronie's disease and significant erectile dysfunction who desires the most reliable treatment, penile prosthesis placement should be strongly considered. In some instances, such as those patients with relatively mild curvature, prosthesis placement alone may result in adequate straightening. However, many patients will require additional straightening maneuvers such as manual modeling, penile plication, and tunica albuginea incision with or without grafting. For patients with severe penile shortening, penile length restoration techniques may also be considered. Herein, we provide a comprehensive clinical review of penile prosthesis placement in men with Peyronie's disease. Specifically, we discuss preoperative indications, intraoperative considerations, adjunctive straightening maneuvers, and postoperative outcomes.
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Affiliation(s)
| | - M Ryan Farrell
- Division of Urology, Rush University Medical Center, Chicago, IL 60612, USA
| | - Laurence A Levine
- Division of Urology, Rush University Medical Center, Chicago, IL 60612, USA
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18
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Carson C. Peyronie's disease: new paradigm for the treatment of a unique cause of erectile dysfunction. Postgrad Med 2020; 132:4-8. [PMID: 33156731 DOI: 10.1080/00325481.2020.1805865] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Peyronie's Disease is an incurable condition of the tunica albuginea of the penis associated with scarring, plaque formation, and penile deformity on erection. It is often associated with erectile dysfunction. Recent data have supported a familial and genetic predisposition to this chronic condition. The etiology of Peyronie's Disease is unknown, but is likely associated with multiple micro traumas to the erect penis in men who are susceptible to the scarring typical of Peyronie's Disease. The treatment of Peyronie's Disease has improved over the past decade as a result of animal studies and the approval of new medications. In the acute phase of the condition, phosphodiesterase type 5 inhibitors have been shown to have some benefit and are supported by animal studies demonstrating reduced fibrosis of the penis in animal models of Peyronie's Disease. In the stable phase of the disease, newer injectable agents have shown great promise. Collagenase clostridium histolyticum is approved for the treatment of Peyronie's plaques by direct injection into the scarred tissue with data showing satisfactory safety and efficacy. Surgical procedures for penile straightening have been refined with improved outcomes in the past decade. For those men with erectile dysfunction and Peyronie's Disease, penile implants can restore erectile function and form. As a result of the new understanding of the risk factors for Peyronie's Disease and recent advances in treatment options, the algorithm for the treatment of Peyronie's Disease has improved outcomes for patients and their partners.
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Affiliation(s)
- Culley Carson
- Department of Urology, University of North Carolina at Chapel Hill , Chapel Hill, NC, USA
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19
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Surgical Planning and Strategies for Peyronie's Disease. Sex Med Rev 2020; 9:478-487. [PMID: 33023863 DOI: 10.1016/j.sxmr.2020.07.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 07/20/2020] [Accepted: 07/27/2020] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Peyronie's disease results in penile curvature, shortening, instability, or pain upon erection-hindering sexual performance and leading to psychological distress. Despite extensive research, surgery is still the mainstay of treatment. OBJECTIVE To present an organized description of the most common surgical techniques used in the correction of Peyronie's disease and to propose a surgical algorithm to guide management. METHODS Using PubMed, we reviewed the published literature regarding surgical treatment of Peyronie's disease and its outcomes. We identified original articles, review articles, and editorials addressing the subject, with a focus on surgical techniques, their indications, and outcomes. RESULTS Peyronie's disease can be treated by corporoplasty or penile prosthesis implantation. Corporoplasty includes convex side-shortening procedures and concave side lengthening procedures. It is indicated when the erectile function is adequate. Shortening procedures include excisional, incisional, and plication-only techniques, and lengthening procedures include partial excision or incision followed by grafting. When refractory erectile dysfunction is present, placement of a penile prosthesis with or without further straightening maneuvers is recommended. We reviewed the indications, advantages, disadvantages, and outcomes of the available techniques and proposed a surgical algorithm to guide management. CONCLUSION Penile shortening procedures are usually indicated in curvatures <60°, in penises with adequate length. Partial excision/incision and grafting are indicated for curvatures >60°, hourglass or hinge deformities, and short penises, if the patient's erectile function is adequate. The presence of "borderline" erectile function and/or ventral curvature tilts the choice toward shortening procedures, and refractory erectile dysfunction is an indication for penile prosthesis placement. Peyronie's disease management remains challenging with many options available, making an accurate risk/benefit assessment of each case and meticulous patient counseling critically important. Almeida JL, Felício J, Martins FE. Surgical Planning and Strategies for Peyronie's Disease. Sex Med Rev 2021;9:478-487.
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20
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Fernández-Pascual E, Manfredi C, Torremadé J, Ibarra FP, Geli JS, Romero-Otero J, García-Baquero R, Poblador AF, Barbará MR, Campos-Juanatey F, Rojo AE, Iribarren IM, Rodríguez JC, Martínez-Salamanca JI. Multicenter Prospective Study of Grafting With Collagen Fleece TachoSil in Patients With Peyronie's Disease. J Sex Med 2020; 17:2279-2286. [PMID: 32830078 DOI: 10.1016/j.jsxm.2020.07.079] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 07/21/2020] [Accepted: 07/23/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND A xenograft consisting of equine collagen coated with human fibrinogen and thrombin (TachoSil; Baxter, CA) has recently been introduced in grafting procedures for Peyronie's disease (PD). AIM To describe the results of a multicenter prospective registry on patients with PD undergoing plaque incision or and grafting (PIG) or plaque excision and grafting (PEG) with collagen fleece TachoSil, to evaluate the efficacy and safety of this procedure. METHODS A prospective non-controlled multicenter study of patients with PD was performed between May 2016 and March 2018. Patients from 10 centers with stable PD for at least 3 months, difficulties in sexual intercourse, normal erectile function with or without pharmacological treatment, curvature >45°, and/or penile shortening and/or complex deformities were included. All patients underwent PIG/PEG with collagen fleece TachoSil. OUTCOMES The main outcome measure of this study were penile curvature correction (intraoperative), penile shortening (intraoperative), erectile function with the 5-item version of the International Index of Erectile Function (IIEF-5) and the Erection Hardness Score, subjective patient outcomes with non-validated questionnaires, and complications. RESULTS A total of 52 patients were enrolled in the study. The mean (SD) preoperative penile curvature was 72.8° (17.0). PIG was the preferred technique (80.8%). Intraoperatively, complete curvature correction was achieved in 92.3%, and no significant penile shortening was recorded in 80.8% of subjects. Subjective penile shortening was reported in 83.3% of patients at 6 months. No objective measurement of penile curvature and length was recorded during follow-up. No statistically significant difference from the baseline was found in IIEF-5 and Erection Hardness Score at 3 or at 6 months, although 16.7% of men experienced a worsening of IIEF-5 scores and 14.3% required de novo phosphodiesterase type 5 inhibitor use. 6 months after surgery, 78.5% of men were satisfied with intervention. Swelling and ecchymosis/hematoma were the most common perioperative complications (40.4%). 2 cases (3.8%) of wound infection were recorded. At 6 months, 35.7% of patients reported mild penile hypesthesia. CLINICAL IMPLICATIONS Our results confirm the high success rate of grafting with TachoSil, and the surgeon perceived low percentage of penile shortening. STRENGTH & LIMITATIONS This is the first multicentre study on patients with PD undergoing grafting with TachoSil without concomitant placement of penile prosthesis. The main limitations are the short follow-up and the relatively small sample size. CONCLUSION Grafting with TachoSil after PIG/PEG in patients with PD is an effective and safe procedure. Among the main advantages of this technique, there are ease of use of the graft and reduced operative time. Fernández-Pascual E, Manfredi C, Torremadé J, et al. Multicenter Prospective Study of Grafting With Collagen Fleece TachoSil in Patients With Peyronie's Disease. J Sex Med 2020;17:2279-2286.
