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Kho YY, Lee SHE, Chin K, Sidek NZ, Ma VC, Seng DH, Cai S, Tan LW, Teo SM, Gogna A, Patel A, Venkatanarasimha N. US of the Penis: Beyond Erectile Dysfunction. Radiographics 2024; 44:e230157. [PMID: 38814798 DOI: 10.1148/rg.230157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
High-frequency US, with a linear transducer and gray-scale, color, and spectral Doppler US techniques, is the primary imaging modality for evaluation of the penis. It can allow delineation of anatomy and assessment of dynamic blood flow; it is easily available and noninvasive or minimally invasive; it is cost effective; and it is well tolerated by patients. US assessment after pharmacologic induction of erection is an additional tool in assessing patients with suspected vasculogenic impotence, and also in selected patients with penile trauma and suspected Peyronie disease. Penile injuries, life-threatening infections, and vascular conditions such as priapism warrant rapid diagnosis to prevent long-term morbidities due to clinical misdiagnosis or delayed treatment. US can facilitate a timely diagnosis in these emergency conditions, even at the point of care such as the emergency department, which can facilitate timely treatment. In addition, color and spectral Doppler US are valuable applications in the follow-up of patients treated with endovascular revascularization procedures for vasculogenic erectile dysfunction. Image optimization and attention to meticulous techniques including Doppler US is vital to improve diagnostic accuracy. Radiologists should be familiar with the detailed US anatomy, pathophysiologic characteristics, scanning techniques, potential pitfalls, and US manifestations of a wide spectrum of vascular and nonvascular penile conditions to suggest an accurate diagnosis and direct further management. The authors review a range of common and uncommon abnormalities of the penis, highlight their key US features, discuss differential diagnosis considerations, and briefly review management. ©RSNA, 2024 Supplemental material is available for this article.
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Affiliation(s)
- Ying Ying Kho
- From the Allied Health Division (Y.Y.K., S.H.E.L., N.Z.S., V.C.M., D.H.S., S.C., L.W.T., S.M.T.) and Division of Radiological Sciences (K.C., A.G., A.P., N.V.), Singapore General Hospital, 31 Third Hospital Ave, Singapore 168753
| | - Sally Hsueh Er Lee
- From the Allied Health Division (Y.Y.K., S.H.E.L., N.Z.S., V.C.M., D.H.S., S.C., L.W.T., S.M.T.) and Division of Radiological Sciences (K.C., A.G., A.P., N.V.), Singapore General Hospital, 31 Third Hospital Ave, Singapore 168753
| | - Kenneth Chin
- From the Allied Health Division (Y.Y.K., S.H.E.L., N.Z.S., V.C.M., D.H.S., S.C., L.W.T., S.M.T.) and Division of Radiological Sciences (K.C., A.G., A.P., N.V.), Singapore General Hospital, 31 Third Hospital Ave, Singapore 168753
| | - Nur Zakiah Sidek
- From the Allied Health Division (Y.Y.K., S.H.E.L., N.Z.S., V.C.M., D.H.S., S.C., L.W.T., S.M.T.) and Division of Radiological Sciences (K.C., A.G., A.P., N.V.), Singapore General Hospital, 31 Third Hospital Ave, Singapore 168753
| | - Voon Chee Ma
- From the Allied Health Division (Y.Y.K., S.H.E.L., N.Z.S., V.C.M., D.H.S., S.C., L.W.T., S.M.T.) and Division of Radiological Sciences (K.C., A.G., A.P., N.V.), Singapore General Hospital, 31 Third Hospital Ave, Singapore 168753
| | - Dorothy Hkawn Seng
- From the Allied Health Division (Y.Y.K., S.H.E.L., N.Z.S., V.C.M., D.H.S., S.C., L.W.T., S.M.T.) and Division of Radiological Sciences (K.C., A.G., A.P., N.V.), Singapore General Hospital, 31 Third Hospital Ave, Singapore 168753
| | - Sihui Cai
- From the Allied Health Division (Y.Y.K., S.H.E.L., N.Z.S., V.C.M., D.H.S., S.C., L.W.T., S.M.T.) and Division of Radiological Sciences (K.C., A.G., A.P., N.V.), Singapore General Hospital, 31 Third Hospital Ave, Singapore 168753
| | - Lee Wei Tan
- From the Allied Health Division (Y.Y.K., S.H.E.L., N.Z.S., V.C.M., D.H.S., S.C., L.W.T., S.M.T.) and Division of Radiological Sciences (K.C., A.G., A.P., N.V.), Singapore General Hospital, 31 Third Hospital Ave, Singapore 168753
| | - Si Min Teo
- From the Allied Health Division (Y.Y.K., S.H.E.L., N.Z.S., V.C.M., D.H.S., S.C., L.W.T., S.M.T.) and Division of Radiological Sciences (K.C., A.G., A.P., N.V.), Singapore General Hospital, 31 Third Hospital Ave, Singapore 168753
| | - Apoorva Gogna
- From the Allied Health Division (Y.Y.K., S.H.E.L., N.Z.S., V.C.M., D.H.S., S.C., L.W.T., S.M.T.) and Division of Radiological Sciences (K.C., A.G., A.P., N.V.), Singapore General Hospital, 31 Third Hospital Ave, Singapore 168753
| | - Ankur Patel
- From the Allied Health Division (Y.Y.K., S.H.E.L., N.Z.S., V.C.M., D.H.S., S.C., L.W.T., S.M.T.) and Division of Radiological Sciences (K.C., A.G., A.P., N.V.), Singapore General Hospital, 31 Third Hospital Ave, Singapore 168753
| | - Nanda Venkatanarasimha
- From the Allied Health Division (Y.Y.K., S.H.E.L., N.Z.S., V.C.M., D.H.S., S.C., L.W.T., S.M.T.) and Division of Radiological Sciences (K.C., A.G., A.P., N.V.), Singapore General Hospital, 31 Third Hospital Ave, Singapore 168753
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Chung E, Lowy M, Gillman M, Love C, Katz D, Neilsen G. Urological Society of Australia and New Zealand (
USANZ
) and Australasian Chapter of Sexual Health Medicine (
AChSHM
) for the Royal Australasian College of Physicians (
RACP
) clinical guidelines on the management of erectile dysfunction. Med J Aust 2022; 217:318-324. [DOI: 10.5694/mja2.51694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 06/04/2021] [Accepted: 06/17/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Eric Chung
- Princess Alexandra Hospital Brisbane QLD
- University of Queensland Brisbane QLD
- AndroUrology Centre Brisbane QLD
