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Cosentino M, Di Nauta M, Boeri L, Ferraioli G, Lucignani G, Ricapito A, Gadda F, Iafrate M, Mancini M, Dal Moro F, Ruiz-Castañe E, Bettocchi C, Montanari E, Sofikitis N. Conservative treatment of Peyronie's disease: a guide. World J Urol 2024; 42:317. [PMID: 38740620 DOI: 10.1007/s00345-024-04975-6] [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: 03/04/2023] [Accepted: 04/05/2024] [Indexed: 05/16/2024] Open
Abstract
PURPOSE To review the literature on the topic, to suggest a common line of treatment applicable across a wide community of specialists, and to contribute in maintaining the high level of interest in this disease. METHODS A comprehensive and exhaustive review of the literature was performed, identifying hundreds of articles on the topic. RESULTS Peyronie's disease is a condition that has been recognized, studied, and treated for centuries; despite this, if one excludes surgery in cases in which the deformity is stable, no clear treatment (or line of treatment) is available for complete relief of signs and symptoms. Treatment options were divided into local, oral, and injection therapy, and a wide variety of drugs, remedies, and options were identified. CONCLUSIONS Low-intensity extracorporeal shock wave therapy, vacuum therapy, penile traction therapy, phosphodiesterase type 5 inhibitors, hyaluronic acid, and collagenase of Clostridium histolyticum may be recommended only in specific contexts. Further studies on individual options or potential combinations are required.
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Affiliation(s)
- Marco Cosentino
- Uro-Andrology Department, Casa di Cura Villa Maria, Via delle Melette 22, 35138, Padua, Italy.
| | - Michele Di Nauta
- Department of Urology and Organ Transplantation, Università di Foggia, Foggia, Italy
| | - Luca Boeri
- Department of Urology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Giordana Ferraioli
- Urology Clinic, Department of Surgical, Oncological and Gastroenterological Sciences, Padova University, Padua, Italy
| | - Gianpaolo Lucignani
- Department of Urology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Anna Ricapito
- Department of Urology and Organ Transplantation, Università di Foggia, Foggia, Italy
| | - Franco Gadda
- Department of Urology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Massimo Iafrate
- Urology Clinic, Department of Surgical, Oncological and Gastroenterological Sciences, Padova University, Padua, Italy
| | - Mariangela Mancini
- Urology Clinic, Department of Surgical, Oncological and Gastroenterological Sciences, Padova University, Padua, Italy
| | - Fabrizio Dal Moro
- Urology Clinic, Department of Surgical, Oncological and Gastroenterological Sciences, Padova University, Padua, Italy
| | - Eduard Ruiz-Castañe
- Andrology Department, Fundacio Puigvert, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Carlo Bettocchi
- Department of Urology and Organ Transplantation, Università di Foggia, Foggia, Italy
| | - Emanuele Montanari
- Department of Urology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Nikolaos Sofikitis
- Department of Urology, Ioannina University School of Medicine, Ioannina, Greece
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Lee HY, Pyun JH, Shim SR, Kim JH. Medical Treatment for Peyronie's Disease: Systematic Review and Network Bayesian Meta-Analysis. World J Mens Health 2024; 42:133-147. [PMID: 37382281 PMCID: PMC10782133 DOI: 10.5534/wjmh.230016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 04/05/2023] [Accepted: 04/06/2023] [Indexed: 06/30/2023] Open
Abstract
PURPOSE To investigate the efficacy of medical treatment options for Peyronie's disease (PD) including oral drugs, intralesional treatment and mechanical treatment compared with placebo treatment using network meta-analysis (NMA). MATERIALS AND METHODS We searched the randomized controlled trials (RCTs) of PD in PubMed, Cochrane library, and EMBASE up to October 2022. RCTs included medical treatment options: oral drugs, intralesional treatment and mechanical treatment. Studies reporting at least one of the outcome measures of interest including curvature degree, plaque size, and structured questionnaires (International Index of Erectile Function, IIEF) were included. RESULTS Finally, 24 studies including 1,643 participants met our selection criteria for NMA. There was no statistically significant treatment compared to placebo of the curvature degree, plaque size, IIEF in Bayesian analysis. The SUCRA values of ranking probabilities for each treatment performance, which indicated that hyperthermia device ranked first in NMA. However, in frequentist analysis, 7 of mono treatments (coenzyme Q10 [CoQ10] 300 mg, hyperthermia device, interferon alpha 2b, pentoxifylline 400 mg, propionyl-L-carnitine 1 g, penile traction therapy [PTT], vitamin E 300 mg) and 2 of combination treatments ("PTT-extracorporeal shockwave treatment", "vitamin E 300 mg-propionyl-L-carnitine 1 g") were statistically significant for improvement of curvature degree, and 9 of mono treatments (CoQ10 300 mg, hyaluronic acid 16 mg, hyperthermia device, interferon alpha 2b, pentoxifylline 400 mg, propionyl-L-carnitine 1 g, verapamil 10 mg, vitamin E 300 mg, vitamin E 400 U) and 3 of combination treatments ("interferon alpha 2b-vitamin E 400 U", "verapamil 10 mg-antioxidants", "vitamin E 300 mg-propionyl-L-carnitine 1 g") were statistically significant in the improvement of plaque size. CONCLUSIONS At present, there is no clinical treatment alternatives that have been demonstrated to be effective compared to placebo. Nonetheless, as the frequentist approach has shown that a number of agents are efficacious, further research is expected to develop more effective treatment options.
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Affiliation(s)
- Hyun Young Lee
- Department of Urology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Jong Hyun Pyun
- Department of Urology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung Ryul Shim
- Department of Health and Medical Informatics, Kyungnam University College of Health Sciences, Changwon, Korea.
| | - Jae Heon Kim
- Department of Urology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea.
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Hayat S, Brunckhorst O, Alnajjar HM, Cakir OO, Muneer A, Ahmed K. A systematic review of non-surgical management in Peyronie's disease. Int J Impot Res 2023; 35:523-532. [PMID: 36289392 PMCID: PMC10499596 DOI: 10.1038/s41443-022-00633-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 09/21/2022] [Accepted: 10/03/2022] [Indexed: 11/08/2022]
Abstract
The efficacy of many non-surgical treatments for Peyronie's disease is unclear. This systematic review aims to critically assess the currently available options and provide a recommendation for treatment based on this. A systematic literature search utilising the Medline (Pubmed), Embase, global health and Cochrane library databases was conducted up to May 2021. All randomised controlled trials assessing non-surgical treatment modalities for Peyronie's Disease were included. Individual study risk of bias was evaluated using the Cochrane tool and GRADE was used to assess evidence strength. Outcome measures were the change in penile curvature (degrees), plaque size (volume or size), International Index of Erectile Function score, pain scores and change in penile length. Prospero registration number: CRD42017064618. Amongst the 5549 articles identified, 41 studies (42 reports) were included. Seven different oral treatment options including vitamin E supplementation showed evidence for improving outcomes such as penile curvature and plaque size. Of the intralesional treatments, Collagenase Clostridium Histolyticum showed evidence for improving penile curvature (Range: 16.3-17 degrees, moderate level certainty of evidence). Intralesional Interferon demonstrated some improvement in curvature (Range: 12-13.5 degrees), plaque size (Range: 1.67-2.2 cm2) and pain, whilst intralesional calcium channel blockers such as Verapamil showed variable evidence for changes in the plaque size and pain. Extracorporeal Shockwave Therapy consistently demonstrated evidence for improving penile pain in stable disease, and two mechanical traction devices improved curvature. Iontophoresis, topical medications, and combination therapies did not demonstrate any consistent improvements in outcome measures. Intralesional options demonstrate the best potential. Overall, results varied with few high-quality randomised trials present.
