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Rosenberg JE, Ergun O, Hwang EC, Risk MC, Jung JH, Edwards ME, Blair Y, Dahm P. Non-surgical therapies for Peyronie's disease. Cochrane Database Syst Rev 2023; 7:CD012206. [PMID: 37490423 PMCID: PMC10351344 DOI: 10.1002/14651858.cd012206.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
BACKGROUND Peyronie's disease is a condition that results in the development of penile plaques that can lead to penile curvature, pain, and erectile dysfunction, making sexual activity difficult. A number of non-surgical interventions exist to improve this condition, which include topical and injection agents as well as mechanical methods; however, their effectiveness remains uncertain. We performed this review to determine the effects of these non-surgical treatments. OBJECTIVES To assess the effects of non-surgical therapies compared to placebo or no treatment in individuals with Peyronie's disease. SEARCH METHODS We performed a comprehensive search using multiple databases (the Cochrane Library, MEDLINE, Embase, Scopus, Google Scholar, and Web of Science), trials registries, other sources of grey literature, and conference proceedings, up to 23 September 2022. We applied no restrictions on publication language or status. SELECTION CRITERIA We included trials in which men with Peyronie's disease were randomized to undergo non-surgical therapies versus placebo or no treatment for penile curvature and sexual function. DATA COLLECTION AND ANALYSIS Two of four review authors, working in pairs, independently classified studies and abstracted data from the included studies. Primary outcomes were: patient-reported ability to have intercourse, quality of life, and treatment-related adverse effects. Secondary outcomes were: degree of penile curvature, discontinuation from treatment (for any reason), subjective patient-reported change in penile curvature, and improvement in penile pain. We performed statistical analyses using a random-effects model. We rated the certainty of evidence (CoE) according to the GRADE approach. MAIN RESULTS Our search identified 1288 relevant references of which we included 18 records corresponding to 14 unique randomized controlled trials (RCTs) with 1810 men. These informed 10 distinct comparisons with relevant outcome data that were mostly extracted from single trials. In this abstract, we focus only on the most clinically relevant comparisons for the three primary outcomes and also include the outcome of degree penile curvature. Injectional collagenase (short-term): We found no short-term evidence on injectional collagenase for patients' self-reported ability to have intercourse and treatment-related adverse effects compared to placebo injection. Injectional collagenase may result in little to no difference in quality of life (scale 0 to 20 with lower scores indicating better quality of life; mean difference (MD) 1.8 lower, 95% confidence interval (CI) -3.58 to -0.02; 1 study, 134 participants; low CoE) and there may be little to no effect on the degree of penile curvature (MD 10.90 degrees less, 95% CI -16.24 to -5.56; 1 study, 136 participants; low CoE). Injectional collagenase (long-term): We also found no long-term evidence on injectional collagenase for patients' self-reported ability to have intercourse compared to placebo injection. It likely results in little to no effect on quality of life (MD 1.00 lower, 95% CI -1.60 to -0.40; 1 study, 612 participants; moderate CoE). Treatment-related adverse effects are likely increased (risk ratio (RR) 2.32, 95% CI 1.98 to 2.72; 1 study, 832 participants; moderate CoE). Injectional collagenase likely results in little to no change in the degree of penile curvature (MD 6.90 degrees less, 95% CI -9.64 to -4.14; 1 study, 612 participants; moderate CoE). Injectional verapamil (short-term): We are very uncertain how injectional verapamil may affect patients' self-reported ability to have intercourse compared to placebo injection short-term (RR 7.00, 95% CI 0.43 to 114.70; 1 study, 14 participants; very low CoE). We found no evidence for the outcome of quality of life. We are very uncertain how injectional verapamil may affect treatment-related adverse effects (RR not estimable; 1 study, 14 participants; very low CoE). Similarly, we are very uncertain how injectional verapamil may affect degree of penile curvature (MD -1.86, 95% CI -10.39 to 6.67; 1 study, 14 participants; very low CoE). We found no long-term data for any outcome. Extracorporeal shock wave treatment (ESWT) (short-term): We are very uncertain how ESWT affects patients' self-reported ability to have intercourse short-term (RR 1.60, 95% CI 0.71 to 3.60; 1 study, 26 participants; very low CoE). ESWT may result in little to no difference in quality of life (MD 3.10, 95% CI 1.57 to 4.64; 2 studies, 130 participants; low CoE). We are very uncertain if ESWT has an effect on treatment-related adverse effects (RR 2.73, 95% CI 0.74 to 10.14; 3 studies, 166 participants; very low CoE). ESWT may result in little to no difference in the degree of penile curvature compared to placebo (RR -2.84, 95% -7.35 to 1.67; 3 studies, 166 participants; low CoE). We found no long-term data for any outcome. Penile traction therapy (short-term): We found no evidence for whether penile traction compared to no treatment affects patients' self-reported ability to have intercourse. We are very uncertain how traction therapy may affect quality of life (MD 1.50 lower, 95% CI -3.42 to 0.42; 1 study, 90 participants; very low CoE). We are also very uncertain how traction therapy may affect treatment-related adverse effects (RR not estimable; 1 study, 90 participants; very low CoE) and how it affects the degree of curvature (MD 7.40 degrees less, 95% CI -11.18 to -3.62; 1 study, 89 participants; very low CoE). We found no long-term data for any outcome. AUTHORS' CONCLUSIONS There is little evidence supporting the effectiveness of most non-surgical treatments for Peyronie's disease. Existing trials are mostly of poor methodological quality and/or fail to address patient-centered outcomes. Injectional collagenase appears to have some effectiveness; however, many individuals may not experience the improvement as clinically relevant, and this comes with the risk of increased adverse events. There is a critical need for better non-surgical treatment options for men with Peyronie's disease.