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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: 17] [Impact Index Per Article: 5.7] [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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Ferretti L, Madec FX, Akakpo W, Methorst C, Carnicelli D, Terrier JE, Morel Journel N, Beley S, Graziana JP, Marcelli F, Hupertan V, Yiou R, Ben-Naoum K, Savareux L, Huyghe E, Faix A. [French Urological Association (AFU) guidelines for Peyronie's disease assessment and treatment]. Prog Urol 2021; 31:477-494. [PMID: 33941460 DOI: 10.1016/j.purol.2020.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 10/31/2020] [Accepted: 11/09/2020] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Peyronie's disease is a common cause for consultation in urology. Many controversies surround its treatment. No French Guidelines have been published so far. The Committee of Andrology and Sexual Medicine of the French Association of Urology therefore offers a series of evidence-based recommendations. MATERIALS AND METHODS These recommendations are made according to the ADAPTE method, based on European (EAU, ESSM), American (AUA, ISSM) and Canadian (CAU) recommendations, integrating French specificities due to the availability of treatments, and an update of the recent bibliography. RESULTS The assessment of the disease is clinical. Patients with functional impairment or significant psychological repercussions may be offered treatment. The benefits and drawbacks of each treatment should be explained to the patient. Regarding non-surgical treatments, no available treatment has market authorization in France. Vitamin E is not recommended. Analgesic (oral or low-intensity shock waves) or proerectile treatments may be offered as needed, as well as traction therapy. Due to the unavailability of collagenase injections, verapamil injections may be offered. Surgical treatments are to be considered in the stabilized phase of the disease, and consist of performing a plication, an incision-graft or the placement of a penile implant according to the patient's wishes, the curvature and the penis size, as well as erectile function. Combination treatments can be offered. CONCLUSION The management of Peyronie's disease is complex, and the levels of evidence for treatments are generally low. The success of treatment will depend on the quality of the initial assessment, the patient's information and understanding of the expected effects, and the practitioner's experience.
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Affiliation(s)
- L Ferretti
- Service d'urologie, MSP Bordeaux Bagatelle, Talence.
| | - F-X Madec
- Service d'urologie, hôpital Foch, Suresnes
| | - W Akakpo
- Département d'urologie, Hôpital Pitié-Salpétrière, Paris
| | - C Methorst
- Service d'urologie, hôpital des 4 Villes, Saint-Cloud
| | - D Carnicelli
- Service d'urologie, hôpital Privé Jean Mermoz, Lyon
| | - J-E Terrier
- Service d'urologie, Hôpital Lyon Sud, Pierre-Bénite
| | | | | | - J-P Graziana
- Clinique Mutualiste de la Porte de l'Orient, Lorient
| | - F Marcelli
- Service d'urologie, andrologie et transplantation rénale, hôpital Huriez CHU Lille, France
| | | | - R Yiou
- Département d'urologie, CHU Henri Mondor, Créteil
| | | | - L Savareux
- Service d'urologie, Hôpital Privé la Chataigneraie, Beaumont
| | - E Huyghe
- Département d'urologie, CHU Rangueil, Toulouse
| | - A Faix
- Centre d'urologie du Polygone, Montpellier
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Rainer QC, Rodriguez AA, Bajic P, Galor A, Ramasamy R, Masterson TA. Implications of Calcification in Peyronie's Disease, A Review of the Literature. Urology 2021; 152:52-59. [PMID: 33476600 DOI: 10.1016/j.urology.2021.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 12/14/2020] [Accepted: 01/03/2021] [Indexed: 02/06/2023]
Abstract
A common characteristic of Peyronie's Disease (PD) is plaque calcification, which is associated with decreased response to treatments and higher rates of surgical intervention. Despite its prevalence in the PD population, the literature on plaque calcification is limited. While the diagnosis of PD is mostly clinical, imaging modalities such as ultrasound can be used to identify plaque calcification. The proper identification of plaque calcification is crucial for guiding management and setting therapeutic expectations for patients with PD. Herein we discuss what is known about PD plaque calcification, including epidemiology, etiology, diagnosis, and management.
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Affiliation(s)
| | | | | | - Anat Galor
- University of Miami Miller School of Medicine, Miami FL; Bruce W Carter VA Medical Center, Miami FL
| | | | - Thomas A Masterson
- University of Miami Miller School of Medicine, Miami FL; Bruce W Carter VA Medical Center, Miami FL.
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6
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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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7
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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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8
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Barbosa AR, Takemura LS, Cha JD, Carneiro A, Lemos GC, Glina S, Korkes F. Surgical Treatment of Peyronie’s Disease: Systematic Review of Techniques Involving or Not Tunica Albuginea Incision. Sex Med Rev 2020; 8:324-332. [DOI: 10.1016/j.sxmr.2019.08.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 08/19/2019] [Accepted: 08/23/2019] [Indexed: 02/03/2023]
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9
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Two dimensional penile ultrasound vibro-elastography for measuring penile tissue viscoelasticity: A pilot patient study and its correlation with penile ultrasonography. J Mech Behav Biomed Mater 2019; 103:103570. [PMID: 32090962 DOI: 10.1016/j.jmbbm.2019.103570] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 07/18/2019] [Accepted: 11/29/2019] [Indexed: 01/01/2023]
Abstract
The purpose of this research is to demonstrate the feasibility of a 2 dimensional (2D) penile ultrasound vibro-elastography (PUVE) technique for measuring the shear wave speed map over an area of regional of interest (ROI) in the penis. In PUVE, a 0.1 s harmonic vibration at a low frequency is generated on the surface of the penis using a handheld vibrator. An ultrasound probe is used to measure the resulting shear wave propagation in the penis. The shear wave speed is analyzed in the ROI of corpus cavernosum from both sides of penis using a 2D wave speed analysis technique. The shear wave speed of the penis is measured at three excitation frequencies of 100 Hz, 150 Hz, and 200 Hz. The viscoelasticity of penis is analyzed based on the wave speed dispersion with frequency. A pilot study was performed in men with ED and/or PD. It is found that both elasticity and viscosity of corpus cavernosa positively correlate with the peak systolic velocity (PSV) from penile ultrasonography. Both elasticity and viscosity of corpus cavernosa negatively correlate with the cardiovascular (CV) risk for patients with ED and/or PD. These results suggest that PUVE may provide a noninvasive and painless technique for assessing patients with ED/PD and their future CV risk. We will further evaluate PUVE in a large cohort of patients with ED/PD.
