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Baudry A, Schirmann A, Guillot-Tantay C, Lebret T, Vidart A, Neuville P, Madec FX. 50 years of inflatable penile implants: Where do we stand in France? THE FRENCH JOURNAL OF UROLOGY 2024; 34:102635. [PMID: 38599322 DOI: 10.1016/j.fjurol.2024.102635] [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: 11/01/2023] [Revised: 01/08/2024] [Accepted: 04/02/2024] [Indexed: 04/12/2024]
Abstract
INTRODUCTION With 50 years' experience, inflatable penile implants are the preferred option for erectile dysfunction refractory to pharmacological and mechanical treatment. Technical and surgical improvements have optimized patient success and satisfaction. However, multi-factorial dissatisfaction persists. OBJECTIVE The aim of this study is to provide an overview of available technological improvements and innovations, as well as the perioperative management and complications of inflatable penile implant surgery. METHOD A literature review was carried out over the last twenty years to answer 4 questions: what are the different inflatable penile implants available in 2023, for which indications, results and complications. RESULTS Four companies propose inflatable penile implants in France. The main improvements have been in the various components of the prosthesis with better cylinder extension, more ergonomic reservoirs, and more manageable pumps, leading to a better durability. Indications have been extended to patients suffering from Peyronie's disease and in emergency cases of priapism. In response to demand from the transgender population, specific phalloplasty implants have been developed. New options are being developed for difficult cases of retracted penis. Results show a high satisfaction rate. Currently the main challenge is the management of infection with the development of rescue protocols using antibiotics to preserve implants - or replace them in a single operation. CONCLUSION After 50years' experience, improvements in penile implants led to effective, satisfactory and safe treatment and can be proposed in new indications. Further development is sill necessary to offer solutions in difficult cases.
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Lledó García E, González García FJ, Jara Rascón J, García Muñoz J, Lledó Graell E, Sánchez Ochoa MA, Hernández Fernández C. Satisfaction assessment study in patients (and their partners) with/without Peyronie's disease and penile prosthesis implantation. Actas Urol Esp 2024; 48:392-397. [PMID: 38367908 DOI: 10.1016/j.acuroe.2024.02.003] [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: 07/05/2023] [Revised: 08/17/2023] [Accepted: 08/19/2023] [Indexed: 02/19/2024]
Abstract
INTRODUCTION AND OBJECTIVE Among the many treatments for erectile dysfunction, implantation of a penile prosthesis has been associated with high patient satisfaction rates. However, patients with coexistent Peyronie's disease (PD) and refractory erectile dysfunction and/or severe deformities may show different results. The aim of our study was to assess and to compare the level of satisfaction, with an inflatable penile prosthesis (IPP), in men with/without coexistent PD. MATERIAL AND METHODS A survey study based on a five-item satisfaction questionnaire was submitted to all those live patients implanted in the period 1992-2022 at our center (n=570) and their partners. Ninety-two percent of implants were inflatable devices. Surgeries were mainly performed by two surgeons. The main outcome measure used was the level of patient and partner satisfaction with sexual intercourse after IPP. RESULTS Of the 570 eligible patients, 479 (84%) completed the survey (393 Non-PD: GROUP 1; 70 non-complex PD-Group 2; 16 complex PD). Eighty-six per cent of patients in Group 1 reported satisfactory sexual intercourse (very or moderately satisfied). Non-complex PD implanted patients (Group 2) reported a global 81% satisfactory sexual intercourse (very or moderately satisfied) (p>0.05). However, when we evaluated the PD subgroup of patients with severe PD who require incision/excision/grafting at the time of implant (Group 3: n=20), only 61% reported satisfactory sexual intercourse (p<0.01) with predominance of moderately satisfied patients over very satisfied: 78% vs. 22%). Additionally, 84% (Group 1), 80% (Group 2) and 54% (Group 3) of partners reported satisfactory intercourses, respectively (p<0.01). Overall, 84% of Group 1 implants and 79% of Group 2 reported that they would undergo the procedure again if the IPP failed (p>0.05; ns). Only 50% of Group 3 patients would do it again. With regard to cosmetic aspects, 48% of the Group 3 implant reported penile shortness or soft glans as the main causes of their dissatisfaction. Only 2.4% of total PP patients expressed difficulty in manipulating the device. CONCLUSION The presence of PD alone may not impact PP patient and partner satisfaction, but patients with more severe baseline deformity who require incision/grafting may be less satisfied with outcomes including penile length and glans sensation.
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Affiliation(s)
- E Lledó García
- Sección de Urología Funcional, Reconstructiva y Andrología-Servicio de Urología, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Gregorio Marañón, Universidad Complutense, Madrid, Spain.
| | - F J González García
- Sección de Urología Funcional, Reconstructiva y Andrología-Servicio de Urología, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Gregorio Marañón, Universidad Complutense, Madrid, Spain
| | - J Jara Rascón
- Sección de Urología Funcional, Reconstructiva y Andrología-Servicio de Urología, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Gregorio Marañón, Universidad Complutense, Madrid, Spain
| | - J García Muñoz
- Facultad de Medicina, Universidad Complutense, Madrid, Spain
| | - E Lledó Graell
- Facultad de Medicina, Universidad Europea, Madrid, Spain
| | - M A Sánchez Ochoa
- Sección de Urología Funcional, Reconstructiva y Andrología-Servicio de Urología, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Gregorio Marañón, Universidad Complutense, Madrid, Spain
| | - C Hernández Fernández
- Sección de Urología Funcional, Reconstructiva y Andrología-Servicio de Urología, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Gregorio Marañón, Universidad Complutense, Madrid, Spain
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Khera M, Bernie HL, Broderick G, Carrier S, Faraday M, Kohler T, Jenkins L, Watter D, Mulhall J, Raheem O, Ramasamy R, Rubin R, Spitz A, Yafi F, Sadeghi-Nejad H. Sexual Medicine Society of North America (SMSNA)/American Urological Association (AUA) telemedicine and men's health white paper. J Sex Med 2024; 21:318-332. [PMID: 38430132 DOI: 10.1093/jsxmed/qdad151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 10/16/2023] [Accepted: 10/20/2023] [Indexed: 03/03/2024]
Abstract
PURPOSE The purpose of this white paper is to educate health care professionals about the evolution of telemedicine (TM) and to propose a hybrid model that leverages the strengths of traditional in-person medicine as well as virtual medicine while maximizing the safety and quality of men's sexual health care. LITERATURE SEARCH STRATEGY A literature search focused on the use of TM in urology and men's health was performed through PubMed/MEDLINE, Embase, and Web of Science (January 1, 2012-April 26, 2022). Keywords included all known permutations of the terminology used to refer to virtual health, care as well as the terminology used to refer to urologic diseases, issues specific to men's health, and men's sexual health concerns. Publications that emerged after the literature search that met this criterion also were incorporated. Opinion pieces, letters to the editor, meeting abstracts, and conference proceedings were excluded. Additional resources were retrieved, such as governmental technical reports, legislative updates and reviews, and blogs. This search strategy yielded 1684 records across databases after removal of duplicates. Abstracts from the retrieved records were reviewed for relevance. Relevant publications were defined as those that reported data on any aspect of TM use specific to urology, men's health, and/or men's sexual health. If relevance was unclear from the abstract, then the full text of the article was retrieved for a more detailed review. In addition, the published evidence-based practice guidelines relevant to care for erectile dysfunction, Peyronie's disease, ejaculatory dysfunction, and hypogonadism were retrieved. The most common reasons for article exclusions were a focus on TM use in disciplines other than urology and the absence of data (ie, opinion pieces). After exclusions, a total of 91 publications remained and constituted the evidence base for this paper.