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Affiliation(s)
- Esaú Fernández-Pascual
- Department of Urology, Puerta de Hierro-Majadahonda University Hospital, Madrid, Spain; Lyx Institute of Urology, Facultad de Medicina, Universidad Francisco de Vitoria, Madrid, Spain
| | - Celeste Manfredi
- Urology Unit, Department of Neurosciences, Reproductive Sciences, and Odontostomatology, University of Naples "Federico II", Naples, Italy
| | - Jose Torremadé
- Department of Urology, Bellvitge University Hospital, Barcelona, Spain.
| | | | | | | | | | | | | | | | | | | | | | - Juan Ignacio Martínez-Salamanca
- Department of Urology, Puerta de Hierro-Majadahonda University Hospital, Madrid, Spain; Lyx Institute of Urology, Facultad de Medicina, Universidad Francisco de Vitoria, Madrid, Spain
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21
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Krakhotkin DV, Chernylovskyi VA, Mottrie A, Greco F, Bugaev RA. New insights into the pathogenesis of Peyronie's disease: A narrative review. Chronic Dis Transl Med 2020; 6:165-181. [PMID: 32885153 PMCID: PMC7451633 DOI: 10.1016/j.cdtm.2020.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Indexed: 12/11/2022] Open
Abstract
Peyronie's disease (PD) is a benign, progressive fibrotic disorder characterized by scar or plaques within the tunica albuginea (TA) of the penis. This study provides new insights into the pathogenesis of PD based on data from different studies regarding the roles of cytokines, cell signaling pathways, biochemical mechanisms, genetic factors responsible for fibrogenesis. A growing body of literature has shown that PD is a chronically impaired, localized, wound healing process within the TA and the Smith space. It is caused by the influence of different pathological stimuli, most often the effects of mechanical stress during sexual intercourse in genetically sensitive individuals with unusual anatomical TA features, imbalanced matrix metalloproteinase/tissue inhibitor of metalloproteinase (MMP/TIMP), and suppressed antioxidant systems during chronic inflammation. Other intracellular signal cascades are activated during fibrosis along with low expression levels of their negative regulators and transforming growth factor-β1 signaling. The development of multikinase agents with minimal side effects that can block several signal cell pathways would significantly improve fibrosis in PD tissues by acting on common downstream mediators.
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Affiliation(s)
- Denis V Krakhotkin
- Outpatient Department, Central District Hospital, Kamenolomni, Rostov Region, Russia
| | | | - Alexandre Mottrie
- Department of Urology, Onze Lieve Vrouw Hospital, Aalst, Belgium.,ORSI Academy, Melle, Belgium
| | | | - Ruslan A Bugaev
- Outpatient Department, Central District Hospital, Kamenolomni, Rostov Region, Russia
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22
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Chung E, Gillman M, Tuckey J, La Bianca S, Love C. A clinical pathway for the management of Peyronie’s disease: integrating clinical guidelines from the International Society of Sexual Medicine, American Urological Association and European Urological Association. BJU Int 2020; 126 Suppl 1:12-17. [DOI: 10.1111/bju.15057] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2020] [Indexed: 01/13/2023]
Affiliation(s)
- Eric Chung
- Department of Urology; Princess Alexandra Hospital; University of Queensland; Brisbane Qld Australia
- Andro Urology Centre; Brisbane Qld Australia
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23
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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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Abdelsayed GA, Setia SA, Levine LA. The Surgical Treatment of Peyronie’s Disease in the Older Man: Patient Characteristics and Surgical Outcomes in Men 65 and Older. J Sex Med 2019; 16:1820-1826. [DOI: 10.1016/j.jsxm.2019.07.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 07/18/2019] [Accepted: 07/31/2019] [Indexed: 11/30/2022]
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Milenkovic U, Ilg MM, Zuccato C, Ramazani Y, De Ridder D, Albersen M. Simvastatin and the Rho-kinase inhibitor Y-27632 prevent myofibroblast transformation in Peyronie's disease-derived fibroblasts via inhibition of YAP/TAZ nuclear translocation. BJU Int 2019; 123:703-715. [PMID: 30536599 DOI: 10.1111/bju.14638] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To uncover the anti-myofibroblast (MFB) properties of Rho-kinase inhibitor (compound Y-27632) and simvastatin in an in vitro model of Peyronie's disease (PD), a sexually debilitating disease caused by an irreversible fibrotic plaque in the penile tunica albuginea (TA). MATERIALS AND METHODS Primary human fibroblasts (FBs) were isolated from surgically obtained TA tissue from patients with PD. To induce MFB status, cells were stimulated with 3 ng/mL transforming growth factor-β1 (TGF-β1). Increasing doses of Y-27632 and simvastatin were added. Real-time quantitative PCR was used to assess mRNA expression of α-smooth muscle actin (α-SMA), collagen III, elastin and connective tissue growth factor (CTGF) after 72 h. Western blot analysis was used to quantify α-SMA protein contents, and immunofluorescence (IF) was used to visualize MFB differentiation by staining for α-SMA after 72 h. A resazurin-based assay was used to assess cell viability to ensure the anti-MFB effect of the drugs. A mechanistic study was performed using IF staining for YAP/TAZ nuclear translocation. RESULTS After 72 h of stimulation with TGF-β1, a six- to 10-fold upregulation of α-SMA could be observed. When treated with Y-27632 or simvastatin, the α-SMA, collagen III, elastin and CTGF mRNA expression was impeded. Additionally, TGF-β1 stimulation showed a twofold increase in α-SMA protein expression, which was reversed to non-stimulated levels after treatment with Y-27632 and simvastatin. Using IF, stimulated cells were identified as MFB (α-SMA+, Vim+) as opposed to the non-stimulated, Y-27632- and simvastatin-treated cells (α-SMA-, Vim+). The resazurin-based assay confirmed that the cell viability was not compromised by the administered drugs. On stimulation with TGF-β1, nuclear translocation of YAP/TAZ could be observed, which was prevented by adding the aforementioned compounds. CONCLUSION Transformation of FBs into the contractile and extracellular matrix-producing MFBs occurs after TGF-β1 stimulation. In our experiments, Rho-kinase inhibition and simvastatin treatment were shown to prevent this in TGF-β1-stimulated cells on an RNA and protein level through the inhibition of YAP/TAZ nuclear translocation. Y-27632 and simvastatin could become a novel treatment option in the early treatment of PD.
