1
|
Roadman D, Wang V, Beer A, Levine L. A contemporary assessment of the evaluation and management of patients presenting to a tertiary medical center with Peyronie's disease. Int J Impot Res 2024; 36:118-124. [PMID: 37468535 DOI: 10.1038/s41443-023-00738-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 07/05/2023] [Accepted: 07/07/2023] [Indexed: 07/21/2023]
Abstract
Peyronie's disease continues to be poorly understood. We characterize the presenting features of Peyronie's disease within a large cohort and elucidate the factors that correlate with surgical intervention. Univariate and multivariate analyses were performed on 1483 consecutive patients to assess pre-operative predictors of surgical intervention for Peyronie's disease. Overall, 1263 patients met inclusion criteria. Mean age was 55.4 ± 11.1 years with a mean duration of disease at presentation of 33.2 ± 42.5 months. Mean primary curvature was 49.8 ± 20.8°. Primary ventral curvature was present in 11.4% and 36.5% of patient had a multiplanar curvature. During penile duplex ultrasound evaluation indentation/narrowing deformities were appreciated in 76.0%, hourglass deformity in 10.1%, and hinge effect in 33.0% of patients. Calcification was seen in 30.1% of patients. Operative intervention occurred in 35.3% of patients. Degree of primary curvature (1.03 OR, p < 0.001), hourglass deformity (1.82 OR, p = 0.01), decreased tunical elasticity (1.20 OR, p = 0.03), and prior intralesional collagenase clostridium histolyticum injections (2.94 OR, p < 0.001) predicted surgical correction on multivariate analysis. Compared to historical studies, we found a higher incidence of severe degree of curvature (27.5% >60°), indentation deformities, hinge-effect, multiplanar curvature and penile calcifications. Ultimately, predictors of surgical intervention included those with worse erectile function and more severe characteristics.
Collapse
Affiliation(s)
- Daniel Roadman
- Rush University Medical Center Department of Urology, 1725 West Harrison Street, Chicago, IL, 60612, USA
| | - Vinson Wang
- The Urology Group, 2000 Joseph E Sanker Blvd, Cincinnati, OH, 45212, USA
| | - Adam Beer
- Buffalo General Medical Center, 100 High Street Buffalo, Buffalo, NY, 14203, USA
| | - Laurence Levine
- Rush University Medical Center Department of Urology, 1725 West Harrison Street, Chicago, IL, 60612, USA.
| |
Collapse
|
2
|
Lehner K, Byrne E, Roshandel MR, Alom M, Helo S, Köhler T, Ziegelmann M. The Discontinuation Rate With Collagenase Clostridium histolyticum for Peyronie's Disease in a High-volume Practice Is Unexpectedly High: Identifying Opportunities for Patient Care Improvement. Urology 2024; 183:121-126. [PMID: 37949244 DOI: 10.1016/j.urology.2023.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 10/16/2023] [Accepted: 10/23/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVE To elucidate reasons for premature discontinuation of Collagenase Clostridium histolyticum (CCH) injections for the treatment of penile curvature associated with Peyronie's disease. METHODS A database of men who underwent CCH injections at a single institution was queried to identify men who completed fewer than 8 injections. Chart review was conducted to identify reasons for treatment discontinuation. When this could not be identified, patients were contacted first via the online patient portal and next by phone. RESULTS Of 406 patients who underwent CCH treatment, 133 did not complete 8 injections (32.8%). The most common reasons for discontinuation were satisfactory curve reduction (27%), unsatisfactory curve reduction (21%), bothersome side effect (15%), and pursuit of surgery (12%). Other less common reasons included other health concerns, pausing treatment due to the COVID-19 pandemic, high cost, transferring care elsewhere, and lack of awareness that more injections were indicated. CONCLUSION We present the largest series of patients to date dedicated to evaluation of CCH discontinuation. We find that up to 1/3 of patients who begin CCH injections will not complete the full treatment course. Understanding the reasons for discontinuation can help providers better stratify patients for CCH treatment vs other modalities. In addition, as previous studies indicate curvature improvements are equally likely to be seen in the final four injections as the first four, our data points to the potential impact of improved patient education for individuals who discontinue due to unsatisfactory curve reduction.