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Affiliation(s)
- Sulaiman Hayat
- MRC Centre for Transplantation, Guy's Hospital Campus, King's College London, King's Health Partners, London, United Kingdom
| | - Oliver Brunckhorst
- MRC Centre for Transplantation, Guy's Hospital Campus, King's College London, King's Health Partners, London, United Kingdom
| | - Hussain M Alnajjar
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Onur Omer Cakir
- Department of Urology, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Asif Muneer
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
- Division of Surgery and Interventional Science, University College London, London, United Kingdom
- NIHR Biomedical Research Centre, University College London Hospital, London, United Kingdom
- Male Genital Cancer Centre, University College London, London, United Kingdom
| | - Kamran Ahmed
- MRC Centre for Transplantation, Guy's Hospital Campus, King's College London, King's Health Partners, London, United Kingdom.
- Department of Urology, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates.
- Khalifa University, Abu Dhabi, United Arab Emirates.
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Ferretti L, Madec FX, Akakpo W, Methorst C, Carnicelli D, Terrier JE, Morel Journel N, Beley S, Graziana JP, Marcelli F, Hupertan V, Yiou R, Ben-Naoum K, Savareux L, Huyghe E, Faix A. [French Urological Association (AFU) guidelines for Peyronie's disease assessment and treatment]. Prog Urol 2021; 31:477-494. [PMID: 33941460 DOI: 10.1016/j.purol.2020.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 10/31/2020] [Accepted: 11/09/2020] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Peyronie's disease is a common cause for consultation in urology. Many controversies surround its treatment. No French Guidelines have been published so far. The Committee of Andrology and Sexual Medicine of the French Association of Urology therefore offers a series of evidence-based recommendations. MATERIALS AND METHODS These recommendations are made according to the ADAPTE method, based on European (EAU, ESSM), American (AUA, ISSM) and Canadian (CAU) recommendations, integrating French specificities due to the availability of treatments, and an update of the recent bibliography. RESULTS The assessment of the disease is clinical. Patients with functional impairment or significant psychological repercussions may be offered treatment. The benefits and drawbacks of each treatment should be explained to the patient. Regarding non-surgical treatments, no available treatment has market authorization in France. Vitamin E is not recommended. Analgesic (oral or low-intensity shock waves) or proerectile treatments may be offered as needed, as well as traction therapy. Due to the unavailability of collagenase injections, verapamil injections may be offered. Surgical treatments are to be considered in the stabilized phase of the disease, and consist of performing a plication, an incision-graft or the placement of a penile implant according to the patient's wishes, the curvature and the penis size, as well as erectile function. Combination treatments can be offered. CONCLUSION The management of Peyronie's disease is complex, and the levels of evidence for treatments are generally low. The success of treatment will depend on the quality of the initial assessment, the patient's information and understanding of the expected effects, and the practitioner's experience.
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Affiliation(s)
- L Ferretti
- Service d'urologie, MSP Bordeaux Bagatelle, Talence.
| | - F-X Madec
- Service d'urologie, hôpital Foch, Suresnes
| | - W Akakpo
- Département d'urologie, Hôpital Pitié-Salpétrière, Paris
| | - C Methorst
- Service d'urologie, hôpital des 4 Villes, Saint-Cloud
| | - D Carnicelli
- Service d'urologie, hôpital Privé Jean Mermoz, Lyon
| | - J-E Terrier
- Service d'urologie, Hôpital Lyon Sud, Pierre-Bénite
| | | | | | - J-P Graziana
- Clinique Mutualiste de la Porte de l'Orient, Lorient
| | - F Marcelli
- Service d'urologie, andrologie et transplantation rénale, hôpital Huriez CHU Lille, France
| | | | - R Yiou
- Département d'urologie, CHU Henri Mondor, Créteil
| | | | - L Savareux
- Service d'urologie, Hôpital Privé la Chataigneraie, Beaumont
| | - E Huyghe
- Département d'urologie, CHU Rangueil, Toulouse
| | - A Faix
- Centre d'urologie du Polygone, Montpellier
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Joseph J, Ziegelmann MJ, Alom M, Savage J, Köhler TS, Trost L. Outcomes of RestoreX Penile Traction Therapy in Men With Peyronie's Disease: Results From Open Label and Follow-up Phases. J Sex Med 2020; 17:2462-2471. [PMID: 33223425 DOI: 10.1016/j.jsxm.2020.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 09/07/2020] [Accepted: 10/03/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND A randomized, controlled clinical trial evaluating the efficacy of RestoreX traction therapy in men with Peyronie's disease (PD) has been completed, with the 3-month results previously reported. The present study presents outcomes from the open-label and follow-up phases of the original trial. AIM To report 6-month (open-label phase) and 9-month (follow-up phase) outcomes from a randomized, controlled trial (NCT03389854). METHODS A randomized controlled trial was performed from 2017 to 2019 in 110 all-comer men with PD. Men were randomized 3:1 to RestoreX (PTT) or no therapy (control) for 3 months, followed by 3-month open-label and follow-up phases. Key outcomes included adverse events (AEs), changes in penile curvature and length, erectile function, and standardized and nonstandardized assessments of PD. OUTCOMES The primary outcomes are safety, penile length, penile curvature, Peyronie's Disease Questionnaire, International Index of Erectile Function, and satisfaction. RESULTS 6-month (n = 64) and 9-month (n = 63) outcomes were reported, with a mean duration of PTT use of 31.1 minutes. No significant AEs were reported, with temporary erythema and discomfort being most common and resolving within minutes. On intent-to-treat analysis, control-to-PTT men experienced significant length (1.7-2.0 cm) and curvature improvements (18-20%). PTT-to-PTT men also achieved additional length (0.6-0.8 cm) without further curvature improvements. An as-treated analysis of PTT use ≥15 minute/day demonstrated 2.0- to 2.3-cm length gains (largest of any PTT to date) and 18-21% curve improvement. All sexual function domains of the International Index of Erectile Function and Peyronie's Disease Questionnaire were significantly improved (except orgasmic domain). 95% of men treated for 6 months experienced length gains (mean 2.0-2.2 cm), and 61% had curve improvements (16.8-21.4° [32.8-35.8%]). RestoreX was preferred 3-4:1 over all other PD treatments, and 100% preferred it over other PTT devices. CLINICAL IMPLICATIONS Use of RestoreX 30 minutes daily results in significant length and curve improvements in PD men without significant AEs. STRENGTHS & LIMITATIONS Strengths include largest randomized study of PTT, blinded assessments, and inclusion of all-comers with few restrictions; limitations include sample size that precludes comparisons between treatment cohorts and lack of long-duration (>3-9 hours) treatment arm. CONCLUSION PTT with RestoreX results in significant improvements in length, curve, and subjective and objective measures of sexual function without significant AEs. RestoreX PTT represents a safe, conservative, low-cost option for managing men with PD. Joseph J, Ziegelmann M, Alom M, et al. Outcomes of RestoreX Penile Traction Therapy in Men With Peyronie's Disease: Results From Open Label and Follow-up Phases. J Sex Med 2020;17:2462-2471.
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Affiliation(s)
| | | | | | - Joshua Savage
- Mayo Clinic, Rochester, MN, USA; Male Fertility and Peyronie's Clinic, Orem, UT, USA
| | | | - Landon Trost
- Mayo Clinic, Rochester, MN, USA; Male Fertility and Peyronie's Clinic, Orem, UT, USA.
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Intralesional Injection Therapy and Atypical Peyronie's Disease: A Systematic Review. Sex Med Rev 2020; 9:434-444. [PMID: 32660728 DOI: 10.1016/j.sxmr.2020.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [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.