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Affiliation(s)
- Mohit Khera
- Scott Department of Urology, Baylor College of Medicine, Houston, TX 77030, United States
| | - Helen L Bernie
- Department of Urology, Indiana University, Indianapolis, IN 46202, United States
| | - Gregory Broderick
- Department of Urology, Mayo Clinic Alix School of Medicine, Jacksonville, Florida 32224, United States
| | - Serge Carrier
- Surgical Department /Urology Division, McGill University, Montreal, Quebec, H4A 3J1, Canada
| | - Martha Faraday
- Four Oaks Consulting, Berryville, VA 22611, United States
| | - Tobias Kohler
- Department of Urology, Mayo Clinic, Rochester, MN 55905, United States
| | - Lawrence Jenkins
- Department of Urology, Tulane University School of Medicine, New Orleans, LA 70112, United States
| | - Daniel Watter
- Morris Psychological Group, P.A., Parsippany, NJ 07054, United States
| | - John Mulhall
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10022, United States
| | - Omer Raheem
- Section of Urology, Department of Surgery, University of Chicago, Chicago, IL 60637, United States
| | - Ranjith Ramasamy
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL 33136, United States
| | - Rachel Rubin
- Department of Urology, Georgetown University, Washington, DC 20007, United States
| | - Aaron Spitz
- Orange County Urology Associates, Laguna Hills, California, CA 92653, United States
| | - Faysal Yafi
- Department of Urology, University of California Irvine, CA 92660, United States
| | - Hossein Sadeghi-Nejad
- Department of Urology, NYU Langone Grossman School of Medicine, New York, NY 10017, United States
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Kraglund R, Durukan E, Giraldi A, Fode M. The association between Peyronie's disease and depression: a scoping review. Sex Med Rev 2024; 12:221-229. [PMID: 37902293 DOI: 10.1093/sxmrev/qead045] [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: 07/28/2023] [Revised: 09/25/2023] [Accepted: 09/29/2023] [Indexed: 10/31/2023]
Abstract
INTRODUCTION Peyronie's disease (PD) can have an immense psychological impact, with depression being a reported possible, severe consequence. To date, no literature reviews have systematically and critically assessed the relationship between PD and depression. OBJECTIVES The study sought to identify and critically appraise the current literature on the association between PD and depression. METHODS Studies had to address men with PD or probable PD and assess depression or depressive symptoms. Quantitative and qualitative, peer-reviewed, primary, empirical studies written in English or Danish were included. According to the guidelines for scoping reviews and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews) guideline, we performed a systematic review of PubMed, PsycINFO, Embase, CINAHL, the Cochrane Library, and Web of Science. Reference lists of included studies were screened for additional sources. Gray literature was searched for in Google Scholar and Bielefeld Academic Search Engine. Data were charted using a data extraction form, and critical appraisal was performed using the QuADS (quality assessment with diverse studies) tool. RESULTS Thirteen studies were included. Most studies had a cross-sectional design, and also cohort studies and longitudinal observational studies without a control group were found. Depression was assessed mainly by validated questionnaires or diagnostic codes. Questionnaire studies found a prevalences of moderate to severe depression of 24% to 48%, while studies using diagnostic codes found depression in 4% to 37% of men with PD. The quality of the included studies varied from 38% to 82% of the maximum possible score in the QuADS assessment. CONCLUSION While most studies describe an association between PD and depression, the evidence is not comprehensive. The current literature is especially at risk of selection bias and the influence of confounding factors, and a direct causality between PD and depression cannot be established. Future research calls for more methodically rigorous studies as well as qualitative studies to understand the relationship.
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Affiliation(s)
- Rune Kraglund
- Department of Urology, Copenhagen University Hospital-Herlev and Gentofte Hospital, Herlev 2730, Denmark
- Sexological Clinic, Mental Health Center, Copenhagen University Hospital-Mental Health Services CPH, Copenhagen 2100, Denmark
| | - Emil Durukan
- Department of Urology, Copenhagen University Hospital-Herlev and Gentofte Hospital, Herlev 2730, Denmark
| | - Annamaria Giraldi
- Sexological Clinic, Mental Health Center, Copenhagen University Hospital-Mental Health Services CPH, Copenhagen 2100, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen 2200, Denmark
| | - Mikkel Fode
- Department of Urology, Copenhagen University Hospital-Herlev and Gentofte Hospital, Herlev 2730, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen 2200, Denmark
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Şahin A, Babayev H, Cirigliano L, Preto M, Falcone M, Altıntas E, Gül M. Unveiling the molecular Hallmarks of Peyronie's disease: a comprehensive narrative review. Int J Impot Res 2024:10.1038/s41443-024-00845-2. [PMID: 38454161 DOI: 10.1038/s41443-024-00845-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 01/26/2024] [Accepted: 02/12/2024] [Indexed: 03/09/2024]
Abstract
Peyronie's disease, a fibroinflammatory disorder, detrimentally impacts the sexual well-being of men and their partners. The manifestation of fibrotic plaques within penile tissue, attributed to dysregulated fibrogenesis, is pathognomonic for this condition. The onset of fibrosis hinges on the perturbation of the equilibrium between matrix metalloproteinases (MMPs), crucial enzymes governing the extracellular matrix, and tissue inhibitors of MMPs (TIMPs). In the context of Peyronie's disease, there is an elevation in TIMP levels coupled with a decline in MMP levels, culminating in fibrogenesis. Despite the scant molecular insights into fibrotic pathologies, particularly in the context of Peyronie's disease, a comprehensive literature search spanning 1995 to 2023, utilizing PubMed Library, was conducted to elucidate these mechanisms. The findings underscore the involvement of growth factors such as FGF and PDGF, and cytokines like IL-1 and IL-6, alongside PAI-1, PTX-3, HIF, and IgG4 in the fibrotic cascade. Given the tissue-specific modulation of fibrosis, comprehending the molecular underpinnings of penile fibrosis becomes imperative for the innovation of novel and efficacious therapies targeting Peyronie's disease. This review stands as a valuable resource for researchers and clinicians engaged in investigating the molecular basis of fibrotic diseases, offering guidance for advancements in understanding Peyronie's disease.
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Affiliation(s)
- Ali Şahin
- Selcuk University School of Medicine, 42250, Konya, Turkey
| | - Huseyn Babayev
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, 7265, Davos, Switzerland
| | - Lorenzo Cirigliano
- Department of Urology, Molinette Hospital, University of Torino, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Mirko Preto
- Department of Urology, Molinette Hospital, University of Torino, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Marco Falcone
- Department of Urology, Molinette Hospital, University of Torino, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Emre Altıntas
- Department of Urology, Selcuk University School of Medicine, 42250, Konya, Turkey
| | - Murat Gül
- Department of Urology, Molinette Hospital, University of Torino, AOU Città della Salute e della Scienza di Torino, Turin, Italy.
- Department of Urology, Selcuk University School of Medicine, 42250, Konya, Turkey.
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Rassweiler JJ, Scheitlin W, Goezen AS, Radecke F. Long-term experiences with high-energy shock wave therapy in the management chronic phase Peyronie's disease using two different electromagnetic lithotripters. World J Urol 2024; 42:124. [PMID: 38453751 PMCID: PMC10920406 DOI: 10.1007/s00345-024-04792-x] [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: 06/29/2023] [Accepted: 01/16/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Extracorporeal shock wave lithotripsy represents one option for the non-surgical management of Peyronie's disease. Despite promising results, several questions are still pending. We want to present the long-term results of a retrospective study using high-energy extracorporeal shock wave lithotripsy. MATERIAL AND METHODS We evaluated retrospectively 110 patients treated between 1996 and 2020 at the Department of Urology, SLK Kliniken Heilbronn for chronic phase Peyronie's disease using two electromagnetic lithotripters (Siemens Lithostar Plus Overhead Module, Siemens Lithoskop) applying high-energy shock waves under local anesthesia and sonographic or fluoroscopic control. A standardized questionnaire focused on the change in pain, curvature, sexual function and the need of penile surgery. RESULTS In 85 of the 110 patients (mean age 54 years) we had sufficient data for evaluation. The median follow-up was 228 (6-288) months. There were no significant complications. Pain reduction was achieved in all patients, 65 (76%) patients were free of pain. Improvement of penile curvature was achieved in 43 patients (51%) ranging from 25% improvement (deflected angle < 30°) to 95% (angle 30-60°). 59 patients (69%) reported problems with sexual intercourse, 40 of those (68%) reported improvement. Only 9 (10.5%) patients underwent surgical correction. We did not observe any significant differences between both electromagnetic devices with stable long-term results. CONCLUSIONS High-energy shock wave therapy delivered by two standard electromagnetic lithotripters is safe and efficient providing stable long-term results. In cases with significant plaque formation, the concept of high-energy ESWT should be considered in future studies.
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Affiliation(s)
- Jens J Rassweiler
- Chair of Urology and Andrology, Danube Private University, Steiner Landstraße 124, 3500, Krems-Stein, Austria.
| | - W Scheitlin
- Department of Urology, SLK Kliniken Heilbronn, Heilbronn, Germany
| | - A S Goezen
- Department of Urology Medius-Kliniken Ruit, University of Tübingen, Ostfildern-Ruit, Germany
| | - F Radecke
- Department of Urology, SLK Kliniken Heilbronn, Heilbronn, Germany
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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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Elgendi K, Zulia N, Beilan J. A Review on Penile Doppler and Ultrasonography for Erectile Dysfunction. Curr Urol Rep 2023; 24:69-74. [PMID: 36417045 DOI: 10.1007/s11934-022-01135-4] [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: 11/08/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE OF REVIEW Herein, we seek to review the clinical applications of penile duplex Doppler ultrasound (PDDU) in sexual medicine practices and discuss the indications, protocols, advantages, and limitations of this diagnostic modality. Other more outdated diagnostic tests, such as cavernosometry, are briefly discussed to provide the reader a background of understanding on the evolution of diagnostic testing within the realm of sexual medicine. RECENT FINDINGS PDDU has become a key diagnostic tool in the clinical evaluation of both erectile dysfunction (ED) and Peyronie's disease (PD). With the assistance of intracavernosal injections such as alprostadil, clinicians can utilize ultrasound technology to produce a detailed description of the hemodynamics of the patient's erection cycle. This information plays a pivotal role in establishing an accurate diagnosis and creating a sensible management plan for the patient. This review aims to provide a better understanding regarding the technique and interpretation of PDDU as it pertains to male sexual function.