Collapse
Affiliation(s)
- Kelly Lehner
- Mayo Clinic Department of Urology, Rochester, MN.
| | - Eileen Byrne
- Mayo Clinic Department of Urology, Rochester, MN
| | | | - Manaf Alom
- Mayo Clinic Department of Urology, Rochester, MN
| | - Sevann Helo
- Mayo Clinic Department of Urology, Rochester, MN
| | | | | |
Collapse
|
3
|
Ziegelmann MJ. Penile indentation and hourglass deformities with Peyronie's disease-what can we reasonably offer our patients? J Sex Med 2023; 20:1230-1232. [PMID: 37784214 DOI: 10.1093/jsxmed/qdad105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 07/14/2023] [Accepted: 07/19/2023] [Indexed: 10/04/2023]
|
4
|
Hayat S, Brunckhorst O, Alnajjar HM, Cakir OO, Muneer A, Ahmed K. A systematic review of non-surgical management in Peyronie's disease. Int J Impot Res 2023; 35:523-532. [PMID: 36289392 PMCID: PMC10499596 DOI: 10.1038/s41443-022-00633-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 09/21/2022] [Accepted: 10/03/2022] [Indexed: 11/08/2022]
Abstract
The efficacy of many non-surgical treatments for Peyronie's disease is unclear. This systematic review aims to critically assess the currently available options and provide a recommendation for treatment based on this. A systematic literature search utilising the Medline (Pubmed), Embase, global health and Cochrane library databases was conducted up to May 2021. All randomised controlled trials assessing non-surgical treatment modalities for Peyronie's Disease were included. Individual study risk of bias was evaluated using the Cochrane tool and GRADE was used to assess evidence strength. Outcome measures were the change in penile curvature (degrees), plaque size (volume or size), International Index of Erectile Function score, pain scores and change in penile length. Prospero registration number: CRD42017064618. Amongst the 5549 articles identified, 41 studies (42 reports) were included. Seven different oral treatment options including vitamin E supplementation showed evidence for improving outcomes such as penile curvature and plaque size. Of the intralesional treatments, Collagenase Clostridium Histolyticum showed evidence for improving penile curvature (Range: 16.3-17 degrees, moderate level certainty of evidence). Intralesional Interferon demonstrated some improvement in curvature (Range: 12-13.5 degrees), plaque size (Range: 1.67-2.2 cm2) and pain, whilst intralesional calcium channel blockers such as Verapamil showed variable evidence for changes in the plaque size and pain. Extracorporeal Shockwave Therapy consistently demonstrated evidence for improving penile pain in stable disease, and two mechanical traction devices improved curvature. Iontophoresis, topical medications, and combination therapies did not demonstrate any consistent improvements in outcome measures. Intralesional options demonstrate the best potential. Overall, results varied with few high-quality randomised trials present.
Collapse
Affiliation(s)
- Sulaiman Hayat
- MRC Centre for Transplantation, Guy's Hospital Campus, King's College London, King's Health Partners, London, United Kingdom
| | - Oliver Brunckhorst
- MRC Centre for Transplantation, Guy's Hospital Campus, King's College London, King's Health Partners, London, United Kingdom
| | - Hussain M Alnajjar
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Onur Omer Cakir
- Department of Urology, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Asif Muneer
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
- Division of Surgery and Interventional Science, University College London, London, United Kingdom
- NIHR Biomedical Research Centre, University College London Hospital, London, United Kingdom
- Male Genital Cancer Centre, University College London, London, United Kingdom
| | - Kamran Ahmed
- MRC Centre for Transplantation, Guy's Hospital Campus, King's College London, King's Health Partners, London, United Kingdom.
- Department of Urology, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates.