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Chung E, Gillman M, Tuckey J, La Bianca S, Love C. A clinical pathway for the management of Peyronie’s disease: integrating clinical guidelines from the International Society of Sexual Medicine, American Urological Association and European Urological Association. BJU Int 2020; 126 Suppl 1:12-17. [DOI: 10.1111/bju.15057] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2020] [Indexed: 01/13/2023]
Affiliation(s)
- Eric Chung
- Department of Urology; Princess Alexandra Hospital; University of Queensland; Brisbane Qld Australia
- Andro Urology Centre; Brisbane Qld Australia
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Abstract
Peyronie's disease (PD) is a devastating disease that affects up to 13% of adult men. While trauma to the erect penis is common prior to onset, it is clear that trauma alone is not sufficient to cause PD. Over the past 40 years, multiple lines of evidence have pointed to a genetic factor that predisposes some men to develop PD. Despite dramatic technological advances in the field of genetics, we have made little progress in identifying the genetic contributors to the disease. This review will critically evaluate the literature concerning the genetics of PD published to date. Particular focus will be placed on study design as much of the data are contradictory yet may still give some insight into the etiology of PD. The challenges in identifying the genetic underpinnings of PD will be discussed along with the potential mechanisms that can overcome these challenges.
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Affiliation(s)
- J Scott Gabrielsen
- Department of Urology, University of Rochester Medical Center, Rochester, NY, USA
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Milenkovic U, Duponselle J, Bivalacqua TJ, Albersen M. Evolving therapies for Peyronie's disease: how can we work towards new drugs? Transl Androl Urol 2020; 9:S284-S294. [PMID: 32257869 PMCID: PMC7108979 DOI: 10.21037/tau.2019.08.09] [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] [Indexed: 12/18/2022] Open
Abstract
Peyronie’s disease (PD) is an idiopathic chronic fibrotic disease that causes a penile curvature (PC), subsequent erectile dysfunction (ED) and impaired sexual intercourse in patients. As of yet, there are no reliable non-surgical treatment options available. Intralesional injection with collagenase Clostridum Histolyticum has been FDA approved since 2013, but post-approval studies have not been unanimously positive. Moreover, it renders a curvature improvement of only 30% on average, usually still requiring surgical intervention to remedy PC. Therefore, there is a need for drugs which could prevent surgery altogether. Development of new drugs can either be through a target-based or phenotypic assay-based approach. The current in vivo model for PD is dependent on treatment of primary PD-derived fibroblasts with transforming growth factor-β1. Moreover, despite the existence of a genetic in vivo PD model, it does not allow for drug screening or testing. While some advances have been made in the past few years, new in vivo and in vivo systems and well-designed studies are urgently needed for the non-surgical treatment of PD.
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Affiliation(s)
- Uros Milenkovic
- Laboratory of Experimental Urology, Department of Development and Regeneration, University of Leuven, Leuven, Belgium.,Department of Urology, University Hospitals of Leuven, Leuven, Belgium
| | - Jolien Duponselle
- Laboratory of Experimental Urology, Department of Development and Regeneration, University of Leuven, Leuven, Belgium
| | - Trinity J Bivalacqua
- James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Maarten Albersen
- Laboratory of Experimental Urology, Department of Development and Regeneration, University of Leuven, Leuven, Belgium.,Department of Urology, University Hospitals of Leuven, Leuven, Belgium
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Verapamil and collagenase differentially affect collagen metabolism in experimental model of Peyronie's disease. Mol Cell Probes 2019; 49:101488. [PMID: 31733276 DOI: 10.1016/j.mcp.2019.101488] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 10/30/2019] [Accepted: 11/12/2019] [Indexed: 02/05/2023]
Abstract
OBJECTIVES Peyronie's disease (PD) is accompanied by remodelling of connective tissue into fibrotic plaque. Treatment of the inflammatory and fibrotic phases of the disease is not established. The aim of the study was to evaluate the effect of verapamil (VER) and bacterial collagenase (COLL) on collagen metabolism and cell migration in fibroblasts with experimental wound healing and inflammation as an in vitro model of PD. MATERIALS AND METHODS In vitro model of PD was designed using experimental model of inflammation induced by Interleukin-1 (IL-1) in cultured fibroblasts and mechanical damage of the cells. Cell viability, cell proliferation, collagen biosynthesis, prolidase activity and cell migration were studied in both models of the cells treated with VER and COLL. RESULTS VER decreased cell viability, DNA and collagen biosynthesis and increased prolidase activity in control fibroblast, while in "wounded" fibroblasts it significantly decreased all the processes. COLL did not affect cell viability and DNA biosynthesis, while inhibited collagen biosynthesis and prolidase activity in both control and "wounded" fibroblasts. In IL-1-treated fibroblasts VER inhibited all studied processes except prolidase activity, while COLL inhibited only collagen biosynthesis and prolidase activity. COLL accelerated cell migration, while VER attenuated the process in fibroblast model of wound healing, compared to control cells. CONCLUSION VER and COLL attenuate collagen biosynthesis in both fibroblast models. The VER-dependent inhibition of collagen biosynthesis was accompanied by inhibition of DNA biosynthesis at high prolidase activity, while COLL affected this process through inhibition of prolidase activity at high rate of DNA biosynthesis. It shows that anti-fibrotic activity of VER/COLL and anti-inflammatory activity of VER may represent approach to establish standard treatment of PD.
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Milenkovic U, Ilg MM, Cellek S, Albersen M. Pathophysiology and Future Therapeutic Perspectives for Resolving Fibrosis in Peyronie’s Disease. Sex Med Rev 2019; 7:679-689. [DOI: 10.1016/j.sxmr.2019.02.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Revised: 02/11/2019] [Accepted: 02/11/2019] [Indexed: 12/12/2022]
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Mulhall JP, Matsushita K, Nelson CJ. Testosterone Levels Are Not Associated With Magnitude of Deformity in Men With Peyronie's Disease. J Sex Med 2019; 16:1283-1289. [PMID: 31303573 DOI: 10.1016/j.jsxm.2019.05.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 05/20/2019] [Accepted: 05/29/2019] [Indexed: 01/02/2023]
Abstract
INTRODUCTION There are some data suggesting that there is a relationship between the magnitude of Peyronie's disease (PD)-associated penile curvature and low serum testosterone. AIM To evaluate the relationship between PD associated penile deformity and total testosterone (TT) and free testosterone (FT) levels. METHODS We identified patients diagnosed with PD who had early morning TT measurements. Because laboratories have different reference values, we analyzed testosterone values 2 ways, as raw values and as standardized values (TT and FT values converted into z-scores for each laboratory). Deformity assessment was conducted during an intracavernosal injection-induced rigid erection. The association between T levels and magnitude of penile curvature was analyzed in a number of ways. First, an independent measure t-test tested differences in curvature degree by TT groups (low T: <300 ng/dL; normal T: ≥300 ng/dL). Second, an association was sought between T levels based on quartiles of the normal range (<300, 300-450, 450-600, and >600 ng/dL). These analyses were conducted for both TT and FT levels and using both raw and standardized T values. Third, multivariable analysis using multiple linear regression was performed in an attempt to define predictors of the degree of penile curvature. Factors entered into the model included: TT level, FT level, patient age, race (white vs other), number of co-morbidities, body mass index, presence of erectile dysfunction, duration of PD, and prostatectomy (yes vs no). MAIN OUTCOME MEASURES The relationship between T levels and the magnitude of penile curvature. RESULTS 184 subjects met all study criteria. Average age was 54 ± 12 years. Mean TT level was 425 ± 176 ng/dL, and mean curvature magnitude was 35° ± 19°. The percent of subjects in the first through fourth TT quartiles was 26%, 34%, 24%, and 16%. As a continuous variable, there was no association between TT levels (r = -0.01, P = .95) or FT levels (r = -0.08, P = .30) and the curvature magnitude. When examining TT groups, there was no difference in mean curvature between the low TT group and the normal TT group (35.4° ± 17° vs 34° ± 20°, P = .70). When analyzing the TT and FT levels standardized into z-scores, there was no association between degree of curvature and TT z-scores (r = -0.003, P = .95) and FT z-scores (r = -0.08, P = .43). There was also no association between testosterone levels and degree of curvature in the multivariable model. CONCLUSIONS There does not appear to be any association between testosterone levels and the magnitude of PD-associated penile deformity. Mulhall JP, Matsushita K, Nelson CJ. Testosterone Levels Are Not Associated With Magnitude of Deformity in Men With Peyronie's Disease. J Sex Med 2019;16:1283-1289.