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Affiliation(s)
- Uros Milenkovic
- Laboratory of Experimental Urology, Department of Development and Regeneration, KU Leuven, Leuven, Belgium.,Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Marcus M Ilg
- Faculty of Health, Education, Medicine and Social Care, Medical Technology Research Centre, Anglia Ruskin University, Chelmsford, UK
| | - Carola Zuccato
- Laboratory of Experimental Urology, Department of Development and Regeneration, KU Leuven, Leuven, Belgium.,Faculty of Medicine and Surgery, University of Padua, Padua, Italy
| | - Yasaman Ramazani
- Department of Pediatric Nephrology and Growth and Regeneration, University Hospitals Leuven and KU Leuven, Leuven, Belgium
| | - Dirk De Ridder
- Laboratory of Experimental Urology, Department of Development and Regeneration, KU Leuven, Leuven, Belgium.,Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Maarten Albersen
- Laboratory of Experimental Urology, Department of Development and Regeneration, KU Leuven, Leuven, Belgium.,Department of Urology, University Hospitals Leuven, Leuven, Belgium
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Kayigil O, Ozcan MF, Cakici OU. The comparison of an acellular matrix graft with an autologous venous graft in the surgical treatment of Peyronie's disease. Andrologia 2018; 51:e13168. [PMID: 30298592 DOI: 10.1111/and.13168] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Revised: 09/05/2018] [Accepted: 09/07/2018] [Indexed: 11/30/2022] Open
Abstract
The aim of this study was to evaluate acellular porcine pericardium (APP) and compared the results with those obtained from venous grafts in the surgical management of Peyronie's disease (PD). An APP (Group 1) and an autologous saphenous vein graft (Group 2) were used in 27 and 26 patients, respectively for Peyronie's correction. The patients' age, body mass index (BMI), operation time, duration of follow-up, preoperative and postoperative IIEF-5 scores, plaque size and loss of sensation were evaluated in both groups. There were no differences between the two groups in terms of age, BMI, follow-up period, and preoperative and postoperative IIEF-5 scores. The postoperative IIEF-5 scores were higher than the preoperative IIEF-5 scores in both groups. The operation time was significantly longer in Group 2 than in Group 1. The duration of sensation loss was shorter in Group 1 compared to Group 2. Penile shortening was similar in both groups.
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Affiliation(s)
- Onder Kayigil
- Yildirim Beyazit University Faculty of Medicine, The Urology Clinics of Ataturk Education and Research Hospital, Ankara, Turkey
| | - Muhammet Fuat Ozcan
- Department of Urology, Ankara Ataturk Education and Research Hospital, Ankara, Turkey
| | - Ozer Ural Cakici
- Department of Urology, Ankara Ataturk Education and Research Hospital, Ankara, Turkey
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Terrier JE, Tal R, Nelson CJ, Mulhall JP. Penile Sensory Changes After Plaque Incision and Grafting Surgery for Peyronie's Disease. J Sex Med 2018; 15:1491-1497. [PMID: 30195564 DOI: 10.1016/j.jsxm.2018.07.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 06/11/2018] [Accepted: 07/10/2018] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Plaque incision and grafting (PIG) for Peyronie's disease (PD) is not devoid of complications such as erectile dysfunction and penile sensory changes. AIM To define the rate and chronology of penile sensation loss after PIG surgery and to define predictors of such. METHODS The study population consisted of patients with PD-associated penile curvature who underwent PIG surgery with at least 6 months of follow-up. Demographics and PD factors were recorded. Patient had preoperative assessment of penile sensation and deformity. Postoperative follow-up occurred at 1 week, 1 month, 6 months, and 1 year after surgery. Neurovascular bundle elevation was conducted with loupe magnification. MAIN OUTCOME MEASURE Penile sensation was evaluated with a biothesiometer and graded on a patient-reported visual analog scale (0-10) in which 0 defined a completely numb area and 10 defined perfect sensation. The degree of sensation loss was defined as extensive (any 1 area >5 cm), major (2-5 cm), and minor (≤2 cm). The penile sensation loss distribution was defined as focal (1 site) or diffuse (>1 site). RESULTS 63 patients were analyzed. Mean age was 56 ± 10 years. Mean duration of PD at the time of PIG was 15 ± 7 (12-38) months. 75% had curvature alone, and 25% had hourglass/indentation deformities. Mean primary curvature was 64˚ ± 28˚. The mean operation duration was 3.5 ± 1.8 hours. 21% had some degree of sensation loss at 1 week, 21% at 1 month, 8% at 6 months, and 3% at 12 months. Only 1 patient (1.5%) at 2 years continued to have extensive sensation loss on the glans and distal shaft with a very elevated sensitivity threshold. Using multivariable analysis, the only predictor of penile sensation loss ≥6 months was a duration of operation >4 hours (odds ratio = 2.1; 95% confidence interval = 1.2-3.0; P < .01). CLINICAL IMPLICATIONS The study highlights the need during patient consent to discuss penile sensation loss. Patients should be informed that rates of penile sensation loss ranges from 2-30% and most patients will have complete resolution of any sensation loss within one year of follow-up. STRENGTH AND LIMITATIONS To our knowledge no other studies have described the chronology and severity of penile sensation following PIG, our study demonstrates the utility of biothesiometry in measuring penile sensation before and after PIG. Number of patients and absence of control group represent a limitation. CONCLUSION Sensation loss is not uncommon after PIG surgery. It decreases in frequency and severity with time with only rare cases occurring >12 months. Longer operations appeared to be more likely associated with sensation loss. Terrier JE, Tal R, Nelson CJ. Penile sensory changes after plaque incision and grafting surgery for Peyronie's disease. J Sex Med 2018;15:1491-1497.