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Affiliation(s)
- Joel E Rosenberg
- Department of Urology, University of California San Diego, San Diego, California, USA
| | - Onuralp Ergun
- Department of Urology, University of Minnesota, Minneapolis, Minnesota, USA
- Urology Section, Minneapolis VA Health Care System, Minneapolis, Minnesota, USA
| | - Eu Chang Hwang
- Department of Urology, Chonnam National University Medical School, Chonnam National University Hwasun Hospital, Hwasun, Korea, South
| | - Michael C Risk
- Urology Section, Minneapolis VA Health Care System, Minneapolis, Minnesota, USA
| | - Jae Hung Jung
- Department of Urology, Yonsei University Wonju College of Medicine, Wonju, Korea, South
- Center of Evidence-Based Medicine, Institute of Convergence Science, Yonsei University, Seoul, Korea, South
| | - Mary E Edwards
- University of Florida Health Science Center Libraries, University of Florida, Gainesville, Florida, USA
| | - Yooni Blair
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | - Philipp Dahm
- Department of Urology, University of Minnesota, Minneapolis, Minnesota, USA
- Urology Section, Minneapolis VA Health Care System, Minneapolis, Minnesota, USA
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Ziegelmann M, Hu Y, Xiang Q, Liu G, McLane MP, Trost L. Incremental Treatment Response by Cycle With Collagenase Clostridium Histolyticum for Peyronie's Disease: A Pooled Analysis of Two Phase 3 Trials. Urology 2023; 175:126-131. [PMID: 36863600 DOI: 10.1016/j.urology.2023.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 01/26/2023] [Accepted: 02/08/2023] [Indexed: 03/04/2023]
Abstract
OBJECTIVE To evaluate cumulative and incremental changes in penile curvature after each treatment cycle of collagenase clostridium histolyticum (CCH) in men with Peyronie's disease (PD). METHODS Data from 2 phase 3, randomized, placebo-controlled trials were analyzed post hoc. Treatment was administered in up to 4 treatment cycles (per cycle: 2 injections, 1-3 days apart, of CCH 0.58 mg or placebo; subsequent penile modeling) at 6-week intervals. Penile curvature was measured at baseline and after each treatment cycle (weeks 6, 12, 18, and 24). Successful response was defined as ≥20% reduction from baseline penile curvature. RESULTS Overall, 832 men (CCH, n = 551; placebo, n = 281) were included in the analysis. After each cycle, mean cumulative percent reduction from baseline penile curvature was significantly greater with CCH vs placebo (P <.001). Following one cycle, 29.9% of CCH recipients exhibited a successful response. Among nonresponders, additional cycles of injections led to further successful responses: 60.8% of first cycle failures achieved response after fourth cycle (8 injections), 42.7% of cycle 1-2 failures achieved response after fourth cycle, and 23.5% of cycle 1-3 failures achieved response after fourth cycle. CONCLUSION Data showed incremental benefits from each of the 4 CCH treatment cycles. Completion of a full series of 4 CCH treatment cycles may optimize improvements in penile curvature in men with PD, including among those who did not clinically respond to previous treatment cycles.
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Affiliation(s)
| | - Yiqun Hu
- Endo Pharmaceuticals Inc., Malvern, PA
| | | | | | | | - Landon Trost
- Department of Urology, Mayo Clinic, Rochester, MN; Male Fertility and Peyronie's Clinic, Orem, UT
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3
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Yang CH, Lin DY, Lin YS, Hsu CY, Tung MC, Tan KT, Ou YC. The Immunological Microenvironment and the Emerging Role of Stem Cells Therapy in Peyronie's Disease: A Systematic Narrative Review. Int J Mol Sci 2023; 24:ijms24010777. [PMID: 36614220 PMCID: PMC9821411 DOI: 10.3390/ijms24010777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 12/25/2022] [Accepted: 12/26/2022] [Indexed: 01/03/2023] Open
Abstract
Current literature has indicated that Peyronie's disease (PD) could be initiated by microtrauma and the subsequent inflammation episodes that follow. PD could be sorted into acute or chronic status, and it can differ when selecting the clinical therapeutics. PD would cause pain and penile deformity to diseased men and impair their erectile function. Occasionally, surgical revision of the penis might be needed to correct the penile curvature. We find that there are limited effective options of intra-lesion injections for the PD plaques. By searching the databases and screening the literature with the PRISMA 2020 guideline, we observed that several preclinical studies that applied stem cell therapy in treating PD were fruitful in the acute phase. Although in the chronic phase of PD, erectile parameters were not significantly improved, and therefore, future studies might be better elevated in certain aspects, such as the sites selected for harvesting stem cells or changing the centrifugation forces. In this review, we concluded the contemporary understanding of inflammatory microenvironments in PD, the stem cell therapy in PD, and our perspectives on future studies. We concluded that there may be great potential in stem cell therapy for treating both acute and chronic phases PD.
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Affiliation(s)
- Che-Hsueh Yang
- Division of Urology, Department of Surgery, Tungs’ Taichung MetroHarbor Hospital, Taichung 435, Taiwan
| | - Dian-Yu Lin
- Division of Urology, Department of Surgery, Tungs’ Taichung MetroHarbor Hospital, Taichung 435, Taiwan
- Joshua Taipei Hernia Center, Central Clinic & Hospital, Taipei 106, Taiwan
- Department of Urology, College of Medicine and Shu-Tien Urological Research Center, National Yang Ming Chiao Tung University, Taipei 106, Taiwan
| | - Yi-Sheng Lin
- Division of Urology, Department of Surgery, Tungs’ Taichung MetroHarbor Hospital, Taichung 435, Taiwan
| | - Chao-Yu Hsu
- Division of Urology, Department of Surgery, Tungs’ Taichung MetroHarbor Hospital, Taichung 435, Taiwan
| | - Min-Che Tung
- Division of Urology, Department of Surgery, Tungs’ Taichung MetroHarbor Hospital, Taichung 435, Taiwan
| | - Kok-Tong Tan
- Division of General Surgery, Department of Surgery, Tungs’ Taichung MetroHarbor Hospital, Taichung 435, Taiwan
- Correspondence: (K.-T.T.); (Y.-C.O.)
| | - Yen-Chuan Ou
- Division of Urology, Department of Surgery, Tungs’ Taichung MetroHarbor Hospital, Taichung 435, Taiwan
- Correspondence: (K.-T.T.); (Y.-C.O.)