- Khalifa University, Abu Dhabi, United Arab Emirates.
| |
Collapse
|
5
|
Roadman D, Wang V, Langbo W, Paddock D, Levine L. Predictors of hinge effect in patients with Peyronie's disease. J Sex Med 2023; 20:1222-1227. [PMID: 37460401 DOI: 10.1093/jsxmed/qdad087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 06/01/2023] [Accepted: 06/06/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND Patients with Peyronie's disease present with a variety of penile deformities. Those with hinge effect can experience bothersome buckling of the erection and instability during penetrative sex; however, the actual characteristics and clinical implications are not fully understood. AIM To determine the factors that cause hinge effect and to assess the role on surgical intervention. METHODS This retrospective review included 1223 consecutive patients who were examined by a single surgeon and had a complete penile duplex evaluation with curvature and hinge assessment. Baseline demographics, penile duplex findings, and clinical outcomes were used to assess for predictors of hinge effect. OUTCOMES Analyses were performed to assess preoperative predictors of hinge effect and surgical intervention. RESULTS Hinge effect was observed at the time of penile duplex Doppler examination in 33% of patients. Circumferential girth discrepancy at point of indentation (odds ratio [OR] 1.82; P < .001), rigidity of erection (OR, 0.82; P = .002), and degree of primary curvature (OR, 1.03; P < .001) predicted the presence of hinge effect. When controlling for rigidity, a girth discrepancy >1 cm did appear to be associated with a hinge. CLINICAL IMPLICATIONS Circumferential girth discrepancy >1 cm, regardless of erectile rigidity, can be associated with hinge effect. STRENGTHS AND LIMITATIONS As a strength, this study included the largest cohort of patients with Peyronie's disease, all of whom were examined in a rigorous and uniform manner via the same operative counseling. However, the study is limited by its retrospective nature and potential for selection and observer bias, given that the treating physician was also assessing all penile deformities as well as performing operative intervention. CONCLUSIONS The presence of hinge effect can cause instability of erections during penetrative sex. Multiple factors may predispose patients to a hinge effect, including the quality of erection and severity of curvature. But when controlling for rigidity, a girth discrepancy >1 cm did appear to be associated with a hinge. While many factors, such as baseline erectile dysfunction and severity of curvature, are important in determining the optimal surgical intervention, assessing for preoperative hinge effect also influenced the surgical approach.
Collapse
Affiliation(s)
- Daniel Roadman
- Department of Urology, Rush University Medical Center, Chicago, IL 60612, United States
| | - Vinson Wang
- The Urology Group, Cincinnati, OH 45212, United States
| | - William Langbo
- Department of Urology, Rush University Medical Center, Chicago, IL 60612, United States
| | - David Paddock
- Department of Urology, Rush University Medical Center, Chicago, IL 60612, United States
| | - Laurence Levine
- Department of Urology, Rush University Medical Center, Chicago, IL 60612, United States
| |
Collapse
|
6
|
Khooblall P, Bole R, Lundy SD, Bajic P. Expanded Utilization of Intralesional Therapies for Treatment of Peyronie's Disease. Res Rep Urol 2023; 15:205-216. [PMID: 37366388 PMCID: PMC10290860 DOI: 10.2147/rru.s386340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 06/15/2023] [Indexed: 06/28/2023] Open
Abstract
Purpose In this narrative review we explore additional indications for which intralesional collagenase Clostridium histolyticum (CCH) injection therapy may be used, in addition to those utilized in the IMPRESS trials. The goal is to provide updated assessment of available intralesional therapies and justify whether to expand clinical indications based on advancements over the last decade. Results Patients receiving CCH in the acute phase of PD have shown significant improvement in penile curvature - which may be even more significant than reported due to progressive curvature over the longitudinal course of injection therapy. Across studies, patients with ventral plaques achieved the greatest curvature improvement (~30°) compared to PD patients with dorsal or lateral plaques. Patients with curvature > 90° have been minimally documented. However, the concept of patients with higher degree of curvature achieving more significant degrees of improvement prevails across studies. Studies including PD patients with volume loss deformities or indentation(s) focus on curvature improvement and do not gauge improvement in these girth loss or indentation features specifically. PD patients with calcification may benefit from CCH, however, critical analysis of included study designs and results compared to placebo do not lend for strong support of CCH in PD at this time. Conclusion Based on the most recent research, the use of CCH in the acute phase of PD and patients with ventral penile plaques may be effective and safe. The limited available research on the efficacy of CCH on calcified plaque(s) and curvature greater than 90° is promising, however, more research is needed to ensure safety and success in this patient cohort. Finally, the current literature continues to show the use of CCH is not effective in PD patients with volume loss, indentation, or hourglass deformity. When expanding the use of CCH to patients not originally included in the IMPRESS trials, providers must prioritize minimizing chances of potential injury to urethral tissue. Finally, further investigation is required to determine whether CCH has utility for curvature greater than 90° or calcified plaques, although the limited available literature is promising.