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Affiliation(s)
- Jean E Terrier
- Male Sexual and Reproductive Medicine Program, Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Raanan Tal
- Male Sexual and Reproductive Medicine Program, Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Christian J Nelson
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - John P Mulhall
- Male Sexual and Reproductive Medicine Program, Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
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Wymer K, Ziegelmann M, Savage J, Kohler T, Trost L. Plaque Calcification: An Important Predictor of Collagenase Clostridium Histolyticum Treatment Outcomes for Men With Peyronie's Disease. Urology 2018; 119:109-114. [DOI: 10.1016/j.urology.2018.06.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 05/31/2018] [Accepted: 06/01/2018] [Indexed: 02/06/2023]
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A Worldwide Survey on Peyronie's Disease Surgical Practice Patterns Among Surgeons. J Sex Med 2018; 15:568-575. [DOI: 10.1016/j.jsxm.2018.01.025] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 01/22/2018] [Accepted: 01/25/2018] [Indexed: 01/07/2023]
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30
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Chung E. Penile Reconstructive Surgery in Peyronie Disease: Challenges in Restoring Normal Penis Size, Shape, and Function. World J Mens Health 2018; 38:1-8. [PMID: 29623703 PMCID: PMC6920076 DOI: 10.5534/wjmh.170056] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 11/30/2017] [Accepted: 12/02/2017] [Indexed: 01/23/2023] Open
Abstract
To provide an overview of current approaches to penile reconstructive surgery in Peyronie disease (PD), and to discuss the challenges in restoring normal penile size and function. A systematic literature search was conducted to identify the published literature relevant to PD and penile reconstructive surgery. A summary of the published guidelines from major organisations is included in this review paper. Penile plication is simple and minimally invasive, and tends to preserve potency in most patients. However, plication invariably results in penile length loss and may, in fact, worsen the existing hour-glass or hinge effect. In contrast, graft reconstructive surgery can address issues relating to the loss of penile length and complex penile deformities, but long-term data highlight the risks of altered glans sensation, recurrent curvature, and/or loss of penile length from graft contracture, as well as the development of erectile dysfunction. Complex penile reconstruction with the concurrent placement of a penile prosthesis and/or graft material is a demanding operation that should be performed by surgeons with extensive prosthetic and reconstructive experience, as the risk of sensory loss, glans ischemia/necrosis, prosthesis-related complications, and failure to gain any meaningful length are serious concerns and cannot be underestimated. While surgical approaches remain the standard of care, they pose considerable risks and require prolonged postoperative rehabilitation. Obtaining proper informed consent and establishing realistic outcome expectations are imperative for successful postoperative outcomes.
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Affiliation(s)
- Eric Chung
- Department of Urology, Princess Alexandra Hospital and University of Queensland, Brisbane, Australia.,AndroUrology Centre, St. Andrew's War Memorial Hospital, Brisbane, Australia.
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31
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Reed-Maldonado AB, Alwaal A, Lue TF. The extra-tunical grafting procedure for Peyronie's disease hourglass and indent deformities. Transl Androl Urol 2018; 7:S1-S6. [PMID: 29644164 PMCID: PMC5881200 DOI: 10.21037/tau.2017.12.03] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background To describe a novel, tunica-sparing surgical technique—extra-tunical grafting (ETG)—for the treatment of penile indent and hourglass (HG) deformities and to describe patient-reported outcomes after the ETG procedure. Methods An IRB-approved, retrospective chart review of ETG patients was performed to collect data including pre-operative deformity, operation performed, and post-operative patient-reported perception of deformity, erectile function, penile sensation, and overall satisfaction with the ETG operation. The indications for surgery were difficulty with sexual intercourse due to deformity and/or poor cosmesis of the penis. Pre-operatively all patients had erections adequate for intercourse with or without medications. The ETG procedure is performed through a ventral longitudinal penile skin incision. The dissection is continued to the level between Dartos and Bucks fascia, circumferentially for HG deformity and focally for indent deformity. The neurovascular bundle (NVB) is left undisturbed. A cadaveric fascia graft is applied, singly or in multiple layers, to fill the exposed tunical depressions. Our preferred graft material is Tutoplast Suspend® (Coloplast, Minneapolis, MN, USA). The graft is sutured into position with multiple interrupted, long-lasting absorbable sutures to achieve the desired penile shaft contour. The urethra is excluded from the graft. Results From October 2013 to June 2017, 36 patients had the ETG procedure for HG and/or indent with or without penile curvature. Results with a minimum of 6 months of follow-up could be extracted for 18 of the patients. One was excluded as he required concurrent excision of a large calcified tunical plaque, which necessitated incision into the tunica albuginea (TA). Follow-up was between 6 and 44 months (average 21 months). All patients reported satisfactory resolution of the HG or indent. No patient reported worsened erectile function. Two patients (11.8%) reported slight penile hypoesthesia, with one of these having had multiple previous penile degloving surgeries for trauma. Ten of the patients reported being “very satisfied” and six reported being “satisfied” with the procedure. One was neutral. All reported that they would recommend the ETG procedure to a friend, and all would repeat the same surgery again. Conclusions The ETG procedure is a straightforward approach to HG and indent deformities to correct the penile deformity and to provide structural support to prevent penile buckling during intercourse. The procedure does not violate the TA and does not require dissection of the NVB. Thus, ETG carries a very low risk of de novo impotence or hypoesthesia as highlighted by this patient series. With such low risk and high patient-reported satisfaction rates, the ETG procedure is a valuable surgical technique for the treatment of complex penile deformities.
