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Roadman D, Wang V, Beer A, Levine L. A contemporary assessment of the evaluation and management of patients presenting to a tertiary medical center with Peyronie's disease. Int J Impot Res 2024; 36:118-124. [PMID: 37468535 DOI: 10.1038/s41443-023-00738-w] [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: 02/10/2023] [Revised: 07/05/2023] [Accepted: 07/07/2023] [Indexed: 07/21/2023]
Abstract
Peyronie's disease continues to be poorly understood. We characterize the presenting features of Peyronie's disease within a large cohort and elucidate the factors that correlate with surgical intervention. Univariate and multivariate analyses were performed on 1483 consecutive patients to assess pre-operative predictors of surgical intervention for Peyronie's disease. Overall, 1263 patients met inclusion criteria. Mean age was 55.4 ± 11.1 years with a mean duration of disease at presentation of 33.2 ± 42.5 months. Mean primary curvature was 49.8 ± 20.8°. Primary ventral curvature was present in 11.4% and 36.5% of patient had a multiplanar curvature. During penile duplex ultrasound evaluation indentation/narrowing deformities were appreciated in 76.0%, hourglass deformity in 10.1%, and hinge effect in 33.0% of patients. Calcification was seen in 30.1% of patients. Operative intervention occurred in 35.3% of patients. Degree of primary curvature (1.03 OR, p < 0.001), hourglass deformity (1.82 OR, p = 0.01), decreased tunical elasticity (1.20 OR, p = 0.03), and prior intralesional collagenase clostridium histolyticum injections (2.94 OR, p < 0.001) predicted surgical correction on multivariate analysis. Compared to historical studies, we found a higher incidence of severe degree of curvature (27.5% >60°), indentation deformities, hinge-effect, multiplanar curvature and penile calcifications. Ultimately, predictors of surgical intervention included those with worse erectile function and more severe characteristics.
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Affiliation(s)
- Daniel Roadman
- Rush University Medical Center Department of Urology, 1725 West Harrison Street, Chicago, IL, 60612, USA
| | - Vinson Wang
- The Urology Group, 2000 Joseph E Sanker Blvd, Cincinnati, OH, 45212, USA
| | - Adam Beer
- Buffalo General Medical Center, 100 High Street Buffalo, Buffalo, NY, 14203, USA
| | - Laurence Levine
- Rush University Medical Center Department of Urology, 1725 West Harrison Street, Chicago, IL, 60612, USA.
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Gao D, Shen Y, Tang B, Ma Z, Chen D, Yu X, Li G, Chang D. The 100 most-cited publications on Peyronie's disease: a bibliometric analysis and visualization study. Int J Impot Res 2024; 36:110-117. [PMID: 37198341 DOI: 10.1038/s41443-023-00703-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 04/16/2023] [Accepted: 04/18/2023] [Indexed: 05/19/2023]
Abstract
This study aimed to summarize the characteristics of the top 100 most-cited publications on Peyronie's disease (PD) research and to analyse past and current research hotspots and trends. The SCI-E database of the Web of Science Core Collection (WoSCC) provided us with the top 100 most-cited publications in PD research, from which we took the following information: general trend of publication, year of publication, nation/region, institution, journal, author, and keywords. VOSviewer (version 1.6.18) and Excel (version 2016) were used for information analysis. Through a standardized search, we ultimately found 1019 papers in the field of PD research, from which we extracted the 100 articles that had received the highest citations. The articles were published between 1949 and 2016. The United States is a major contributor to PD research (n = 67). The University of California, Los Angeles, was the institution with the largest number of articles (n = 11). These articles were published in 16 journals, with the largest number appearing in the Journal of Urology (n = 47). The author with the most articles was Levine LA (n = 9). Gelbard MK's articles had the highest citation frequency (n = 1158). Erectile dysfunction (n = 19) was the keyword with the highest frequency, indicating that PD-related erectile dysfunction was the leading focus of research in this field. Most of the keywords that have appeared in the past decade are related to the clinical treatment of PD. Therefore, we believe that improving patients' erectile function to the greatest extent in clinical treatment is the frontier and hot spot of future research.
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Affiliation(s)
- Dawei Gao
- TCM Regulating Metabolic Diseases Key Laboratory of Sichuan Province, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yifeng Shen
- TCM Regulating Metabolic Diseases Key Laboratory of Sichuan Province, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Bo Tang
- TCM Regulating Metabolic Diseases Key Laboratory of Sichuan Province, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Ziyang Ma
- TCM Regulating Metabolic Diseases Key Laboratory of Sichuan Province, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Di'ang Chen
- TCM Regulating Metabolic Diseases Key Laboratory of Sichuan Province, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xujun Yu
- TCM Regulating Metabolic Diseases Key Laboratory of Sichuan Province, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
- School of Medicine and Life Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Guangsen Li
- TCM Regulating Metabolic Diseases Key Laboratory of Sichuan Province, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Degui Chang
- TCM Regulating Metabolic Diseases Key Laboratory of Sichuan Province, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China.
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Zhao S, Wu X, Zhang Y, Zhang C. Role of Shear Wave Elastography in the Diagnosis of Peyronie Disease. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2024; 43:397-403. [PMID: 37948532 DOI: 10.1002/jum.16372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 10/20/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVES The present study aims to explore the role of shear wave elastography (SWE) in the diagnosis of Peyronie disease (PD). METHODS A total of 59 PD patients and 59 age-matched healthy adult men were included in this study. The B-mode ultrasound (US) and SWE were performed for all subjects, and the Young modulus (YM) values of the corresponding regions of the penis in the PD and control groups were recorded and compared. RESULTS The mean age of the included PD patients and age-matched controls was 53.81 years (SD 9.52, range 32-73). On B-mode US evaluation, 41 (69.5%) of 59 included PD patients were found to have penile plaques, and the remaining 18 (30.5%) patients had no evidence of penile plaque. After evaluation using SWE, the YM values in the penile plaque region of these 41 patients with penile dysplasia were found to be significantly higher (60.29 kPa ± 19.95) than those outside the plaque (in the same patient) (21.05 kPa ± 4.58) and in the same penile region of the control group (20.59 kPa ± 4.65) (P < .001). In the remaining 18 PD patients, the results showed that the YM value of the abnormal penile region in the PD patients (56.67 kPa ± 13.52) was significantly higher than the YM value outside the abnormal penile region in the same patients (22.79 kPa ± 4.31) and in the same penile region in the control group (19.87 kPa ± 3.48) (P < .001; P < .001). CONCLUSIONS In conclusion, this study showed that SWE as a non-invasive technique is useful in identifying and differentiating penile plaques in PD patients and is a simple, rapid and complementary method to B-mode US.
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Affiliation(s)
- Sheng Zhao
- The Department of Ultrasound, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xu Wu
- The Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yuyang Zhang
- The Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Chaoxue Zhang
- The Department of Ultrasound, The First Affiliated Hospital of Anhui Medical University, Hefei, China
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Paulis G, Paulis A, De Giorgio G, Quattrocchi S. Measurement of Oxidative Stress Index (OSI) in Penile Corpora Cavernosa and Peripheral Blood of Peyronie's Disease Patients: A Report of 49 Cases. Metabolites 2024; 14:55. [PMID: 38248858 PMCID: PMC10821449 DOI: 10.3390/metabo14010055] [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: 12/11/2023] [Revised: 01/10/2024] [Accepted: 01/13/2024] [Indexed: 01/23/2024] Open
Abstract
Peyronie's disease (PD) is a chronic inflammatory disease affecting the penile albuginea. Oxidative stress (OS) is important for the development of the disease; therefore, it seemed interesting to us to directly measure OS at both the site of the disease and in peripheral blood. For a precise OS study, it is necessary to evaluate not only the single results of the total oxidant status (TOS) and total antioxidant status (TAS) but also their ratio: OS index (OSI) (arbitrary unit) = TOS/TAS × 100. This study included 49 PD patients examined and diagnosed in our Peyronie's care center and a control group of 50 cases. We collected blood samples from both the penis and a vein in the upper extremity; we used d-ROMs and PAT-test (FRAS kit) for OS measurement. Pearson's study found a statistical correlation between penile OSI values and PD plaque volumes: p-value = 0.002. No correlation was found between systemic OSI values and PD plaque volumes: p-value = 0.27. Penile OSI values were significantly reduced after the elimination of the PD plaque (p < 0.00001). The mean value of the penile OSI indices in the PD patients after plaque elimination corresponded to 0.090 ± 0.016 (p = 0.004). The comparison between the penile OSI values of the PD patients (with plaque elimination) and the control group revealed no statistically significant differences (p = 0.130). The absence of a correlation between Peyronie's plaque volume and systemic OSI values indicates that it is preferable to carry out the OS study by taking a sample directly from the site of the disease. By carrying out a penile OSI study, it would be possible to obtain a precise plaque-volume-dependent oxidative marker. Even if the study did not demonstrate any correlation between OSI indices and anxious-depressive state, we detected a high prevalence of anxiety (81.6%) and depression (59.1%) in PD patients.
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Affiliation(s)
- Gianni Paulis
- Peyronie’s Care Center, Department of Urology and Andrology, Castelfidardo Clinical Analysis Center, 00185 Rome, Italy
| | - Andrea Paulis
- Neurosystem for Applied Psychology and Neuroscience, Janet Clinical Centre, 00195 Rome, Italy;
| | - Giovanni De Giorgio
- Section of Ultrasound Diagnostics, Department of Urology and Andrology, Castelfidardo Clinical Analysis Center, 00185 Rome, Italy;
| | - Salvatore Quattrocchi
- Clinical Analysis Laboratory, Castelfidardo Clinical Analysis Center, 00185 Rome, Italy;
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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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Mousavi Ghahfarrokhi SS, Mahdigholi FS, Amin M. Collateral beauty in the damages: an overview of cosmetics and therapeutic applications of microbial proteases. Arch Microbiol 2023; 205:375. [PMID: 37935975 DOI: 10.1007/s00203-023-03713-7] [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: 09/12/2023] [Revised: 10/14/2023] [Accepted: 10/16/2023] [Indexed: 11/09/2023]
Abstract
Microbial proteases are enzymes secreted by a variety of microorganisms, including bacteria and fungi, and have attracted significant attention due to their versatile applications in the food and pharmaceutical industries. In addition, certain proteases have been used in the development of skin health products and cosmetics. This article provides a review of microbial proteases in terms of their classification, sources, properties, and applications. Moreover, different pharmacological and molecular investigations have been reviewed. Various biological activities of microbial proteases, such as Arazyme, collagenase, elastin, and Nattokinase, which are involved in the digestion of dietary proteins, as well as their potential anti-inflammatory, anti-cancer, antithrombotic, and immunomodulatory effects have been included. Furthermore, their ability to control infections and treat various disorders has been discussed. Finally, this review highlights the potential applications and future perspectives of microbial proteases in biotechnology and biomedicine, and proposes further studies to develop new perspectives for disease control and health-promoting strategies using microbial resources.