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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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5
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Ziegelmann MJ, Heslop D, Houlihan M, Bajic P, Helo S, Trost L, Kohler T. The Influence of Indentation Deformity on Outcomes With Intralesional Collagenase Clostridium Histolyticum Monotherapy for Peyronie's Disease. Urology 2020; 139:122-128. [DOI: 10.1016/j.urology.2020.01.035] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 01/23/2020] [Accepted: 01/27/2020] [Indexed: 11/24/2022]
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6
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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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7
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Cocci A, Russo GI, Salonia A, Cito G, Regis F, Polloni G, Giubilei G, Cacciamani G, Capece M, Falcone M, Greco I, Timpano M, Minervini A, Gacci M, Cai T, Garaffa G, Giammusso B, Arcaniolo D, Mirone V, Mondaini N. Predictive Factors of Patients' and Their Partners' Sexual Function Improvement After Collagenase Clostridium Histolyticum Injection for Peyronie's Disease: Results From a Multi-Center Single-Arm Study. J Sex Med 2019; 15:716-721. [PMID: 29699756 DOI: 10.1016/j.jsxm.2018.03.084] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 03/06/2018] [Accepted: 03/27/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND Collagenase Clostridium histolyticum (CCH; Xiapex) injections represent the only licensed medical treatment for Peyronie's disease (PD). AIM To evaluate the efficacy and safety of CCH injections in men with stable PD, using a modified treatment protocol and to assess partners' bother improvement in a large cohort of White-European sexually active heterosexual men treated in a single tertiary-referral center. METHODS All the 135 patients enrolled underwent a thorough assessment, which included history taking, physical examination, and pharmacologically induced artificial erection test (intra-cavernous injection) to assess the degree of penile curvature (PC) at baseline and after the completion of the treatment. Patients with calcified plaque and/or ventral curvature were excluded. All patients underwent a modified treatment protocol, which consisted of 3 intra-lesional injections of 0.9 mg of CCH performed at 4-week intervals at the point of maximum curvature. After each injection, patients were instructed to follow a strict routine involving daily penile stretching in the intervals between injections. OUTCOMES International Index of Erectile Function (IIEF)-15, Global Assessment of PD, PD questionnaires (PDQ), and Female Sexual Function Index (FSFI) questionnaire were performed at baseline and at the end of treatment. RESULTS Overall, 135 patients completed the study protocol. Before treatment, 18 (13.33%) partners showed a degree of sexual dysfunction. Baseline median IIEF-15, FSFI, and PDQ scores were, respectively, 59.0, 35.0, and 23.0. Overall, both IIEF-total and all domains significantly improved after treatment (all P < .01). A PC mean change of 19.07 (P = .00) was measured. At the univariate linear regression analysis, IIEF-15, IIEF-erectile function, IIEF-sexual desire, and IIEF-intercourse satisfaction were positively associated with FSFI (all P ≤ .03); conversely, PDQ-penile pain, PDQ-symptom bother, and post-treament penile curvature (P ≤ .04) were associated with a decreased FSFI score. Furthermore, median change of PC was significantly associated with median change of FSFI (r = 0.25; 95% CI 0.02-0.11; P = .004). Global satisfaction after treatment was 89.6% (121/135). CLINICAL TRANSLATION This modified CCH treatment protocol could improve both patients' and partner's sexual function. STRENGTH AND LIMITATIONS This was an open-label, single-arm clinical study, without placebo. where only heterosexual couples in stable relationships were included. Furthermore, no real assessment of female sexual distress was carried out and long-term sexual function in both patients and female partners were not taken into account. CONCLUSIONS The modified treatment schedule with CCH injections for stable PD has a positive impact on both patients' and partners' sexual function in heterosexual couples with a stable sexual relationship. Cocci A, Russo GI, Salonia A, et al. Predictive Factors of Patients' and Their Partners' Sexual Function Improvement After Collagenase Clostridium Histolyticum Injection for Peyronie's Disease: Results From a Multi-Center Single-Arm Study. J Sex Med 2018;15:716-721.
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Affiliation(s)
- Andrea Cocci
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy.
| | | | - Andrea Salonia
- Department of Urology, San Raffaele Hospital, Milano, Italy
| | - Gianmartin Cito
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Federica Regis
- Department of Urology, University of Catania, Catania, Italy
| | | | | | | | - Marco Capece
- Department of Urology, University of Naples, Naples, Italy
| | - Marco Falcone
- Department of Urology, Molinette Hospital, University of Turin, Turin, Italy
| | - Isabella Greco
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | | | - Andrea Minervini
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Mauro Gacci
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Tommaso Cai
- Department of Urology, University of Trento, Trento, Italy
| | - Giulio Garaffa
- Institute of Urology, University College of London, London, United Kingdom
| | - Bruno Giammusso
- Department of Urology, University of Catania, Catania, Italy
| | | | | | - Nicola Mondaini
- Department of Urology, Santa Maria Annunciata Hospital, Florence, Italy
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Pequeno ACL, Arruda AA, Silva DF, Duarte Neto JMW, Silveira Filho VM, Converti A, Marques DAV, Porto ALF, Lima CA. Production and characterization of collagenase from a new Amazonian Bacillus cereus strain. Prep Biochem Biotechnol 2019; 49:501-509. [PMID: 30945982 DOI: 10.1080/10826068.2019.1587627] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
A new collagenase producing a strain of Bacillus cereus, isolated from the pollen of a bee of Amazon Region (Brazil), had its enzyme characterized and the production medium composition and culture conditions enhanced. A two-level design on three factors, namely initial medium pH, the substrate (gelatin) concentration and agitation intensity, allowed identifying the first two variables as the most significant ones, while a central composite design (CCD) was subsequently used to identify their optimal levels. Statistics highlighted maximized collagenolytic activity when substrate concentration and initial medium pH were selected at their highest levels (positive effects), whereas agitation intensity at the lowest (negative effect). Triplicate runs performed under predicted optimal conditions (pH 7.8 and 1.7% gelatin concentration) yielded a collagenolytic activity (305.39 ± 5.15 U) 4.6- to 15-fold those obtained with the preliminary design. The enzyme displayed optimum activity at 45 °C and pH 7.2, was stable over wide ranges of pH values and temperatures (7.2-11.0 and 25-50 °C, respectively) and was strongly inhibited by 10 mM phenylmethylsulphonyl fluoride. The zymogram showed two prominent bands at 50 and 76 kDa. These results are a first attempt to elucidate the features of this new collagenase, its production conditions, and possible scale-up.