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Affiliation(s)
| | - Amjad Alwaal
- Department of Urology, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Tom F Lue
- Department of Urology, University of California, San Francisco, CA, USA
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Grande P, Antonini G, Cristini C, De Berardinis E, Gatto A, Di Lascio G, Lemma A, Gentile G, Di Pierro GB. Penoscrotal versus minimally invasive infrapubic approach for inflatable penile prosthesis placement: a single-center matched-pair analysis. World J Urol 2018; 36:1167-1174. [PMID: 29492584 DOI: 10.1007/s00345-018-2249-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Accepted: 02/21/2018] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To compare perioperative results, safety and efficacy profile in patients receiving inflatable penile prosthesis (IPP) via penoscrotal (PS) or minimally invasive infrapubic (MII) approach for erectile dysfunction. METHODS A matched-pair analysis was performed including 42 patients undergoing IPP implantation via PS (n = 21) or MII (n = 21) between 2011 and 2016. Clinical and surgical data were prospectively collected. Patients' and partners' outcomes were assessed by the International Index of Erectile Function (IIEF), Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) and Quality of Life and Sexuality with Penile Prosthesis (QoLSPP) questionnaires. RESULTS Mean (SD) operative time was 128 (40.6) min in group PS and 91 (43.0) min in group MII (p = 0.041). Complications occurred in 3/21 (14%) and 2/21 (10%) patients in groups PS and MII (p = 0.832). Overall, no differences were observed concerning the device utilisation (p = 0.275). However, in group MII 4/21 (19%) patients were able to resume sexual activity prior to 4 postoperative weeks, while in group PS no patient was (p = 0.012). Mean (SD) scores for questionnaires were similar between groups PS and MII: IIEF [20.9 (7.3) vs. 20.7 (4.8); p = 0.132], patient EDITS [76.0 (25.6) vs. 74.7 (20.8); p = 0.256] and partner EDITS [72.5 (29.1) vs. 73.1 (21.4); p = 0.114]. Similarly, QoLSPP showed comparable results among the groups PS and MII: functional domain [3.9 (1.4) vs. 4.0 (1.2); p = 0.390], personal [4.0 (1.2) vs. 4.1 (1.0); p = 0.512], relational [3.7 (1.5) vs. 3.9 (1.2); p = 0.462] and social [4.0 (1.2) vs. 3.9 (1.2); p = 0.766]. CONCLUSIONS PS and MII demonstrated to be safe and efficient techniques, leading to high level of both patients and partners satisfaction. Additionally, the minimally invasive infrapubic approach showed a shorter operative time and a tendency for a faster return to sexual activity.
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Affiliation(s)
- Pietro Grande
- Department of Obstetrical and Gynaecological Sciences and Urological Sciences, 'Sapienza' University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Gabriele Antonini
- Department of Obstetrical and Gynaecological Sciences and Urological Sciences, 'Sapienza' University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Cristiano Cristini
- Department of Obstetrical and Gynaecological Sciences and Urological Sciences, 'Sapienza' University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Ettore De Berardinis
- Department of Obstetrical and Gynaecological Sciences and Urological Sciences, 'Sapienza' University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Antonio Gatto
- Department of Obstetrical and Gynaecological Sciences and Urological Sciences, 'Sapienza' University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Giovanni Di Lascio
- Department of Obstetrical and Gynaecological Sciences and Urological Sciences, 'Sapienza' University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Andrea Lemma
- Department of Obstetrical and Gynaecological Sciences and Urological Sciences, 'Sapienza' University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | | | - Giovanni Battista Di Pierro
- Department of Obstetrical and Gynaecological Sciences and Urological Sciences, 'Sapienza' University of Rome, Viale del Policlinico 155, 00161, Rome, Italy.
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Abstract
With the increased prevalence of Peyronie’s disease (PD) among men, there is also an up-rise of associated erectile dysfunction (ED) which can be devastating psychologically and sexually to most men. A wide range of therapies including medical and surgical procedures are available to satisfactorily address this condition. However when ED coexists, the gold standard treatment is penile prosthetic prosthesis (PP) with or without additional straightening procedures. We herein systematically review the contemporary literature addressing the role of the PP in the management of PD with concomitant ED with particular emphasis on patient’s satisfaction, outcomes and safety.
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Affiliation(s)
- Omer A Raheem
- Department of Urology, University of California San Diego Health, San Diego, California, USA
| | - Tung-Chin Hsieh
- Department of Urology, University of California San Diego Health, San Diego, California, USA
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Abedi G, Yafi FA. Tunical Incision Techniques for Peyronie’s Disease. CURRENT SEXUAL HEALTH REPORTS 2017. [DOI: 10.1007/s11930-017-0110-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Angulo J, Arance I, Gómez-Llorens C, Esquinas C, Gómez-Martín C, Fernández-Cañamaque J. Total phallic reconstruction using radial forearm free flap after iatrogenic penile amputation. Actas Urol Esp 2017; 41:471-476. [PMID: 27889116 DOI: 10.1016/j.acuro.2016.09.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 09/23/2016] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The iatrogenic loss of the penis is a rare situation. We present a challenging case of deferred total penile reconstruction in a genetic male. MATERIAL AND METHODS A 57-year-old man with the loss of the penis due to a penile abscess and necrosis secondary to penile curvature surgery. The reconstruction was performed over several operations using a radial forearm free flap (RFFF) and placement of a customised inflatable prosthesis a year later. RESULTS During the first operation, the penile abscess was drained, the necrotic residues were debrided and placement of hypogastric drainage. Seven weeks later, phalloplasty was performed with RFFF and a tube-in-tube neourethra was constructed. Multiple microsurgical anastomosis was performed, and the donor site was coated with a skin graft from the thigh of partial thickness. The surgery lasted 10hours and had the complication of hair growth in the neourethra, which required mechanical endoscopic depilation on repeated occasions. The patient regained penile sensitivity. Eighteen months after the phalloplasty, a Zephyr single-body inflatable prosthesis (Geneva, Switzerland) was implanted, using the tunica albuginea of the proximal corpus cavernosum. The patient was satisfied with the aesthetics and urinary and sensory function. Four months later, the patient is gaining confidence to consider penetration. CONCLUSIONS Despite the risk of postoperative complications and the need for multiple operations, phallic reconstruction with RFFF and the placement of a customised prosthetic implant can improve urinary and sexual function secondary to the loss of the penis.