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Affiliation(s)
- Seyed Sadeq Mousavi Ghahfarrokhi
- Department of Drug and Food Control, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
- Pharmaceutical Microbiology Group, Pharmaceutical Quality Assurance Research Center, The Institute of Pharmaceutical Sciences (TIPS), Tehran University of Medical Sciences, Tehran, Iran
- Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Fateme Sadat Mahdigholi
- Department of Biomaterials, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohsen Amin
- Department of Drug and Food Control, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.
- Pharmaceutical Microbiology Group, Pharmaceutical Quality Assurance Research Center, The Institute of Pharmaceutical Sciences (TIPS), Tehran University of Medical Sciences, Tehran, Iran.
- Room No. 1-221, Faculty of Pharmacy, 16th Azar Street, Tehran University of Medical Sciences, Tehran, Iran.
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Wang X, Liu H, Tang G, Wu G, Chu Y, Wu J, Cui Y. Updated recommendations on the therapeutic role of extracorporeal shock wave therapy for peyronie's disease: systematic review and meta-analysis. BMC Urol 2023; 23:145. [PMID: 37700253 PMCID: PMC10498627 DOI: 10.1186/s12894-023-01320-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 09/08/2023] [Indexed: 09/14/2023] Open
Abstract
BACKGROUND The therapeutic role of extracorporeal shockwave therapy (ESWT) for Peyronie's disease (PD) has been controversial in a long term. We aimed to further evaluate the therapeutic effect of ESWT for PD on the basis of available high-quality studies. METHODS The PubMed, CENTRAL and Embase databases were searched for articles published from January 1st, 2000 to December 31, 2022. Only randomized controlled trials (RCTs) using ESWT to treat PD were included. Meta-analysis and forest plots were carried out using Review Manager 5.4.1 software, and outcomes were reviewed by 2 authors independently. Using the Risk of Bias assessment form (ROB-2) by Cochrane Collaboration for quality assessment. PRISMA 2020 guidelines were used in this article to achieve the quantitative and qualitative synthesis of data. RESULTS A total of four RCTs were included. 151 patients in the ESWT group and 150 patients in the control group. The meta-analysis results showed that ESWT could significantly reduce plaque size (OR 2.59, 95%CI 1.15 to 5.85, P = 0.02) and relieve pain (MD -1.55, 95%CI -2.46 to -0.64, P = 0.0008); but it has no significant effect on reducing the penile curvature (OR 1.93, 95%CI 0.87-4.26, P = 0.11) and improving sexual function (MD 2.6, 95%CI -1.63 to 6.83, P = 0.23), there is also no significant difference in complication rates between groups (OR 2.94, 95%CI 0.66 to 13.03, P = 0.16). The risk of bias of results is low. The limitations of this study are that the number of included studies is too small, some experimental outcomes are missing, and the expression of outcomes is not unified. CONCLUSIONS For PD, ESWT can be considered as a safe short-term treatment, which can reduce plaque size and relieve pain, but cannot improve penile curvature and sexual function. Its long-term efficacy remains to be discussed. REGISTRATION NUMBER PROSPERO (ID: CRD42023436744).
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Affiliation(s)
- Xiaofeng Wang
- Department of Urology, Qindao University Medical College Affiliated Yantai Yuhuangding Hospital, No. 20 East Yuhuangding Road, Yantai, Shandong, 264000, China
| | - Hongquan Liu
- Department of Urology, Qindao University Medical College Affiliated Yantai Yuhuangding Hospital, No. 20 East Yuhuangding Road, Yantai, Shandong, 264000, China
| | - Gonglin Tang
- Department of Urology, Qindao University Medical College Affiliated Yantai Yuhuangding Hospital, No. 20 East Yuhuangding Road, Yantai, Shandong, 264000, China
| | - Gang Wu
- Department of Urology, Qindao University Medical College Affiliated Yantai Yuhuangding Hospital, No. 20 East Yuhuangding Road, Yantai, Shandong, 264000, China
| | - Yongli Chu
- Department of Urology, Qindao University Medical College Affiliated Yantai Yuhuangding Hospital, No. 20 East Yuhuangding Road, Yantai, Shandong, 264000, China
| | - Jitao Wu
- Department of Urology, Qindao University Medical College Affiliated Yantai Yuhuangding Hospital, No. 20 East Yuhuangding Road, Yantai, Shandong, 264000, China.
| | - Yuanshan Cui
- Department of Urology, Qindao University Medical College Affiliated Yantai Yuhuangding Hospital, No. 20 East Yuhuangding Road, Yantai, Shandong, 264000, China.
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Hayat S, Brunckhorst O, Alnajjar HM, Cakir OO, Muneer A, Ahmed K. A systematic review of non-surgical management in Peyronie's disease. Int J Impot Res 2023; 35:523-532. [PMID: 36289392 PMCID: PMC10499596 DOI: 10.1038/s41443-022-00633-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 09/21/2022] [Accepted: 10/03/2022] [Indexed: 11/08/2022]
Abstract
The efficacy of many non-surgical treatments for Peyronie's disease is unclear. This systematic review aims to critically assess the currently available options and provide a recommendation for treatment based on this. A systematic literature search utilising the Medline (Pubmed), Embase, global health and Cochrane library databases was conducted up to May 2021. All randomised controlled trials assessing non-surgical treatment modalities for Peyronie's Disease were included. Individual study risk of bias was evaluated using the Cochrane tool and GRADE was used to assess evidence strength. Outcome measures were the change in penile curvature (degrees), plaque size (volume or size), International Index of Erectile Function score, pain scores and change in penile length. Prospero registration number: CRD42017064618. Amongst the 5549 articles identified, 41 studies (42 reports) were included. Seven different oral treatment options including vitamin E supplementation showed evidence for improving outcomes such as penile curvature and plaque size. Of the intralesional treatments, Collagenase Clostridium Histolyticum showed evidence for improving penile curvature (Range: 16.3-17 degrees, moderate level certainty of evidence). Intralesional Interferon demonstrated some improvement in curvature (Range: 12-13.5 degrees), plaque size (Range: 1.67-2.2 cm2) and pain, whilst intralesional calcium channel blockers such as Verapamil showed variable evidence for changes in the plaque size and pain. Extracorporeal Shockwave Therapy consistently demonstrated evidence for improving penile pain in stable disease, and two mechanical traction devices improved curvature. Iontophoresis, topical medications, and combination therapies did not demonstrate any consistent improvements in outcome measures. Intralesional options demonstrate the best potential. Overall, results varied with few high-quality randomised trials present.
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Affiliation(s)
- Sulaiman Hayat
- MRC Centre for Transplantation, Guy's Hospital Campus, King's College London, King's Health Partners, London, United Kingdom
| | - Oliver Brunckhorst
- MRC Centre for Transplantation, Guy's Hospital Campus, King's College London, King's Health Partners, London, United Kingdom
| | - Hussain M Alnajjar
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Onur Omer Cakir
- Department of Urology, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Asif Muneer
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
- Division of Surgery and Interventional Science, University College London, London, United Kingdom
- NIHR Biomedical Research Centre, University College London Hospital, London, United Kingdom
- Male Genital Cancer Centre, University College London, London, United Kingdom
| | - Kamran Ahmed
- MRC Centre for Transplantation, Guy's Hospital Campus, King's College London, King's Health Partners, London, United Kingdom.
- Department of Urology, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates.
- Khalifa University, Abu Dhabi, United Arab Emirates.
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9
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Roadman D, Wang V, Langbo W, Paddock D, Levine L. Predictors of hinge effect in patients with Peyronie's disease. J Sex Med 2023; 20:1222-1227. [PMID: 37460401 DOI: 10.1093/jsxmed/qdad087] [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: 02/23/2023] [Revised: 06/01/2023] [Accepted: 06/06/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND Patients with Peyronie's disease present with a variety of penile deformities. Those with hinge effect can experience bothersome buckling of the erection and instability during penetrative sex; however, the actual characteristics and clinical implications are not fully understood. AIM To determine the factors that cause hinge effect and to assess the role on surgical intervention. METHODS This retrospective review included 1223 consecutive patients who were examined by a single surgeon and had a complete penile duplex evaluation with curvature and hinge assessment. Baseline demographics, penile duplex findings, and clinical outcomes were used to assess for predictors of hinge effect. OUTCOMES Analyses were performed to assess preoperative predictors of hinge effect and surgical intervention. RESULTS Hinge effect was observed at the time of penile duplex Doppler examination in 33% of patients. Circumferential girth discrepancy at point of indentation (odds ratio [OR] 1.82; P < .001), rigidity of erection (OR, 0.82; P = .002), and degree of primary curvature (OR, 1.03; P < .001) predicted the presence of hinge effect. When controlling for rigidity, a girth discrepancy >1 cm did appear to be associated with a hinge. CLINICAL IMPLICATIONS Circumferential girth discrepancy >1 cm, regardless of erectile rigidity, can be associated with hinge effect. STRENGTHS AND LIMITATIONS As a strength, this study included the largest cohort of patients with Peyronie's disease, all of whom were examined in a rigorous and uniform manner via the same operative counseling. However, the study is limited by its retrospective nature and potential for selection and observer bias, given that the treating physician was also assessing all penile deformities as well as performing operative intervention. CONCLUSIONS The presence of hinge effect can cause instability of erections during penetrative sex. Multiple factors may predispose patients to a hinge effect, including the quality of erection and severity of curvature. But when controlling for rigidity, a girth discrepancy >1 cm did appear to be associated with a hinge. While many factors, such as baseline erectile dysfunction and severity of curvature, are important in determining the optimal surgical intervention, assessing for preoperative hinge effect also influenced the surgical approach.