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10
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Sharma KL, Alom M, Trost L. The Etiology of Peyronie's Disease: Pathogenesis and Genetic Contributions. Sex Med Rev 2019; 8:314-323. [PMID: 31540807 DOI: 10.1016/j.sxmr.2019.06.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 06/06/2019] [Accepted: 06/11/2019] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Peyronie's disease (PD) is a chronic fibrosing condition that contributes to penile deformity, curvature, and pain. Initial familial studies demonstrated potential genetic links to PD. Since that time, very few investigations have significantly advanced the science in this area. Hence, there is a large opportunity and significant need to better study the underlying genomics and pathogenesis of PD. AIM To summarize the current genomic literature relevant to PD. METHODS A review was performed of all PubMed-indexed literature from 1970-2018 relating to the pathophysiology and genetics of PD. Key findings were categorically summarized to include epidemiology, risk factors, inheritance patterns, chromosomal instability, genetic associations, epigenetics, differential gene expression, and preclinical models of PD. MAIN OUTCOME MEASURES Summary of the current literature on the genetics of PD. RESULTS PD is a common condition and has several known risk factors and comorbid disease associations. Although men with PD are believed to be genetically predisposed, there are likely several subtypes of the condition, each with varied pathophysiological disorders and contributing factors. Available data suggest that PD is associated with underlying genetic instability, including dysregulation of genes relating to fibrosis and cellular degradation, thus, resulting in abnormal plaque development and penile deformity. Preclinical models, including cell cultures and rat models, demonstrate several consistencies with PD clinical and histopathologic characteristics; however, an ideal model with spontaneous development of PD is lacking. CONCLUSION Based on limited data, PD likely represents a heterogeneous condition, with both heritable and environmentally-driven epigenetic factors contributing to its development and progression. However, there remains a significant gap in the literature on the underlying cause and pathophysiology of the condition, suggesting a substantial need for further investigation and study. Sharma KL, Alom M, Trost L. The Etiology of Peyronie's Disease: Pathogenesis and Genetic Contributions. Sex Med Rev 2020;8:314-323.
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Chung E. Contemporary and Novel Imaging Studies for the Evaluation of Erectile Dysfunction. Med Sci (Basel) 2019; 7:medsci7080087. [PMID: 31404996 PMCID: PMC6723672 DOI: 10.3390/medsci7080087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 08/02/2019] [Accepted: 08/06/2019] [Indexed: 01/25/2023] Open
Abstract
Traditionally, it was thought that the pathogenesis of erectile dysfunction (ED) can be divided into psychological and organic factors. However, recent literature supports the development and progression of ED due to multidimensional alterations of a complex interplay of central and peripheral systems, from neural cognitive and efferent networks to loco-regional neuro-hormonal factors which are responsible for impaired penile vascular hemodynamics and ensuing lack of, or suboptimal, blood flow into the penis and/or veno-occlusive dysfunction. It is recognised that ED is strongly correlated with cardiovascular health and published clinical guidelines advocate screening for cardiovascular and metabolic risk factors in men presenting with ED. Over the past few decades, various imaging modalities have been developed and utilised to provide objective evaluation for ED to better characterise the state of penile health and exclude psychogenic components. The following article evaluates current and emerging imaging diagnostic tools for ED.
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Affiliation(s)
- Eric Chung
- AndroUrology Centre, Brisbane, QLD 4000, Australia.
- Princess Alexandra Hospital, University of Queensland, Brisbane, QLD 4102, Australia.
- Macquarie University Hospital, Sydney, NSW 2109, Australia.
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12
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Ziegelmann MJ, Farrell MR, Levine LA. Clinical characteristics and surgical outcomes in men undergoing tunica albuginea plication for congenital penile curvature who present with worsening penile deformity. World J Urol 2019; 38:305-314. [PMID: 31079186 DOI: 10.1007/s00345-019-02787-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 04/25/2019] [Indexed: 10/26/2022] Open
Abstract
PURPOSE Men with congenital penile curvature (CPC) can develop new onset worsening of their lifelong curvature. We sought to evaluate clinical characteristics and postoperative outcomes after tunica albuginea plication (TAP) in patients presenting with CPC who reported new onset worsened curvature (CPC-WC), and compare these with patients reporting stable lifelong curve ("CPC-only"). METHODS A retrospective review of demographics, history/exam findings, and postoperative outcomes for patients with CPC who underwent TAP from 2012 to 2018 was performed. Patients were differentiated based on whether or not they reported new onset worsening of their penile curvature preoperatively (CPC-WC versus CPC only). Statistical analysis was performed to identify differences in clinical characteristics and postoperative outcomes after TAP. RESULTS 60 patients were included [CPC only (n = 39) and CPC-WC (n = 21)]. Mean curvature was 62° (SD 23). CPC-WC patients were older [median 34 years (IQR 27:52) versus 24 years (IQR 20:34); p = 0.004], and more likely to report penile shortening and psychological bother (p < 0.05). On physical examination, CPC-WCs were more likely to have a discrete palpable tunical scar and diminished penile elasticity (p ≤ 0.0002). With median follow up of 12 months, satisfactory straightening with TAP was reported in 56/60 patients (93%) including 35/39 (90%) CPC only and 21/21 (100%) CPC-WC. CONCLUSIONS In men undergoing TAP for CPC, we found that 35% reported new onset worsening of their original curvature preoperatively. These patients were older and more likely to report penile shortening or exhibit palpable tunical scarring with decreased elasticity on examination compared to those with lifelong stable curvature. Regardless, TAP resulted in satisfactory penile straightening in the majority of patients.