Collapse
Affiliation(s)
- Prajit Khooblall
- Cleveland Clinic, Center for Men’s Health, Glickman Urological and Kidney Institute, Cleveland, OH, USA
| | - Raevti Bole
- Cleveland Clinic, Center for Men’s Health, Glickman Urological and Kidney Institute, Cleveland, OH, USA
| | - Scott D Lundy
- Cleveland Clinic, Center for Men’s Health, Glickman Urological and Kidney Institute, Cleveland, OH, USA
| | - Petar Bajic
- Cleveland Clinic, Center for Men’s Health, Glickman Urological and Kidney Institute, Cleveland, OH, USA
| |
Collapse
|
7
|
Levine LA. What's the new thing for surgical treatment of Peyronie disease? Extratunical grafting. J Sex Med 2023; 20:416-417. [PMID: 36763947 DOI: 10.1093/jsxmed/qdac039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 11/16/2022] [Accepted: 11/17/2022] [Indexed: 01/28/2023]
Affiliation(s)
- Laurence A Levine
- Rush University Medical Center, Chicago, IL 60612, United States.,Uropartners, LLC, Chicago, IL 60612, United States
| |
Collapse
|
8
|
Flores A, Tyler A, Green B, Price T, Savage J, Brearton K, Helo S, Ziegelmann M, Kohler T, Trost L. Improved Peyronie's Disease Curvature Outcomes Using a Novel Collagenase Administration Protocol. Urology 2022; 170:117-123. [PMID: 36241063 DOI: 10.1016/j.urology.2022.09.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 09/19/2022] [Accepted: 09/27/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To report outcomes of a novel collagenase clostridium histolyticum (CCH) injection protocol. METHODS A prospective, sequential database was maintained of all Peyronie's men undergoing CCH injections since 2015. Our protocol has evolved to include changes with injection technique, timing, aggressive modeling/traction, and wrapping. Results of the "traditional" and "novel" techniques were compared using two definitions: "most recent" assessment and final assessments among men who "completed eight (injections) or were satisfied." RESULTS A total of 509 men underwent greater than or equal to 1 CCH series (traditional, n = 280; novel n = 229). Baseline demographic/clinicopathologic characteristics were similar between groups. Results demonstrated significantly greater curve improvements with the novel technique ("most recent" median 30° vs 20° or 46% vs 28%; "completed eight or satisfied" 34° vs 20° or 58% vs 30%). Using the "completed eight or satisfied" definition, 94% vs 66% of men achieved greater than or equal to 20% improvement (odds ratio 7.6), and 60% vs 24% achieved greater than or equal to 50% improvements (odds ratio 5.0) in the novel cohort (all P < .0001). Importantly, the International Index of Erectile Function Erectile Function Domain score was unchanged, and subjective erectile function (50% vs 5%, P < .0001) and sensation improved (17% vs 8% improved, P = .01) with the new protocol. The novel cohort also reported higher rates of surgery prevention (53% vs 18%), restored/facilitated penetration (57% vs 21%), and hematomas (56% vs 26%), necessitating changes to wrapping procedures (all P < .0001). CONCLUSIONS Use of the novel CCH protocol results in significant improvements with curvature without negatively impacting erectile function or sensation. Given its specialized nature, it is not recommended for low-volume CCH injectors.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | - Landon Trost
- CURE PD; Male Fertility and Peyronie's Clinic; Brigham Young University; Mayo Clinic.