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Self-reported Clinical Meaningfulness Early in the Treatment Course Predicts Objective Outcomes in Men Undergoing Collagenase Clostridium histolyticum Injections for Peyronie Disease. Urology 2017; 106:107-112. [DOI: 10.1016/j.urology.2017.04.045] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 04/11/2017] [Accepted: 04/30/2017] [Indexed: 01/22/2023]
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37
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Chung E, Ralph D, Kagioglu A, Garaffa G, Shamsodini A, Bivalacqua T, Glina S, Hakim L, Sadeghi-Nejad H, Broderick G. Evidence-Based Management Guidelines on Peyronie's Disease. J Sex Med 2017; 13:905-23. [PMID: 27215686 DOI: 10.1016/j.jsxm.2016.04.062] [Citation(s) in RCA: 118] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Revised: 03/19/2016] [Accepted: 03/27/2016] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Despite recent advances in our knowledge and treatment strategies in Peyronie's Disease (PD), much remained unknown about this disease. AIM To provide a clinical framework and key guideline statements to assist clinicians in an evidence-based management of PD. METHODS A systematic literature search was conducted to identify published literature relevant to PD. The search included all relevant articles published up to June 2015, including preclinical studies and published guidelines. References used in the text were assessed according to their level of evidence, and guideline recommendations were graded based on the Oxford Centre for Evidence-Based Medicine Levels of Evidence. Owing to the paucity of larger series and randomized placebo-controlled trials with regard to surgical intervention, guideline statements are provided as clinical principle or expert opinion. MAIN OUTCOME MEASURES This literature was discussed at a panel meeting, and selected articles with the highest evidence available were used to create consensus guideline statements for the Fourth International Consultation on Sexual Medicine guidelines on PD. RESULTS In addition to existing Third International Consultation on Sexual Medicine guidelines on PD, seven new summary recommendations were created. CONCLUSION A greater understanding of the scientific basis of PD is greatly needed to address our understanding of the pathophysiology, clinical epidemiology, psychosocial, and diagnostic assessment as well as treatment strategies.
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Affiliation(s)
- Eric Chung
- Department of Urology, University of Queensland, Princess Alexandra Hospital, Brisbane, QLD, Australia; AndroUrology Centre, St. Andrew's War Memorial Hospital, Brisbane, QLD, Australia.
| | - David Ralph
- Institute of Urology, University College London Hospital, London, UK
| | - Ates Kagioglu
- Department of Urology, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Guilio Garaffa
- Institute of Urology, University College London Hospital, London, UK
| | | | - Trinity Bivalacqua
- James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Sidney Glina
- Instituto H. Ellis and Department of Urology, Ipiranga Hospital, Sao Paulo, Brazil
| | - Lawrence Hakim
- Department of Urology, Cleveland Clinic Florida, Weston, FL, USA
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Small Intestinal Submucosa Grafting for Peyronie Disease: Outcomes and Patient Satisfaction. Urology 2017; 100:117-124. [DOI: 10.1016/j.urology.2016.09.055] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 09/15/2016] [Accepted: 09/20/2016] [Indexed: 12/22/2022]
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39
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Use of a Non–cross-linked Xenograft (Xenform) in Surgical Treatment of Peyronie's Disease. Urology 2016; 95:103-7. [DOI: 10.1016/j.urology.2016.05.040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 05/20/2016] [Accepted: 05/24/2016] [Indexed: 01/28/2023]
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40
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Anaissie J, Yafi FA. A review of surgical strategies for penile prosthesis implantation in patients with Peyronie's disease. Transl Androl Urol 2016; 5:342-50. [PMID: 27298781 PMCID: PMC4893506 DOI: 10.21037/tau.2016.04.04] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 03/09/2016] [Indexed: 12/25/2022] Open
Abstract
The introduction of the inflatable penile prosthesis (IPP) has revolutionized the treatment of patients with both Peyronie's disease (PD) and erectile dysfunction (ED). A thorough literature review was performed in order to review the surgical strategies used to treat PD, using the PubMed online database with the keywords "penile prosthesis", "surgical management" and "Peyronie's disease". Patient satisfaction rates of 72-100% and partner satisfaction rates of 89% have been reported in the literature, although strong preoperative education may be needed to prepare patients for risks such as penile shortening, seen in up to 54% of patients. Three-piece IPPs are most commonly used, and when comparing the two most popular models (AMS 700 CX vs. Coloplast Titan), no significant differences were seen in functional outcomes or patient satisfaction. Simple insertion of an IPP has been shown to resolve curvature in 33-90% of patients, but surgeons may often need to also utilize ancillary straightening procedures for residual curvatures. Manual modeling can correct residual curvature with an 86-100% success rate, but with a 4% risk of urethral injury. When the post-modeling residual curvature exceeds 30 degrees, a plaque-releasing incision or plication is recommended to further reduce curvature. Grafting is recommended if the resulting incisional defect is larger than two centimeters. Alternative straightening techniques such as plication prior to IPP insertion, endoscopic plaque resection, the "scratch technique" and bone saw plaque incision have also been described.