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Affiliation(s)
- Matthew J Ziegelmann
- Division of Urology, Rush University Medical Center, 1725 West Harrison Street, Suite #352, Chicago, IL, 60612, USA
| | - Michael Ryan Farrell
- Division of Urology, Rush University Medical Center, 1725 West Harrison Street, Suite #352, Chicago, IL, 60612, USA
| | - Laurence A Levine
- Division of Urology, Rush University Medical Center, 1725 West Harrison Street, Suite #352, Chicago, IL, 60612, USA.
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13
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Avant RA, Ziegelmann M, Nehra A, Alom M, Kohler T, Trost L. Penile Traction Therapy and Vacuum Erection Devices in Peyronie's Disease. Sex Med Rev 2019; 7:338-348. [DOI: 10.1016/j.sxmr.2018.02.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Revised: 01/26/2018] [Accepted: 02/05/2018] [Indexed: 11/17/2022]
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14
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Liu Y, Zheng D, Liu X, Shi X, Shu S, Li J. Ultrasound on Erect Penis Improves Plaque Identification in Patients With Peyronie's Disease. Front Pharmacol 2019; 10:312. [PMID: 31019463 PMCID: PMC6458259 DOI: 10.3389/fphar.2019.00312] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Accepted: 03/14/2019] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To compare the sensitivity of identification of penile plaques in the erect and flaccid penises by ultrasound in patients with Peyronie's disease (PD). MATERIALS AND METHODS A total of 75 PD patients were screened by palpation and ultrasonography for penile lesions in both flaccid and erect penises induced by prostaglandin E1 (PG-1) injection. RESULTS A total of 138 lesions were identified by ultrasound in the erect penises induced by injection of PG-1. However, only 74.6% of the lesions (103) were detectable by the palpation of the flaccid penises, and 84.1% (116) by ultrasound of the flaccid penises. The ultrasound confirmed 99 of the palpated lesions in the flaccid penises. The detection rate of lesions in drug-induced erect penises by ultrasound was significantly higher than those in the flaccid penises by the ultrasound (P < 0.01) or palpation (P < 0.0005) The type of penile lesions identified by ultrasonography included tunical thickening, calcifications, septal fibrosis, and intracavernosal fibrosis. The ratios of these lesions confirmed by ultrasound were 52.6, 33.6, 6.0, and 7.8%, respectively, in the flaccid penises, and 55.8, 28.3, 8.7, and 7.2%, respectively, in the erect penises. CONCLUSION Drug-induced erection can be used in suspicious PD patients when penile lesion is not identified by palpation or ultrasound in the flaccid penis.
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Affiliation(s)
- Yu Liu
- Department of Ultrasonography, Second Clinical Medical College, Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
| | - Dequan Zheng
- Andrology Center, Second Clinical Medical College, Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
| | - Xiaolin Liu
- Department of Ultrasonography, Second Clinical Medical College, Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
| | - Xiaohong Shi
- Department of Ultrasonography, Second Clinical Medical College, Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
| | - Shengchun Shu
- Department of Ultrasonography, Second Clinical Medical College, Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
| | - Jinbing Li
- Department of Ultrasonography, Second Clinical Medical College, Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
- *Correspondence: Jinbing Li,
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Chung E, Gillman M, Rushton D, Love C, Katz D. Prevalence of penile curvature: a population-based cross-sectional study in metropolitan and rural cities in Australia. BJU Int 2018; 122 Suppl 5:42-49. [DOI: 10.1111/bju.14605] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Eric Chung
- Department of Urology; Princess Alexandra Hospital; University of Queensland; Brisbane Qld Australia
- AndroUrology Centre; St Andrew's War Memorial Hospital; Brisbane Qld Australia
| | - Michael Gillman
- AndroUrology Centre; St Andrew's War Memorial Hospital; Brisbane Qld Australia
| | - Derren Rushton
- Actelion Pharmaceuticals Australia; Belrose NSW Australia
| | | | - Darren Katz
- Department of Urology; Western Health; Melbourne Vic. Australia
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Cocci A, Russo GI, Briganti A, Salonia A, Cacciamani G, Capece M, Falcone M, Timpano M, Cito G, Verze P, Giammusso B, Morgia G, Mirone V, Minervini A, Gacci M, Cai T, Serni S, Carini M, Giubilei G, Mondaini N. Predictors of treatment success after collagenase Clostridium histolyticum
injection for Peyronie's disease: development of a nomogram from a multicentre single-arm, non-placebo controlled clinical study. BJU Int 2018; 122:680-687. [PMID: 29791971 DOI: 10.1111/bju.14410] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Andrea Cocci
- Department of Urology; Careggi Hospital; University of Florence; Florence Italy
| | - Giorgio Ivan Russo
- Urology Section; Department of Surgery; University of Catania; Catania Italy
| | - Alberto Briganti
- Department of Urology; Urological Research Institute; San Raffaele Scientific Institute; Vita-Salute University; Milan Italy
| | - Andrea Salonia
- Department of Urology; Urological Research Institute; San Raffaele Scientific Institute; Vita-Salute University; Milan Italy
| | | | - Marco Capece
- Department of Urology; University of Naples; Naples Italy
| | - Marco Falcone
- Department of Urology; Molinette Hospital; University of Turin; Turin Italy
| | | | - Gianmartin Cito
- Department of Urology; Careggi Hospital; University of Florence; Florence Italy
| | - Paolo Verze
- Department of Urology; University of Naples; Naples Italy
| | | | - Giuseppe Morgia
- Urology Section; Department of Surgery; University of Catania; Catania Italy
| | | | - Andrea Minervini
- Department of Urology; Careggi Hospital; University of Florence; Florence Italy
| | - Mauro Gacci
- Department of Urology; Careggi Hospital; University of Florence; Florence Italy
| | - Tommaso Cai
- Department of Urology; Santa Chiara Regional Hospital; Trento Italy
| | - Sergio Serni
- Department of Urology; Careggi Hospital; University of Florence; Florence Italy
| | - Marco Carini
- Department of Urology; Careggi Hospital; University of Florence; Florence Italy
| | - Gianluca Giubilei
- Department of Urology; Careggi Hospital; University of Florence; Florence Italy
| | - Nicola Mondaini
- Department of Urology; Santa Maria Annunciata Hospital; Florence Italy