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Affiliation(s)
- Kareem Elgendi
- Nova Southeastern University College of Osteopathic Medicine, Fort Lauderdale, FL, USA
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Chu KY, Molina ML, Ledesma B, Zucker I, Saltzman RG, Masterson TA, Ramasamy R. A Phase 2 Randomized, Placebo-controlled Crossover Trial to Evaluate Safety and Efficacy of Platelet-rich Plasma Injections for Peyronie's Disease: Clinical Trial Update. Eur Urol Focus 2023; 9:11-13. [PMID: 36100520 DOI: 10.1016/j.euf.2022.08.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 08/30/2022] [Indexed: 11/04/2022]
Abstract
Intralesional injection of platelet-rich plasma for Peyronie's disease appears to be safe according to early observations from an ongoing clinical trial. Efficacy data remain elusive until completion of the trial.
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Affiliation(s)
- Kevin Y Chu
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Manuel L Molina
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Brian Ledesma
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Isaac Zucker
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Russell G Saltzman
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Thomas A Masterson
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ranjith Ramasamy
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL, USA.
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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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11
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Achraf C, Abdelghani PA, Jihad PEA. Platelet-rich plasma in patients affected with Peyronie's disease. Arab J Urol 2022; 21:69-75. [PMID: 37234679 PMCID: PMC10208162 DOI: 10.1080/2090598x.2022.2135284] [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: 05/30/2022] [Accepted: 10/09/2022] [Indexed: 11/02/2022] Open
Abstract
Objectives The objective of our study is to discover and evaluate the effects of repeated intralesional injections inside the tunica albuginea of platelet-rich plasma (PRP) in the treatment of Peyronie's disease (PD). Methods As part of a prospective study over 12 months from February 2020 until February 2021, on Sixty-five patients with Peyronie's disease, and penile curvature between 25 and 45°. Patients were stratified into two groups, the first with a curvature between 25 and 35° and the second between 35 and 45°. Gathered data included patient-demographics, Injection technique, outcomes: both quantitative (curvature assessments) and qualitative (state of erectile function, pain during intercourse), and complications. Results Patients in both groups received an average of 6.1 injections of PRP during the study period. Angulation was significantly improved in both groups an average final improvement of 16.88° (SD = 3.35) (p < 0.001) in the first group and 17.27° (SD = 4.22) (p < 0.001) in the second group. Pain during sex decreased from 70.7% to 34.25%, and 55.5% of patients had easier sexual intercourse. Conclusions The positive results of our series of treatment for Peyronie's disease by injection of platelet-rich plasma are encouraging both methodologically (simplicity) and clinical (safety and efficacy) as well as patient satisfaction.
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Piraino J, Chaudhary H, Ames K, Okoye F, Sterling M, Clavell-Hernandez J, Levine L, Ziegelmann MJ. A Consistent Lack of Consistency in Defining the Acute and Chronic Phases of Peyronie's Disease: A Review of the Contemporary Literature. Sex Med Rev 2022; 10:698-713. [PMID: 37051957 DOI: 10.1016/j.sxmr.2022.08.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 07/21/2022] [Accepted: 08/10/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Treatment recommendations for Peyronie's Disease (PD) differ based on whether a patient is in the acute/active versus chronic/stable phase of the disease, yet there are no agreed upon criteria for defining these clinical entities. OBJECTIVES To review the criteria used to define acute and chronic phase PD in modern PD intervention studies. METHODS We performed a search engine review to identify indexed publications for PD intervention studies and review articles / meta-analyses from the year 2011-2020. Outcomes results were catalogued and summarized across articles. As a result of the substantial heterogeneity of outcome measures and follow-up intervals, meta-analytic techniques were not applied to the data analysis. RESULTS We identified a total of 104 studies that met inclusion criteria and had available information for review (n = 79 primary intervention studies; n = 25 review articles/meta-analyses/guidelines). Among the queried studies, we were unable to identify a consensus with respect to the criteria used to define acute and chronic phases of PD. 33% of primary intervention studies did not specifically define their criteria for acute and chronic phase PD, despite referencing these populations as part of the inclusion criteria in many instances. Studies used heterogenous criteria including total symptom duration, duration of "stable" symptoms, and presence/absence of pain. CONCLUSION Due to varying definitions across the literature, we were unable to create a standardized definition of acute and chronic phase Peyronie's in terms of time. Our findings emphasize the need for greater consensus in defining the treatment cohorts with future studies that assess treatment for men with PD.
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Topcuoglu M, Çakan M. Effects of long term sildenafil on the acute phase of Peyronie’s disease in a combination treatment. Arch Ital Urol Androl 2022; 94:319-322. [DOI: 10.4081/aiua.2022.3.319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 07/02/2022] [Indexed: 11/23/2022] Open
Abstract
Objectives: The aim of this study was to investigate the impact of the addition of 50 mg daily sildenafil to pentoxifylline-colchicine combination ther-apy on the Peyronie's plaque features in patients with the acute phase of Peyronie's disease (PD). Methods: In this retrospective and non-randomized clinical study, patients were divided into 2 groups as group 1; (n = 107) who received colchicine and pentoxyfillin plus 50 mg daily oral sildenafil, and as group 2; (n = 79) who received only colchicine and pentoxyfillin. Patients were compared in terms of degree of curvature, pain in erection and erectile function at the baseline and at 6-month follow up. Pain in erection and erectile func-tion were evaluated by visual Analogue Scale (EF-VAS), and the shortened version of the International Index of Erectile Function (IIEF-5). Improvement in the degree of curvature and change in EF-VAS scores were primary endpoints of the study. Change in IIEF-5 score was the secondary endpoint of the study.
Results: The two groups were statistically similar in terms of demographics and baseline features of PD. A statistically signifi-cant reduction in degree of curvature and EF-VAS scores was shown in group 1 compared to group 2.There was also a signifi-cantly higher IIEF-5 score in group 1 compared to group 2. No significant side effects were detected in both groups during treatment period.Conclusions: Adding sildenafil to pentoxifylline-colchicine com-bination treatment seems to improve PD related symptoms in the acute phase PD. PDE5i may contribute to relieve the Peyronie's symptoms in ED patients through their antifibrotic effects.
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Anderson D, Laforge J, Ross MM, Vanlangendonck R, Hasoon J, Viswanath O, Kaye AD, Urits I. Male Sexual Dysfunction. Health Psychol Res 2022; 10:37533. [PMID: 35999971 PMCID: PMC9392840 DOI: 10.52965/001c.37533] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2023] Open
Abstract
Male sexual dysfunction is a series of conditions, most notably including erectile dysfunction (ED), Peyronie's disease (PD), and premature ejaculation (PE), defined by impaired sexual functioning. The prevalence of male sexual dysfunction increases with age and is relatively high with greater than 50% of men aged 40 to 70 describing some degree of erectile dysfunction. Risk factors for male sexual dysfunction include age, diabetes mellitus (DM), cancer, stroke, hypertension, penile trauma, depression, anxiety, and disturbance in central serotonin neurotransmission and 5-HT postsynaptic receptor functioning. Sexual questionnaires including the International Index of Erectile Dysfunction, Sexual Health Inventory for Men, and the Premature Ejaculation Diagnostic Tool are useful in screening for these disorders. Focused history and physical can establish diagnoses. For a condition to be diagnosed as male sexual dysfunction, the patient or their partner must view their sexual functioning as impaired. Treatment of male sexual dysfunction is etiology dependent. For ED, first-line therapy is a phosphodiesterase-5 inhibitor or mental health care for psychogenic ED. More complicated cases may be treated with injections, surgery, or shockwave therapy. PD is either treated with medications for pain management, collagenase clostridium histolyticum injection, corpoplasty, plication, or shockwave therapy. PE may be treated behaviorally or with SSRIs as first line medication.
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Affiliation(s)
| | - John Laforge
- Department of Anesthesiology, Louisiana State University Health Shreveport
| | - Maggie M Ross
- Department of Anesthesiology, Louisiana State University Health Shreveport
| | | | - Jamal Hasoon
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School
| | - Omar Viswanath
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School; Valley Anesthesiology and Pain Consultants, Envision Physician Services; Department of Anesthesiology, University of Arizona College of Medicine Phoenix; Department of Anesthesiology, Creighton University School of Medicine
| | - Alan D Kaye
- Department of Anesthesiology, Louisiana State University Health Shreveport
| | - Ivan Urits
- Department of Anesthesiology, Louisiana State University Health Shreveport; Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School
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15
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Campbell JD, Matti D, Abed H, Di Pierdominico A. Technological Advancements for Treating Erectile Dysfunction and Peyronie's Disease. Urol Clin North Am 2021; 49:175-184. [PMID: 34776050 DOI: 10.1016/j.ucl.2021.07.013] [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: 11/17/2022]
Abstract
Over the past decade, there have been several advancements in the technologies available to treatment erectile dysfunction and Peyronie's disease. Vacuum erection devices, penile traction devices, low-intensity extracorporeal shockwave therapy, and penile prosthesis surgery have evolved and are changing the way we treat men's health. Although significant improvements have been made, further work is needed to standardize treatment, create universal algorithms for technological applications, and simply their use.