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Affiliation(s)
- Daniel Roadman
- Department of Urology, Rush University Medical Center, Chicago, IL 60612, United States
| | - Vinson Wang
- The Urology Group, Cincinnati, OH 45212, United States
| | - William Langbo
- Department of Urology, Rush University Medical Center, Chicago, IL 60612, United States
| | - David Paddock
- Department of Urology, Rush University Medical Center, Chicago, IL 60612, United States
| | - Laurence Levine
- Department of Urology, Rush University Medical Center, Chicago, IL 60612, United States
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10
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Shaeer O, Shaeer K. Shaeer's corporal rotation IV: length-preserving correction of congenital ventral penile curvature. J Sex Med 2023; 20:699-703. [PMID: 37122108 DOI: 10.1093/jsxmed/qdad028] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 02/07/2023] [Accepted: 02/12/2023] [Indexed: 05/02/2023]
Abstract
BACKGROUND For cases with severe penile curvature, the loss in length with shortening techniques or the loss in rigidity with incision grafting can compromise the results, hence the advent of Shaeer's corporal rotation III technique, which corrects the most severe degrees of ventral penile curvature without loss in length, though with a certain degree of narrowing. AIM We sought to describe Shaeer's corporal rotation IV, aiming at correction of moderate-to-severe ventral penile curvature with minimal shortening, minimal narrowing, and minimal mobilization of the neurovascular bundle, among other improvements such as using thicker suture material to decease recurrence while inverting the surgical knots. METHODS Forty-two patients with congenital ventral penile curvature were selected for the study with a curve ranging from 60° to 90°. Patients were randomized into 1 of the 2 groups: Shaeer's corporal rotation III (SCR-III) and SCR-IV. In SCR-IV, rotation is used to correct the main brunt of curvature, up to 70% to 80% of the curve. Plication is used to correct the residual curvature up to 100% straightness. This keeps the rotation points fewer and closer to the midline, thereby minimizing narrowing and mobilization of the neurovascular bundle. OUTCOMES Both groups were compared with regard to intraoperative erection angle, length, and girth, before and after rotation, as well as subjectively reported postoperative recurrence, penile sensitivity, satisfaction, and IIEF. RESULTS The postcorrection angle was zero for all cases in the 2 groups. Dorsal length decreased by 3% in the SCR-IV group compared with 0.5% in the SCR-III group (2.5% difference). The difference in circumference between the narrowest and widest points was 2% in the SCR-IV group vs 9.3% in the SCR-III group (7.3% difference). The average operative time was 19.2% shorter with SCR-IV. Girth asymmetry was reported in 1 (4.8%) of 21 patients in the SCR-IV group compared with 15 (71.4%) of 21 in the SCR-III group. Partial hyposensitivity of the penis was reported in 9.5% in the SCR-IV group compared with 19% in the SCR-III group. CLINICAL IMPLICATIONS SCR-IV is an improvement over former versions of the technique, with higher patient satisfaction. STRENGTHS AND LIMITATIONS A strength of the study is the long follow-up period. Limitations include being a single-center study and reliance on patient reporting to evaluate recurrence and satisfaction. CONCLUSION The SCR-IV technique corrects moderate and severe degrees of congenital ventral penile curvature, with little or no compromise in penile length, girth, or sensitivity.
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Affiliation(s)
- Osama Shaeer
- Department of Andrology, Kasr El Aini Faculty of Medicine, Cairo University, Cairo 12311 ARE, Egypt
| | - Kamal Shaeer
- Department of Andrology, Kasr El Aini Faculty of Medicine, Cairo University, Cairo 12311 ARE, Egypt
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11
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Feyisetan O. Peyronie’s Disease: A Brief Overview. Cureus 2023; 15:e37037. [PMID: 37143639 PMCID: PMC10153789 DOI: 10.7759/cureus.37037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2023] [Indexed: 04/04/2023] Open
Abstract
Peyronie's disease is an acquired connective tissue disease of the tunica albuginea of the penis which usually presents with penile curvature/deformity and a palpable penile plaque. It is more common in Caucasian men over the fifth decade of life, but it is an under-reported disease. Conservative and non-surgical options are supported by limited evidence except for intralesional injection of collagenase clostridium histolyticum and have limited success. The improved outcome of surgical treatment is accompanied by the risk of erectile dysfunction. This is a brief overview of Peyronie's disease, its impact on the patient, and the available treatment options.
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Traeger M, Leiber-Caspers C, Chierigo F, Cakir OO, Gratzke C, Schlager D. Penile Autophotography Underestimates the Degree of Penile Curvature in Peyronie's Disease. Eur Urol Focus 2023; 9:64-68. [PMID: 36335039 DOI: 10.1016/j.euf.2022.10.009] [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: 08/15/2022] [Revised: 09/23/2022] [Accepted: 10/21/2022] [Indexed: 02/12/2023]
Abstract
BACKGROUND Penile curvature is the most debilitating symptom of Peyronie's disease (PD); the evaluation of the degree of angulation is essential for planning treatment strategy. However, the most used method of penile at-home autophotography (AHP) is associated with some potential pitfalls and discrepancies compared with different assessment methods. OBJECTIVE To compare the degree of penile curvature quantified by AHP and in-office intracavernosal alprostadil injection (ICI) prior to therapy. DESIGN, SETTING, AND PARTICIPANTS Data from 55 PD patients of a single tertiary referral center were analyzed. All patients provided standardized AHP of the erect phallus. Clinic-based assessment included ICI with curvature measurement and completion of the International Index of Erectile Function (IIEF-15). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The Wilcoxon and/or chi-square test was used to compare the degree of curvature obtained using AHP and ICI, and to evaluate whether erectile dysfunction was a predictor of a relevant difference of >10° in curvature assessment between AHP and ICI. RESULTS AND LIMITATIONS Our study showed a significant (p < 0.001) difference in the degree of penile curvature between AHP (48° [38°; 55°]) and ICI (50° [40°; 65°]). Patients suffering from erectile dysfunction tend to have a higher difference in the degree of penile curvature between AHP and ICI than patients with good erectile function (p < 0.001). Our study is not devoid of limitations. First, we did not use Peyronie's Disease Questionnaire, as suggested by the European Association of Urology guidelines. Second, we did not evaluate inter- and intraobserver variations in the measurements. CONCLUSIONS AHP tends to underestimate the extent of penile curvature compared to ICI. Erectile dysfunction is an independent predictor of measurement differences of >10° between AHP and ICI. PATIENT SUMMARY It is necessary to evaluate the degree of penile curvature in Peyronie's disease prior to therapy decision. The at-home self-photography underestimates the real degree of penile curvature compared with an erection by in-office penile drug injection. Especially men suffering from erectile dysfunction carry the risk of a high difference in the measured degree of penile curvature, with a potential impact on the further treatment.
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Affiliation(s)
- Max Traeger
- Department of Urology, Faculty of Medicine, Medical Center, University of Freiburg, Freiburg, Germany.
| | - Christian Leiber-Caspers
- Department of Urology, Faculty of Medicine, Medical Center, University of Freiburg, Freiburg, Germany; Department of Urology, Alexianer Hospital, Krefeld, Germany
| | - Francesco Chierigo
- Department of Urology, IRCCS San Martino Hospital, University of Genoa, Genoa, Italy
| | - Omer Onur Cakir
- Department of Urology, King's College Hospitals, London, UK; University College London, Division of Surgery & Interventional Science, London, UK
| | - Christian Gratzke
- Department of Urology, Faculty of Medicine, Medical Center, University of Freiburg, Freiburg, Germany
| | - Daniel Schlager
- Department of Urology, Faculty of Medicine, Medical Center, University of Freiburg, Freiburg, Germany
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Trama F, Illiano E, Iacono F, Ruffo A, di Lauro G, Aveta A, Crocetto F, Manfredi C, Costantini E. Use of penile shear wave elastosonography for the diagnosis of Peyronie's Disease: a prospective case-control study. Basic Clin Androl 2022; 32:15. [PMID: 35971058 PMCID: PMC9380314 DOI: 10.1186/s12610-022-00164-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 06/13/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To evaluate the stiffness of the tunica albuginea (TA), we used a new noninvasive diagnostic technique called shear wave elastography (SWE). We determined whether SWE values are correlated with the degree of penile curvature, the time of disease onset, and pain severity experienced by patients during erection. This study analyzed the elasticity of the TA of patients with Peyronie's disease compared to that of the control group. We also analyzed any correlations between the stiffness of the cavernous bodies and the degree of curvature, time from diagnosis to curvature onset, and erectile pain severity. This was a prospective case-control study involving 100 men enrolled from September 2020 to August 2021. Participants were divided into group A (case group, n = 50), which included men with PD, with or without pain, and with penile curvature, or group B (control group, n = 50), which included healthy patients older than 18 years who visited the urology clinic for reasons other than PD. The medical history was collected for all patients who also underwent objective examination, B-mode ultrasound evaluation, and SWE. The International Index of Erectile Function (IIEF-15) visual analog scale (VAS) questionnaire was administered to all participants. RESULTS There were no significant between-group differences regarding age, weight, and height (p > 0.05); however, there was a significant difference in the stiffness values (p < 0.05). An inverse correlation was observed between stiffness and the VAS score (p < 0.0001). A positive correlation was observed between the degree of curvature (p < 0.0001) and the time of curvature onset (p < 0.0001). The IIEF-15 scores were poorer in group A than in group B (p < 0.0001). CONCLUSION SWE is an inexpensive, noninvasive method that can be used to measure the stiffness of PD patients.
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Affiliation(s)
- Francesco Trama
- Andrology and Urogynecology Clinic, Santa Maria Terni Hospital, University of Perugia, Perugia, Italy.
| | - Ester Illiano
- Andrology and Urogynecology Clinic, Santa Maria Terni Hospital, University of Perugia, Perugia, Italy
| | - Fabrizio Iacono
- Department of General and Specialized Surgeries, Intensive Care and Pain Management, Renal Transplantation, University of Federico II, NephrologyNaples, Italy
| | - Antonio Ruffo
- U.O. Urologia, Clinica Nostra Signora Di Lourdes, Massa di Somma, Naples, Italy
| | | | - Achille Aveta
- Department of General and Specialized Surgeries, Intensive Care and Pain Management, Renal Transplantation, University of Federico II, NephrologyNaples, Italy
| | - Felice Crocetto
- Department of General and Specialized Surgeries, Intensive Care and Pain Management, Renal Transplantation, University of Federico II, NephrologyNaples, Italy
| | - Celeste Manfredi
- Department of Woman, Child and General and Specialized Surgery, Urology Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Elisabetta Costantini
- Andrology and Urogynecology Clinic, Santa Maria Terni Hospital, University of Perugia, Perugia, Italy
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Moisés da Silva GV, Dávila FJ, Rosito TE, Martins FE. Global Perspective on the Management of Peyronie's Disease. FRONTIERS IN REPRODUCTIVE HEALTH 2022; 4:863844. [PMID: 36303674 PMCID: PMC9580779 DOI: 10.3389/frph.2022.863844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 04/11/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Peyronie's disease is the disease that results in an alteration in the curvature of the penis, which can lead to a shortening of length, pain in erection, or difficulties in penetration, thus leading the patient to psychological alterations due to loss of functionality such as aesthetic alteration. That is why there are several studies to define the best form of treatment, which currently continues to be the first choice surgical treatment. Objective We present the most recommended therapies for Peyronie's disease and suggest an algorithm as a guide to direct therapy. Methods We used the PubMed platform to review the literature related to Peyronie's disease. Various editorials were reviewed as well as original articles and reviews focusing on the various treatments as well as their indications and results. Results Peyronie's disease in which conservative or drug treatment does not have a response, surgical treatment with corporoplasty, penile prosthesis implantation or both may be indicated. Corporoplasty refers to both the plication of the tunica albuginea as well as the incision of the tunica with the placement of a graft. An accurate history should always be carried out to identify erectile dysfunction as well as to be able to guide you on the repercussions of the treatment. If refractory erectile dysfunction is present, placement of a penile prosthesis with or without further adjunctive straightening maneuvers is recommended. We reviewed the indications, advantages, disadvantages, and results of the available techniques, and proposed a surgical treatment algorithm. 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. An accurate risk/benefit assessment of the individual patient as well as meticulous patient counseling are critically important.