| |
Collapse
|
9
|
Geelhoed JP, Wegelin O, Tromp E, de Boer B, de Jong I, Beck JJH. Improvement in the ability to have sex in patients with Peyronie's disease treated with Collagenase Clostridium histolyticum. BJUI Compass 2022; 4:66-73. [PMID: 36569498 PMCID: PMC9766863 DOI: 10.1002/bco2.185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 07/20/2022] [Accepted: 07/21/2022] [Indexed: 11/05/2022] Open
Abstract
Objective To describe the results of intralesional Collagenase Clostridium histolyticum (CCH) treatment in patients with Peyronie's disease (PD) in real-world setting. PD is characterized by curvature of the erect penis caused by fibrotic tissue in the tunica albuginea. Patients and methods Patients with stable PD and curvature of 30° to 90° were prospectively enrolled. CCH injections were initially given using a scheme of four cycles of two injections within 48-72 h every 6 weeks. Later using a modified scheme of three injections every 4 weeks, combined with a vacuum erection device (VED) twice daily. All patients were requested to take pictures of the erect penis prior to and following treatment, from above and laterally. Curvature was measured by three independent researchers based on the provided pictures using a goniometer. Furthermore, patients filled in the Peyronie Disease Questionnaire-NL (PDQ-NL) and Patient Reported Outcome Measurement (PROM). The primary outcome was reduction in curvature and the ability to have penetrating sex again. Secondary outcomes include pain scores during injections, changes in PDQ-NL, PROM and complications of CCH treatment. Results Sixty-three patients were included, mean age was 56.0 years (range 39-70) and mean reduction in curvature 20.6° (SD 10.2, range 5-49); 74.5% of the patients were able to have penetrating sex again following treatment, compared with 41.2% prior to treatment. According to the PROM questions, sexual improvement was seen in 66.7% of patients. The satisfaction rate was 6.8 (SD 1.8). All patients save two recommend treatment. Conclusions Intralesional treatment with CCH in men with PD leads to a mean curvature improvement of 20.6°. Following treatment, 74.5% of men were able to have sexual intercourse and 54.9% of the couples were satisfied with their sex life. No major complications occurred in the patients treated with CCH. CCH is not available in Europe anymore despite good results.
Collapse
Affiliation(s)
| | - Olivier Wegelin
- St. Antonius ZiekenhuisNieuwegeinThe Netherlands,University Medical Center UtrechtUtrechtThe Netherlands
| | - Ellen Tromp
- St. Antonius ZiekenhuisNieuwegeinThe Netherlands,GGD regio UtrechtUtrechtThe Netherlands
| | | | - Igle‐Jan de Jong
- University Medical Center Groningen, Department of UrologyUniversity of GroningenGroningenThe Netherlands
| | | |
Collapse
|
10
|
Chung E, Yafi FA. Pharmacotherapy in Peyronie's disease: a state-of-the-art review on established contemporary and emerging drugs. Expert Opin Pharmacother 2022; 23:1035-1042. [PMID: 35209789 DOI: 10.1080/14656566.2022.2043274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Current clinical guidelines on Peyronie's disease (PD) advocate non-surgical treatment options as the first-line therapy despite inconsistent clinical outcomes when compared to definitive penile reconstructive surgery. AREAS COVERED This article examines the current understanding of established contemporary and emerging pharmacotherapies for PD. Emphasis has been placed on published clinical studies on drugs in the last 10 years. EXPERT OPINION Published studies have shown that combination therapy is likely more effective than monotherapy. Combined treatment modalities involving various oral and/or intralesional pharmacotherapies together with mechanical devices or clinical psychosexual therapy may provide additional or synergistic benefits for PD patients. A multidisciplinary approach coupled with more novel targets for pharmacological intervention could deliver a more effective treatment paradigm to prevent or at least delay the need for definitive penile reconstructive surgery. Drugs targeting the inhibition of TGF-β1 pathway and myofibroblast transformation are of great interest and studies into next-generation genetic sequencing and transcriptional biomarker regulatory pathways in PD will provide useful insights into the pathophysiology of PD, and assist the development of future regenerative technology including cellular-based therapies to target various anti-fibrotic molecular mechanisms and the potential to be integrated into existing treatment armamentarium for PD.