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Affiliation(s)
- Jeffrey D Campbell
- Division of Urology, Department of Surgery, Western University, London, Ontario, Canada.
| | - Danny Matti
- Division of Urology, Department of Surgery, Western University, London, Ontario, Canada
| | - Haider Abed
- Division of Urology, Department of Surgery, Western University, London, Ontario, Canada
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16
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Punjani N, Nascimento B, Salter C, Miranda E, Terrier J, Taniguchi H, Jenkins L, Mulhall JP. Predictors of Depression in Men With Peyronie's Disease Seeking Evaluation. J Sex Med 2021; 18:783-788. [PMID: 33712403 PMCID: PMC9087901 DOI: 10.1016/j.jsxm.2021.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 01/25/2021] [Accepted: 02/01/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Peyronie's disease (PD) has negative impacts on the psychosocial status of men including depression warranting clinical evaluation in up to 50% of men. AIM To examine predictors of depression in patients with early PD seeking evaluation. METHODS All PD patients at a high-volume PD practice underwent screening and curvature assessment after intracavernosal injection. Complex deformity was defined as any degree of multiplanar curvature, curvature >60 degrees, or presence of hourglass deformity. Men completed the PD questionnaire (PDQ), a validated depression questionnaire (CES-D) as well as the Self-Esteem and Relationship (SEAR) questionnaire. Scores of ≥16 on CES-D were considered indicative of moderate/severe depression. Predictors of the presence of depression were defined using univariable and multivariable logistic regression. OUTCOMES Demographic, bother and curve related predictors of depression in men with PD. RESULTS 408 men completed all questionnaires. Mean age was similar between depressed and nondepressed groups (57 ± 10 years overall, P = .60 between groups). Proportions of erectile dysfunction were similar between groups (P = .96). Mean PD duration was similar between groups (19 ± 35 months overall, P = .46 between groups). Mean degree of curvature was 38 ± 2 degrees in the depressed vs 33 ± 1 degrees in the nondepressed groups (P = .03). A complex deformity was seen in 64.5% in the depressed vs 61.5% in the nondepressed (P = .56). A total of 110 (27%) patients had CESD scores ≥16. 74% depressed men were in relationships compared to 84% nondepressed men (P < .01). Other characteristics including bother, pain, duration of disease, curve complexity and instability were similar between the two groups. On univariable analysis, factors protective against depression included being partnered (OR 0.42, 95%CI 0.24-0.75, P < .01) and higher total SEAR scores (OR 0.95, 95%CI 0.94-0.97, P < .01). Elevated PDQ domain scores were associated with depression (Psychologic Symptoms 1.05, 95%CI 1.02-1.10, P < .01; Pain 1.08, 95%CI 1.03-1.12, P < .01; Bother 1.11, 95% CI 1.05-1.68, P < .01) as well as baseline history of depression (OR 2.93, 95%CI 1.67-5.14, P < .001). On multivariable analysis, only total SEAR score remained protective against depression (OR 0.96, 95%CI 0.94-0.97, P < .001). CLINICAL IMPLICATIONS Providers must recognize that men with PD seeking evaluation have meaningful rates of depression for which early recognition is necessary. STRENGTHS AND LIMITATIONS Retrospective review of a large prospectively collected dataset from a single center of men with PD utilizing a validated screening tool for depression. CONCLUSION While no significant demographic, bother or curve related factors predicted depression in early PD men seeking evaluation, it remains a significant problem warranting further prospective evaluation. P. Nahid, N. Bruno, S. Carolyn, et al. Predictors of Depression in Men With Peyronie's Disease Seeking Evaluation. J Sex Med 2021;18:783-788.
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Affiliation(s)
- Nahid Punjani
- Sexual & Reproductive Medicine Program, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Urology, Center for Male Reproductive Medicine and Microsurgery, Weill Cornell Medicine of Cornell University, New York, NY, USA
| | - Bruno Nascimento
- Sexual & Reproductive Medicine Program, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Universidade de Sao Paulo Faculdade de Medicina Hospital das Clinicas, Urology, Sao Paulo, Brazil
| | - Carolyn Salter
- Sexual & Reproductive Medicine Program, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Eduardo Miranda
- Sexual & Reproductive Medicine Program, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Universidade Federal do Ceara, Division of Urology, Fortaleza, Brazil
| | - Jean Terrier
- Sexual & Reproductive Medicine Program, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Hisanori Taniguchi
- Sexual & Reproductive Medicine Program, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Lawrence Jenkins
- Sexual & Reproductive Medicine Program, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - John P Mulhall
- Sexual & Reproductive Medicine Program, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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17
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De Rose AF, Mantica G, Bocca B, Szpytko A, Van der Merwe A, Terrone C. Supporting the role of penile trauma and micro-trauma in the etiology of Peyronie's disease. Prospective observational study using the electronic microscope to examine two types of plaques. Aging Male 2020; 23:740-745. [PMID: 30879382 DOI: 10.1080/13685538.2019.1586870] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES The etiopathogenesis of Peyronie's disease (PD) remains not clearly understood. The most accepted theory attributes the histological lesions of PD to the effects of trauma to the corpora cavernosum of the penis. The aim of our study is to verify whether similar histological features exist between these two tissues, providing new evidence in favor of the traumatic theory in the etiopathogenesis of Peyronie's disease. MATERIALS AND METHODS A prospective observational study was carried out at our institution from January 2013 to June 2018, involving patients having undergone surgery for PD and those with delayed surgery for penile trauma. Both excised PD and post-traumatic plaques were analyzed by blind pathologists with an 80kV potential acceleration electron microscope. RESULTS Five patients were identified with a post-traumatic plaque (Group 1) and therefore an equal number of PD patients were enrolled for Group 2. The ultrastructural characteristics of the two types of preparations were very similar. In all the samples we showed an inflammatory reaction of the structure of the tunica albuginea, a production of the disorganized extracellular matrix, a proliferation of inflammatory cells and fibroblasts. Furthermore, we have found an increase in the density and collagen deposits grouped in the extracellular space and within the fibroblasts. CONCLUSIONS These findings support the theory that attributes lesions and symptoms typical of PD to the effects of cavernous body trauma.
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Affiliation(s)
- Aldo Franco De Rose
- Department of Urology, Policlinico San Martino Hospital, University of Genova, Genova, Italy
| | - Guglielmo Mantica
- Department of Urology, Policlinico San Martino Hospital, University of Genova, Genova, Italy
- Department of Urology, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Bruna Bocca
- Department of Pathology, Policlinico San Martino Hospital, University of Genova, Genova, Italy
| | - Alexander Szpytko
- Department of Urology, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - André Van der Merwe
- Department of Urology, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Carlo Terrone
- Department of Urology, Policlinico San Martino Hospital, University of Genova, Genova, Italy
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18
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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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19
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Cai Z, Song X, Zhang J, Yang B, Li H. Practical Approaches to Treat ED in PDE5i Nonresponders. Aging Dis 2020; 11:1202-1218. [PMID: 33014533 PMCID: PMC7505261 DOI: 10.14336/ad.2019.1028] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 08/28/2019] [Indexed: 12/21/2022] Open
Abstract
Erectile dysfunction (ED) is a common sexual disorder in adult males and one of the most important factors affecting their quality of life and that of their partners. Although PDE5 inhibitors (PDE5is) are the first choice for improving erectile function, there is a substantial proportion of ED patients, termed PDE5i nonresponders, who do not respond to PDE5is. Because of the lack of effective therapies, these patients always have serious social and psychological problems due to ED, which should be addressed. Here, we review the available literature about ED and PDE5is and propose several strategies for mitigating ED in PDE5i nonresponders.
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Affiliation(s)
- Zhonglin Cai
- 1Department of Urology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaoqing Song
- 2Department of Pathology, First Affiliated Hospital and College of Basic Medical Sciences, China Medical University, Shenyang, China
| | - Jianzhong Zhang
- 1Department of Urology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Bin Yang
- 3Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Hongjun Li
- 1Department of Urology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
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20
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Reddy AG, Dick BP, Natale C, Akula KP, Yousif A, Hellstrom WJG. Application of Botulinum Neurotoxin in Male Sexual Dysfunction: Where Are We Now? Sex Med Rev 2020; 9:320-330. [PMID: 32641225 DOI: 10.1016/j.sxmr.2020.05.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 05/11/2020] [Accepted: 05/21/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Botulinum neurotoxin (BoNT) is a recognized therapeutic agent of modern medical care, routinely used to treat medical conditions affecting a variety of organ systems including the musculoskeletal, integumentary, and urological domains. Ongoing research is exploring BoNT's potential role as a therapeutic agent for a variety of male sexual pathologies. OBJECTIVE To review and analyze the literature regarding BoNT as a treatment option for male sexual dysfunction. METHODS A PubMed search was performed for English-language articles in peer-reviewed journals between 1970 and 2019 (with one article from 1897). Relevant articles referenced within these texts were also included. One article did not have an accompanied English full-text available. The following search terms were used: "Botox", "Botulinum toxin", "Botulinum toxin A", "Onabotulinum A", "Abobutlinum A", "BoNT", "BoNT-A", "Male sexual health", "Male sexual pathology", "Peyronie's disease", "Premature ejaculation", "Scrotal Pain", "Penile Retraction", "Scrotox", "Erectile Dysfunction", and "Botox in Urology". RESULTS There is interest in the potential role of BoNT in the treatment of male sexual pathologies. We identified studies that used BoNT to treat chronic scrotal content pain, premature ejaculation, erectile dysfunction, Peyronie's disease, penile retraction, and more. However, despite preclinical/clinical data indicating some potential efficacy and safety in these settings, a lack of robust clinical trial data has resulted in no current Food and Drug Administration-approved indications for the use of BoNT in the treatment of male sexual pathology. As a result, much of the current use of BoNT by today's providers is "off-label," and ongoing clinical trials aim to further elucidate the potential role of this therapeutic agent. CONCLUSION Current data suggest that BoNT could have a potential role as a treatment option for certain types of male sexual pathologies. However, more randomized controlled trial data regarding its long-term safety and efficacy are necessary before a widespread clinical adoption can take place. Reddy AG, Dick BP, Natale C, et al. Application of Botulinum Neurotoxin in Male Sexual Dysfunction: Where Are We Now?. J Sex Med 2021;9:320-330.