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Affiliation(s)
- Gabriel Veber Moisés da Silva
- Department of Urology, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- *Correspondence: Gabriel Veber Moisés da Silva
| | - Francisco Javier Dávila
- Department of Urology, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Tiago Elias Rosito
- Department of Urology, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Francisco E. Martins
- Department of Urology, University of Lisbon, School of Medicine, Centro Hospitalar Universitario Lisboa Norte (CHULN), Lisbon, Portugal
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Tourchi A, Nascimento B, de Freitas Miranda A, Miranda E, Bessa J, Nahas WC, Filho RS, Srougi M, Machado B. Grafting Area Reduction in Peyronie's Disease Surgery: Comparative Assessment Between Double Y Vs iGrafter APP Using 3D-Printed Penile Models. J Sex Med 2022; 19:669-675. [DOI: 10.1016/j.jsxm.2022.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 12/12/2021] [Accepted: 01/06/2022] [Indexed: 10/19/2022]
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Longo L, Longo D. Laser Photobiomodulation of the Induratio Penis Plastica or La Peyronie's Syndrome. Photobiomodul Photomed Laser Surg 2022; 40:287-291. [DOI: 10.1089/photob.2021.0102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Leonardo Longo
- eCampus University, International Academy for Laser Medicine and Surgery, Institute for Laser Medicine, Firenze, Italy
| | - Diego Longo
- Department of Experimental and Clinical Medicine, Physiological Sciences Unit, University of Florence, Folrence, Italy
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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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18
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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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19
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Ustriyana P, Hennefarth MR, Srirangapatanam S, Jung H, Wang Y, Chen L, Lue TF, Lin G, Kang M, Stoller ML, Ho SP. Mineralized Peyronie's plaque has a phenotypic resemblance to bone. Acta Biomater 2022; 140:457-466. [PMID: 34818578 DOI: 10.1016/j.actbio.2021.11.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 11/14/2021] [Accepted: 11/17/2021] [Indexed: 01/04/2023]
Abstract
Mineralized Peyronie's plaque (MPP) impairs penile function. The association, colocalization, and dynamic interplay between organic and inorganic constituents can provide insights into biomineralization of Peyronie's plaque. Human MPPs (n = 11) were surgically excised, and the organic and inorganic constituents were spatially mapped using multiple high-resolution imaging techniques. Multiscale image analyses resulted in spatial colocalization of elements within a highly porous material with heterogenous composition, lamellae, and osteocytic lacuna-like features with a morphological resemblance to bone. The lower (520 ± 179 mg/cc) and higher (1024 ± 155 mg/cc) mineral density regions were associated with higher (11%) and lower (7%) porosities in MPP. Energy dispersive X-ray and micro-X-ray fluorescent spectroscopic maps in the higher mineral density regions of MPP revealed higher counts of calcium (Ca) and phosphorus (P), and a Ca/P ratio of 1.48 ± 0.06 similar to bone. More importantly, higher counts of zinc (Zn) were localized at the interface between softer (more organic to inorganic ratio) and harder (less organic to inorganic ratio) tissue regions of MPP and adjacent softer matrix, indicating the involvement of Zn-related proteins and/or pathways in the formation of MPP. In particular, dentin matrix protein-1 (DMP-1) was colocalized in a matrix rich in proteoglycans and collagen that contained osteocytic lacuna-like features. This combined materials science and biochemical with correlative microspectroscopic approach provided insights into the plausible cellular and biochemical pathways that incite mineralization of an existing fibrous Peyronie's plaque. STATEMENT OF SIGNIFICANCE: Aberrant human penile mineralization is known as mineralized Peyronie's plaque (MPP) and often results in a loss of form and function. This study focuses on investigating the spatial association of matrix proteins and elemental composition of MPP by colocalizing calcium, phosphorus, and trace metal zinc with dentin matrix protein 1 (DMP-1), acidic proteoglycans, and fibrillar collagen along with the cellular components using high resolution correlative microspectroscopy techniques. Spatial maps provided insights into cellular and biochemical pathways that incite mineralization of fibrous Peyronie's plaque in humans.
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Affiliation(s)
- Putu Ustriyana
- Division of Preclinical Education, Biomaterials & Engineering, Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California San Francisco, CA, United States
| | - Matthew R Hennefarth
- Division of Preclinical Education, Biomaterials & Engineering, Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California San Francisco, CA, United States
| | - Sudarshan Srirangapatanam
- Division of Preclinical Education, Biomaterials & Engineering, Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California San Francisco, CA, United States
| | - Haeyoon Jung
- Division of Preclinical Education, Biomaterials & Engineering, Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California San Francisco, CA, United States
| | - Yongmei Wang
- Division of Preclinical Education, Biomaterials & Engineering, Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California San Francisco, CA, United States
| | - Ling Chen
- Division of Preclinical Education, Biomaterials & Engineering, Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California San Francisco, CA, United States
| | - Tom F Lue
- Department of Urology, School of Medicine, University of California, San Francisco, California, United States
| | - Guiting Lin
- Department of Urology, School of Medicine, University of California, San Francisco, California, United States
| | - Misun Kang
- Division of Preclinical Education, Biomaterials & Engineering, Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California San Francisco, CA, United States
| | - Marshall L Stoller
- Department of Urology, School of Medicine, University of California, San Francisco, California, United States
| | - Sunita P Ho
- Division of Preclinical Education, Biomaterials & Engineering, Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California San Francisco, CA, United States; Department of Urology, School of Medicine, University of California, San Francisco, California, United States.
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20
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Defeudis G, Mazzilli R, Tenuta M, Rossini G, Zamponi V, Olana S, Faggiano A, Pozzilli P, Isidori AM, Gianfrilli D. Erectile dysfunction and diabetes: A melting pot of circumstances and treatments. Diabetes Metab Res Rev 2022; 38:e3494. [PMID: 34514697 PMCID: PMC9286480 DOI: 10.1002/dmrr.3494] [Citation(s) in RCA: 66] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 09/03/2021] [Indexed: 02/06/2023]
Abstract
Diabetes mellitus (DM), a chronic metabolic disease characterised by elevated levels of blood glucose, is among the most common chronic diseases. The incidence and prevalence of DM have been increasing over the years. The complications of DM represent a serious health problem. The long-term complications include macroangiopathy, microangiopathy and neuropathy as well as sexual dysfunction (SD) in both men and women. Erectile dysfunction (ED) has been considered the most important SD in men with DM. The prevalence of ED is approximately 3.5-fold higher in men with DM than in those without DM. Common risk factors for the development of DM and its complications include sedentary lifestyle, overweight/obesity and increased caloric consumption. Although lifestyle changes may help improve sexual function, specific treatments are often needed. This study aims to review the definition and prevalence of ED in DM, the impact of DM complications and DM treatment on ED and, finally, the current and emerging therapies for ED in patients with DM.
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Affiliation(s)
- Giuseppe Defeudis
- Unit of Endocrinology and DiabetesDepartment of MedicineUniversity Campus Bio‐Medico di RomaRomeItaly
| | - Rossella Mazzilli
- Department of Clinical and Molecular MedicineSapienza University of RomeRomeItaly
| | - Marta Tenuta
- Department of Experimental MedicineSapienza University of RomeRomeItaly
| | - Giovanni Rossini
- Unit of Endocrinology and DiabetesDepartment of MedicineUniversity Campus Bio‐Medico di RomaRomeItaly
| | - Virginia Zamponi
- Department of Clinical and Molecular MedicineSapienza University of RomeRomeItaly
| | - Soraya Olana
- Department of Clinical and Molecular MedicineSapienza University of RomeRomeItaly
| | - Antongiulio Faggiano
- Department of Clinical and Molecular MedicineSapienza University of RomeRomeItaly
| | - Paolo Pozzilli
- Unit of Endocrinology and DiabetesDepartment of MedicineUniversity Campus Bio‐Medico di RomaRomeItaly
| | - Andrea M. Isidori
- Department of Experimental MedicineSapienza University of RomeRomeItaly
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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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Miranda A. Auxetic Expansion of the Tunica Albuginea for Penile Length and Girth Restoration Without a Graft: A Translational Study. Sex Med 2021; 9:100456. [PMID: 34753024 PMCID: PMC8766266 DOI: 10.1016/j.esxm.2021.100456] [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: 07/27/2021] [Revised: 09/25/2021] [Accepted: 09/28/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction Several conditions can cause penile length and girth loss. Surgical techniques have been used to restore these penile alterations in patients with severe erectile dysfunction during penile prosthesis implantation. One technique uses multiple small incisions in a mesh pattern (similar to a skin mesh) with satisfactory curvature correction without using a graft, however, this technique does not allow simultaneous increase in penile length and girth. Aim To identify a new surgical technique that increases both the length and girth at the same place on the corpora cavernosa (CC), allowing a simultaneously longitudinal and transverse increase of the tunica albuginea. Methods A sheet with a star-shaped perforation was created using a mathematical model to allow a longitudinal and transversal increase in the material. Two previously published penile model simulators, with and without deformity, were used to test the mechanical modification of this incision pattern in the CC. Main Outcome Measure The effect of the incisions pattern on the geometry of the CC simulator. Results The star-shaped incision (auxetic) simultaneously increased the length, girth, and volume of the CC simulator. This auxetic technique could correct any penile deformity, re-establishing the original penile anatomy. The new auxetic incision is only a conceptual and experimental technique awaiting clinical evidence. Conclusion The data presented here show that the auxetic technique successfully increases both the length and girth at the same place on the CC simulators, opening a new potential solution to correct challenging cases of complex penile deformities and to restore volume loss. Miranda A, Auxetic Expansion of the Tunica Albuginea for Penile Length and Girth Restoration Without a Graft: A Translational Study. Sex Med 2021;9:100456.
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Affiliation(s)
- Alexandre Miranda
- Reconstructive Urology and Andrology Section, Department of Urology, Ipanema Federal, Rio de Janeiro, Brazil.