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Punjani N, Stern N, Brock G. Characterization of Septal and Punctate Scarring in Peyronie's Disease. Urology 2018; 118:87-91. [PMID: 29800632 DOI: 10.1016/j.urology.2018.05.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 05/04/2018] [Accepted: 05/11/2018] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To characterize patients with isolated septal scarring (ISS) and punctate scarring (PS) in Peyronie's disease (PD) and to highlight the importance of duplex ultrasonography in the workup of patients with PD. MATERIALS AND METHODS Data from all men undergoing duplex ultrasonography at London Health Sciences Center for PD or erectile dysfunction over a 3-year period were retrospectively reviewed. RESULTS Our cohort included 722 patients with duplex ultrasound. ISS were demonstrated in 217 patients (30%), and PS in 197 (27%), with 72 (33%) and 148 (75%), respectively, having a normal physical examination. In both ISS and PS groups, more than half of patients also had associated erectile dysfunction. Predictive factors for ISS on multivariate analysis included trauma history (odds ratio [OR] 1.90, P = .04) and age (OR 1.02, P = .01). Patients with ISS were more likely to have dorsal curvature (OR 3.81, P <.01). CONCLUSION Limited data exist in the literature regarding ISS and PS in PD. Our study illustrates that one-third of ISS and three-quarters of PS would have remained unrecognized without duplex ultrasonography, and it highlights its importance in the workup and subsequent management of these patients. Further studies are needed to better understand and to determine the at-risk patient and the associated clinical implications of ISS and PS, and to ultimately provide optimized and individualized management strategies.
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Affiliation(s)
- Nahid Punjani
- Division of Urology, Department of Surgery, Western University, London, Ontario, Canada
| | - Noah Stern
- Division of Urology, Department of Surgery, Western University, London, Ontario, Canada
| | - Gerald Brock
- Division of Urology, Department of Surgery, Western University, London, Ontario, Canada.
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18
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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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19
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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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20
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Zhang X, Zhou B, Miranda AF, Trost LW. A Novel Noninvasive Ultrasound Vibro-elastography Technique for Assessing Patients With Erectile Dysfunction and Peyronie Disease. Urology 2018; 116:99-105. [PMID: 29548864 DOI: 10.1016/j.urology.2018.01.040] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 01/15/2018] [Accepted: 01/31/2018] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To translate a novel ultrasound vibro-elastography (UVE) technique for noninvasively measuring viscoelasticity of the penis. METHODS A pilot study of UVE was performed in men with erectile dysfunction or Peyronie disease. Assessments were performed in triplicate on the lateral aspect of the penis (bilaterally) at 100, 150, and 200 Hz before and after erectogenic injection administration. Viscoelasticity of the corpora was also calculated and compared before and after injection and against measures of erectile function, including the International Index of Erectile Function-Erectile Function Domain, and the total erectogenic medication volume required for achieving a firm erection. RESULTS Significant increases in viscoelasticity were found after erectogenic injection, validating the ability of UVE to measure dynamic changes with erections. Baseline measures also significantly correlated with the volume of erectogenic medication required to achieve an erection (100 Hz, parameter estimate [PE] 2.21, P <.001; 150 Hz, PE 0.53, P = .03; 200 Hz, PE 0.34, P = .07) but not with age and International Index of Erectile Function-Erectile Function Domain. As erectogenic medications likely represent the most accurate measure of erectile function, these findings suggest a potential role for UVE as a viable diagnostic modality for erectile dysfunction. CONCLUSION This first report of the use of elastography with erectile function in humans demonstrates significant associations with responsiveness to erectogenic injection medications. These data have significant potential implications for broader clinical practice and merit further study and validation.
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Affiliation(s)
| | - Boran Zhou
- Department of Radiology, Mayo Clinic, Rochester, MN
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21
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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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Paulis G, Romano G, Paulis A. Prevalence, psychological impact, and risk factors of erectile dysfunction in patients with Peyronie's disease: a retrospective analysis of 309 cases. Res Rep Urol 2016; 8:95-103. [PMID: 27486570 PMCID: PMC4958366 DOI: 10.2147/rru.s109319] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Peyronie's disease (PD) is a chronic inflammatory disease involving the tunica albuginea of the penis. Erectile dysfunction (ED) is a possible invalidating symptom of PD. The aim of this study was to evaluate the prevalence, psychological impact, and risk factors of ED in patients with PD. The study was conducted by carrying out a retrospective analysis of the clinical records of 309 patients with PD who visited our andrology clinic. All patients underwent the following tests: body mass index, common blood tests and hormone assays, questionnaire for erectile function assessment, dynamic penile color Doppler ultrasonography, imaging of the penis at maximum erection with photographic poses according to Kelâmi, psychosexual impact evaluation with PD Questionnaire (symptom bother score), evaluation of depression symptoms with the Patient Health Questionnaire-9, and evaluation of the intensity of penile pain with the pain intensity numeric rating scale. ED was observed in 37.5% of the cases. We divided the cases into two groups: group A (PD + ED), 116 cases, and group B (PD without ED), 193 cases. After multivariate analysis, we concluded that the following comorbidities are independent risk factors for ED: dyslipidemia, obesity, chronic prostatitis, benign prostatic hyperplasia, and autoimmune diseases. A depressive disorder was observed in 62.4%, and it was more frequent in patients with PD + ED (91.37% versus 45.07% group B). Sexual bother was greater in group A compared with group B (9.7 versus 7.6). Intensities of depressive symptoms and sexual bother were significantly higher compared with cases with no curvature when the bend angle was ≥30°. Our study confirms that an integrated psychological support with medical treatment is needed in patients with PD.