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Affiliation(s)
- Alexsandra C L Pequeno
- a Laboratory of Biotechnology and Therapeutic Innovation, University of Pernambuco-UPE , Garanhuns , PE , Brazil
| | - Aline A Arruda
- b Laboratory of Immunopathology Keizo Asami (LIKA) , Federal University of Pernambuco-UFPE , Recife , PE , Brazil
| | - Douglas F Silva
- a Laboratory of Biotechnology and Therapeutic Innovation, University of Pernambuco-UPE , Garanhuns , PE , Brazil
| | - José M W Duarte Neto
- b Laboratory of Immunopathology Keizo Asami (LIKA) , Federal University of Pernambuco-UFPE , Recife , PE , Brazil
| | - Vladimir M Silveira Filho
- a Laboratory of Biotechnology and Therapeutic Innovation, University of Pernambuco-UPE , Garanhuns , PE , Brazil
| | - Attilio Converti
- c Department of Civil, Chemical and Environmental Engineering , Genoa University , Genoa , Italy
| | - Daniela A V Marques
- d Laboratory of Microbiology and Parasitology, University of Pernambuco (UPE) , Serra Talhada , PE , Brazil
| | - Ana L F Porto
- e Department of Morphology and Animal Physiology , Federal Rural University of Pernambuco- UFRPE , Recife , PE , Brazil
| | - Carolina A Lima
- a Laboratory of Biotechnology and Therapeutic Innovation, University of Pernambuco-UPE , Garanhuns , PE , Brazil
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9
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Di Mauro M, Russo GI, Della Camera PA, Di Maida F, Cito G, Mondaini N, Capece M, Falcone M, Sessa F, Mari A, Campi R, Sabini C, Serni S, Gacci M, Minervini A, Carini M, Cimino S, Morelli G, Cocci A. Extracorporeal Shock Wave Therapy in Peyronie's Disease: Clinical Efficacy and Safety from a Single-Arm Observational Study. World J Mens Health 2019; 37:339-346. [PMID: 30929330 PMCID: PMC6704308 DOI: 10.5534/wjmh.180100] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 12/22/2018] [Accepted: 01/17/2019] [Indexed: 12/30/2022] Open
Abstract
Purpose In this study, we aimed to determine the role of extracorporeal shockwave therapy (ESWT) in the management of Peyronie's disease (PD). Materials and Methods A total of 325 patients suffering from PD were enrolled in this single-arm clinical study. All patients were received ESWT using a schedule of 1 treatment/wk. Penile curvature was measured by a goniometer after intracavernosal drug-induced erection using Alprostadil. Plaque size was measured with a ruler and sexual function assessed by the international index of erectile function (IIEF)-15 score. Severity of erectile dysfunction was classified as severe (IIEF-15 ≤10), moderate (IIEF-15 between 11 and 16), or mild (IIEF-15 between 17 and 25). Results were evaluated at baseline and 3 months after the treatment. Results All the patients completed the study protocol. Median age was 59.0 years (55.0–64.0 years). After treatment, the median (interquartile range, IQR) plaque size reduced from 1.78 cm2 (1.43–2.17 cm2) to 1.53 cm2 (1.31–1.96 cm2) (p<0.001); the median (IQR) penile length in erection increased from 13.0 cm (12.0–14.0 cm) to 14 cm (13.0–15.0 cm) (p<0.001) and the median (IQR) penile curvature from 30.4° (22.2°–35.4°) to 25.0° (20.2°–30.4°) (p<0.001). We also observed a decrease in pain assessed by visual analogue scale (7 vs. 3; p<0.001), an improvement in each of the IIEF sub-domains (p<0.001) and an improvement in all three PD questionnaire domains (p<0.001). Conclusions Based on our findings, ESWT could be considered a safe and efficient minimally invasive option for the management of the patients suffering from PD.
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Affiliation(s)
- Marina Di Mauro
- Urology Section, Department of Surgery, University of Catania, Catania, Italy
| | - Giorgio Ivan Russo
- Urology Section, Department of Surgery, University of Catania, Catania, Italy.
| | | | | | - Gianmartin Cito
- Department of Urology, University of Florence, Florence, Italy
| | | | - Marco Capece
- Department of Urology, University of Naples, Naples, Italy
| | - Marco Falcone
- Department of Urology, Molinette Hospital, University of Turin, Turin, Italy
| | - Francesco Sessa
- Department of Urology, University of Florence, Florence, Italy
| | - Andrea Mari
- Department of Urology, University of Florence, Florence, Italy
| | - Riccardo Campi
- Department of Urology, University of Florence, Florence, Italy
| | - Carlotta Sabini
- Department of Urology, University of Florence, Florence, Italy
| | - Sergio Serni
- Department of Urology, University of Florence, Florence, Italy
| | - Mauro Gacci
- Department of Urology, University of Florence, Florence, Italy
| | | | - Marco Carini
- Department of Urology, University of Florence, Florence, Italy
| | - Sebastiano Cimino
- Urology Section, Department of Surgery, University of Catania, Catania, Italy
| | | | - Andrea Cocci
- Department of Urology, University of Florence, Florence, Italy
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Abdel Raheem A, Johnson M, Ralph D, Garaffa G. Collagenase clostridium histolyticum: a novel medical treatment for Peyronie's disease. MINERVA UROL NEFROL 2018; 70:380-385. [DOI: 10.23736/s0393-2249.18.03118-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Cwikla DJ, Yafi FA. Intralesional collagenase Clostridium histolyticum in the management of Peyronie's disease: current best practice. Ther Adv Urol 2018; 10:139-153. [PMID: 29560030 PMCID: PMC5851106 DOI: 10.1177/1756287218755020] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 12/31/2017] [Indexed: 11/16/2022] Open
Abstract
The use of Clostridium histolyticum collagenase (CCH) has become increasingly widespread for the treatment of Peyronie's disease (PD) in recent years. Numerous trials have confirmed both its safety and efficacy in appropriately selected patients with this condition. The purpose of this review is to examine pivotal trials demonstrating the efficacy of CCH, revisit viable candidates for treatment with intralesional injection therapy, and provide a summary of injection technique and appropriate management of patients receiving this treatment at the time of therapy and in follow up.