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Affiliation(s)
- Amit G Reddy
- Department of Urology, Tulane University School of Medicine, New Orleans, USA
| | - Brian P Dick
- Department of Urology, Tulane University School of Medicine, New Orleans, USA
| | - Caleb Natale
- Department of Urology, Tulane University School of Medicine, New Orleans, USA
| | - Kole P Akula
- Department of Urology, Tulane University School of Medicine, New Orleans, USA
| | - Ayad Yousif
- Department of Urology, Tulane University School of Medicine, New Orleans, USA
| | - Wayne J G Hellstrom
- Department of Urology, Tulane University School of Medicine, New Orleans, USA.
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21
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Can O, Özbir S, Atalay HA, Çakır SS, Culha MG, Canat HL. The relationship between testosterone levels and Peyronie's disease. Andrologia 2020; 52:e13727. [PMID: 32589321 DOI: 10.1111/and.13727] [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: 03/31/2020] [Revised: 05/06/2020] [Accepted: 05/31/2020] [Indexed: 12/23/2022] Open
Abstract
Aetiologic and predisposing factors are still controversial about Peyronie's disease (PD). However, it is thought to be the result of connective tissue disorder or healing defect. Androgens are known to affect collagen metabolism and wound healing in the body. The aim of this study was to investigate the relationship between PD and low testosterone levels. One hundred and forty-seven Peyronie patients and 137 healthy volunteers were included in the study. In both groups, demographic data, medical history, physical examination and erectile capacity were recorded. Blood samples were collected from all subjects in the early morning hours after an overnight fast. The mean level of serum total testosterone was lower in men with PD compared with the controls (3.9 ± 1.1 vs. 4.2 ± 1.7 ng/ml respectively) (p = .062). However, statistically significant relationship was not found between PD and low serum testosterone levels. There was no significant correlation between penile plaque dimension or penile curvature degree and testosterone levels. Large randomised-controlled prospective studies are needed to reveal this possible association.
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Affiliation(s)
- Osman Can
- Department of Urology, Basaksehir City Hospital, Istanbul, Turkey
| | - Sait Özbir
- Department of Urology, Cemil Taşcıoglu City Hospital, Istanbul, Turkey
| | | | - Süleyman Sami Çakır
- Department of Urology, Atlas University, Medicine Hospital, Istanbul, Turkey
| | | | - Halil Lütfi Canat
- Department of Urology, Cemil Taşcıoglu City Hospital, Istanbul, Turkey
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22
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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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23
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Zhang CD, Clark J, Greenlund LS. 36-Year-Old Man With Persistent Erection. Mayo Clin Proc 2020; 95:1059-1063. [PMID: 32299673 DOI: 10.1016/j.mayocp.2019.10.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 09/27/2019] [Accepted: 10/16/2019] [Indexed: 11/19/2022]
Affiliation(s)
- Catherine D Zhang
- Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Rochester, MN
| | - Jennifer Clark
- Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Rochester, MN
| | - Laura S Greenlund
- Advisor to residents and Consultant in Community Internal Medicine, Mayo Clinic, Rochester, MN.
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Review of Intralesional Collagenase Clostridium Histolyticum Injection Therapy and Related Combination Therapies in the Treatment of Peyronie's Disease (an Update). Sex Med Rev 2020; 9:340-349. [PMID: 32199788 DOI: 10.1016/j.sxmr.2020.01.005] [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: 09/18/2019] [Revised: 01/21/2020] [Accepted: 01/23/2020] [Indexed: 01/02/2023]
Abstract
INTRODUCTION Collagenase Clostridium histolyticum (CCH) is an injectable agent used to treat Peyronie's disease (PD) by enzymatically degrading the interstitial collagen in plaques. CCH has been administered via multiple treatment protocols, in combination therapies, to patients with varying curvatures and in both the acute and stable phases of this condition. OBJECTIVES To review the current literature and provide an update on CCH as an injectable therapy for PD, as a singular therapy or in conjunction with combination therapies, and its associated complications. We provide a brief background of PD treatments, evaluate CCH efficacy in penile curvature reduction and subjective improvement in a variety of protocols, and compare combination therapies (penile traction, sildenafil), plaque location, and efficacy in both acute and stable diseases. METHODS We performed a systematic review of the existing PubMed literature pertaining to CCH injection therapy in the treatment of PD and compared the effectiveness to different treatment modalities. RESULTS CCH is a safe and effective injectable agent for all curvature directions in both acute and stable PD. It can be used in conjunction with multiple penile modeling techniques, in combination with sildenafil, and following a shortened administration protocol. Moderate to severe treatment-related adverse events occur at a rate of 9% and are typically managed conservatively. CONCLUSION Intralesional injections of CCH are FDA approved as a nonsurgical treatment for men with PD. The IMPRESS trials were instrumental in demonstrating the efficacy and safety of CCH and provided a standard protocol for administration. Additional studies are required to optimize treatment protocols and use in combination therapies. Further investigation of patients with ventral curvatures, hourglass deformities, and those in acute phase is needed. Natale C, McLellan D, Yousif A, et al. Review of Intralesional Collagenase Clostridium Histolyticum Injection Therapy and Related Combination Therapies in the Treatment of Peyronie's Disease (an Update). Sex Med 2021;9:340-349.
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Basilius JR, Hotaling JM, Pastuszak AW. Unwinding Fibrosis in Peyronie's Disease. J Sex Med 2020; 17:835-837. [PMID: 32111535 DOI: 10.1016/j.jsxm.2020.01.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 01/10/2020] [Indexed: 01/19/2023]
Affiliation(s)
- Jacob R Basilius
- Division of Urology, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - James M Hotaling
- Division of Urology, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Alexander W Pastuszak
- Division of Urology, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA.
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Reddy RS, Yi YA, Fuentes J, Bergeson RL, Davenport MT, Morey AF. Preventing the need for revision surgery after penile plication reconstruction of Peyronie's deformities. Transl Androl Urol 2020; 9:82-86. [PMID: 32055471 PMCID: PMC6995937 DOI: 10.21037/tau.2019.07.19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 07/12/2019] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND The need for repeat penile plication (PP) for persistent penile deformity has previously been associated with (I) poor initial erectile response to intracavernosal injection (ICI), (II) an inadequate number of corrective sutures, and (III) a lack of sutures along the proximal shaft of the penis. We present our current experience with PP after implementing corrective measures to assess whether our need for revision surgery was reduced. METHODS We performed a retrospective review of patients who underwent PP for Peyronie's disease (PD) between 2009-2018 and had a minimum follow-up of 6 months. We updated our surgical technique in 2016 by (I) using supplemental intracorporal saline injections if the initial erection response to prostaglandin E1 injection was inadequate, (II) increasing numbers of corrective plication sutures, and (III) emphasizing more proximal suture placement. Patients were stratified into two groups and outcomes compared (prior technique versus current technique). RESULTS Of 472 PP patients who met inclusion criteria, 340 (72%) plication patients before 2016 were compared to 132 (28%) performed after 2016. The revision rate in the current cohort (1.5%, 2/132) decreased by more than half compared to the previous cohort (3.8%, 13/340). Mean preoperative angle of curvature was similar between the two groups (50.4 vs. 51.4 degrees, P=0.64), while the average residual postoperative degree was smaller in the current group (7.36 vs. 2.14 degrees, P<0.001). Fewer sutures were used in the early cohort than in the current (7.63 vs. 8.38, P=0.04). After revision, all cases were functionally straight, with a mean postoperative curvature of 4 degrees at a median follow-up of 10.6 months (IQR, 2.08-20.7). CONCLUSIONS Ensuring adequate rigidity with additional ICI and focusing a greater number of corrective sutures in a more proximal location appears to help prevent the need for revision plication surgery.