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Affiliation(s)
- John P Mulhall
- Sexual & Reproductive Medicine Program, Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
| | - Kazuhito Matsushita
- Sexual & Reproductive Medicine Program, Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA; Department of Urology, Juntendo University, Graduate School of Medicine, Tokyo, Japan
| | - Christian J Nelson
- Departments of Psychiatry/Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
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Alom M, Sharma KL, Toussi A, Kohler T, Trost L. Efficacy of Combined Collagenase Clostridium histolyticum and RestoreX Penile Traction Therapy in Men with Peyronie’s Disease. J Sex Med 2019; 16:891-900. [DOI: 10.1016/j.jsxm.2019.03.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 02/24/2019] [Accepted: 03/03/2019] [Indexed: 10/27/2022]
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Ziegelmann MJ, Farrell MR, Levine LA. Clinical characteristics and surgical outcomes in men undergoing tunica albuginea plication for congenital penile curvature who present with worsening penile deformity. World J Urol 2019; 38:305-314. [PMID: 31079186 DOI: 10.1007/s00345-019-02787-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 04/25/2019] [Indexed: 10/26/2022] Open
Abstract
PURPOSE Men with congenital penile curvature (CPC) can develop new onset worsening of their lifelong curvature. We sought to evaluate clinical characteristics and postoperative outcomes after tunica albuginea plication (TAP) in patients presenting with CPC who reported new onset worsened curvature (CPC-WC), and compare these with patients reporting stable lifelong curve ("CPC-only"). METHODS A retrospective review of demographics, history/exam findings, and postoperative outcomes for patients with CPC who underwent TAP from 2012 to 2018 was performed. Patients were differentiated based on whether or not they reported new onset worsening of their penile curvature preoperatively (CPC-WC versus CPC only). Statistical analysis was performed to identify differences in clinical characteristics and postoperative outcomes after TAP. RESULTS 60 patients were included [CPC only (n = 39) and CPC-WC (n = 21)]. Mean curvature was 62° (SD 23). CPC-WC patients were older [median 34 years (IQR 27:52) versus 24 years (IQR 20:34); p = 0.004], and more likely to report penile shortening and psychological bother (p < 0.05). On physical examination, CPC-WCs were more likely to have a discrete palpable tunical scar and diminished penile elasticity (p ≤ 0.0002). With median follow up of 12 months, satisfactory straightening with TAP was reported in 56/60 patients (93%) including 35/39 (90%) CPC only and 21/21 (100%) CPC-WC. CONCLUSIONS In men undergoing TAP for CPC, we found that 35% reported new onset worsening of their original curvature preoperatively. These patients were older and more likely to report penile shortening or exhibit palpable tunical scarring with decreased elasticity on examination compared to those with lifelong stable curvature. Regardless, TAP resulted in satisfactory penile straightening in the majority of patients.
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Affiliation(s)
- Matthew J Ziegelmann
- Division of Urology, Rush University Medical Center, 1725 West Harrison Street, Suite #352, Chicago, IL, 60612, USA
| | - Michael Ryan Farrell
- Division of Urology, Rush University Medical Center, 1725 West Harrison Street, Suite #352, Chicago, IL, 60612, USA
| | - Laurence A Levine
- Division of Urology, Rush University Medical Center, 1725 West Harrison Street, Suite #352, Chicago, IL, 60612, USA.
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Gallo L, Sarnacchiaro P. Ten-year experience with multimodal treatment for acute phase Peyronie's disease: A real life clinical report. Actas Urol Esp 2019; 43:182-189. [PMID: 30704797 DOI: 10.1016/j.acuro.2018.08.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Revised: 08/04/2018] [Accepted: 08/27/2018] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To present our experience with multimodal therapy for Peyronie's disease. METHODS Retrospective data were collected since 2008 to 2017. The following features were evaluated at baseline and after treatment: age, duration of disease, erectile function, erected penile curvature, and stretched penile length. All patients were offered the same protocol including: 12 intralesional verapamil injections, oral therapy (OT) ?L-arginine 2g once and pentoxifylline 400mg 3 times a day for 6 months?, and penile traction therapy. The adherence to each of the 3 components of multimodal treatment was evaluated. RESULTS One hundred and seventy-seven individuals were considered. Depending on the grade of adherence our survey was divided into 3 groups. Group 1: patients who only completed OT; group 2: men who accomplished OT and intralesional verapamil injections; group 3: patients who completed the entire protocol. Seventy-six, 45 and 56 men were assigned to group 1, 2 and 3 respectively. The mean age at the diagnosis was 59±8.4, 59.1±5.9 and 54.2±4.8 years, while the mean duration of the disease was 6.3±3.4, 4.8±2.9 and 3.9±3.1 months in group 1, 2 and 3. The erected penile curvature before and after treatment was 24.2±9 and 23.7±8.9° in group 1 (P<.36); 25.4±16.8 and 24.1±13.6° in group 2 (P<.34), and 34.3±17.9 and 26.1±17.2° in group 3 (P<.001). CONCLUSIONS OT alone was successful to block the progression of the disease. The add of intralesional verapamil injections to OT brought only mild improvements. The complete protocol significantly reduced erected penile curvature and improved erectile function.
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Affiliation(s)
- L Gallo
- Gallo Uro-Andrology Centre, Nápoles, Italia.
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16
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Avant RA, Ziegelmann M, Nehra A, Alom M, Kohler T, Trost L. Penile Traction Therapy and Vacuum Erection Devices in Peyronie's Disease. Sex Med Rev 2019; 7:338-348. [DOI: 10.1016/j.sxmr.2018.02.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Revised: 01/26/2018] [Accepted: 02/05/2018] [Indexed: 11/17/2022]
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Randhawa K, Shukla CJ. Non-invasive treatment in the management of Peyronie's disease. Ther Adv Urol 2019; 11:1756287218823671. [PMID: 30792820 PMCID: PMC6376494 DOI: 10.1177/1756287218823671] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 12/05/2018] [Indexed: 12/16/2022] Open
Abstract
Peyronies disease (PD) is estimated to affect approximately 3-9% of men worldwide and maybe associated with pain, erectile dysfunction and penile deformity including shortening. The condition has significant debilitating effects on quality of life, self-esteem and psychological wellbeing in addition to sexual function. Surgical results add further to this by patients having dissatisfaction with various aspects of outcomes. Non-surgical management may allow patients to avoid the morbidities associated with surgery and still achieve improved functional and aesthetic outcomes. Several non-surgical options are currently being employed in the treatment of PD that may reduce or stabilize both objective measures (e.g. penile length and deformity) and subjective measures (including sexual function, pain and partner satisfaction). Nonsurgical management can allow patients to avoid the morbidities associated with surgery and still achieve improved functional and aesthetic outcomes. In this article we explore the current non-surgical management options for PD including oral, mechanical therapies, intralesional and topical treatments. We also briefly discuss future treatment options in the form of stem cell therapy.