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Use of grafting materials during penile prosthesis implantation in patients with Peyronie's disease-a systematic review. Int J Impot Res 2021; 34:534-542. [PMID: 34718344 DOI: 10.1038/s41443-021-00479-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 09/28/2021] [Accepted: 10/07/2021] [Indexed: 11/09/2022]
Abstract
Severe Peyronie's disease (PD) and concomitant erectile dysfunction (ED) may require plaque incision/excision and grafting (PIG) as an adjunct to penile prosthesis implantation (IPP). Currently, there is no available consensus on the best graft material to use. Our aim was to systematically review graft materials used as patches following PIG + IPP. Literature search was performed in March 2021. Only original articles in English with a series of 10 or more patients were included. Overall, a total of 17 studies were included, corresponding to a cohort of 662 patients. The mean age ranged from 45 to 65 years and most patients had curvatures >45°. Average penile lengthening ranged from 1 to 3.5 cm, average residual curvatures from 0 to 20% and decreased glans sensitivity from 0 to 20%. Eighty to 100% of patients were satisfied with cosmetic and functional results. PIG + IPP with the use of various grafts offers promising results for the treatment of patients suffering from severe PD with concomitant ED. Unfortunately, the absence of high quality and comparative studies makes it difficult to establish the optimum graft. Therefore, the level of experience of the surgical team with one or more methods should guide their choice.
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Peyronie disease: Our first experience with Ducket Baskin tunica albuginea plication (TAP) technique. Int J Surg Case Rep 2021; 87:106451. [PMID: 34624830 PMCID: PMC8501669 DOI: 10.1016/j.ijscr.2021.106451] [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: 08/16/2021] [Revised: 09/22/2021] [Accepted: 09/22/2021] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Peyronie's Disease is a deformity of the penis. Surgical procedure options for Peyronie's disease treatment include grafting (curvature >60°) or plication (curvature <60°). This case report emphasizes the curvature degree and therapy options chosen, such as tunica albuginea plication instead of grafting. CASE PRESENTATION A 55-year-old male complains about a curved penis during erection. Examination shows penile bending 70° ventrally with ±15 cm length and 2x4cm size. The patient underwent Ducket-Baskin tunica albuginea placation (TAP). Postoperative unbent penis size decrement of ±3 cm, neither pain nor erectile dysfunction felt. CLINICAL DISCUSSION Tunica plication is usually recommended in Peyronie's disease patients with curvature less than 60°, without an hourglass or hinge if grafting is not available. This technique is more simple, safe, the higher success rate of curvature correction (> 80%), low recurrency, low complication rate of penile hypoesthesia (approximately 10%), as well as low risk for postoperative erectile dysfunction. CONCLUSION In our case, the tunica albuginea plication technique gives a good outcome in Peyronie's disease reconstruction.
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25
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Paulis G, Pisano F, Palmieri A, Cai T, Palumbo F, Giammusso B. Urologists' knowledge base and practice patterns in Peyronie's disease. A national survey of members of the italian andrology society. Arch Ital Urol Androl 2021; 93:348-355. [PMID: 34839643 DOI: 10.4081/aiua.2021.3.348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 08/09/2021] [Indexed: 11/23/2022] Open
Abstract
Peyronie's disease is a chronic inflammatory disease involving the formation of plaque in the tunica albuginea of the corpora cavernosa, resulting in penis deformity. It is often associated with penile pain, especially in younger patients, but it is not rare for pain to be absent; the disease is also associated with erectile dysfunction and a depressive state in a large percentage of cases. OBJECTIVE Aim of our study was to explore the basic knowledge base and diagnostic and therapeutic practice patterns in Peyronie's disease (PD) of a large number of physicians belonging to the Italian Andrology Society (SIA). METHODS Our survey is based on two questionnaires which were e-mailed to the members of the SIA. The first questionnaire explored diagnostic and therapeutic practice patterns of SIA physicians, while the second questionnaire focused on their knowledge of the disease, as well as their training and level of experience in the specific field. We then planned to compare our outcomes with similar PD surveys from other countries. RESULTS The first questionnaire was answered by 142 SIA physicians. The second questionnaire was answered by 83 SIA physicians. Most respondents (74.6%) chose penile ultrasonography as first-line diagnostic approach and 47.1% prefer to perform a color Doppler ultrasound after pharmaco-induced erection. Concerning the therapeutic practice patterns in active stage of the disease, most respondents (99.29%) prefer conservative medical therapy. Additionally, most respondents (64.78%), when failure of conservative treatment had been established, considered surgical treatment necessary, specifically corporoplasty, which may be associated with other techniques. CONCLUSIONS The results of our survey show that, in comparison to their foreign counterparts, Italian SIA uro-andrologists have a more proactive diagnostic approach right from when patients first present. When PD is still in its active stage, SIA uro-andrologists mostly opt for medical therapy. In advanced disease or if conservative treatment fails, our survey indicates a greater preference for surgical treatment. Answers to the theoretical knowledge questions showed that SIA physicians have a good understanding of the disease's etiology, epidemiology, and clinical picture, and of the appropriate indications for treatment.
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Affiliation(s)
- Gianni Paulis
- Peyronie's Care Center, Department of Uro-Andrology, Castelfidardo Medical Team, Rome.
| | - Francesca Pisano
- Peyronie's Care Center, Department of Uro-Andrology, Castelfidardo Medical Team, Rome.
| | - Alessandro Palmieri
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples.
| | - Tommaso Cai
- Department of Urology, Santa Chiara Regional Hospital, Trento.
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Mortensen J, Skov-Jeppesen SM, Ladegaard PBJ, Lund L. A Randomized, Single-Blinded Clinical Trial Evaluating the Effect of Extracorporeal Shockwave Treatment (ESWT) as Add-On Therapy to Vacuum Erectile Device on Peyronie's Disease. Res Rep Urol 2021; 13:715-722. [PMID: 34557454 PMCID: PMC8453443 DOI: 10.2147/rru.s325929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 08/16/2021] [Indexed: 11/24/2022] Open
Abstract
Purpose The aim of this study was to investigate whether ESWT with a higher energy as an add-on therapy to vacuum-pump followed by manipulation exercises could reduce the penile curvature, pain and improve IIEF-5 score. Materials and Methods Men aged >18 and <80 years and diagnosed with PD in stable phase with no history of penile surgery or previous ESWT treatment were eligible to participate. They were randomised to either active ESWT (n = 16) or sham ESWT (n = 16). Both groups were treated once a week for five weeks. Each treatment session consisted of 2000 shockwaves at 0.5mJ/mm2. All patients in both groups used a vacuum pump followed by manipulation exercises. Results Thirty men completed the study protocol. Mean age in the treatment group was 61.7 (SD 8.3) and 63 (SD 7.35) in the control group. After six months, mean change in penile curvature was −12.8 (SD 13) degrees in the treatment group and −6.6 (SD 8.9) in the control group (p = 0.204). Mean IIEF-5 score decreased by 0.17 (SD 3) in the treatment group and 3.06 (SD 5.5) in the control group (p = 0.086) at six-month follow-up. Pain was assessed using both VAS and PDQ and demonstrated no difference between the groups after six months (p = 0.648). Conclusion In the treatment group, we observed a greater but non-significant change in penile curvature and no adverse effects.
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Affiliation(s)
- Jonas Mortensen
- Department of Urology, Odense University Hospital, Odense, Denmark
| | - Sune Møller Skov-Jeppesen
- Department of Urology, Odense University Hospital, Odense, Denmark.,Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | | | - Lars Lund
- Department of Urology, Odense University Hospital, Odense, Denmark.,Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
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Extracorporeal Shockwave Therapy in Peyronie's Disease: Systematic Review and Meta-Analysis. J Sex Med 2021; 18:1705-1714. [PMID: 37057504 DOI: 10.1016/j.jsxm.2021.06.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 06/16/2021] [Accepted: 06/21/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Peyronie's disease (PD) is associated with penile pain, deviation, and sexual dysfunction. Up till now, there is no conservative standard treatment for PD. However, the role of Extracorporeal Shock Wave Therapy (ESWT) is gaining increasing interest. AIM To evaluate the effect of ESWT on penile deviation, plaque size, erectile function, pain scale, and the rate of complications in PD patients. METHODS PubMed database was searched for articles published from January 2000 to November 2020, using related keywords and including randomized controlled trials (RCTs) only. Meta-analysis and forest plots were carried out using RevMan, and outcomes were reviewed by 2 authors independently. PRISMA guidelines were used in this article to achieve the quantitative and qualitative synthesis of data. OUTCOMES Changes in penile deviation, plaque size, erectile function, pain scale, and the rate of ESWT related complications. RESULTS The search yielded 73 articles. Three RCTs, including 117 patients in the ESWT group and 121 patients in the placebo group, were reviewed. ESWT is associated with reduction in plaque size (OR = 2.59, 95% CI (1.15-5.85), P= .02). No significant difference in reduction of penile deviation angle or rate of bruises were detected in post ESWT group when compared to placebo. No evidence was found to show an effect of ESWT on erectile function or pain scale. CLINICAL IMPLICATIONS Based on the available RCTs, ESWT fails to improve penile curvature or pain in men with PD. Although ESWT may reduce plaque size, this remains of questionable clinical significance. STRENGTHS & LIMITATIONS RCTs used different metrics to report the same outcome. Missed data were imputed to match the requirements of meta-analysis. However, there is still much data that cannot be estimated. CONCLUSION The current data suggest that ESWT fails to improve penile curvature or pain in men with PD. Although ESWT may reduce plaque size, this remains of questionable clinical significance, and further studies are required to confirm findings. Bakr AM, El-Sakka A. Extracorporeal Shockwave Therapy in Peyronie's Disease: Systematic Review and Meta-Analysis. J Sex Med 2021;18:1705-1714.
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28
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García-Gómez B, Martínez-Salamanca JI, Sarquella-Geli J, Justo-Quintas J, García-Rojo E, Fernández-Pascual E, Ruíz-Castañé E, Romero-Otero J. Peyronie's Disease Questionnaire (PDQ): Spanish translation and validation. Int J Impot Res 2021; 34:501-504. [PMID: 34282285 DOI: 10.1038/s41443-021-00460-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 06/25/2021] [Accepted: 07/06/2021] [Indexed: 11/09/2022]
Abstract
The Peyronie's Disease Questionnaire (PDQ) is a 15-question self-reported questionnaire that evaluates the severity and physical and psychosexual issues of Peyronie's disease (PD) symptoms in three scales: "psychological and physical symptoms," "penile pain," and "symptom bother." Previous studies validated the PDQ US version and confirmed its test-retest reliability and responsiveness. The aim is to translate and validate the Spanish version of the PDQ to be used in the clinical practice and in PD research studies in Spain. A non-interventional, observational study with 160 PD patients was conducted. Patients included from four healthcare centers in Spain and completed the PDQ in two study visits separated for a period of 4-7 days from March 2018 to June 2019. Patients received no type of treatment or intervention. Different statistical tests were applied to the data in order to validate the structural and construct of the PDQ, as well as its internal reliability, temporal stability reliability, reliability between observers, and test-retest reliability. Cronbach's alpha over 0.9 showed good internal consistency. We found an ICC agreement of 0.82 (test-retest) for the three scales of the Spanish version of the PDQ, which demonstrates good reliability. When comparing Visit 1 and Visit 2 questionnaires mean scores, the PDQ showed non-significant differences, as expected because no intervention or treatment was administered to the patients between visits. Translation and validation of the PDQ for the Spanish population makes available a valid, useful, and reliable tool to properly evaluate quality of life of men suffering PD.