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Affiliation(s)
- Daniel J. Cwikla
- Department of Urology, University of California Irvine, Orange, CA, USA
| | - Faysal A. Yafi
- Department of Urology, University of California Irvine, 333 The City Blvd W, Suite 2100, Orange, CA 92868, USA
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Self-reported Clinical Meaningfulness Early in the Treatment Course Predicts Objective Outcomes in Men Undergoing Collagenase Clostridium histolyticum Injections for Peyronie Disease. Urology 2017; 106:107-112. [DOI: 10.1016/j.urology.2017.04.045] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 04/11/2017] [Accepted: 04/30/2017] [Indexed: 01/22/2023]
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Safety Profile of Collagenase Clostridium Histolyticum Stratified by Degree of Penile Curvature in Patients With Peyronie Disease. Urology 2017; 106:237.e9-237.e14. [DOI: 10.1016/j.urology.2017.05.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 05/01/2017] [Accepted: 05/02/2017] [Indexed: 11/17/2022]
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Toscano L, Rezende MV, Mello LF, Paulillo D, Glina S. A prospective, randomized, single - blind study comparing intraplaque injection of thiocolchicine and verapamil in Peyronie's Disease: a pilot study. Int Braz J Urol 2017; 42:1005-1009. [PMID: 24893912 PMCID: PMC5066899 DOI: 10.1590/s1677-5538.ibju.2015.0598] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 03/21/2016] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To compare the response to tiocolchicine and verapamil injection in the plaque of patients with Peyronie's disease. MATERIALS AND METHODS Prospective, single-blind, randomized study, selecting patients who have presented Peyronie's disease for less than 18 months. Thiocolchicine 4mg or verapamil 5mg were given in 7 injections (once a week). Patients who had received any treatment for Peyronie's disease in the past three months were excluded. The parameters used were the International Index of Erectile Function (IIEF-5) score, analysis of the curvature on pharmaco-induced erections and size of the plaque by ultrasonography. RESULTS Twenty-five patients were randomized, 13 received thiocolchicine and 12 were treated with verapamil. Both groups were statistically similar. The mean curvature was 46.7º and 36.2º before and after thiocolchicine, respectively (p=0.019) and 50.4º and 42.08º before and after verapamil, respectively (p=0.012). The curvature improved in 69% of patients treated with thiocolchicine and in 66% of those who received verapamil. Regarding sexual function, there was an increase in the IIEF-5 from 16.69 to 20.85 (p=0.23) in the thiocolchicine group. In the verapamil group the IIEF-5 score dropped from 17.50 to 16.25 (p=0.58). In the thiocolchicine group, the plaque was reduced in 61% of patients. In the verapamil group, 8% presented decreased plaque size. No adverse event was associated to thiocolchicine. CONCLUSION The use of thiocolchicine in Peyronie's disease demonstrated improvement on penile curvature and reduction in plaque size. Thiocolchicine presented similar results to verapamil in curvature assessment. No significant side effects were observed with the use of tiocolchicine.
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Affiliation(s)
- L Toscano
- Departamento de Urologia, Hospital Ipiranga, São Paulo, Brasil
| | - M V Rezende
- Departamento de Urologia, Hospital Ipiranga, São Paulo, Brasil
| | - L F Mello
- Departamento de Urologia, Hospital Ipiranga, São Paulo, Brasil
| | - D Paulillo
- Departamento de Urologia, Hospital Ipiranga, São Paulo, Brasil
| | - S Glina
- Departamento de Urologia, Hospital Ipiranga, São Paulo, Brasil
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Kuhlmann PK, DeLay KJ, Anaissie J, Hellstrom WJG, Yafi FA. Collagenase Clostridium histolyticum in the treatment of Peyronie's disease: patient selection and perspectives. Patient Prefer Adherence 2017; 11:431-448. [PMID: 28280315 PMCID: PMC5338950 DOI: 10.2147/ppa.s113507] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The safety and efficacy of the use of collagenase Clostridium histolyticum (CCH) for the treatment of Peyronie's disease has been confirmed over the past several years. However, identification of the ideal patient population for use of this treatment is not well established. Multiple studies have attempted to delineate various patient-specific factors that may predict response to treatment with CCH, with the intent of enhancing patient selection. To date, these include baseline curvature severity, duration of disease, disease phase at presentation, plaque calcification, baseline erectile function, plaque size, age, comorbid diabetes, previous penile trauma, responsiveness to first treatment cycle, baseline penile shortening or pain, prior treatment with intralesional injection, compliance with plaque modeling, and atypical curvature. In addition, other studies have sought to explore various aspects of treatment with CCH that may affect patient perspective of treatment. They have focused on patient-reported outcomes, female partner considerations, cost of treatment, and potential confounders of patient satisfaction. This review provides a summary and analysis of currently available literature on topics of patient selection and perspectives in regard to treatment of Peyronie's disease with CCH.