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Affiliation(s)
| | - C. J. Shukla
- Western General Hospital, Crewe Road South, Edinburgh, EH4 2XU, UK
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19
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Setia SA, Levine LA. Devices for penile traction: the long and winding road to treating Peyronie's disease. Expert Rev Med Devices 2018; 15:517-526. [PMID: 30016597 DOI: 10.1080/17434440.2018.1502083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Penile traction therapy (PTT) is increasingly being recognized as a viable nonsurgical approach to Peyronie's disease (PD). The goal of this article is to review the current literature on PTT with attention to traction protocols, devices, and outcomes. AREAS COVERED Literature on the pathophysiology of PD, PTT as primary and adjunctive treatment for PD, perioperative use of PTT, and vacuum erection devices are all reviewed. Pertinent literature was obtained from the PubMed database. The key words 'penile traction,' 'mechanotransduction,' and 'Peyronie's disease' were searched and results were narrowed down based on relevance to the review. EXPERT COMMENTARY PTT appears beneficial but the true magnitude of effect is difficult to discern. Most studies are not randomized, have small sample sizes, lack control arms, or have varying traction protocols. Patient compliance is critical and new devices and traction protocols are needed to maximize the benefit of PTT.
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Affiliation(s)
- Shaan A Setia
- a Rush University Medical Center - Urology , Chicago , Illinois , USA
| | - Laurence A Levine
- a Rush University Medical Center - Urology , Chicago , Illinois , USA
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Mateus M, Ilg MM, Stebbeds WJ, Christopher N, Muneer A, Ralph DJ, Cellek S. Understanding the Role of Adenosine Receptors in the Myofibroblast Transformation in Peyronie’s Disease. J Sex Med 2018; 15:947-957. [DOI: 10.1016/j.jsxm.2018.05.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Revised: 05/01/2018] [Accepted: 05/08/2018] [Indexed: 12/27/2022]
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21
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Trama F, Riccardo F, Ruffo A, Celentano G, Romeo G, Russo A. Elastosonographic Changes in Patients with Peyronie's Disease, before and after Treatment with a Compound Based on <i>Ecklonia bicyclis</i>, <i>Tribulus terrestris</i>, and Water-Soluble Chitosan. ACTA ACUST UNITED AC 2018. [DOI: 10.4236/oju.2018.83009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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22
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Penile Length: Measurement Technique and Applications. Sex Med Rev 2017; 6:261-271. [PMID: 29289534 DOI: 10.1016/j.sxmr.2017.10.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 10/01/2017] [Accepted: 10/06/2017] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Penile size has long been an important fixation in men's lives. On the one hand, a smaller penis has been associated with anxiety and apprehension; on the other hand, a larger penis has generally been related to virility and strength. These perceptions predominate during an erection, when penile size is representative of a man's masculinity. AIM To assess adult penile length and summarize average penile length assessments from the literature; analyze how various urologic diseases and therapies affect penile length and volume; and review how surgical treatments for Peyronie's disease, penile prosthesis implantation, and radical prostatectomy can affect penile size to appropriately counsel patients seeking such therapies and set realistic goals for patients. METHODS To achieve the aim of this review, we analyzed the literature on penile size and volume and how these can be affected by various urologic diagnoses and therapies. We summarize common diagnoses and therapies that can affect penile size. MAIN OUTCOME MEASURE We thoroughly discuss how the aforementioned diagnoses and therapies can negatively affect penile size. In doing so, we allow readers to understand the intricacies of penile size when faced with such diagnoses and therapies in their patients. RESULTS Surgical treatments for Peyronie's disease, penile prosthesis implantation for refractory erectile dysfunction, and radical prostatectomy for prostate cancer can lead to a decrease in penile size. CONCLUSION Urologists must recognize that the different therapies they offer can affect a man's penile size, often negatively. This in turn can lead to poorer satisfaction outcomes in patients. Davoudzadeh EP, Davoudzadeh NP, Margolin E, et al. Penile Length: Measurement Technique and Applications. Sex Med Rev 2018;6:261-271.
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Chung E, Ralph D, Kagioglu A, Garaffa G, Shamsodini A, Bivalacqua T, Glina S, Hakim L, Sadeghi-Nejad H, Broderick G. Evidence-Based Management Guidelines on Peyronie's Disease. J Sex Med 2017; 13:905-23. [PMID: 27215686 DOI: 10.1016/j.jsxm.2016.04.062] [Citation(s) in RCA: 118] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Revised: 03/19/2016] [Accepted: 03/27/2016] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Despite recent advances in our knowledge and treatment strategies in Peyronie's Disease (PD), much remained unknown about this disease. AIM To provide a clinical framework and key guideline statements to assist clinicians in an evidence-based management of PD. METHODS A systematic literature search was conducted to identify published literature relevant to PD. The search included all relevant articles published up to June 2015, including preclinical studies and published guidelines. References used in the text were assessed according to their level of evidence, and guideline recommendations were graded based on the Oxford Centre for Evidence-Based Medicine Levels of Evidence. Owing to the paucity of larger series and randomized placebo-controlled trials with regard to surgical intervention, guideline statements are provided as clinical principle or expert opinion. MAIN OUTCOME MEASURES This literature was discussed at a panel meeting, and selected articles with the highest evidence available were used to create consensus guideline statements for the Fourth International Consultation on Sexual Medicine guidelines on PD. RESULTS In addition to existing Third International Consultation on Sexual Medicine guidelines on PD, seven new summary recommendations were created. CONCLUSION A greater understanding of the scientific basis of PD is greatly needed to address our understanding of the pathophysiology, clinical epidemiology, psychosocial, and diagnostic assessment as well as treatment strategies.
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Affiliation(s)
- Eric Chung
- Department of Urology, University of Queensland, Princess Alexandra Hospital, Brisbane, QLD, Australia; AndroUrology Centre, St. Andrew's War Memorial Hospital, Brisbane, QLD, Australia.
| | - David Ralph
- Institute of Urology, University College London Hospital, London, UK
| | - Ates Kagioglu
- Department of Urology, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Guilio Garaffa
- Institute of Urology, University College London Hospital, London, UK
| | | | - Trinity Bivalacqua
- James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Sidney Glina
- Instituto H. Ellis and Department of Urology, Ipiranga Hospital, Sao Paulo, Brazil
| | - Lawrence Hakim
- Department of Urology, Cleveland Clinic Florida, Weston, FL, USA
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Ziegelmann MJ, Viers BR, Montgomery BD, Avant RA, Savage JB, Trost LW. Clinical Experience With Penile Traction Therapy Among Men Undergoing Collagenase Clostridium histolyticum for Peyronie's Disease. Urology 2017; 104:102-109. [DOI: 10.1016/j.urology.2017.01.054] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 01/04/2017] [Accepted: 01/19/2017] [Indexed: 12/13/2022]
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Campbell J, Alzubaidi R. Understanding the cellular basis and pathophysiology of Peyronie's disease to optimize treatment for erectile dysfunction. Transl Androl Urol 2017; 6:46-59. [PMID: 28217450 PMCID: PMC5313310 DOI: 10.21037/tau.2016.11.01] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Erectile dysfunction (ED) is a common condition that significantly impacts a man’s physical and psychological well-being. ED is often associated with Peyronie’s disease (PD), which is an abnormal curvature of the penis. Delayed treatment of or surgical invention for PD often results in ED and therefore unsatisfied patients. The pathophysiology of PD is incompletely understood, but has been studied extensively and based on our current understanding of PD physiology, many medical treatment options have been proposed. In this paper, we will review what is known about the pathophysiology of PD and the medical treatment options that have been trialed as a result. More investigations in regards to the basic science of PD need to be carried out in order to elucidate the exact mechanisms of the fibrosis, and propose new, more successful treatment options which should be implemented prior to the onset of ED.