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Affiliation(s)
- Rohit S Reddy
- Department of Urology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Yooni A Yi
- Department of Urology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Jorge Fuentes
- Department of Urology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Rachel L Bergeson
- Department of Urology, UT Southwestern Medical Center, Dallas, TX, USA
| | | | - Allen F Morey
- Department of Urology, UT Southwestern Medical Center, Dallas, TX, USA
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Epifanova MV, Gvasalia BR, Durashov MA, Artemenko SA. Platelet-Rich Plasma Therapy for Male Sexual Dysfunction: Myth or Reality? Sex Med Rev 2020; 8:106-113. [DOI: 10.1016/j.sxmr.2019.02.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 01/29/2019] [Accepted: 02/04/2019] [Indexed: 01/01/2023]
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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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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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Increased Risk of Cancer in Men With Peyronie's Disease: A Cohort Study Using a Large United States Insurance Claims Database. Sex Med 2019; 7:403-408. [PMID: 31530474 PMCID: PMC6963113 DOI: 10.1016/j.esxm.2019.08.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 08/02/2019] [Accepted: 08/14/2019] [Indexed: 01/19/2023] Open
Abstract
Background Men with Peyronie’s disease (PD) may have an increased prevalence of certain comorbidities, including malignancy. We sought to examine the clinical relationship between PD and subsequent diagnosis of malignancy. Methods Using data from the IBM Health MarketScan claims database from 2007 to 2013, we compared men with PD to a control group of men without PD or erectile dysfunction matched for age and duration of follow-up. We compared incidence of 18 categories of malignancy between both groups using a Cox regression model. Results In total, 48,423 men with PD and 484,230 controls were identified. The mean age within both cohorts was 50 ± 9.4 years old, and mean follow-up time was approximately 4.4 ± 2.1 years. After being controlled for age, year of evaluation, obesity, smoking, number of outpatient visits, number of urologist visits, and duration of follow-up, men with PD had an increased risk of all cancers (hazard ratio = 1.10, 95% CI = 1.06–1.14), stomach cancer (1.43, 1.06–1.14), testis cancer (1.39, 1.05–1.84), and melanoma (1.19, 1.02–1.38) when compared with controls. The strengths in using the MarketScan database are the anonymous nature of the data, accessibility, and the power provided by the large number of patient visits recorded. Limitations include a lack of detail in certain facets of patient clinical data, and the lack of long-term follow-up to assess the impact of time on other potentially associated conditions. Conclusions This manuscript is the first to our knowledge to describe a relationship between PD and cancer. Men with PD may be at increased risk for certain malignancies compared with age-matched controls. Further investigation is needed to explore the clinical implications of these findings. Pastuszak AW, Thirumavalavan N, Kohn TP, et al. Increased Cancer Risk in Men With Peyronie’s Disease: A Cohort Study Using a Large US Insurance Claims Database. Sex Med 2019;7:403–408.
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Özbir S, Değirmentepe RB, Atalay HA, Alkan I, Çakır SS, Ötünçtemur A, Canat HL. The role of inflammatory parameters (neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and monocyte-to-eosinophil ratio) in patients with Peyronie's disease. Andrology 2019; 8:348-352. [PMID: 31512411 DOI: 10.1111/andr.12702] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 08/07/2019] [Accepted: 08/12/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVES The aim of the study was to investigate the ability of the systemic inflammatory parameters to predict the discrimination of the phases of Peyronie's disease (PD). MATERIALS AND METHODS Demographic, clinical, and laboratory data from 156 patients with PD were analyzed. A complete blood count (CBC) was obtained for every patient, and the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and monocyte-to-eosinophil ratio (MER) were calculated for every men. Subsequently, patients were divided into two groups based upon the phase of the disease. RESULTS The mean age was 51.9 ± 9.6 in all study population. The mean duration between symptom onset and patient evaluation was 4.2 ± 3.2 months in acute phase group, while it was 32.7 ± 31.7 months in chronic phase group (p < 0.001). There were no significant differences between the groups according to comorbidities such as diabetes, hypertension, lipid abnormalities, ischemic heart disease, smoking, and alcohol consumption. There was a statistically significant difference in NLR and PLR between two groups (p = 0.008, p = 0.008, respectively). NLR and PLR were significantly correlated with discrimination status in univariate analysis (p = 0.003, p = 0.005, respectively). Multivariate regression analysis revealed that NLR was the only independent risk factor for discrimination of the phases of PD (p < 0.001). The ROC analysis revealed a cutoff value of 1.8 (AUC 0.712, p < 0.001; sensitivity 61.1%; specificity 75.0%) for the NLR. CONCLUSION Our study demonstrated that NLR could be helpful to differentiate the chronic phase from the acute phase in patients with PD. Therefore, NLR could be used as an objective biomarker to the management of the disease and choosing the appropriate treatment.
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Affiliation(s)
- S Özbir
- Department of Urology, Okmeydanı Training and Research Hospital, Şişli-İstanbul, Turkey
| | - R B Değirmentepe
- Department of Urology, Okmeydanı Training and Research Hospital, Şişli-İstanbul, Turkey
| | - H A Atalay
- Department of Urology, Okmeydanı Training and Research Hospital, Şişli-İstanbul, Turkey
| | - I Alkan
- Department of Urology, Okmeydanı Training and Research Hospital, Şişli-İstanbul, Turkey
| | - S S Çakır
- Department of Urology, Okmeydanı Training and Research Hospital, Şişli-İstanbul, Turkey
| | - A Ötünçtemur
- Department of Urology, Okmeydanı Training and Research Hospital, Şişli-İstanbul, Turkey
| | - H L Canat
- Department of Urology, Okmeydanı Training and Research Hospital, Şişli-İstanbul, Turkey
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Characteristics predictive of response to collagenase clostridium histolyticum for Peyronie’s disease: a review of the literature. World J Urol 2019; 38:279-285. [DOI: 10.1007/s00345-019-02850-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 06/11/2019] [Indexed: 01/03/2023] Open
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Patel DP, Christensen MB, Hotaling JM, Pastuszak AW. A review of inflammation and fibrosis: implications for the pathogenesis of Peyronie's disease. World J Urol 2019; 38:253-261. [PMID: 31190155 DOI: 10.1007/s00345-019-02815-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 05/17/2019] [Indexed: 01/07/2023] Open
Abstract
Peyronie's disease (PD) is a superficial fibrosing disorder that causes penile deformity and can interfere with sexual intercourse and reproduction, as well as diminish quality of life. While the exact mechanism of PD is still being investigated, there is likely a genetic component to the predisposition to penile plaque formation. Ultimately, however, perturbations in normal wound healing and aberrant deposition of extracellular matrix components lead to fibrotic tissue deposition. Fibrosis in PD is regulated by a complex pathway of inflammatory and fibrotic mediators. Currently there are no treatments for PD that address an underlying cause or disease progression. In this review, we provide an overview of the known inflammatory and fibrotic mediators of PD and explore the pathophysiology of other human superficial fibrosing disorders to develop further insights into PD.
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Affiliation(s)
- Darshan P Patel
- Division of Urology, Department of Surgery, Center for Reconstructive Urology and Men's Health, University of Utah School of Medicine, 30 N 1900 E, Rm # 3B420, Salt Lake City, UT, 84132, USA
| | - Michael B Christensen
- Division of Urology, Department of Surgery, Center for Reconstructive Urology and Men's Health, University of Utah School of Medicine, 30 N 1900 E, Rm # 3B420, Salt Lake City, UT, 84132, USA
| | - James M Hotaling
- Division of Urology, Department of Surgery, Center for Reconstructive Urology and Men's Health, University of Utah School of Medicine, 30 N 1900 E, Rm # 3B420, Salt Lake City, UT, 84132, USA
| | - Alexander W Pastuszak
- Division of Urology, Department of Surgery, Center for Reconstructive Urology and Men's Health, University of Utah School of Medicine, 30 N 1900 E, Rm # 3B420, Salt Lake City, UT, 84132, USA.
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Antoniassi T, Júnior FNF, Spessoto LCF, Guerra LH, Campos SS, Taboga S. Anti-fibrotic effect of mycophenolate mofetil on Peyronie's disease experimentally induced with TGF-β. Int J Impot Res 2019; 32:201-206. [PMID: 31000815 DOI: 10.1038/s41443-019-0138-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 01/28/2019] [Accepted: 03/11/2019] [Indexed: 02/07/2023]
Abstract
The aim of the present study was to evaluate the histological, histochemical, and stereological changes caused by mycophenolate mofetil (MMF) on the tunica albuginea of rat penises submitted to an injection of transforming growth factor beta (TGF-β) for the induction of Peyronie's disease (PD). Twenty adult male Wistar rats were divided into four groups: Control group; TGF-β group (TGF-β injection); MMF-7d group (treated with MMF 7 days after induction with TGF-β); and MMF-30d group (treated with MMF 30 days after induction with TGF-β). The steorological evaluation included the relative volume of different types of connective fibres of the tunica albuginea. The histochemical analysis revealed the fragmentation and degradation of elastin in the tunica albuginea. This process was partially reversed in the MMF-7d group and a situation very close to normality was observed in the MMF-30d group. In the collagen III/collagen I ratio it was observed increase in this ratio in the TGF-β (59.4 ± 5.53) and MMF-7d (49 ± 18.2) groups and a decrease in the MMF-30d group (28.7 ± 4), approaching normality. The injection of TGF-β promoted fibrotic alterations in the penile tunica albuginea in Wistar rats corresponding to PD. In this model, MMF acts as a regenerating anti-fibrotic agent.
