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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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Reddy AG, Dai MC, Song JJ, Pierce HM, Patel SR, Lipshultz LI. Peyronie's Disease: An Outcomes-Based Guide to Non-Surgical and Novel Treatment Modalities. Res Rep Urol 2023; 15:55-67. [PMID: 36756281 PMCID: PMC9901485 DOI: 10.2147/rru.s278796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 01/11/2023] [Indexed: 02/05/2023] Open
Abstract
The clinical landscape of Peyronie's disease is everchanging. There has been growing interest in non-invasive therapeutic options that could assist patients with achieving a meaningful reduction in penile curvature without surgical intervention. These therapies are wide-ranging in terms of their mechanisms of action, efficacies, and short- and long-term safety profiles. Recently, an abundance of outcomes literature on longstanding and novel non-surgical treatment modalities has been published. For sexual medicine providers hoping to offer patients the most up-to-date and evidence-based treatments for the management of Peyronie's disease, it can be challenging to gain a thorough understanding of this body of literature. In this clinical management review, the workup and current theories on the pathophysiology of Peyronie's disease are reviewed, and the most recent outcomes data on the currently available non-surgical treatment modalities are presented. With an accurate understanding of the current landscape of Peyronie's disease treatment, sexual health providers will be able to better evaluate and engage in evidence-based shared decision-making with their patients.
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Affiliation(s)
- Amit G Reddy
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA
| | - Michelle C Dai
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA
| | - Jeffrey J Song
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA
| | - Hudson M Pierce
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA
| | - Sagar R Patel
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA
| | - Larry I Lipshultz
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA,Correspondence: Larry I Lipshultz, Scott Department of Urology, Baylor College of Medicine, 7200 Cambridge Street, Suite 10B, Houston, TX, 77030, USA, Tel +1 713 798-6270, Fax +1 713 798-6007, Email
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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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Conservative Therapy for Peyronie's Disease: a Contemporary Review of the Literature. Curr Urol Rep 2021; 22:6. [PMID: 33420664 DOI: 10.1007/s11934-020-01024-8] [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] [Accepted: 11/23/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE OF REVIEW To analyze the literature on current conservative treatment options for Peyronie's disease (PD). RECENT FINDINGS Conservative therapy with intralesional collagenase clostridium histolyticum (CCH) is safe and efficacious in either the acute or chronic phases of PD. Combination treatment with penile traction therapy (PTT) can produce even better results. While most PTT devices require extended periods of therapy up to 8 h per day, the RestoreX® device can be effective at 30-90 min per day. A variety of conservative therapies are available for treatment of PD. The available literature does not reveal any treatment benefit of oral therapies. Intralesional therapy is the mainstay conservative treatment of PD. Intralesional CCH therapy is the first Food and Drug Administration-approved intralesional therapy and represents the authors' preference for medical therapy. The most effective conservative management of PD likely requires a combination of therapies.
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Abstract
Treating men with Peyronie's disease remains a challenging problem facing clinicians working across urology and sexual medicine fields. Patients can often be left disappointed by current treatment paradigms, and an overall lack of suitable molecular targets has limited the options for novel, effective medical therapy. Managing men with Peyronie's disease often involves careful counselling alongside multifaceted and possible combination treatments to help improve symptoms whilst ameliorating potential side effects of therapy. We review the latest medical literature and evidence in the contemporary management of Peyronie's disease.
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Affiliation(s)
- Asrit Babu
- Department of Urology, Leeds Teaching Hospitals, Leeds, UK
| | - Oliver Kayes
- Department of Urology, Leeds Teaching Hospitals, Leeds, UK
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Geng Q, Wang F, Han Q, Chen SF, Ouyang B, Li Z, Zhao Y, Gao QH, Yu GJ, Guo J. Antioxidant Mechanism of Xiaojin Pill () for Treatment of Peyronie's Disease in Rats Based on Matrix Metalloproteinases. Chin J Integr Med 2019; 25:671-676. [PMID: 31650486 DOI: 10.1007/s11655-019-3203-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2018] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To evaluate the effects of Xiaojin Pill () in the treatment of Peyronie's disease (PD) in a rat model. METHODS Twenty-four male Sprague-Dawley rats were randomly divided into four groups with 6 in each: sham operation, PD model, vehicle control and Xiaojin Pill groups. The rats in the sham operation group received penile tunica albsginea (TA) injection with 50 μL vehicle, while the rats in the other 3 groups received 50 μL penile TA injection of 50 μg transforming growth factor (TGF)-β1. Forty-two days after the injection, rats in the vehicle control and Xiaojin Pill groups received 0.5 mL water and Xiaojin Pill solution (107 mg/kg of body weight), respectively by gavage for 28 days, while those in the sham operation and PD model groups did not receive any intervention. After intervention, the expressions of matrix metalloproteinase 2/9 (MMP2/9), nitric oxidesynthase (NOS), superoxide dismutase (SOD) and malondialdehyde (MDA) were measured. RESULTS Rats in the PD model and vehicle control groups presented obvious fibrosis in corpus cavernosum (CC) and demonstrated a significantly increased expressions of MMP2 and MMP9 in the CC compared with the sham operation group (all P<0.01). In contrast, the expressions of MMP2 and MMP9 in the Xiaojin Pill group were significantly down-regulated (both P<0.01). In addition, the levels of NOS and MDA in CC were significantly increased while the activity of SOD was decreased in the PD model and vehicle control groups compared with the sham operation group (all P<0.01). After Xiaojin Pill treatment, the levels of MDA, NOS and SOD appeared to be corrected (all P<0.01). CONCLUSIONS Xiaojin Pill could reduce fibrosis in the CC by decreasing the expressions of MMPs, NOS and MDA, and by increasing the activity of SOD. Therefore, Xiaojin Pill might be a therapeutic option for PD.
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Affiliation(s)
- Qiang Geng
- Department of Andrology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China
| | - Fu Wang
- Department of Andrology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China
| | - Qiang Han
- Department of Andrology, Beijing's Capital Medical University Traditional Chinese Medicine Hospital, Beijing, 100010, China
| | - Shao-Feng Chen
- Department of Andrology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China
| | - Bin Ouyang
- Department of Andrology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China
| | - Zhong Li
- Department of Andrology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China
| | - Yu Zhao
- Department of Andrology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China
| | - Qing-He Gao
- Department of Andrology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China
| | - Guo-Jin Yu
- Department of Andrology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China
| | - Jun Guo
- Department of Andrology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China.
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Abstract
A patient with Dupuytren's disease noted progressive disappearance of the contractures of both hands over a 3-year period while taking coenzyme Q10 daily for an unrelated condition. The function and appearance of his hands were restored to almost normal.
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Affiliation(s)
- Wilma Lourens
- Department of Medicine, Sligo University Hospital, Sligo, Ireland
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