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Affiliation(s)
- Jeffrey Campbell
- London Health Sciences Centre and St. Joseph's Health Care, Western University, London, Ontario, Canada
| | - Raidh Alzubaidi
- London Health Sciences Centre and St. Joseph's Health Care, Western University, London, Ontario, Canada
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26
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Talib RA, Ibrahim MA, Cangüven Ö. Nonsurgical treatment options in Peyronie's Disease: 2016 update. Turk J Urol 2016; 42:217-223. [PMID: 27909612 DOI: 10.5152/tud.2016.40799] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Peyronie's disease (PD) is an inflammatory condition of penile tunica albuginea which commonly ends with penile curvature and difficulty in vaginal penetration. Unfortunately, the pathophysiology of PD has not been completely understood. In this paper, we will review what is known about the pathophysiology of PD and the nonsurgical medical treatment options that have been trialed as a result. In the last 5 years, commonly used oral medications left their places to intralesional therapies. Clostridium collagenase, which is the only Food and Drug Administration (FDA) approved treatment for PD, is now the most prescribed intralesional therapy in the last years. Clostridium collagenase is advised for patients whose penile curvature is > 30° and < 90°. Because of its side effects, patients should be counseled before intralesional Clostridium collagenase treatment. Until finding best treatment solution for PD, more investigations in regards to the basic science of PD need to be carried out in order to elucidate the exact mechanisms of the fibrosis.
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Affiliation(s)
- Raidh A Talib
- Department of Urology, Hamad General Hospital, Doha, Qatar
| | | | - Önder Cangüven
- Department of Urology, Hamad General Hospital, Doha, Qatar
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27
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Ferretti L, Fandel TM, Qiu X, Zhang H, Orabi H, Wu AK, Banie L, Wang G, Lin G, Lin CS, Lue TF. Tunica albuginea allograft: a new model of LaPeyronie's disease with penile curvature and subtunical ossification. Asian J Androl 2015; 16:592-6. [PMID: 24759578 PMCID: PMC4104088 DOI: 10.4103/1008-682x.125900] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
The pathophysiology of LaPeyronie's disease (PD) is considered to be multifactorial, involving genetic predisposition, trauma, inflammation and altered wound healing. However, these factors have not yet been validated using animal models. In this study, we have presented a new model obtained by tunica albuginea allograft. A total of 40, 16-week-old male rats were used. Of these, 8 rats served as controls and underwent a 10 × 2-mm-wide tunical excision with subsequent autografting, whereas the remaining 32 underwent the same excision with grafting of the defect with another rat's tunica. Morphological and functional testing was performed at 1, 3, 7 and 12 weeks after grafting. Intracavernous pressure, the degree of penile curvature and elastic fiber length were evaluated for comparison between the allograft and control groups. The tissues were obtained for histological examination. The penile curvature was significantly greater in the allografted rats as compared with the control rats. The erectile function was maintained in all rats, except in those assessed at 12 weeks. The elastin fiber length was decreased in the allografted tunica as compared to control. SMAD2 expression was detected in the inner part of the allograft, and both collagen-II- and osteocalcin-positive cells were also noted. Tunica albuginea (TA) allograft in rats is an excellent model of PD. The persistence of curvature beyond 12 weeks and the presence of ossification in the inner layer of the TA were similar to those observed in men with PD. Validation studies using this animal model would aid understanding of the PD pathophysiology for effective therapeutic interventions.
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Affiliation(s)
- Ludovic Ferretti
- Department of Urology, University of Bordeaux, Bordeaux, France; Department of Urology, Knuppe Molecular Urology Laboratory, University of California San Francisco, San Francisco, California, USA; Hospital d'Instruction des Armées Robert Picqué, Villenave D'Ornon, France,
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Hussein AA, Alwaal A, Lue TF. All about Peyronie's disease. Asian J Urol 2015; 2:70-78. [PMID: 29264123 PMCID: PMC5730743 DOI: 10.1016/j.ajur.2015.04.019] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Revised: 01/31/2015] [Accepted: 02/10/2015] [Indexed: 12/27/2022] Open
Abstract
Peyronie's disease (PD) is an acquired connective tissue disorder of the tunica albuginea of the corpus cavernosum, characterized by excessive fibrosis and plaque formation. PD can result in significant physical and psychological morbidity; as it may prevent intercourse and cause adverse impacts on partner relationships. The exact etiology and pathophysiology remain unclear, and many misconceptions about the disease associations, course and treatment exist. The disease has two distinct stages. The acute stage is characterized by pain, and disease may progress during this stage. Non-surgical managements at this stage aim to alleviate pain and stabilize the disease. Results for non-surgical treatment are often conflicting. The chronic stage occurs 6–12 months later, where pain disappears and the deformity stabilizes. Surgical treatment is reserved for significant deformity or with inability to penetrative intercourse. The choice of the surgical technique depends on the length of the penis, degree of deformity, erectile function, patients' expectations and surgeon's preference.
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Affiliation(s)
- Ahmed A Hussein
- Department of Urology, University of California, San Francisco, CA, USA.,Department of Urology, Cairo University, Egypt
| | - Amjad Alwaal
- Department of Urology, University of California, San Francisco, CA, USA.,Department of Urology, King Abdul Aziz University, Saudi Arabia
| | - Tom F Lue
- Department of Urology, University of California, San Francisco, CA, USA
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Hussein AA, Alwaal A, Lue TF. WITHDRAWN: All about Peyronie’s disease. Asian J Urol 2015. [DOI: 10.1016/j.ajur.2015.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Alizadeh M, Karimi F, Fallah MR. Evaluation of verapamil efficacy in Peyronie's disease comparing with pentoxifylline. Glob J Health Sci 2014; 6:23-30. [PMID: 25363175 PMCID: PMC4796342 DOI: 10.5539/gjhs.v6n7p23] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 08/11/2014] [Accepted: 07/28/2014] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Peyronie's disease described as penile curvature, fibromathosis and pain that occur most often in men aged 40 to 60 years. The main complaint that caused the patient to visit the clinic is nodules on the upper surface of the penis, causing curvature and distortion particularly during erection, but they don't have any urinary problem. In this study, we evaluated the effect of verapamil compared to pentoxifylline in Peyronie's disease. METHODS In this study, 90 patients with signs and symptoms of Peyronie's disease which were diagnosed and were in the age range 40 to 70 years enrolled. The patients were randomly divided into 3 groups. First group received pentoxifylline orally at a dose of 400 mg three times a day, in the second group verapamil (10 mg every other week for up to 12 sessions) was injected into the lesion and the third group received both treatments in combination. RESULTS In patients, who received pentoxifylline, curvature reduction was 26.7%, plaque size reduction was 30%, the recovery rate of erectile dysfunction was 46.7% and pain reduced was 73.3%. Each of these cases in patients, who used beta-blockers, was 36.7%, 33.3%, 66.7% and 76.6%. In combination therapy, curvature reduction was 36.7%, plaque size reduction was 33.3%, the recovery rate of erectile dysfunction was 86.7% and pain reduced was 80%. CONCLUSION In our study there was no significant difference between two groups using verapamil or pentoxifylline, but there was a significant improvement in combination therapy group. Due to our results we propose that combination therapy can improve results and should be considered as a choice in treatment of Peyronie's disease.