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Affiliation(s)
- James Anaissie
- Department of Urology, Tulane University School of Medicine, New Orleans, LA 70112, USA
| | - Faysal A Yafi
- Department of Urology, Tulane University School of Medicine, New Orleans, LA 70112, USA
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Menon V, Breyer B, Copp HL, Baskin L, Disandro M, Schlomer BJ. Do adult men with untreated ventral penile curvature have adverse outcomes? J Pediatr Urol 2016; 12:31.e1-7. [PMID: 26776946 PMCID: PMC4914378 DOI: 10.1016/j.jpurol.2015.09.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 09/01/2015] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Congenital ventral penile curvature without hypospadias is often treated surgically in childhood. The history of untreated ventral curvature is unknown. OBJECTIVE This study's aim was to examine the association of untreated ventral penile curvature with various sexual and psychosexual outcomes. STUDY DESIGN An electronic survey was advertised to men older than 18 years on Facebook. Men with possible ventral penile curvature identified themselves by choosing sketches that most closely represented their anatomy. Outcomes assessed included: Sexual Health Inventory for Men, difficulty of intercourse because of curvature, International Prostate Symptom Score, Penile Perception Score, psychosexual milestones, paternity, infertility, sitting to urinate, and the CDC HRQOL-4 module. RESULTS Among participants, 81 out of 684 men (11.8%) reported untreated ventral penile curvature. Participants with self-reported curvature noted more difficulty with intercourse because of curvature (4.5 vs 4.9, p < 0.001), more unhealthy mental days (8.6 vs 6.2, p = 0.02), and increased dissatisfaction with penile self-perception compared with men without reported curvature (8.6 vs 9.5, p < 0.001). DISCUSSION Men with possible untreated ventral curvature reported worse penile perception scores, more mentally unhealthy days, and increased difficulty with intercourse secondary to curvature compared with men without curvature. A limitation to this study is selection bias; responses collected were self-reported from survey volunteers. Additionally, the question identifying ventral penile curvature is not validated but performed well in pretesting. Most questions were from validated surveys, but some were modeled after validated surveys and/or contained high face validity types of questions. CONCLUSION Men with possible untreated ventral penile curvature reported more dissatisfaction with penile appearance, increased difficulty with intercourse, and more unhealthy mental days. Given high success rates, low complications, and improved outcomes after surgical correction of penile curvature reported in the literature, our results support correction of congenital penile curvature in childhood.
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Affiliation(s)
- Vani Menon
- University of Texas Southwestern and Children's Health, Dallas, TX, USA
| | - Benjamin Breyer
- Department of Urology, University of California San Francisco, San Francisco, CA, USA
| | - Hillary L Copp
- Department of Urology, University of California San Francisco, San Francisco, CA, USA
| | - Laurence Baskin
- Department of Urology, University of California San Francisco, San Francisco, CA, USA
| | - Michael Disandro
- Department of Urology, University of California San Francisco, San Francisco, CA, USA
| | - Bruce J Schlomer
- University of Texas Southwestern and Children's Health, Dallas, TX, USA.
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Yafi FA, Sangkum P, McCaslin IR, Hellstrom WJG. Strategies for penile prosthesis placement in Peyronie's disease and corporal fibrosis. Curr Urol Rep 2015; 16:21. [PMID: 25712763 DOI: 10.1007/s11934-015-0491-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Peyronie's disease (PD) is a wound healing disorder of the tunica albuginea of the penis. PD is generally categorized into two phases: the early acute inflammatory and late chronic fibrotic. Surgical reconstruction is only recommended during the latter established phase. There are a variety of options when erections are functional. However, when erectile dysfunction is present, the gold standard treatment is the placement of an inflatable penile prosthesis with or without additional straightening procedures. General recommendations include that after implanting and inflating the cylinders, if a clinically significant curvature is present, manual modeling is performed. If a residual curve >30° remains after modeling, then various techniques, including plaque releasing incision, is the next step. Grafting can be considered if tunical defects are >2.0 cm. Causes of corporal fibrosis include complications from an infected implant such as explantation, priapism, penile trauma, and prolonged use of an intracavernosal injection agent. Implant placement in the setting of corporal fibrosis can be technically challenging. Available strategies include incision or excision of the scar, corporotomies with or without grafting, the use of cavernotomes, or other specialized dilators, implant downsizing, and transcorporeal resection.
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Affiliation(s)
- Faysal A Yafi
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA
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Abstract
INTRODUCTION After its U.S. FDA approval in 2013, Collagenase Clostridium histolyticum (CCh) has seen increasing use as a nonoperative treatment for Peyronie's disease (PD). We review the history of CCh and trials that led to its adoption. AIM To provide a historical and contemporary context for the evolution of Collagenase Clostridium histolyticum as a treatment modality for Peyronie's disease. METHODS A comprehensive search of peer-reviewed literature was performed pertaining to CCh and its biochemical and clinical significance. MAIN OUTCOME MEASURE The main outcome studied was the efficacy and safety profile of CCh in PD. CCh use in other diseases processes and its associated outcomes are also described. RESULTS CCh injection yields objective improvement in penile curvature across multiple trials in PD patients. Recently, level 1 strength of evidence has emerged supporting its widespread use. As such, CCh stands as the only FDA-approved injectable therapy for PD. Adverse events were namely limited to local reactions. Serious systemic complications and need for intervention were rare. CONCLUSIONS CCh is a safe and effective treatment for PD patients with deformities and plaque configuration amenable to injectable therapy. Multiple trials have demonstrated improvements in objective and subjective metrics such as penile curvature and bother scores. However, multiyear follow-up is needed to assess durability and its sustained clinical significance. Currently, refinement in dosing and technique has established a niche for CCh in PD patients who are affected by their symptoms but are not yet committed to surgical intervention. Yang KK and Bennett N. The history of collagenase clostridium histolyticum.
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Affiliation(s)
- Kevin K Yang
- Lahey Hospital and Medical CenterInstitute of UrologyBurlingtonMAUSA
| | - Nelson Bennett
- Lahey Hospital and Medical CenterInstitute of UrologyBurlingtonMAUSA.
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Lyons MD, Carson CC, Coward RM. Special considerations for placement of an inflatable penile prosthesis for the patient with Peyronie's disease: techniques and patient preference. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2015; 8:331-40. [PMID: 26251633 PMCID: PMC4524455 DOI: 10.2147/mder.s57252] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Placement of an inflatable penile prosthesis (IPP) is the mainstay of surgical treatment for patients with Peyronie’s disease (PD) and concomitant medication-refractory erectile dysfunction. Special considerations and adjunctive surgical techniques during the IPP procedure are often required for patients with PD to improve residual penile curvature, as well as postoperative penile length. The surgical outcomes and various adjunctive techniques are not significantly different from one another, and selection of the appropriate technique must be tailored to patient-specific factors including the extent of the deformity, the degree of penile shortening, and preoperative patient expectations. The aims of this review were to assess the current literature on published outcomes and surgical techniques involving IPP placement in the treatment of PD. Patient satisfaction and preferences are reported, along with the description and patient selection for surgical techniques that include manual penile modeling, management of refractory curvature with concurrent plication, and correction of severe residual curvature and penile shortening with tunica release and plaque incision and grafting. A thorough description of the available techniques and their associated outcomes may help guide surgeons to the most appropriate choice for their patients.