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Affiliation(s)
- Thiago Antoniassi
- Department of Urology, São José Rio Preto School of Medicine (FAMERP), São Paulo, Brazil
| | | | | | - Luiz Henrique Guerra
- Department of Biology, São Paulo State University (UNESP /IBILCE), São Paulo, Brazil
| | | | - Sebastião Taboga
- Department of Biology, São Paulo State University (UNESP /IBILCE), São Paulo, Brazil
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Kelenjian S, Mattjie RA, Franz R, Biedermann T, Brockow K. Klinische Merkmale und Management oberflächlicher Fibromatosen. J Dtsch Dermatol Ges 2019; 17:393-398. [DOI: 10.1111/ddg.13808_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 08/22/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Shinorik Kelenjian
- Klinik und Poliklinik für Dermatologie und Allergologie am BiedersteinTechnische Universität München München Deutschland
| | - Rebeca Assuncao Mattjie
- Klinik und Poliklinik für Dermatologie und Allergologie am BiedersteinTechnische Universität München München Deutschland
| | - Regina Franz
- Klinik und Poliklinik für Dermatologie und Allergologie am BiedersteinTechnische Universität München München Deutschland
| | - Tilo Biedermann
- Klinik und Poliklinik für Dermatologie und Allergologie am BiedersteinTechnische Universität München München Deutschland
| | - Knut Brockow
- Klinik und Poliklinik für Dermatologie und Allergologie am BiedersteinTechnische Universität München München Deutschland
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Kelenjian S, Mattjie RA, Franz R, Biedermann T, Brockow K. Clinical features and management of superficial fibromatoses. J Dtsch Dermatol Ges 2019; 17:393-397. [PMID: 30865379 DOI: 10.1111/ddg.13808] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 08/22/2018] [Indexed: 11/30/2022]
Abstract
Fibromatoses are a group of benign connective tissue tumors characterized by the infiltrative, aggressive proliferation of well-differentiated fibroblasts, leading to frequent local recurrence. Within this heterogeneous disease group, superficial fibromatoses show slower growth and more benign infiltration of surrounding tissues than deep fibromatoses. Superficial fibromatoses relevant to dermatology include palmar, plantar, and penile fibromatosis, knuckle pads, pachydermodactyly and infantile digital fibromatosis. They present clinically with subcutaneous nodules or cords that lead to local infiltration and limited mobility of the affected areas. Treatment options vary from watchful waiting, non-invasive methods such as radiotherapy and intralesional corticosteroid/collagenase injections to radical surgical procedures. Early intervention may disrupt disease progression and may even restore functional ability. These disorders should therefore be recognized and treated early in the course of the disease.
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Affiliation(s)
- Shinorik Kelenjian
- Department of Dermatology and Allergy Biederstein, Technical University of Munich, Munich, Germany
| | - Rebeca Assuncao Mattjie
- Department of Dermatology and Allergy Biederstein, Technical University of Munich, Munich, Germany
| | - Regina Franz
- Department of Dermatology and Allergy Biederstein, Technical University of Munich, Munich, Germany
| | - Tilo Biedermann
- Department of Dermatology and Allergy Biederstein, Technical University of Munich, Munich, Germany
| | - Knut Brockow
- Department of Dermatology and Allergy Biederstein, Technical University of Munich, Munich, Germany
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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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Patient perspectives on Peyronie's disease: results of poststudy interviews from a phase 2 trial of collagenase clostridium histolyticum. Int J Impot Res 2018; 31:263-268. [PMID: 30237548 PMCID: PMC6760640 DOI: 10.1038/s41443-018-0027-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 01/24/2018] [Accepted: 04/01/2018] [Indexed: 11/09/2022]
Abstract
Intralesional injection of collagenase clostridium histolyticum (CCH) improves Peyronie’s disease (PD) symptoms; however, patient perspectives regarding PD and CCH treatment have not been fully elucidated. This cross-sectional qualitative study included heterosexual men with PD who received ≥1 injection of study medication and had ≥1 posttreatment Peyronie’s Disease Questionnaire (PDQ) assessment during a prior phase 2b clinical trial. These patients were “responders” if they reported (as part of the Global Assessment of the PDQ) that overall symptoms and effects of PD had at least “improved in a small but important way” after CCH therapy. Among 45 patients interviewed, penile bending or curvature was the most common and bothersome PD symptom reported (by 97.8% and 48.9% of patients, respectively). Patients indicated that multiple alterations were necessary in their sex lives because of penile symptoms and specified that these changes impacted their emotional health and partner relationship. Treatment with CCH improved PD symptoms (44.4%), frequency of or ability to have vaginal intercourse (22.2%) and partner relationship (22.2%), particularly among responders. Given that physical, psychologic and sexual function are impacted by PD, clinical trials that evaluate treatments for PD should include patient-reported outcome measures (e.g., the PDQ) to assess overall well-being after treatment.
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Objective Assessments of Peyronie’s Disease. Sex Med Rev 2018; 6:438-445. [DOI: 10.1016/j.sxmr.2017.12.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 12/06/2017] [Accepted: 12/11/2017] [Indexed: 01/11/2023]
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Villegas MR, Baeza A, Usategui A, Ortiz-Romero PL, Pablos JL, Vallet-Regí M. Collagenase nanocapsules: An approach to fibrosis treatment. Acta Biomater 2018; 74:430-438. [PMID: 29734007 DOI: 10.1016/j.actbio.2018.05.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 04/19/2018] [Accepted: 05/03/2018] [Indexed: 12/15/2022]
Abstract
Fibrosis is a common lesion in different pathologic diseases and defined by the excessive accumulation of collagen. Different approaches have been used to treat different conditions characterized by fibrosis. The FDA and EMA approved the use of collagenase to treat palmar fibromatosis (Dupuytren's contracture). The EMA approved additionally its use in severe Peyronie's disease, but it has been used off label in other conditions [1,2]. The approved treatment includes up to three (in palmar fibromatosis) or up to eight (in penile fibromatosis) injections followed by finger extension or penile modeling procedures, typically causing severe pain. Frequent single injections are adequate to treat palmar fibromatosis [3]. The need to repeatedly inject doses of this enzyme can be due to the labile nature of collagenase, which exhibits a complete activity loss after a short period of time. This study presents a novel strategy to manage this enzyme based on the synthesis of polymeric nanocapsules that contain collagenase encapsulated within their matrix. These nanocapsules have been engineered for achieving a gradual release of the encapsulated enzyme for a longer time, which can be up to ten days. The efficacy of these nanocapsules has been tested in a murine model of local dermal fibrosis, and the results demonstrate a reduction in fibrosis greater than that with the injection of free enzyme; this type of treatment showed a significant improvement compared to conventional therapy of free collagenase. STATEMENT OF SIGNIFICANCE The use of proteins as therapeutic molecules has recently attracted great interest. Collagenase injection is the current treatment for fibrotic diseases. Unfortunately, proteins have a low stability and presume several repetition cycles to obtain an effective treatment. This article describes a novel treatment for these types of diseases using collagenase nanocapsules designed to exhibit a sustainable release of the encapsulated enzyme, which maintains the enzymatic activity for a long period of time. The therapeutic effect of nanocapsules was tested in a murine mouse model of local dermal fibrosis, and the results showed an important improved effect compared to the effect of the administration of free enzyme. These results indicate a high potential for this novel system to improve the current treatment for fibrotic diseases.
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Affiliation(s)
- M Rocío Villegas
- Departamento de Química en Ciencias Farmaceúticas, Facultad de Farmacia, Universidad Complutense de Madrid, 28040 Madrid, Spain; Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Spain
| | - Alejandro Baeza
- Departamento de Química en Ciencias Farmaceúticas, Facultad de Farmacia, Universidad Complutense de Madrid, 28040 Madrid, Spain; Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Spain.
| | - Alicia Usategui
- Servicio de Reumatología, Instituto de Investigación Hospital 12 de Octubre (I+12 Medical School), Universidad Complutense de Madrid, Spain
| | - Pablo L Ortiz-Romero
- Servicio de Dermatología, Instituto de Investigación Hospital 12 de Octubre (I+12 Medical School), Universidad Complutense de Madrid, Spain
| | - José L Pablos
- Servicio de Reumatología, Instituto de Investigación Hospital 12 de Octubre (I+12 Medical School), Universidad Complutense de Madrid, Spain
| | - María Vallet-Regí
- Departamento de Química en Ciencias Farmaceúticas, Facultad de Farmacia, Universidad Complutense de Madrid, 28040 Madrid, Spain; Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Spain.