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Affiliation(s)
- Paige K Kuhlmann
- University of Missouri-Columbia School of Medicine, Columbia, MO
| | - Kenneth J DeLay
- Department of Urology, Tulane University School of Medicine, New Orleans, LA
| | - James Anaissie
- Department of Urology, Tulane University School of Medicine, New Orleans, LA
| | - Wayne JG Hellstrom
- Department of Urology, Tulane University School of Medicine, New Orleans, LA
| | - Faysal A Yafi
- Department of Urology, University of California Irvine, Orange, CA, USA
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Campbell J, Alzubaidi R. Understanding the cellular basis and pathophysiology of Peyronie's disease to optimize treatment for erectile dysfunction. Transl Androl Urol 2017; 6:46-59. [PMID: 28217450 PMCID: PMC5313310 DOI: 10.21037/tau.2016.11.01] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Erectile dysfunction (ED) is a common condition that significantly impacts a man’s physical and psychological well-being. ED is often associated with Peyronie’s disease (PD), which is an abnormal curvature of the penis. Delayed treatment of or surgical invention for PD often results in ED and therefore unsatisfied patients. The pathophysiology of PD is incompletely understood, but has been studied extensively and based on our current understanding of PD physiology, many medical treatment options have been proposed. In this paper, we will review what is known about the pathophysiology of PD and the medical treatment options that have been trialed as a result. More investigations in regards to the basic science of PD need to be carried out in order to elucidate the exact mechanisms of the fibrosis, and propose new, more successful treatment options which should be implemented prior to the onset of ED.
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Affiliation(s)
- Jeffrey Campbell
- London Health Sciences Centre and St. Joseph's Health Care, Western University, London, Ontario, Canada
| | - Raidh Alzubaidi
- London Health Sciences Centre and St. Joseph's Health Care, Western University, London, Ontario, Canada
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Mucić G, Rašković B, Polović N. Characterization of Novel Collagenolytic Proteases. Methods Mol Biol 2017; 1626:71-78. [PMID: 28608201 DOI: 10.1007/978-1-4939-7111-4_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] [Indexed: 06/07/2023]
Abstract
Collagenolytic proteases have many potential applications in different areas of science, industry, and medicine. The determination of the activity of such proteins is paramount to their application. Here, we describe methods which can be applied to determine the activity and some basic characteristics of potential collagenases.
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Affiliation(s)
- Goran Mucić
- Department of Biochemistry, Faculty of Chemistry, University of Belgrade, Belgrade, Serbia.
| | - Brankica Rašković
- Department of Biochemistry, Faculty of Chemistry, University of Belgrade, Belgrade, Serbia
| | - Natalija Polović
- Department of Biochemistry, Faculty of Chemistry, University of Belgrade, Belgrade, Serbia
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Talib RA, Ibrahim MA, Cangüven Ö. Nonsurgical treatment options in Peyronie's Disease: 2016 update. Turk J Urol 2016; 42:217-223. [PMID: 27909612 DOI: 10.5152/tud.2016.40799] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Peyronie's disease (PD) is an inflammatory condition of penile tunica albuginea which commonly ends with penile curvature and difficulty in vaginal penetration. Unfortunately, the pathophysiology of PD has not been completely understood. In this paper, we will review what is known about the pathophysiology of PD and the nonsurgical medical treatment options that have been trialed as a result. In the last 5 years, commonly used oral medications left their places to intralesional therapies. Clostridium collagenase, which is the only Food and Drug Administration (FDA) approved treatment for PD, is now the most prescribed intralesional therapy in the last years. Clostridium collagenase is advised for patients whose penile curvature is > 30° and < 90°. Because of its side effects, patients should be counseled before intralesional Clostridium collagenase treatment. Until finding best treatment solution for PD, more investigations in regards to the basic science of PD need to be carried out in order to elucidate the exact mechanisms of the fibrosis.
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Affiliation(s)
- Raidh A Talib
- Department of Urology, Hamad General Hospital, Doha, Qatar
| | | | - Önder Cangüven
- Department of Urology, Hamad General Hospital, Doha, Qatar
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20
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Contemporary Review of Treatment Options for Peyronie's Disease. Urology 2016; 95:16-24. [DOI: 10.1016/j.urology.2016.02.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 01/15/2016] [Accepted: 02/02/2016] [Indexed: 12/19/2022]
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Dhillon S. Collagenase Clostridium histolyticum in Peyronie’s disease: a guide to its use in the EU. DRUGS & THERAPY PERSPECTIVES 2016. [DOI: 10.1007/s40267-016-0318-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Abstract
Background Peyronie’s disease (PD) is an acquired fibrotic disorder (disorganized collagen deposition) in the tunica albuginea. This scar tissue or “plaque” builds up in the tunica albuginea and results in penile deformities. PD can have a significant negative impact on mood and quality of life. Although the psychological impact of PD has generally been understudied, there has been a growing body of literature that has assessed the impact PD can have on men’s mental health and relationships. The aim of this study is to review the current literature focused on the psychological and relationship impact of PD. Methods We performed a MEDLINE search limited to English language literature using the terms: “Peyronie’s Disease AND Psychological OR Psychosocial”. Select references were then included for review. Results The research in this area confirms the clinical impressions of men with PD, which is that depression and relationship distress is prevalent. Approximately 50% of men with PD suffer from depressive symptoms and upwards of 80% report distress related to PD. It appears that these rates remain relatively stable over time. High rates of relationship stress were also reported as over 50% of men reported that PD had negatively impacted their relationship. Qualitative work in this area helps us understand the nature of this distress. Regarding body image and self-esteem, men described themselves as “abnormal”, “ugly”, “disgusting”, “like a cripple”, and a “half man”, and some of them described feelings of shame. Many men reported that they lost their sexual confidence, or ability to initiate sex with a partner, while most reported a decrease in sexual interest. Additionally, many men expressed a sense of stigmatization and isolation. This led to difficulties in speaking about their disease with sexual partners or healthcare professionals. Conclusions Taken in total, these studies indicate that those who actively treat PD should assess for distress or depressive symptoms. The standard assessment of PD could include the Peyronie’s Disease Questionnaire (PDQ), and at least two questions on individual and relationship distress, or the use of a validated questionnaire to assess depression.