Collapse
Affiliation(s)
- Eric Chung
- AndroUrology Centre, Brisbane Qld and Sydney, NSW, Australia.,Department of Urology, University of Queensland, Princess Alexandra Hospital, Brisbane, QLD, Australia.,Department of Urology, Macquarie University Hospital, Sydney, NSW, Australia
| | - Faysal A Yafi
- Department of Urology, University of California Irvine, Orange, CA, USA
| |
Collapse
|
11
|
Choi EJ, Schneider D, Xu P, El-Khatib FM, Yafi FA. Future concepts and therapy approaches for Peyronie’s disease. Expert Opin Orphan Drugs 2020. [DOI: 10.1080/21678707.2020.1804861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Edward J. Choi
- Department of Urology, University of California, Irvine Health, Orange, CA, USA
| | - Douglas Schneider
- Department of Urology, University of California, Irvine Health, Orange, CA, USA
| | - Perry Xu
- Department of Urology, University of California, Irvine Health, Orange, CA, USA
| | - Farouk M. El-Khatib
- Department of Urology, University of California, Irvine Health, Orange, CA, USA
| | - Faysal A. Yafi
- Department of Urology, University of California, Irvine Health, Orange, CA, USA
| |
Collapse
|
12
|
|
13
|
Choi EJ, Xu P, El-Khatib FM, Yafi FA. Intralesional Injection Therapy and Atypical Peyronie's Disease: A Systematic Review. Sex Med Rev 2021; 9:434-44. [PMID: 32660728 DOI: 10.1016/j.sxmr.2020.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 05/14/2020] [Accepted: 05/21/2020] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Peyronie's disease (PD) is an inflammatory disorder of the tunica albuginea causing fibrotic changes including abnormal penile curvature, pain, and erectile dysfunction. Approximately 10% of PD patients will have atypical features including ventral plaques, hourglass deformities, unilateral indentations, severely shortened penile length, and multiplanar curvatures. Currently, the only intralesional treatment approved by the United States Food and Drug Administration is considered off-label for atypical PD. Furthermore, treatment of atypical PD, especially ventral plaques, is met with hesitation, in part due to potential urethral injury. OBJECTIVES To systematically review the available literature for the safety and efficacy of intralesional injections for atypical PD. METHODS A thorough literature search of the PubMed database was performed on manuscripts published between 1982 and 2020. Keywords included atypical Peyronie's disease, ventral plaque, hourglass deformity, and injection. RESULTS 15 articles met the criteria for evaluation. Overall, 1,357 patients with PD were treated with intralesional therapy, of which 250 patients were considered to have an atypical presentation. 162 (648%) of the patients were treated with intralesional collagenase Clostridium histolyticum, 49 (19.6%) with verapamil, 29 (11.6%) with interferon alfa-2b, 5 (2.0%) with hyaluronic acid, and another 5 (2.0%) with onabotulinumtoxinA. There was only 1 reported severe adverse event (penile fracture), which was surgically repaired. There were no reports of urethral injury. CONCLUSION Intralesional injection treatment may be a safe alternative option for atypical PD. There is a great need for future research to closely monitor the role of intralesional therapy in this cohort. Choi EJ, Xu P, El-Khatib FM, et al. Intralesional Injection Therapy and Atypical Peyronie's Disease: A Systematic Review. Sex Med Rev 2021;9:434-444.
Collapse
|