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Affiliation(s)
- Gianni Paulis
- Department of Surgical Sciences, Andrology Center, Regina Apostolorum Hospital, Albano L., Italy
- Department of Uro-Andrology, Peyronie’s Disease Care Center, Rome, Italy
| | - Gennaro Romano
- Department of Urologic Oncology, Section of Avellino, Italian League Against Cancer, Avellino, Italy
| | - Andrea Paulis
- Section of Psycho-Sexology, Peyronie’s Disease Care Center, Rome, Italy
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Chung E. Peyronie's disease and low intensity shock wave therapy: Clinical outcomes and patient satisfaction rate in an open-label single arm prospective study in Australian men. Korean J Urol 2015; 56:775-80. [PMID: 26568796 PMCID: PMC4643174 DOI: 10.4111/kju.2015.56.11.775] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 10/01/2015] [Indexed: 11/18/2022] Open
Abstract
Purpose To evaluate the efficacy, safety and patient satisfaction outcomes following low intensity extracorporeal shock wave therapy (LiESWT) in men with Peyronie's disease (PD) using a standardised protocol. Materials and Methods In this open-label single arm prospective study, patients with PD were enrolled following informed consent. Patient demographics, change in penile curvature and plaque hardness, International Index of Erectile Function (IIEF)-5 score, and overall satisfaction score (on a 5-point scale) were recorded. Treatment template consists of 3000 shock waves to the Peyronie's plaque over 20 minutes, twice weekly for 6 weeks. Results The majority of patients have PD history longer than 6 months (mean, 12.8 months; range, 6-28 months). Two thirds of patients have received and failed oral medical therapy. There were improvements in penile curvature (more than 15 degrees in 33% of men), plaque hardness (60% of men) and penile pain (4 out of 6 men) following LiESWT. There was a moderate improvement in IIEF-5 score (>5 points reported in 20% of men). No complication was reported and the majority of patients were satisfied (rated 4 out of 5; 70% of men) and would recommend this therapy to others. Conclusions In a carefully selected group of men with PD, LiESWT appears to be safe, has moderate efficacy and is associated with high patient satisfaction rate in the short term.
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Affiliation(s)
- Eric Chung
- University of Queensland, Department of Urology, Princess Alexandra Hospital, Brisbane, QLD, Australia. ; AndroUrology Centre, St Andrew's War Memorial Hospital, Brisbane, QLD, Australia
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Peak TC, Mitchell GC, Yafi FA, Hellstrom WJ. Role of collagenase clostridium histolyticum in Peyronie's disease. Biologics 2015; 9:107-16. [PMID: 26491251 PMCID: PMC4598203 DOI: 10.2147/btt.s65619] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Peyronie's disease is a localized connective tissue disease characterized by an active, inflammatory phase and a stable, quiescent phase, with the eventual development of collagenous plaques within the tunica albuginea of the penis. Risk factors primarily associated with Peyronie's disease include Dupuytren's contracture, penile trauma, and family history. A variety of treatment strategies have been utilized, including oral and topical agents, electromotive drug administration, intralesional injections, extracorporeal shockwave therapy, penile traction, and surgery. However, most of these strategies are ineffective, with surgery being the only definitive treatment. Collagenase clostridium histolyticum is a newly US Food and Drug Administration-approved agent for intralesional injection. It is thought to downregulate many of the disease-related genes, cytokines, and growth factors and degrade collagen fibers. It also suppresses cell attachment, spreading, and proliferation. Collagenase clostridium histolyticum has been clinically proven to be a safe and effective therapeutic option, demonstrating decreases in penile curvature and plaque consistency, as well as increases in patient satisfaction. During clinical evaluation, the Peyronie's Disease Questionnaire was validated as an effective tool for assessing treatment outcomes.
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Affiliation(s)
- Taylor C Peak
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Gregory C Mitchell
- Section of Andrology, Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Faysal A Yafi
- Section of Andrology, Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Wayne J Hellstrom
- Section of Andrology, Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA
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Hussein AA, Alwaal A, Lue TF. All about Peyronie's disease. Asian J Urol 2015; 2:70-78. [PMID: 29264123 PMCID: PMC5730743 DOI: 10.1016/j.ajur.2015.04.019] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Revised: 01/31/2015] [Accepted: 02/10/2015] [Indexed: 12/27/2022] Open
Abstract
Peyronie's disease (PD) is an acquired connective tissue disorder of the tunica albuginea of the corpus cavernosum, characterized by excessive fibrosis and plaque formation. PD can result in significant physical and psychological morbidity; as it may prevent intercourse and cause adverse impacts on partner relationships. The exact etiology and pathophysiology remain unclear, and many misconceptions about the disease associations, course and treatment exist. The disease has two distinct stages. The acute stage is characterized by pain, and disease may progress during this stage. Non-surgical managements at this stage aim to alleviate pain and stabilize the disease. Results for non-surgical treatment are often conflicting. The chronic stage occurs 6–12 months later, where pain disappears and the deformity stabilizes. Surgical treatment is reserved for significant deformity or with inability to penetrative intercourse. The choice of the surgical technique depends on the length of the penis, degree of deformity, erectile function, patients' expectations and surgeon's preference.