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Jordan GH, Carson CC, Lipshultz LI. Minimally invasive treatment of Peyronie's disease: evidence-based progress. BJU Int 2014; 114:16-24. [DOI: 10.1111/bju.12634] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Gerald H. Jordan
- Department of Urology; Eastern Virginia Medical School; Norfolk VA USA
| | - Culley C. Carson
- Division of Urologic Surgery; University of North Carolina; Chapel Hill NC USA
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Favilla V, Russo GI, Privitera S, Castelli T, Madonia M, La Vignera S, Condorelli R, Calogero AE, Farina FP, Cimino S, Morgia G. Combination of intralesional verapamil and oral antioxidants for Peyronie's disease: a prospective, randomised controlled study. Andrologia 2013; 46:936-42. [DOI: 10.1111/and.12178] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2013] [Indexed: 12/13/2022] Open
Affiliation(s)
- V. Favilla
- Department of Urology; University of Catania; Catania Italy
| | - G. I. Russo
- Department of Urology; University of Catania; Catania Italy
| | - S. Privitera
- Department of Urology; University of Catania; Catania Italy
| | - T. Castelli
- Department of Urology; University of Catania; Catania Italy
| | - M. Madonia
- Department of Urology; University of Sassari; Sassari Italy
| | - S. La Vignera
- Department of Internal Medicine and Systemic Diseases; Section of Endocrinology, Andrology and Internal Medicine; University of Catania; Catania Italy
| | - R. Condorelli
- Department of Internal Medicine and Systemic Diseases; Section of Endocrinology, Andrology and Internal Medicine; University of Catania; Catania Italy
| | - A. E. Calogero
- Department of Internal Medicine and Systemic Diseases; Section of Endocrinology, Andrology and Internal Medicine; University of Catania; Catania Italy
| | - F. P. Farina
- Department of Urology; University of Sassari; Sassari Italy
| | - S. Cimino
- Department of Urology; University of Catania; Catania Italy
| | - G. Morgia
- Department of Urology; University of Catania; Catania Italy
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Abstract
Erectile dysfunction (ED) impacts more than 50% of men older than 40 years; Peyronie disease (PD) affects up to 10% of men, with an adverse impact on normal sexual function and overall well-being. ED can also be the first sign of other underlying disease. The office-based evaluation of ED and PD is the first step in the management of these devastating conditions of men's health. New and exciting nonsurgical therapies are now available to help treat these conditions and restore sexual function and quality of life.
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Ferretti L, Faix A, Droupy S. La maladie de Lapeyronie. Prog Urol 2013; 23:674-84. [DOI: 10.1016/j.purol.2013.02.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Accepted: 02/06/2013] [Indexed: 01/21/2023]
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Chung E, De Young L, Solomon M, Brock GB. Peyronie's Disease and Mechanotransduction: An In Vitro Analysis of the Cellular Changes to Peyronie's Disease in a Cell‐Culture Strain System. J Sex Med 2013; 10:1259-67. [DOI: 10.1111/jsm.12082] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Gokce A, Wang JC, Powers MK, Hellstrom WJ. Current and emerging treatment options for Peyronie's disease. Res Rep Urol 2013; 5:17-27. [PMID: 24400231 PMCID: PMC3826933 DOI: 10.2147/rru.s24609] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Peyronie’s disease (PD) is a condition of the penis, characterized by the presence of localized fibrotic plaque in the tunica albuginea. PD is not an uncommon disorder, with recent epidemiologic studies documenting a prevalence of 3–9% of adult men affected. The actual prevalence of PD may be even higher. It is often associated with penile pain, anatomical deformities in the erect penis, and difficulty with intromission. As the definitive pathophysiology of PD has not been completely elucidated, further basic research is required to make progress in the understanding of this enigmatic condition. Similarly, research on effective therapies is limited. Currently, nonsurgical treatments are used for those men who are in the acute stage of PD, whereas surgical options are reserved for men with established PD who cannot successfully penetrate. Intralesional treatments are growing in clinical popularity as a minimally invasive approach in the initial treatment of PD. A surgical approach should be considered when men with PD do not respond to conservative, medical, or minimally invasive therapies for approximately 1 year and cannot have satisfactory sexual intercourse. As scientific breakthroughs in the understanding of the mechanisms of this disease process evolve, novel treatments for the many men suffering with PD are anticipated.
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Affiliation(s)
- Ahmet Gokce
- Department of Urology, Tulane University - School of Medicine, New Orleans, LA, USA
| | - Julie C Wang
- Department of Urology, Tulane University - School of Medicine, New Orleans, LA, USA
| | - Mary K Powers
- Department of Urology, Tulane University - School of Medicine, New Orleans, LA, USA
| | - Wayne Jg Hellstrom
- Department of Urology, Tulane University - School of Medicine, New Orleans, LA, USA
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Abstract
Peyronie's disease (PD) is most simply referred to as a fibrotic wound-healing disorder of the tunica albuginea. It is both a physically and psychologically devastating disorder that causes penile deformity, curvature, hinging, narrowing and shortening, which may compromise sexual function. Although a variety of non-surgical treatments have been suggested, none to date offer a reliable and effective correction of the penile deformity. As a result, surgery remains the gold standard treatment option, offering the most rapid and reliable treatment which will be the focus of this article. We review the preoperative evaluation, surgical algorithm, graft materials and postoperative management of PD. Outcomes for tunical shortening, tunical lengthening and penile prosthesis placement for penile straightening are reviewed. Tunica albuginea plication is the preferred method of straightening for men with adequate rigidity and less severe disease defined as curvature less than 70° without narrowing/hinging. Men who have more severe, complex deformity, but maintain strong preoperative erectile function should be considered candidates for straightening with plaque incision or partial excision and grafting. Finally, for those men who have inadequate rigidity and PD, penile prosthesis placement with straightening is the best approach to address both problems.
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Affiliation(s)
- Laurence A Levine
- Department of Urology, Rush University Medical Center, Chicago, IL 60612, USA.
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Knobloch K. [Penis deviation with or without pain in Peyronie's disease--an update]. MMW Fortschr Med 2012; 154:45-6. [PMID: 23173285 DOI: 10.1007/s15006-012-1343-1] [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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Jang JH, Ryu JK, Suh JK. Activin Receptor-Like Kinase 5 Inhibitor Attenuates Fibrosis in Fibroblasts Derived from Peyronie's Plaque. Korean J Urol 2012; 53:44-9. [PMID: 22323974 PMCID: PMC3272556 DOI: 10.4111/kju.2012.53.1.44] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2011] [Accepted: 07/20/2011] [Indexed: 12/21/2022] Open
Abstract
Purpose Transforming growth factor-β1 (TGF-β1) is the key fibrogenic cytokine associated with Peyronie's disease (PD). The aim of this study was to determine the antifibrotic effect of 3-((5-(6-Methylpyridin-2-yl)-4-(quinoxalin-6-yl)-1H-imidazol-2-yl) methyl)benzamide (IN-1130), a small-molecule inhibitor of the TGF-β type I receptor activin receptor-like kinase 5 (ALK5), in fibroblasts isolated from human PD plaque. Materials and Methods Plaque tissue from a patient with PD was used for primary fibroblast culture, and we then characterized primary cultured cells. Fibroblasts were pretreated with IN-1130 (10 µM) and then stimulated with TGF-β1 protein (10 ng/ml). We determined the inhibitory effect of IN-1130 on TGF-β1-induced phosphorylation of Smad2 and Smad3 or the nuclear translocation of Smad proteins in fibroblasts. Western blot analyses for plasminogen activator inhibitor-1, fibronectin, collagen I, and collagen IV were performed to evaluate effect of IN-1130 on the production of extracellular matrix proteins. Results The treatment of fibroblasts with TGF-β1 significantly increased phosphorylation of Smad2 and Smad3 and induced translocation of Smad proteins from the cytoplasm to the nucleus. Pretreatment with IN-1130 substantially inhibited TGF-β1-induced phosphorylation of Smad2 and Smad3 and nuclear accumulation of Smad proteins. The TGF-β1-induced production of extracellular matrix proteins was also significantly inhibited by treatment with IN-1130 and returned to basal levels. Conclusions Overexpression of TGF-β and activation of Smad transcriptional factors are known to play a crucial role in the pathogenesis of PD. Thus, inhibition of the TGF-β signaling pathway by ALK5 inhibitor may represent a promising therapeutic strategy for treating PD.