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Affiliation(s)
- Borja García-Gómez
- Urology Department, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
| | | | | | | | - Esther García-Rojo
- Urology Department, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
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Melgarejo-Segura MT, Funes-Padilla C, Morales-Martínez A, López-Carmona-Pintado F, Arrabal-Martín M. Safety and Efficacy Study of Collagenase Clostridium Histolyticum Applied With an Intensive Protocol in the Treatment of Peyronie's Disease. Sex Med 2021; 9:100375. [PMID: 34091243 PMCID: PMC8240339 DOI: 10.1016/j.esxm.2021.100375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 03/06/2021] [Accepted: 04/03/2021] [Indexed: 11/28/2022] Open
Abstract
Introduction Collagenase clostridium histolyticum (CCH) is a treatment for Peyronie's disease (PD) whose efficacy and safety has been demonstrated using a classic protocol and a shortened protocol. Aim To evaluate the efficacy and safety of an even more intense protocol in which a CCH injection is applied for 3 separate cycles of 1 week. Methods Prospective, nonrandomized, clinical study of a cohort of 13 patients with PD and non-ventral curvatures, between 30 and 90 degrees and with stable disease were included. Under local anesthesia, 0.9 mg of CCH is infiltrated in 3 parallel and equidistant transverse bands across the plaque in 3 sessions separated by 1 week. Between sessions the patient is instructed to perform home modeling and penis stretching. Main Outcome Measures The measurements collected were from girth, length of the penis and length of the plaque. Side and degree of curvature. Ultrasound evaluation of the plaque characteristics and assessing the interface between the tunica albuginea and Buck's fascia. Furthermore, questionnaires were collected: International Index of Erectile Function (IIEF) and 15-question and Peyronie's Disease Questionnaire (PDQ). All these parameters were evaluated before and after treatment. Results An improvement in curvature was obtained in 76.9% of patients, reaching an improvement in the angle of curvature after the treatment cycles by an average of 19 ° (range 0-35 °) from the beginning. There are also improvements in the results of the IIEF and PDQ questionnaires. Length, penis girth, and plate length measurements hardly changed after treatment. Reported adverse effects are mild and limited to the penis. Conclusions We demonstrate the safety and efficacy of CCH in the treatment of PD using a more intense protocol than the previous ones. In addition, reducing the overall duration of allows for greater adherence and compliance of patients. Melgarejo-Segura MT, Funes-Padilla C, Morales-Martínez A, et al. Safety and Efficacy Study of Collagenase Clostridium Histolyticum Applied With an Intensive Protocol in the Treatment of Peyronie's Disease. Sex Med 2021;9:100375.
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Rico L, Villasante N, Blas L, Bonnano N, Ameri C. Initial experience in the treatment of Peyronie’s disease using testicular vaginal tunica graft. JOURNAL OF CLINICAL UROLOGY 2021. [DOI: 10.1177/20514158211016646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Peyronie’s disease (PD) is a progressive disorder of the connective tissue of the tunica albuginea of the penis that produces an abnormal curvature, painful erections and different degrees of erectile dysfunction (ED). The aim of this study is to evaluate our initial experience in the surgical treatment of PD using an autologous graft of testicular vaginal tunica. Materials and methods: A retrospective study of 23 patients was carried out between 2015 and 2019. The successful surgical stretching rate was defined as a functional 20 degrees of curvature or less. Postoperative sexual function and complications rate were evaluated as secondary objectives. We used the abbreviated IIEF-5 questionnaire and evaluated the sexual function before and after the surgical procedure. Wilcoxon signed-rank test for paired samples (U test) was used, considering a value of p<0.05 to be statistically significant. Results: Only one patient presented a recurrence of the penile curvature, resulting in a 95.6% success rate of functional stretching. We observed a 1.6 and 0.9 difference between pre- and postoperative total score and satisfaction ( p = 0.002 and p = 0.003 respectively) Conclusion: In this series, the use of testicular vaginal tunic was found to be safe and effective with a significant change in the quality of sexual life, especially reflected in the overall satisfaction after the procedure and a low rate of complications. Level of evidence: Not applicable for this multicentre audit.
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Affiliation(s)
- Luis Rico
- Hospital Aleman de Buenos Aires, Argentina
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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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Simon DP, Alter K, Bajic P, Levine LA. Device profile of the Ambicor two-piece inflatable penile prosthesis for treatment of erectile dysfunction: overview of its safety and efficacy. Expert Rev Med Devices 2020; 18:9-14. [DOI: 10.1080/17434440.2021.1853524] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Daniel P. Simon
- Division of Urology, Rush University Medical Center, Chicago, IL, USA
| | - Kevin Alter
- Rush Medical College, Rush University Medical Center, Chicago, IL, USA
| | - Petar Bajic
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
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Deebel NA, Scarberry K, Dutta R, Matz E, Terlecki RP. Salvage Penile Plication Is an Effective Modality for Resolving Residual Curvature After Surgery for Peyronie's Disease. Sex Med 2020; 8:686-690. [PMID: 33036958 PMCID: PMC7691978 DOI: 10.1016/j.esxm.2020.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 07/25/2020] [Accepted: 09/03/2020] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Penile plication is highly successful in appropriately selected patients with Peyronie's disease; however, a minority of patients experience residual curvature or delayed recurrence of curvature. Revision surgery outcomes are seldomly reported. AIM To determine the efficacy of salvage penile plication for the correction of residual and recurrent curvature. METHODS Our institutional review board-approved prospective single-surgeon database of patients with Peyronie's disease was reviewed for cases performed from 2011 to 2019. Patients requiring salvage procedures were analyzed. A successful salvage was defined by residual curvature <20° with patient-reported satisfaction. Potential etiologies for initial plication failure were examined. MAIN OUTCOME MEASURE The outcomes of this study are subjective and patient-reported success of salvage plication. RESULTS Data analysis identified 134 men treated surgically for Peyronie's disease. Management involved plication in 105 (78.4%), incision and grafting in 14 (10.4%), excision and grafting with inflatable penile prosthesis in 7 (5.2%), plication with inflatable penile prosthesis in 6 (4.5%), or grafting, plication, and inflatable penile prosthesis in 2 (1.5%). Mean preoperative degree of curvature before initial surgery was 55° (30°-90°). Of this cohort, 5.2% (n=7) required salvage plication for a median residual or recurrent curvature of 45° (35°-90°). Initially, 3 men (43%) received an 8-dot plication, 3 (43%) underwent 16-dot plication, and 1 (14%) received plaque incision and grafting. Among salvage patients, 4 (57%) had initially satisfying results followed by recurrence of curvature and 3 (43%) desired correction of residual curvature. Salvage plication entailed an 8-dot plication in 3 (42.9%) and a 16-dot plication procedure in 4 (57.1%). The median time to salvage surgery was 9 (3-15) months, with all patients showing intraoperative resolution of curvature. At a median follow-up of 12 (1-20) months, 6 (85.7%) patients reported satisfaction with residual curvature <20°. CONCLUSION Patients with residual or delayed recurrence of curvature after plication for Peyronie's disease can be effectively managed with salvage plication. Deebel NA, Scarberry K, Dutta R, et al. Salvage Penile Plication Is an Effective Modality for Resolving Residual Curvature After Surgery for Peyronie's Disease. Sex Med 2020;8:686-690.
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Affiliation(s)
- Nicholas A Deebel
- Department of Urology, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Kyle Scarberry
- Department of Urology, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Rahul Dutta
- Department of Urology, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Ethan Matz
- Department of Urology, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Ryan P Terlecki
- Department of Urology, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA.
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Comparing Outcomes of Grafts Used in Peyronie’s Disease Surgery: a Systematic Review. CURRENT SEXUAL HEALTH REPORTS 2020. [DOI: 10.1007/s11930-020-00283-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Jensen CFS, Jacobsen FM, Quallich S, Fode M, Sønksen J, Malaeb BS, Ohl DA. Patient‐reported outcomes from a single‐centre prospective post‐marketing study on Collagenase
Clostridium Histolyticum
injections for Peyronie's disease. Andrologia 2020; 52:e13733. [DOI: 10.1111/and.13733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/23/2020] [Accepted: 06/05/2020] [Indexed: 11/26/2022] Open
Affiliation(s)
- Christian Fuglesang S. Jensen
- Department of Urology, Herlev and Gentofte Hospital University of Copenhagen Copenhagen Denmark
- Department of Urology University of Michigan Ann Arbor MI USA
| | - Frederik M. Jacobsen
- Department of Urology, Herlev and Gentofte Hospital University of Copenhagen Copenhagen Denmark
| | | | - Mikkel Fode
- Department of Urology, Herlev and Gentofte Hospital University of Copenhagen Copenhagen Denmark
| | - Jens Sønksen
- Department of Urology, Herlev and Gentofte Hospital University of Copenhagen Copenhagen Denmark
| | - Bahaa S. Malaeb
- Department of Urology University of Michigan Ann Arbor MI USA
| | - Dana A. Ohl
- Department of Urology University of Michigan Ann Arbor MI USA
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Cocci A, Di Maida F, Russo GI, Capogrosso P, Francesco L, Rizzo M, Di Mauro M, Salonia A, Cito G, Falcone M, Romano A, Polloni G, Martinez-Salamanca JI, Fernández-Pascual E, Minervini A, Mondaini N. Efficacy of Collagenase Clostridium histolyticum (Xiapex ®) in Patients with the Acute Phase of Peyronie's Disease. Clin Drug Investig 2020; 40:583-588. [PMID: 32342279 DOI: 10.1007/s40261-020-00916-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND OBJECTIVE: Plaque formation ordinarily takes place in the acute phase of Peyronie's disease. There is no unanimous consent regarding the management of the acute phase of Peyronie's disease. The objective of this study was to evaluate the advantages of using a single intralesional injection of collagenase Clostridium histolyticum in patients with the active phase of Peyronie's disease and to assess its effect on disease progression by reducing penile curvature and ameliorating pain during sexual intercourse. METHODS Sexually active men aged older than 18 years with the acute phase of Peyronie's disease were enrolled. All patients received treatment with a single intralesional injection of collagenase Clostridium histolyticum. The primary outcome of the study was the change in penile curvature after treatment while secondary outcomes were the change in sexual function (International Index of Erectile Function [IIEF-5]) and in the Peyronie Disease Questionnaire (PDQ) and its sub-scores, PDQ-PS (psychological symptoms), PDQ-PP (penile pain) and PDQ-BD (bother disease). RESULTS Overall, 74 patients were enrolled. Mean penile curvature at baseline was 41.1° ± 12.2°. The mean changes before and at the 3-month evaluation in terms of penile curvature, Visual Analog Scale score at rest, and Visual Analog Scale score during intercourse were - 19.3 ± 8.4 (p < 0.0001), - 0.8 ± 1.1 (p < 0.0001) and - 3.8 ± 0.9 (p < 0.0001) with the benefit persisting also after 6 months. Moreover, improvements of mean IIEF-5 score (1.1 ± 0.9, p = 0.03; 0.9 ± 0.5, p = 0.02), PDQ-PS (- 2.7 ± 2.2; - 2.5 ± 2.0, p = 0.01), PDQ-PP (- 1.2 ± 1.6; - 1.1 ± 1.2, p = 0.02) and PDQ-BD (- 3.8 ± 3.4; - 3.5 ± 3.1, p = 0.001) were observed 3 and 6 months after the end of treatment, respectively. At the multivariable regression analysis, the time since disease onset (modelled with non-linear terms) and baseline curvature were independently associated with the degree of curvature improvement (coefficient: 0.30; 95% confidence interval 0.16-0.44) after a single intralesional injection (all p < 0.03). CONCLUSIONS Although intralesional therapy with collagenase Clostridium histolyticum is not yet indicated for the acute phase of Peyronie's disease, these preliminary results suggest the effectiveness of this minimally invasive option by improving penile curvature and IIEF-5 and PDQ scores.