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Affiliation(s)
- Ahmed A Hussein
- Department of Urology, University of California, San Francisco, CA, USA.,Department of Urology, Cairo University, Egypt
| | - Amjad Alwaal
- Department of Urology, University of California, San Francisco, CA, USA.,Department of Urology, King Abdul Aziz University, Saudi Arabia
| | - Tom F Lue
- Department of Urology, University of California, San Francisco, CA, USA
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Hussein AA, Alwaal A, Lue TF. WITHDRAWN: All about Peyronie’s disease. Asian J Urol 2015. [DOI: 10.1016/j.ajur.2015.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Penile Doppler Ultrasound Predicting Cardiovascular Disease in Men with Erectile Dysfunction. Curr Urol Rep 2015; 16:16. [DOI: 10.1007/s11934-015-0482-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Al-Helow MR, Abdul-Hady H, Fathalla MM, Zakaria MA, Hussein O, El Gahndour T. The role of biofeedback in the rehabilitation of veno-occlusive erectile dysfunction. EGYPTIAN RHEUMATOLOGY AND REHABILITATION 2014. [DOI: 10.4103/1110-161x.147362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Pavlinec JG, Hakky TS, Yang C, Massis K, Munarriz R, Carrion RE. Penile Artery Shunt Syndrome: A Novel Cause of Erectile Dysfunction after Penile Revascularization Surgery. J Sex Med 2014; 11:2338-41. [DOI: 10.1111/jsm.12543] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Alga Ecklonia bicyclis, Tribulus terrestris, and glucosamine oligosaccharide improve erectile function, sexual quality of life, and ejaculation function in patients with moderate mild-moderate erectile dysfunction: a prospective, randomized, placebo-controlled, single-blinded study. BIOMED RESEARCH INTERNATIONAL 2014; 2014:121396. [PMID: 25136552 PMCID: PMC4127274 DOI: 10.1155/2014/121396] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 06/01/2014] [Indexed: 12/18/2022]
Abstract
We aimed to evaluate the efficacy of oral therapy with alga Ecklonia bicyclis, Tribulus terrestris, and glucosamine oligosaccharide (Tradamix TX1000) in patients with erectile dysfunction (ED) at 3 months of follow-up. From January 2013 to September 2013, 177 patients diagnosed with mild-moderate ED (IIEF-EF < 26) were enrolled in this multicenter, single-blinded, placebo-controlled study and randomized in Group A (Tradamix, n = 87) and Group B (placebo, n = 90). Penile color Doppler ultrasound measures, IIEF-15 questionnaire, male sexual health questionnaire-ejaculation disorder (MSHQ-EjD), and sexual quality of life (SQoL-M) were collected. We observed significant changes of the IIEF-15 in Group A (mean difference: 11.54; P < 0.05) at 3 months versus Group B (P < 0.05). PSV (P < 0.05), IIEF-intercourse satisfaction (P < 0.05), IIEF-orgasmic function (mean P < 0.05), IIEF-sexual desire (P < 0.05), IIEF-overall satisfaction (P < 0.05), MSHQ-EjD (mean difference: 1.21; P < 0.05), and SQoL-M (mean difference: 10.2; P < 0.05) were significantly changed in Group A versus baseline and Group B. Patients with moderate arterial dysfunction showed significant increase of PSV (P < 0.05), IIEF-EF (P < 0.05), MSHQ-EjD (P < 0.05), and SQoL-M (P < 0.05) in Group A. Therapy with Tradamix improves erectile and ejaculation function and sexual quality of life in patients with mild-moderate ED and in particular for those with moderate arterial dysfunction.
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The direction and severity of penile curvature does not have an impact on concomitant vasculogenic erectile dysfunction in patients with Peyronie’s disease. Int J Impot Res 2014; 27:6-8. [DOI: 10.1038/ijir.2014.25] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Revised: 06/05/2014] [Accepted: 06/13/2014] [Indexed: 12/22/2022]
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Martínez‐Salamanca JI, Egui A, Moncada I, Minaya J, Ballesteros CM, del Portillo L, Sola I, Carballido J. Acute Phase Peyronie's Disease Management with Traction Device: A Nonrandomized Prospective Controlled Trial with Ultrasound Correlation. J Sex Med 2014; 11:506-15. [DOI: 10.1111/jsm.12400] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Levine L, Rybak J, Corder C, Farrel MR. Peyronie's disease plaque calcification--prevalence, time to identification, and development of a new grading classification. J Sex Med 2013; 10:3121-8. [PMID: 24119147 DOI: 10.1111/jsm.12334] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Peyronie's disease (PD) is a connective tissue disorder of the penis in which a fibrous scar in the tunica albuginea can result in multiple penile deformities. AIM The study aims to investigate the prevalence and time to identification of plaque calcification (PC) in our PD patient population and whether stratification of calcification based on severity seen on ultrasound would serve as a predictor of treatment progression to surgery. METHODS A retrospective review of 1,041 men presenting with PD from 1993 to 2009 was performed. Eight hundred thirty-four underwent penile duplex ultrasound. MAIN OUTCOME MEASURES PC was graded as: grade 1 (<0.3 cm), grade 2 (>0.3 cm, <1.5 cm), grade 3 (>1.5 cm; or ≥ 2 plaques >1.0 cm). A matched control group with noncalcified plaques (n = 236) was selected for comparison. RESULTS Two hundred eighty-four men (34%) were found to have PC noted on ultrasound, and 98 had fully documented dimensions of the PC. Forty-one percent were found to have grade 1, 28% grade 2, and 32% grade 3. When analyzed by grade and progression to surgery, 23% of grade 1, 32% of grade 2, and 55% of grade 3 patients had surgery. Those with grade 3 PC were more likely to undergo surgical intervention for PD (OR 2.28 95% CI 1.07-4.86) and more likely to undergo a grafting procedure than control patients (P < 0.0001). CONCLUSIONS Men with PC are not more likely to undergo surgery than those without PC (OR 0.95, 95% CI 0.58-1.57). PC is not uncommon, as it was found in 34% of our cohort. PC does not appear to be an indication of mature or stable disease, as it was identified by ultrasound in 37% of patients less than 12 months after onset of symptoms. Men with grade 3 PC have an increased likelihood of progression to surgical intervention and a higher likelihood of undergoing a grafting procedure.