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Affiliation(s)
- Jean E Terrier
- 1 Department of Urology, CHU Lyon Sud Hospices Civiles de Lyon, Lyon, France ; 2 Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Christian J Nelson
- 1 Department of Urology, CHU Lyon Sud Hospices Civiles de Lyon, Lyon, France ; 2 Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
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Watkin N. Editorial Comment. Urology 2015. [DOI: 10.1016/j.urology.2015.04.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Yafi FA, Pinsky MR, Sangkum P, Hellstrom WJG. Therapeutic advances in the treatment of Peyronie's disease. Andrology 2015; 3:650-60. [PMID: 26097120 DOI: 10.1111/andr.12058] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Revised: 04/30/2015] [Accepted: 05/05/2015] [Indexed: 12/17/2022]
Abstract
Peyronie's disease (PD) is an under-diagnosed condition with prevalence in the male population as high as 9%. It is a localized connective tissue disorder of the penis characterized by scarring of the tunica albuginea. Its pathophysiology, however, remains incompletely elucidated. For the management of the acute phase of PD, there are currently numerous available oral drugs, but the scientific evidence for their use is weak. In terms of intralesional injections, collagenase clostridium histolyticum is currently the only Food and Drug Administration-approved drug for the management of patients with PD and a palpable plaque with dorsal or dorsolateral curvature >30°. Other available intralesional injectable drugs include verapamil and interferon-alpha-2B, however, their use is considered off-label. Iontophoresis, shockwave therapy, and radiation therapy have also been described with unconvincing results, and as such, their use is currently not recommended. Traction therapy, as part of a multimodal approach, is an underused additional tool for the prevention of PD-associated loss of penile length, but its efficacy is dependent on patient compliance. Surgical therapy remains the gold standard for patients in the chronic phase of the disease. In patients with adequate erectile function, tunical plication and/or incision/partial excision and grafting can be offered, depending on degree of curvature and/or presence of destabilizing deformity. In patients with erectile dysfunction non-responsive to oral therapy, insertion of an inflatable penile prosthesis with or without straightening procedures should be offered.
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Affiliation(s)
- F A Yafi
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA
| | - M R Pinsky
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA
| | - P Sangkum
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA
| | - W J G Hellstrom
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA
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Lipshultz LI, Goldstein I, Seftel AD, Kaufman GJ, Smith TM, Tursi JP, Burnett AL. Clinical efficacy of collagenase Clostridium histolyticum in the treatment of Peyronie's disease by subgroup: results from two large, double-blind, randomized, placebo-controlled, phase III studies. BJU Int 2015; 116:650-6. [PMID: 25711400 DOI: 10.1111/bju.13096] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVES To examine the efficacy of intralesional collagenase Clostridium histolyticum (CCH) in defined subgroups of patients with Peyronie's disease (PD). PATIENTS AND METHODS The efficacy of CCH compared with placebo, assessed from baseline to week 52, was examined in subgroups of participants from the Investigation for Maximal Peyronie's Reduction Efficacy and Safety Studies (IMPRESS) I and II. The subgroups were defined according to: severity of penile curvature deformity at baseline (30-60° [n = 492] and 61-90° [n = 120]); PD duration (1 to ≤2 [n = 201], >2 to ≤4 [n = 212] and >4 years [n = 199]); degree of plaque calcification (no calcification [n = 447], non-contiguous stippling [n = 103] and contiguous calcification that did not interfere with injection of CCH [n = 62]); and baseline erectile function (International Index of Erectile Function [IIEF] scores 1-5 [n = 22], 6-16 [n = 106] and ≥17 [n = 480]). RESULTS Reductions in penile curvature deformity and PD symptom bother were observed in all subgroups. Penile curvature deformity reductions were significantly greater with CCH than with placebo for the following subgroups: baseline penile curvature 30-60° and 61-90°; disease duration >2 to ≤4 years and >4 years; no calcification; and IIEF score ≥17 (high IIEF-erectile function score; P < 0.05 for all). PD symptom bother reductions were significantly greater in the CCH group for: penile curvature 30-60°; disease duration >4 years; no calcification; and IIEF score 1-5 (no sexual activity) and ≥17 (P < 0.05 for all). CONCLUSIONS In this analysis, clinical efficacy of CCH treatment for reducing penile curvature deformity and PD symptom bother was found across subgroups. In the IMPRESS I and II overall, adverse events (AEs) were typically mild or moderate, although treatment-related serious AEs, including corporal rupture or penile haematoma, occurred. Future studies could be considered to directly assess the efficacy and safety of CCH treatment in defined subgroups of PD patients, with the goal of identifying predictors of optimum treatment success.
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Affiliation(s)
- Larry I Lipshultz
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA
| | - Irwin Goldstein
- San Diego Sexual Medicine, Alvarado Hospital, San Diego, CA, USA
| | | | | | - Ted M Smith
- Auxilium Pharmaceuticals, Inc., Chesterbrook, PA, USA
| | - James P Tursi
- Auxilium Pharmaceuticals, Inc., Chesterbrook, PA, USA
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Sherer BA, Godlewski KF, Levine LA. Pharmacologic therapy for Peyronie's disease: what should we prescribe? Expert Opin Pharmacother 2015; 16:1299-311. [PMID: 25927285 DOI: 10.1517/14656566.2015.1041503] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Peyronie's disease (PD) is a wound healing disorder of the penis with a myriad of proposed treatment options reported in the literature. Evaluating the available data and therapeutic management of PD can be challenging and confusing, even for the most experienced treating physician. This review provides a comprehensive overview of pharmacologic treatment options for PD, focusing on the best available evidence. AREAS COVERED A comprehensive literature search for published articles evaluating oral, topical, and injectable pharmacologic agents for PD was completed. Prospective, controlled trials were given precedence for inclusion. EXPERT OPINION Although a multitude of oral agents have been proposed and evaluated in PD patients, results vary widely and a reproducible objective benefit has not yet been strongly established for any single oral agent. Well-designed, large-scale, randomized controlled trials evaluating oral agents in PD patients are lacking. Consistent objective benefit from injectable agents has been supported for years by various non-controlled trials. Recently, injectable collagenase Clostridium histolyticum became the first pharmacologic agent to obtain FDA approval for use in PD patients, supported by data from a large-scale, Phase III randomized controlled trial. Further elucidation of the genetic and mechanistic pathways involved in the development and progression of PD will help define future therapeutic targets.