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Affiliation(s)
- Andrea Cocci
- Department of Urology, Careggi Hospital, University of Florence, Viale S. Luca, 50134, Florence, FI, Italy
| | - Fabrizio Di Maida
- Department of Urology, Careggi Hospital, University of Florence, Viale S. Luca, 50134, Florence, FI, Italy.
| | - Giorgio Ivan Russo
- Urology Section, Department of Surgery, University of Catania, Catania, Italy
| | - Paolo Capogrosso
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Lotti Francesco
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Michele Rizzo
- Department of Urology, University of Trieste, Trieste, Italy
| | - Marina Di Mauro
- Urology Section, Department of Surgery, University of Catania, Catania, Italy
| | - Andrea Salonia
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Gianmartin Cito
- Department of Urology, Careggi Hospital, University of Florence, Viale S. Luca, 50134, Florence, FI, Italy
| | - Marco Falcone
- Urology Clinic, A.O.U. Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Andrea Romano
- Department of Urology, Careggi Hospital, University of Florence, Viale S. Luca, 50134, Florence, FI, Italy
| | | | | | - Esaù Fernández-Pascual
- Department of Urology, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Andrea Minervini
- Department of Urology, Careggi Hospital, University of Florence, Viale S. Luca, 50134, Florence, FI, Italy
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Ragheb A, Eraky A, Osmonov D. A decade of grafting techniques as a sole treatment for Peyronie's disease. Andrology 2020; 8:1651-1659. [PMID: 32623827 DOI: 10.1111/andr.12857] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 06/27/2020] [Accepted: 06/27/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Peyronie's disease (PD) can be a cosmetically and functionally devastating condition. Surgical approaches have been proposed in the chronic stages of PD as plication or plaque incision/excision with grafting to preserve penile size in complex cases. Although several surgeons nowadays are inclined toward the utilization of non-autologous grafts owing to the ease of their preparation and availability, synthetic graft procedures still await more technical improvements and supporting evidence before their consideration for standard care. OBJECTIVES In this review, our goal is to facilitate an insight into the most promising grafting materials used for the management of PD and techniques associated. MATERIALS AND METHODS A PubMed review was conducted for all the studies on our topic within the past ten years (January 2009 until December 2019). The outcome parameters we documented and compared comprised of operative time, follow-up time, postoperative penile cosmesis and function, and, finally, overall patient satisfaction related to each technique. RESULTS Our search yielded 23 English-written original study articles in addition to a single case report on the various grafting techniques utilized as the sole treatment for PD, each demonstrating different outcomes and points of comparison. CONCLUSION A successful grafting procedure for PD requires an appropriately tailored surgical modality and an experienced surgeon. Nevertheless, proper preoperative patient counseling on all aspects of his condition and opted treatment modality while setting clear and realistic expectations remains key for overall patient satisfaction.
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Affiliation(s)
- Ahmed Ragheb
- Department of Urology and Pediatric Urology, University Hospital Schleswig Holstein, Kiel, Germany.,Department of Urology, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| | - Ahmed Eraky
- Department of Urology and Pediatric Urology, University Hospital Schleswig Holstein, Kiel, Germany
| | - Daniar Osmonov
- Department of Urology and Pediatric Urology, University Hospital Schleswig Holstein, Kiel, Germany
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Harvey N, Pearce I. At what cost is collagenase clostridium histolyticum viable for treating Peyronie's disease in a public healthcare system? Andrology 2020; 8:1304-1311. [DOI: 10.1111/andr.12830] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 05/19/2020] [Accepted: 05/21/2020] [Indexed: 01/30/2023]
Affiliation(s)
- Neil Harvey
- Urology Department Stepping Hill Hospital Stockport NHS Foundation Trust Poplar Grove UK
| | - Ian Pearce
- Urology Department Manchester Royal Infirmary Manchester University Hospitals Foundation Trust Manchester UK
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Segundo A, Glina S. Prevalence, Risk Factors, and Erectile Dysfunction Associated With Peyronie's Disease Among Men Seeking Urological Care. Sex Med 2020; 8:230-236. [PMID: 32007472 PMCID: PMC7261680 DOI: 10.1016/j.esxm.2019.11.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 10/27/2019] [Accepted: 11/03/2019] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION Peyronie's disease (PD) is a connective tissue disorder of the penis characterized by an abnormality in collagen structure of penile tunica albuginea. AIM We sought to investigate the prevalence, risk factors, and the relationship between erectile dysfunction (ED) and PD in male patients aged 30-80 years seeking urological care. METHODS This is a cross-sectional study using data collected from October 2016 to October 2017 in an outpatient clinic associated with the Brazilian Public Health System. All men aged 30 to 80 years were invited to participate. Data collected were related to the clinical history and sexual habits of patients using the International Index of Erectile Function, in addition to the physical examination of the penis and laboratory parameters. MAIN OUTCOME MEASURE Descriptive statistics and multivariate logistic regression models tested the prevalence, risk factors, and the relationship between ED and PD in male patients. RESULTS The study included 656 individuals, who were distributed as per age, marital status, race, educational level, and income. Of these participants, 86 (13.11%) presented with fibrous plaques compatible with PD at the physical examination. Among the risk factors evaluated, PD was associated with diabetes, smoking, and obesity in 43.02, 64.17, and 26.74% of patients, respectively. The presence of penile plaques compatible with PD was more prevalent in men with ED, history of penile trauma, and complaint of penile deformity. There was a higher prevalence of plaques in the distal penis. CONCLUSION The PD among the studied population was associated with risk factors such as diabetes, smoking, and obesity. Other clinical characteristics, such as history of penile trauma, penile deformity, and ED, were reported in patients with PD. There was a higher prevalence of plaques in the distal penis, specifically in the corona of the glans penis. The prevalence of PD was different from that in the published literature, our results show that numbers thus more studies are needed. Segundo A, Glina S. Prevalence, Risk Factors, and Erectile Dysfunction Associated With Peyronie's Disease Among Men Seeking Urological Care. Sex Med 2020;8:230-236.
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Affiliation(s)
- Antonio Segundo
- Department of Urology, Faculdade Medicina ABC, Santo André, Brazil.
| | - Sidney Glina
- Department of Urology, Faculdade Medicina ABC, Santo André, Brazil
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Fernández-Pascual E, Quintana Franco L, Fraile Poblador A, Martínez-Ballesteros C, Martínez-Salamanca J. Complex Peyronie's disease cases: surgery with or without penile prosthesis placement. Actas Urol Esp 2020; 44:351-356. [PMID: 32303370 DOI: 10.1016/j.acuro.2020.01.008] [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: 10/16/2019] [Accepted: 01/24/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION AND OBJECTIVE Surgery is the treatment of choice for patients with Peyronie's disease presenting difficulty in penetration or erectile dysfunction without adequate response to therapy. Several techniques have been described, and urologists must be aware of their possible complications and sequelae in order to offer the patient the best possible alternative. PATIENTS AND METHODS Three complex cases of patients with Peyronie's disease are presented. The first case exposes a complication after penile plication for the treatment of a major dorsal curve. The second case refers to difficult anal penetration secondary to a problem of erection direction after plaque incision surgery with oral mucosa grafting. The last case is a patient with a late post-operative complication of a three-piece prosthesis placement with plaque incision and equine collagen patch. RESULTS Surgical options for each case are detailed and discussed. After patients were informed, the decision was taken in a consensual manner. CONCLUSIONS Surgery for Peyronie's disease requires the urologist's consideration of the functional, aesthetic and psychological spheres. A systematic approach to all of these avoids complications, sequels and improves results.
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About the drawback of collagenase. Int J Impot Res 2020; 33:570-571. [PMID: 32317742 DOI: 10.1038/s41443-020-0286-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 03/22/2020] [Accepted: 04/09/2020] [Indexed: 01/19/2023]
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Ruellas da Silva T, Barrela Neto M, Damião R, da Silva Ruellas EA. A universal mathematical model applied to the congenital ventral penile curvature. Clin Anat 2020; 33:906-910. [PMID: 32239554 DOI: 10.1002/ca.23594] [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: 01/29/2019] [Revised: 02/27/2020] [Accepted: 03/21/2020] [Indexed: 11/07/2022]
Abstract
INTRODUCTION The macroscopic dynamic of fetal penis development presents a pattern resembling the unfolding of a spiral, so congenital ventral penile curvature could indicate that this natural sequence has been interrupted. Our aim in this article is to offer a mathematical model of congenital ventral curvature of the penis. MATERIALS AND METHODS Five individuals who presented with congenital ventral penile curvature and three who presented with acquired penile ventral curvature due to Peyronie's disease were evaluated. The penises were photographed during an induced erection test and the penile curvature patterns were compared with an equiangular spiral. When an association was found, a potential relationship to the golden spiral-a type of equiangular spiral-was also assessed. The mathematical spiral relationships were analyzed using Wolfram CDF Player® (Logarithmic Spiral) and PhiMatrix® software. The Wolfram software generated logarithmic spirals equivalent to the penile curvature with appropriate mathematical values. The PhiMatrix software, which builds any golden spirals from golden rectangles, was used to check whether the spiral was golden as well as equiangular. RESULTS An equiangular spiral that was also golden was found in all cases of congenital ventral penile curvature. In contrast, none of the acquired penile ventral curvature cases showed a specific pattern. CONCLUSION Congenital ventral penile curvature has the mathematical pattern of a golden spiral. Our results offer a mathematical algorithm for potential use in surgical reconstruction procedures, regenerative medicine, tissue engineering, robotics, and body-machine interfaces.