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Affiliation(s)
- Laurence Levine
- Department of Urology, Rush University Medical Center, Chicago, IL, USA
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Affiliation(s)
- Alex K Wu
- Department of Urology, University of California, San Francisco, USA
| | - Tom F Lue
- Department of Urology, University of California, San Francisco, USA
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Iacono F, Prezioso D, Ruffo A, Illiano E, Romeo G, Amato B. Tunical plication in the management of penile curvature due La Peyronie's disease. Our experience on 47 cases. BMC Surg 2012; 12 Suppl 1:S25. [PMID: 23173735 PMCID: PMC3499200 DOI: 10.1186/1471-2482-12-s1-s25] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Peyronie's disease is an acquired connective tissue disorder of the penile tunica albuginea with fibrosis and inflammation. The disease produces palpable plaques, penile curvature and pain during erections. Patients report negative effects in four major domains: physical appearance and self-image, sexual function and performance. These changes damage sexual life and compromise the quality of life. Our objective is to review the patient's sexual life after penile tunical plicature using the International Index of Erectile Function (IIEF) and the Sexual Encounter Profile (SEP) questionnaires. METHODS A total of 47 patients with Peyronie's disease (PD) were enrolled at our urology department and they underwent correction of penile deviation between February 2009 and March 2010. Mean patient age was 56 years and mean follow-up was 24 months. Patients with painless PD plaque with no progression in angulation for at least 12 months were chosen for surgery. They underwent a penile tunical plication.IIEF and SEP questionnaire were administered to all patients. RESULTS Of all treated patients, 94% were able to insert their penis in the partner's vagina (p<0.01; SEP question 2), compared with 62% preoperatively and 90% of them was satisfied overall with the sexual intercourse (p<0.01; SEP question 5) .Patients had a significantly higher endpoint and a greater change from baseline for the remaining SEP questions related to achievement of an erection, satisfaction of erection hardness (SEP questions 1 and 4; p < 0:001).We reported a significant improvement in the IIEF scores (from a baseline total score of 25.2 +/- 3.2 to a final score of 38.3 +/- 5.2; P<0.01). It resulted in significantly higher endpoint IIEF scores across all five IIEF domains: Erectile Function, Intercourse Satisfaction, Orgasmic Function, Sexual Desire and Overall Satisfaction. The main complaint was penile shortening (28 patients, 60%), feeling of the suture during flaccidity and tumescence (37 patients, 80%). CONCLUSION Patient quality of life improved after surgery thanks to the improvement of their sexual life. The complications are unimportant and few bother symptoms are reported. The significant improvement in erectile function was also supported by IIEF and SEP questionnaire data. Nowadays tunical plication is a safe, advantageous and useful technique to treat patients suffering of Peyronie's disease.
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Affiliation(s)
- Fabrizio Iacono
- Department of Urology, University “Federico II” of Naples, Via Pansini, 5 - 80131 – Naples, Italy
| | - Domenico Prezioso
- Department of Urology, University “Federico II” of Naples, Via Pansini, 5 - 80131 – Naples, Italy
| | - Antonio Ruffo
- Department of Urology, University “Federico II” of Naples, Via Pansini, 5 - 80131 – Naples, Italy
| | - Ester Illiano
- Department of Urology, University “Federico II” of Naples, Via Pansini, 5 - 80131 – Naples, Italy
| | - Giuseppe Romeo
- Department of Urology, University “Federico II” of Naples, Via Pansini, 5 - 80131 – Naples, Italy
| | - Bruno Amato
- Department of General, Geriatric, Oncologic Surgery and Advanced Technologies, University “Federico II” of Naples, Via Pansini, 5 - 80131 – Naples, Italy
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Salonia A, Castagna G, Saccà A, Ferrari M, Capitanio U, Castiglione F, Rocchini L, Briganti A, Rigatti P, Montorsi F. Is erectile dysfunction a reliable proxy of general male health status? The case for the International Index of Erectile Function-Erectile Function domain. J Sex Med 2012; 9:2708-15. [PMID: 22897643 DOI: 10.1111/j.1743-6109.2012.02869.x] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Erectile dysfunction (ED) has emerged progressively as a sentinel marker of cardiovascular disease (CVD). The correlation between ED and the burden arising from multiple comorbid conditions has been incompletely analyzed. AIM Assess whether erectile function, defined with the International Index of Erectile Function-Erectile Function (IIEF-EF) domain score, is associated with health-significant comorbidities scored with the Charlson comorbidity index (CCI). METHODS Clinical and hemodynamic variables of the last 140 consecutive patients who underwent penile color Doppler ultrasonography for new-onset ED were considered. Patients were assessed with a thorough medical and sexual history. Health-significant comorbidities were scored with the CCI. MAIN OUTCOME MEASURE Descriptive statistics and either linear or logistic regression models tested the association among IIEF-EF, hemodynamic parameters, and CCI, which was included in the model both as continuous and categorized variable (0 vs. ≥1). RESULTS Complete data were available for 138 patients (98.6%) (mean age 46.6 years [standard deviation 13.0]; range 21-75 years). CCI was 0, 1, and ≥2 in 94 (68.1%), 23 (16.7%), and 21 (15.25%) patients, respectively. Of all, 35 patients (79.5%) did not have a CVD comorbidity. Mean IIEF-EF was 13.7 (9.3). ED severity was no ED, mild, mild to moderate, moderate, and severe in 12 (9.1%), 28 (20.2%), 12 (9.1%), 23 (16.2%), and 63 (45.5%) patients, respectively. At multivariable linear regression analysis, CCI significantly worsened with increased age (β=0.33; P=0.001) and decreased IIEF-EF values (β=-0.25; P=0.01). At logistic regression analysis, age (odds ratio [OR]: 1.05; P=0.004) and IIEF-EF (OR: 0.95; P=0.04) emerged as significant predictors of categorized CCI. CONCLUSIONS Severity of ED, as objectively interpreted with IIEF-EF, accounts for a higher CCI, which may be considered a reliable proxy of a lower general male health status regardless of the etiology of ED.
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Affiliation(s)
- Andrea Salonia
- Department of Urology, University Vita-Salute San Raffaele, Milan, Italy.
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Serefoglu EC, Mandava SH, Sikka SC, Hellstrom WJG. PENILE DOPPLER SONOGRAPHIC AND CLINICAL CHARACTERISTICS IN PEYRONIE'S DISEASE AND/OR ERECTILE DYSFUNCTION: AN ANALYSIS OF 1500 MEN WITH SEXUAL DYSFUNCTION. BJU Int 2012; 110:E154-5; author reply E155-6. [DOI: 10.1111/j.1464-410x.2012.10674_3.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Chung E, Brock GB. REPLY. BJU Int 2012. [DOI: 10.1111/j.1464-410x.2012.10674_4.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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