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Affiliation(s)
- Benjamin A Sherer
- Rush University Medical Center , 1725 W Harrison St, Chicago, IL 60612, Suite 348 , USA +1 312 563 3480 ; +1 312 563 5007 ;
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Raskovic B, Bozovic O, Prodanovic R, Niketic V, Polovic N. Identification, purification and characterization of a novel collagenolytic serine protease from fig (Ficus carica var. Brown Turkey) latex. J Biosci Bioeng 2014; 118:622-7. [DOI: 10.1016/j.jbiosc.2014.05.020] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2013] [Revised: 05/21/2014] [Accepted: 05/28/2014] [Indexed: 11/24/2022]
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Coyne KS, Currie BM, Thompson CL, Smith TM. The test-retest reliability of the Peyronie's disease questionnaire. J Sex Med 2014; 12:543-8. [PMID: 25402673 DOI: 10.1111/jsm.12769] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The Peyronie's Disease Questionnaire (PDQ) is a disease-specific, patient-reported outcome instrument designed to measure the psychosexual consequences and treatment outcomes of Peyronie's disease (PD). AIM The aim of this study was to evaluate the test-retest reliability of the PDQ. METHODS Adult men with PD were recruited through eight clinical sites across the United States. Participants completed the PDQ during two study visits scheduled 7 (± 3) days apart. At Visit 1, participants completed a sociodemographic questionnaire, the PDQ, and the International Index of Erectile Function (IIEF). At Visit 2, participants repeated the PDQ and completed an Overall Treatment Effect (OTE) scale. Test-retest reliability of the PDQ was assessed in a stable subsample (as determined by responses to the OTE). Intraclass correlation coefficients (ICCs) were calculated to evaluate the degree of association between the three PDQ subscale scores at Visits 1 and 2. Internal consistency of the subscales was also evaluated using Cronbach's alpha. MAIN OUTCOME MEASURE The main outcome measure was the PDQ. RESULTS Of the 61 PD patients (mean age 59.3) who took part in the study, the majority were not receiving treatment for their PD (n=35, 57.4%). The sample's mean score on the erectile function domain of IIEF was 19.7 (± 8.2), indicating mild-moderate dysfunction. Nearly two-thirds reported penile pain at baseline (n=37, 63.8%). Of the participants with baseline PDQ data and who had engaged in vaginal intercourse in the past 3 months, 57 completed both study visits. The PDQ demonstrated excellent test-retest reliability in 53 stable patients. The ICC was 0.85 for the Psychological and Physical Symptom subscale, 0.89 for the Peyronie's Symptom Bother subscale, and 0.88 for the Penile Pain subscale. The Cronbach's alpha estimates for all three subscales were acceptable at the >0.70 level. CONCLUSIONS The PDQ is a highly reproducible measure of PD and can be an effective end point in clinical trials evaluating treatments for PD.
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Jiang P, Christakos A, Fam M, Sadeghi-Nejad H. Prophylactic phenylephrine for iatrogenic priapism: a pilot study with Peyronie's patients. Korean J Urol 2014; 55:665-9. [PMID: 25324950 PMCID: PMC4198766 DOI: 10.4111/kju.2014.55.10.665] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 08/20/2014] [Indexed: 12/03/2022] Open
Abstract
Purpose Although penile duplex Doppler ultrasonography (PDDU) is a common and integral procedure in a Peyronie's disease workup, the intracavernosal injection of vasoactive agents can carry a serious risk of priapism. Risk factors include young age, good baseline erectile function, and no coronary artery disease. In addition, patients with Peyronie's disease undergoing PDDU in an outpatient setting are at increased risk given the inability to predict optimal dosing. The present study was conducted to provide support for a standard protocol of early administration of phenylephrine in patients with a sustained erection after diagnostic intracavernosal injection of vasoactive agents to prevent the deleterious effects of iatrogenic priapism. Materials and Methods This was a retrospective review of Peyronie's disease patients who received phenylephrine reversal after intracavernosal alprostadil (prostaglandin E1) administration to look at the priapism rate. Safety was determined on the basis of adverse events reported by subjects and efficacy was determined on the basis of the rate of priapism following intervention. Results Patients with Peyronie's disease only had better hemodynamic values on PDDU than did patients with Peyronie's disease and erectile dysfunction. All of the patients receiving prophylactic phenylephrine had complete detumescence of erections without adverse events, including no priapism cases. Conclusions The reversal of erections with phenylephrine after intracavernosal injections of alprostadil to prevent iatrogenic priapism can be effective without increased adverse effects.
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Affiliation(s)
- Pengbo Jiang
- Department of Urology, Rutgers-New Jersey Medical School, Newark, NJ, USA
| | - Athena Christakos
- Department of Urology, Rutgers-New Jersey Medical School, Newark, NJ, USA
| | - Mina Fam
- Department of Urology, Rutgers-New Jersey Medical School, Newark, NJ, USA
| | - Hossein Sadeghi-Nejad
- Department of Urology, Rutgers-New Jersey Medical School, Newark, NJ, USA. ; Center for Male Reproductive Medicine & Microsurgery, Hackensack University Medical Center, Hackensack, NJ, USA
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Sherer BA, Warrior K, Levine LA. 2013-2014 Updates in Peyronie’s Disease Management. Curr Urol Rep 2014; 15:459. [DOI: 10.1007/s11934-014-0459-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Dincer M, Serefoglu EC. Re: Baseline characteristics from an ongoing phase 3 study of collagenase clostridium histolyticum in patients with Peyronie's disease. J Sex Med 2014; 11:1350. [PMID: 24602117 DOI: 10.1111/jsm.12490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Murat Dincer
- Department of Urology, Bagcilar Training & Research Hospital, Istanbul, Turkey
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