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Cocci A, Russo GI, Briganti A, Salonia A, Cacciamani G, Capece M, Falcone M, Timpano M, Cito G, Verze P, Giammusso B, Morgia G, Mirone V, Minervini A, Gacci M, Cai T, Serni S, Carini M, Giubilei G, Mondaini N. Predictors of treatment success after collagenase Clostridium histolyticum
injection for Peyronie's disease: development of a nomogram from a multicentre single-arm, non-placebo controlled clinical study. BJU Int 2018; 122:680-687. [PMID: 29791971 DOI: 10.1111/bju.14410] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Andrea Cocci
- Department of Urology; Careggi Hospital; University of Florence; Florence Italy
| | - Giorgio Ivan Russo
- Urology Section; Department of Surgery; University of Catania; Catania Italy
| | - Alberto Briganti
- Department of Urology; Urological Research Institute; San Raffaele Scientific Institute; Vita-Salute University; Milan Italy
| | - Andrea Salonia
- Department of Urology; Urological Research Institute; San Raffaele Scientific Institute; Vita-Salute University; Milan Italy
| | | | - Marco Capece
- Department of Urology; University of Naples; Naples Italy
| | - Marco Falcone
- Department of Urology; Molinette Hospital; University of Turin; Turin Italy
| | | | - Gianmartin Cito
- Department of Urology; Careggi Hospital; University of Florence; Florence Italy
| | - Paolo Verze
- Department of Urology; University of Naples; Naples Italy
| | | | - Giuseppe Morgia
- Urology Section; Department of Surgery; University of Catania; Catania Italy
| | | | - Andrea Minervini
- Department of Urology; Careggi Hospital; University of Florence; Florence Italy
| | - Mauro Gacci
- Department of Urology; Careggi Hospital; University of Florence; Florence Italy
| | - Tommaso Cai
- Department of Urology; Santa Chiara Regional Hospital; Trento Italy
| | - Sergio Serni
- Department of Urology; Careggi Hospital; University of Florence; Florence Italy
| | - Marco Carini
- Department of Urology; Careggi Hospital; University of Florence; Florence Italy
| | - Gianluca Giubilei
- Department of Urology; Careggi Hospital; University of Florence; Florence Italy
| | - Nicola Mondaini
- Department of Urology; Santa Maria Annunciata Hospital; Florence Italy
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Dell'Atti L, Galosi AB. Sonographic patterns of Peyronie's disease in patients with absence of palpable plaques. Int Braz J Urol 2018; 44:362-369. [PMID: 29211402 PMCID: PMC6050571 DOI: 10.1590/s1677-5538.ibju.2017.0298] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 10/13/2017] [Indexed: 01/01/2023] Open
Abstract
PURPOSE Non-palpable isolated septal plaques of the penis are likely present in a significant number of patients affected by erectile dysfunction (ED) and penile pain without deformity or curvature. The aim of this study was to evaluate the ultrasound (US) patterns observed in patients investigated for ED or penile pain without curvature. MATERIALS AND METHODS We reviewed the medical records of 386 patients who underwent an initial colour-Doppler ultrasonography (CDU) of the penis for DE and/or penile pain without curvature. After satisfying inclusion criteria, 41 patients were individualized. All patients had a non-palpable plaque with involvement of the penile septum. Three US patterns were identified: focal hyperecoic thickening of the intercavernosum septum (IS) with acoustic shadow (pattern 1), non-calcified thickening (isoechoic or slightly hyperechoic (pattern 2), and microcalcifications in the IS without associated acoustic shadow (pattern 3). RESULTS Patients' mean age was 51.3±16.7. ED was the predominant disorder in 73.2% of patients, followed by penile pain and length loss in 19.5% and 7.3% of patients, respectively. 32(78.1%) patients showed the pattern 1, 6 (14.6%) pattern 2, and 3 (7.3%) pattern 3. Plaques size varied from 3 to 13 mm. The penile hemodynamic response to CDU reported abnormal findings distally to the septal plaques in 20 patients (<25cm/sec). Median left and right cavernosum artery flows measured a peak systolic velocity of 31cm/sec and 33 cm/sec, respectively. CONCLUSIONS We believe that an US study with CDU provides a way to characterize, localize, and deliver treatment choice in patients with Peyronie's Disease.
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Affiliation(s)
- Lucio Dell'Atti
- Department of Urology, Polytechnic University of Marche Region, University Hospital "Ospedali Riuniti", Ancona, Italy
| | - Andrea Benedetto Galosi
- Department of Urology, Polytechnic University of Marche Region, University Hospital "Ospedali Riuniti", Ancona, Italy
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43
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Ralph DJ, Abdel Raheem A, Liu G. Treatment of Peyronie's Disease With Collagenase Clostridium histolyticum and Vacuum Therapy: A Randomized, Open-Label Pilot Study. J Sex Med 2017; 14:1430-1437. [DOI: 10.1016/j.jsxm.2017.08.015] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 08/24/2017] [Accepted: 08/31/2017] [Indexed: 11/25/2022]
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44
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Hatzichristodoulou G, Osmonov D, Kübler H, Hellstrom WJ, Yafi FA. Contemporary Review of Grafting Techniques for the Surgical Treatment of Peyronie's Disease. Sex Med Rev 2017; 5:544-552. [DOI: 10.1016/j.sxmr.2017.01.006] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 01/31/2017] [Accepted: 01/31/2017] [Indexed: 11/25/2022]
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45
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Abedi G, Yafi FA. Tunical Incision Techniques for Peyronie’s Disease. CURRENT SEXUAL HEALTH REPORTS 2017. [DOI: 10.1007/s11930-017-0110-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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46
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Cordon BH, Osmonov D, Hatzichristodoulou G, Morey AF. Peyronie's penile plication. Transl Androl Urol 2017; 6:639-644. [PMID: 28904896 PMCID: PMC5583063 DOI: 10.21037/tau.2017.07.18] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 07/07/2017] [Indexed: 11/29/2022] Open
Abstract
Penile plication has become the preferred surgical technique for Peyronie's disease (PD) as it can be performed efficiently, safely, with a high success rate, low morbidity and a low complication rate. Here in we describe two modern plication techniques in detail: the Kiels Knot plication and the minimally invasive penoscrotal plication. Benefits of the techniques include no palpable sutures for the Kiels Knot Plication and less surgical trauma for the penoscrotal plication. Plication has a low rate of failure. However, when it does occur it is usually secondary to under-correction. Failures typically present early postoperatively and a contributing factor to underestimating the deformity is a poor intraoperative artificial erection. Complex, severe, or multiplanar deformities will require more sophisticated intraoperative decision-making, but can be managed effectively with penile plication nonetheless.
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Affiliation(s)
- Billy H. Cordon
- Columbia University Division of Urology at Mount Sinai Medical Center, Miami Beach, FL, USA
| | - Daniar Osmonov
- Department of Urology and Pediatric Urology, University Hospital Schleswig Holstein, Campus Kiel, Germany
| | - Georgios Hatzichristodoulou
- Department of Urology and Pediatric Urology, University Hospital of Julius-Maximilians-University of Würzburg, Würzburg, Germany
| | - Allen F. Morey
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
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47
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Role of interleukin-6 and pentraxin 3 as an early marker in Peyronie’s disease. Kaohsiung J Med Sci 2017; 33:195-200. [DOI: 10.1016/j.kjms.2017.01.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 01/15/2017] [Accepted: 01/23/2017] [Indexed: 01/12/2023] Open
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48
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Yan S, Yap T, Minhas S. Collagenase clostridium histolyticum intralesional injections for the treatment of Peyronie's disease: a safety profile. Transl Androl Urol 2017; 6:123-126. [PMID: 28217460 PMCID: PMC5313303 DOI: 10.21037/tau.2016.12.08] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- Sylvia Yan
- St George's University Hospitals NHS Foundation Trust, London, UK
| | - Tet Yap
- St George's University Hospitals NHS Foundation Trust, London, UK
| | - Suks Minhas
- University College London Hospitals NHS Foundation Trust, London, UK
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49
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Abstract
INTRODUCTION Peyronie's disease (PD) is a fibrotic diathesis of the tunica albuginea that results in penile plaque formation and penile deformity, negatively affecting sexual and psychosocial function of both patients and their partners. In this review, we discuss the PD literature and PD treatment options, with special emphasis on potential future therapies. METHODS The PD literature was reviewed, and articles of interest were identified using keyword search in PubMed. Articles evaluating investigational and novel PD treatments were emphasized. RESULTS Existing PD treatment modalities are diverse and include oral, topical, intralesional, mechanical, and surgical therapies. Surgical treatment has high success rates and is indicated in men with significant, stable deformity. The United States Food and Drug Administration-approved intralesional collagenase Clostridium histolyticum injection therapy is a minimally invasive option with demonstrated efficacy in PD. Other nonsurgical therapies have been reported, including Botox and stem cell therapy, but these currently have little or equivocal evidence to support their efficacy. CONCLUSIONS Further research is essential to develop novel, safe, and effective minimally invasive PD treatment options. This work is ongoing, with the promise of specific, targeted, and highly effective therapies on the horizon.
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Affiliation(s)
- Aylin N Bilgutay
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA
| | - Alexander W Pastuszak
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA; Center for Reproductive Medicine, Baylor College of Medicine, Houston, TX, USA
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