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Affiliation(s)
- Matthew D Lyons
- Department of Urology, University of North Carolina, Chapel Hill, NC, USA
| | - Culley C Carson
- Department of Urology, University of North Carolina, Chapel Hill, NC, USA
| | - Robert M Coward
- Department of Urology, University of North Carolina, Chapel Hill, NC, USA
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Yafi FA, Pinsky MR, Sangkum P, Hellstrom WJG. Therapeutic advances in the treatment of Peyronie's disease. Andrology 2015; 3:650-60. [PMID: 26097120 DOI: 10.1111/andr.12058] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Revised: 04/30/2015] [Accepted: 05/05/2015] [Indexed: 12/17/2022]
Abstract
Peyronie's disease (PD) is an under-diagnosed condition with prevalence in the male population as high as 9%. It is a localized connective tissue disorder of the penis characterized by scarring of the tunica albuginea. Its pathophysiology, however, remains incompletely elucidated. For the management of the acute phase of PD, there are currently numerous available oral drugs, but the scientific evidence for their use is weak. In terms of intralesional injections, collagenase clostridium histolyticum is currently the only Food and Drug Administration-approved drug for the management of patients with PD and a palpable plaque with dorsal or dorsolateral curvature >30°. Other available intralesional injectable drugs include verapamil and interferon-alpha-2B, however, their use is considered off-label. Iontophoresis, shockwave therapy, and radiation therapy have also been described with unconvincing results, and as such, their use is currently not recommended. Traction therapy, as part of a multimodal approach, is an underused additional tool for the prevention of PD-associated loss of penile length, but its efficacy is dependent on patient compliance. Surgical therapy remains the gold standard for patients in the chronic phase of the disease. In patients with adequate erectile function, tunical plication and/or incision/partial excision and grafting can be offered, depending on degree of curvature and/or presence of destabilizing deformity. In patients with erectile dysfunction non-responsive to oral therapy, insertion of an inflatable penile prosthesis with or without straightening procedures should be offered.
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Affiliation(s)
- F A Yafi
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA
| | - M R Pinsky
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA
| | - P Sangkum
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA
| | - W J G Hellstrom
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA
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Abstract
Peyronie's disease (PD) has a significant impact on the quality of life of both patients and their partners due to the compromised sexual function and physical deformation resulting from the condition. PD is a connective tissue disorder marked by fibrotic healing of the tunica albuginea, leading to penile deformities including curvature, shortening, loss of girth, hourglass appearance, and hinging. Despite the multiple medical therapies available, surgery is the gold standard of treatment once the plaque has stabilized. We present a review of the disease process, preoperative evaluation, operative planning, surgical treatments with outcomes and complications, and nascent developments in surgical management and graft development. Options include tunical lengthening procedures, tunical shortening procedures, and penile prosthesis. Decision-making is governed by degree of curvature, erectile function, and associated penile deformities. In cases with curvature of less than 60-70 degrees, adequate penile length, and no hourglass deformity, patients are candidates for tunical shortening procedures. Patients with curvature greater than 60-70 degrees, penile hourglass or hinge-destabilizing deformities, and adequate erectile function should be counseled with regard to tunical lengthening procedures. Patients with poor preoperative erectile function should undergo inflatable penile prosthesis placement, with possible secondary straightening procedures. Technique selection should be based upon surgeon preference, expertise, and experience, as evidence does not necessarily support one procedure over another.
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Affiliation(s)
- Uwais B Zaid
- Department of Urology, UCSF School of Medicine, 400 Parnassus Ave, UC Clinics, San Francisco, CA, 94143, USA,
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Mirheydar HS, Palazzi KL, Parsons JK, Chang D, Hsieh TC. Hospital-based trends in penile prosthetic surgery. J Sex Med 2015; 12:1092-8. [PMID: 25664424 DOI: 10.1111/jsm.12829] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION We examined national and regional trends in hospital-based penile prosthetic surgery and identified patient-specific factors predicting receipt of inflatable vs. semi-rigid penile prostheses. AIMS To improve our understanding of the surgical treatment for erectile dysfunction (ED). METHODS We utilized the Nationwide Inpatient Sample (NIS) from 1998 to 2010 in the United States and the California Office of Statewide Health Planning and Development (OSHPD) database from 1995 to 2010. Total number of penile implants performed and proportions of inflatable vs. semi-rigid prosthesis were examined. Multivariate analysis (MVA) was performed to identify factors associated with selection of inflatable vs. semi-rigid prostheses. MAIN OUTCOME MEASURES Primary outcome measure is the total number of hospital-based penile prosthetic surgeries performed in the United States over a 12-year period (1998-2010). Secondary outcome measures include proportion of inflatable and semi-rigid prosthesis implantations and factors influencing receipt of different prostheses. RESULTS We identified 53,967 penile prosthetic surgeries in the NIS; annual number implanted decreased from 4,703 to 2,338. Inflatable prostheses incurred higher costs but had a similar length of stay (LOS). In MVA, Caucasian race, Peyronie's disease, and private insurance were independently associated with receipt of an inflatable prosthesis. We identified 7,054 penile prostheses in OSHPD; annual number implanted decreased from 760 to 318. The proportion of inflatable prostheses increased significantly from 78.4% to 88.4% between 2001 and 2010. Inflatable prostheses incurred higher costs but had similar median LOS. In MVA, Caucasians and men without spinal cord injury were more likely to receive inflatable prosthesis. CONCLUSION Hospital-based penile prosthetic surgery has decreased substantially both nationwide and in California. In the United States, Caucasian race, Peyronie's disease, and private insurance were independently associated with receipt of an inflatable penile prosthesis. California population data correlated with national trends and can be utilized to further study surgical management of ED.
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Sherer BA, Warrior K, Levine LA. 2013-2014 Updates in Peyronie’s Disease Management. Curr Urol Rep 2014; 15:459. [DOI: 10.1007/s11934-014-0459-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Langston JP, Carson CC. Peyronie's disease: Review and recent advances. Maturitas 2014; 78:341-3. [DOI: 10.1016/j.maturitas.2014.05.024] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Revised: 05/27/2014] [Accepted: 05/28/2014] [Indexed: 02/03/2023]
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