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Affiliation(s)
- Tamiris Ruellas da Silva
- Service of Urology, Pedro Ernesto Memorial Hospital, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Miguel Barrela Neto
- Service of Urology, Pedro Ernesto Memorial Hospital, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Ronaldo Damião
- Service of Urology, Pedro Ernesto Memorial Hospital, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Eloísio A da Silva Ruellas
- Service of Urology, Pedro Ernesto Memorial Hospital, Rio de Janeiro State University, Rio de Janeiro, Brazil
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Abdessater M, Kanbar A, Gas J, Bart S, Coloby P, Beley S, Sleiman W. [Non-surgical management of Peyronie's disease: State of current knowledge]. Prog Urol 2020; 30:353-364. [PMID: 32279954 DOI: 10.1016/j.purol.2020.03.002] [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: 12/14/2019] [Revised: 02/01/2020] [Accepted: 03/05/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Peyronie's disease is an inflammatory disorder of the penis, where scar tissue creates a plaque at the level of the albuginea, limits its extension, and leads to a bent and shorter penis during erections. There are no international standards for the evaluation and the treatment of the disease. The aim of this article is to review the current knowledge about the management of Peyronie's disease and to suggest an algorithm to help physicians evaluate and manage this condition. MATERIAL AND METHODS A literature review was conducted through PubMed database following PRISMA guidelines using the Mesh terms: Peyronie, disease, treatment and diagnosis. Results are presented in a descriptive manner. RESULTS Multiple treatment strategies have been proposed, but no conclusive randomized clinical trial is done to assess their efficacies. The oral treatment was shown to be more beneficial in the setting of a multi-modal approach to treat the acute phase. The non-steroidal anti-inflammatories and the potassium para-aminobenzoate are superior to the other molecules of oral therapy for pain management. Local treatment with topical verapamil, iontophoresis and intra-lesional injection of verapamil, interferon alfa-2b and collagenase clostridium histolyticum (CCH) revolutionized the management of the disease by the modification of the plaque size and angulation. Alternative treatments using extra-corporeal shock wave or traction devices are promising. Intra-lesional injection of CCH is the only therapy approved by the Food and Drug Administration for this condition after the stabilization of the disease. The channeling of the plaque before CCH injections is making better results than the initial protocol, concerning angulation improvement. CONCLUSION Multiple therapeutic strategies exist for the management of the Peyronie's disease, but they lack evidence based data. Further randomized clinical trials are needed to evaluate the current practices and to study more efficient treatments.
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Affiliation(s)
- M Abdessater
- Service d'urologie et de transplantation rénale, hôpital universitaire Pitié-Salpêtrière, AP-HP, Paris, France.
| | - A Kanbar
- Service d'urologie, groupe hospitalier diaconesses, Croix-Saint-Simon, Paris, France
| | - J Gas
- Département d'urologie, andrologie et transplantation rénale, centre hospitalier universitaire de Toulouse, Toulouse, France
| | - S Bart
- Service d'urologie, centre hospitalier René-Dubos, Pontoise, France
| | - P Coloby
- Service d'urologie, centre hospitalier René-Dubos, Pontoise, France
| | - S Beley
- Service d'urologie, groupe hospitalier diaconesses, Croix-Saint-Simon, Paris, France
| | - W Sleiman
- Service d'urologie, centre hospitalier René-Dubos, Pontoise, France
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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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Ahn ST, Lee DH, Jeong HG, Kim JW, Moon DG. Scrotal septum detachment during penile plication to compensate for loss of penile length compared with conventional surgical technique. Investig Clin Urol 2020; 61:224-230. [PMID: 32158974 PMCID: PMC7052414 DOI: 10.4111/icu.2020.61.2.224] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 11/04/2019] [Indexed: 11/29/2022] Open
Abstract
Purpose To evaluate the efficacy and safety of penile elongation featuring simple scrotal septum detachment from the penile base to compensate for the loss of penile length during penile plication in patients with Peyronie's disease compared with conventional penile plication. Materials and Methods We conducted a retrospective analysis of 38 patients (24–75 years of age) with Peyronie's disease who underwent penile plication with or without our novel technique from January 2009 to May 2018. Penile elongation was achieved by release and detachment of the scrotal septum from the penile base to the level of the scrotal fat tissue. The objective outcome of change in stretched penile length (SPL) and the subjective outcome of patient perception of postoperative penile length were compared between groups. Any postoperative complications were recorded. Results Of the 38 patients, 16 underwent penile plication with scrotal septum detachment (elongation group) and 22 underwent penile plication only (conventional group). The postoperative mean SPL was increased in the elongation group and decreased in the conventional group (1.2±1.3 cm vs. −0.5±0.3 cm, p<0.001). Fourteen of 16 patients (87.5%) in the elongation group reported perceived penile lengthening after surgery, whereas 17/22 patients (77.3%) in the conventional group complained of penile shortening. We encountered no procedure-related complications such as hematoma, infection, or necrosis in either group. Conclusions Simple detachment of the scrotal septum from the penile base afforded both objective and subjective penile elongation without any severe complications compared with conventional penile plication.
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Affiliation(s)
- Sun Tae Ahn
- Department of Urology, Korea University Guro Hospital, Seoul, Korea
| | - Dong Hyun Lee
- Department of Urology, Korea University Guro Hospital, Seoul, Korea
| | - Hyeong Guk Jeong
- Department of Urology, Korea University Guro Hospital, Seoul, Korea
| | - Jong Wook Kim
- Department of Urology, Korea University Guro Hospital, Seoul, Korea
| | - Du Geon Moon
- Department of Urology, Korea University Guro Hospital, Seoul, Korea
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Capece M, Arcaniolo D, Manfredi C, Palmieri A, De Sio M, Verze P, Fusco F, Longo N, Mirone V. Second cycle of intralesional Collagenase Clostridium histolyticum for Peyronie's disease using the modified shortened protocol: Results from a retrospective analysis. Andrologia 2020; 52:e13527. [PMID: 32003061 DOI: 10.1111/and.13527] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 12/16/2019] [Accepted: 12/31/2019] [Indexed: 01/30/2023] Open
Abstract
The purpose of this study was to evaluate the effectiveness and safety of the second cycle of Collagenase Clostridium histolyticum injections using the modified shortened protocol. We performed a retrospective analysis on patients who had already undergone the first cycle of injections using the modified shortened protocol and requested more injections to improve the remaining curvature. The International Index of Erectile Function, the Peyronie's Disease Questionnaire and the Global Assessment of Peyronie's Disease questionnaire were self-administered to all patients. All the parameters were recorded at baseline, after the first cycle and after the second cycle of injections. All adverse events were recorded. Seventeen patients completed two cycles of injections. All patients had a reduction of the initial curvature after the first cycle, with a mean improvement of 17.4° (27.4%). After the second cycle, the reduction of the curvature was 7.9° (17.1%), and 29.4% of patients had no further improvement. No severe side effect was recorded. The results of the present study confirm the effectiveness and safety of the modified shortened protocol of Collagenase C. histolyticum injections for Peyronie's disease. However, the second cycle of three injections may be less effective, and patients may not be completely satisfied.
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Affiliation(s)
- Marco Capece
- Urology Unit, Department of Neurosciences, Reproductive Sciences, and Odontostomatology, University of Naples "Federico II", Naples, Italy
| | - Davide Arcaniolo
- Urology Unit, Department of Woman Child and of General and Specialist Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Celeste Manfredi
- Urology Unit, Department of Neurosciences, Reproductive Sciences, and Odontostomatology, University of Naples "Federico II", Naples, Italy.,Urology Unit, Department of Woman Child and of General and Specialist Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Alessandro Palmieri
- Urology Unit, Department of Neurosciences, Reproductive Sciences, and Odontostomatology, University of Naples "Federico II", Naples, Italy
| | - Marco De Sio
- Urology Unit, Department of Woman Child and of General and Specialist Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Paolo Verze
- Urology Unit, Department of Neurosciences, Reproductive Sciences, and Odontostomatology, University of Naples "Federico II", Naples, Italy
| | - Ferdinando Fusco
- Urology Unit, Department of Neurosciences, Reproductive Sciences, and Odontostomatology, University of Naples "Federico II", Naples, Italy
| | - Nicola Longo
- Urology Unit, Department of Neurosciences, Reproductive Sciences, and Odontostomatology, University of Naples "Federico II", Naples, Italy
| | - Vincenzo Mirone
- Urology Unit, Department of Neurosciences, Reproductive Sciences, and Odontostomatology, University of Naples "Federico II", Naples, Italy
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Vieiralves RR. Editorial Comment: Low-Intensity Shock Wave Therapy in Sexual Medicine-Clinical Recommendations. Int Braz J Urol 2019; 46:134-135. [PMID: 31851474 PMCID: PMC6968905 DOI: 10.1590/s1677-5538.ibju.2020.01.09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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DiGiorgio L, Mendez M, Parker J, Carrion R. Surgical Techniques and Pitfalls for Excision and Grafting. CURRENT SEXUAL HEALTH REPORTS 2019. [DOI: 10.1007/s11930-019-00207-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Intraoperative methods for residual curvature correction during penile prosthesis implantation in patients with Peyronie's disease and refractory erectile dysfunction. Int J Impot Res 2019; 32:43-51. [PMID: 31754245 DOI: 10.1038/s41443-019-0215-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 09/27/2019] [Accepted: 11/05/2019] [Indexed: 12/27/2022]
Abstract
Peyronie's disease, or fibrous transformations of the tunica albuginea of the corpora cavernosa that cause penile curvature, is estimated to affect 3.2-8.9% of the male population. Treatment options for PD are based on the severity of the penile deformity and erectile function; of which surgical options include manual modeling during penile prosthesis implantation, plication, plaque incision, and grafting. Multiple approaches may be employed; each with its own advantages, limitations, and risk/benefit ratios. In this regard, we sought to review and highlight the current approaches for the management of residual curvature, optimal patient selection, and preoperative planning.
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