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Affiliation(s)
- Jin Hyuk Jang
- National Research Laboratory of Regenerative Sexual Medicine, Department of Urology, Inha University School of Medicine, Incheon, Korea
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Abern MR, Larsen S, Levine LA. Combination of Penile Traction, Intralesional Verapamil, and Oral Therapies for Peyronie's Disease. J Sex Med 2012; 9:288-95. [DOI: 10.1111/j.1743-6109.2011.02519.x] [Citation(s) in RCA: 88] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Drugs of the future for Peyronie's disease. Med Hypotheses 2011; 78:305-11. [PMID: 22154542 DOI: 10.1016/j.mehy.2011.11.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2011] [Accepted: 11/08/2011] [Indexed: 01/01/2023]
Abstract
With the increasing awareness of Peyronie's disease (PD), the interest in new concept medications to treat the disorder is escalating. Profibrogenic factors such as transforming growth factor (TGF)-beta1, endothelin (ET-1), connective tissue growth factor (CTGF), angiotensin (Ang) II and platelet derived growth factor (PDGF), all appear to be involved in the pathogenesis of PD. β-Thymosins, pirfenidone, nitric oxide (NO) donors, phosphodiesterase (PDE)-5 inhibitors, matrix metalloproteinases (MMPs)/anti-tissue inhibitor of metalloproteinases (TIMP)-1 reduce collagen synthesis, while decorin, follistatin, and Smad 7 exert antifibrotic effects; all have been proposed for the treatment of PD. Alternative and/or novel approaches for the treatment of PD are needed in part because of the recognized multifactorial etiology of this complex disorder. A comprehensive approach for translating available experimental information into clinically effective drug trials for the treatment of PD is needed. We propose a multi-faceted approach for drug development to generate novel drug products for the treatment of PD.
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Chung E, De Young L, Brock GB. Rat as an animal model for Peyronie's disease research: a review of current methods and the peer-reviewed literature. Int J Impot Res 2011; 23:235-41. [PMID: 21776004 DOI: 10.1038/ijir.2011.36] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2011] [Revised: 05/24/2011] [Accepted: 06/23/2011] [Indexed: 01/18/2023]
Abstract
While the exact mechanism of Peyronie's disease (PD) remains an enigma, the pathophysiology of PD is considered to be multifactorial, with interactions of genetic predisposition, trauma, tissue inflammation and aberrant wound healing. A non-systematic review of the existing English language literature pertaining to the use of rodent models in the evaluation of PD was performed using the Medline database. Multiple free-text searches were performed on key words: animal models of PD, transforming growth factor β1 (TGF β1), tunical and/or corporal fibrosis, subtunical injection and penile myofibroblasts. The most frequently reported models of PD can be classified as TGF β1, fibrin and surgical trauma-induced models. In vitro studies using Peyronie's fibroblast culture media have also provided further insights into cellular mechanism of PD. At the present time, the research in PD is hampered by the lack of universally accepted animal model and this is likely attributed to the limited insight into PD mechanisms and the difficulties faced by current animal models to truly represent the complexity and complete spectrum of human disease.
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Affiliation(s)
- E Chung
- Department of Urology, Princess Alexandra Hospital, Brisbane, QLD, Australia.
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Paulis G, D'Ascenzo R, Nupieri P, De Giorgio G, Orsolini G, Brancato T, Alvaro R. Effectiveness of antioxidants (propolis, blueberry, vitamin E) associated with verapamil in the medical management of Peyronie's disease: a study of 151 cases. ACTA ACUST UNITED AC 2011; 35:521-7. [PMID: 21950543 PMCID: PMC3437487 DOI: 10.1111/j.1365-2605.2011.01219.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
A total of 151 patients (age: 24–74 years, mean: 55 ± 10.3) diagnosed with Peyronie's disease were enrolled in a non-surgical treatment. In addition to medical histories and physical examinations, all patients underwent the following tests: penile ultrasound, IIEF questionnaire and photographic documentation. The penile curvature was measured by taking a photograph during maximum erection. All 151 patients were treated at different times and with different combinations of drugs, and afterwards, they were clinically studied and divided into five different treatment groups: 1st = verapamil (injection + iontophoresis) + vitamin E + topical diclofenac + blueberries; 2nd = verapamil (injection + iontophoresis) + vitamin E + topical diclofenac + propolis; 3rd = verapamil (injection) + vitamin E + topical Diclofenac; 4th = verapamil (iontophoresis) + vitamin E + topical diclofenac; 5th = verapamil (injection + iontophoresis) + topical diclofenac + blueberries + propolis. All patients were treated for 6 months after which they underwent the same follow-up tests as performed prior to the treatment. The following was achieved: group 1 had the most reduction in plaque size (−66.4%; p = 0.000), group 2 obtained the highest rate where penile curvature disappeared (24.5%; p = 0.019); the best results with reference to decrease in curvature angle were reached by the 2nd group (−14°) and group 1 obtained −9.6° (p = 0.000).
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Affiliation(s)
- G Paulis
- Andrology Service, Regina Apostolorum Hospital, Albano Laziale, Rome, Italy.
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Abstract
Non-surgical treatment of Peyronie's disease (PD) has come a long way since it was first described in 1743. A myriad of treatment options are currently available, including oral, intralesional and external energy therapies. The purpose of this article is to review the contemporary literature on non-surgical therapies for PD, and where possible, focus on randomized, placebo-controlled trials, as well as review the latest guidelines for the management of PD from the International Committee on Sexual Medicine, which conveyed its findings in July 2009. At this time, it appears that a combination of oral agents and/or intralesional injection with traction therapy may provide a synergy between the chemical effects of the drugs and the mechanical effects of traction. Until a reliable treatment emerges, it does appear that some of the non-surgical treatments discussed can be used to stabilize the scarring process and may result in some reduction of deformity with improved sexual function.
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45
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Gur S, Limin M, Hellstrom WJG. Current status and new developments in Peyronie's disease: medical, minimally invasive and surgical treatment options. Expert Opin Pharmacother 2011; 12:931-44. [PMID: 21405946 DOI: 10.1517/14656566.2011.544252] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Peyronie's disease (PD) is a wound-healing disorder of the tunica albuginea of the penis which affects 3-9% of adult males. Clinically, any combination of plaque formation, penile pain, angulation and erectile dysfunction may appear. This condition may progress, stabilize or, uncommonly, regress during the initial acute phase (6-18 months). AREAS COVERED Information regarding this review was searched in PubMed until August 2010. Vitamin E, paraaminobenzoate and colchicine are sparingly employed oral medical therapies. Intralesional injections as a minimally invasive therapy for PD includes injection with verapamil, interferon-α-2b, and collagenase. Men suffering with PD who have significant penile deformity precluding successful coitus can be appraised for surgical correction. Surgery is considered the gold standard and includes plication, incision and grafting- or penile-prosthesis-related procedures. EXPERT OPINION This paper provides a broad overview of the subject of PD, available nonsurgical options and surgical approaches that will aid in the routine clinical diagnosis and management of PD. Increased public and medical awareness of PD prevalence, presentation, diagnosis and treatment options will serve well the large population of men who suffer in silence with this common condition.
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Affiliation(s)
- Serap Gur
- Department of Urology, Health Sciences Center, Tulane University, New Orleans, Louisiana 70112, USA
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Larsen SM, Levine LA. Peyronie’s Disease: Review of Nonsurgical Treatment Options. Urol Clin North Am 2011; 38:195-205. [DOI: 10.1016/j.ucl.2011.02.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abdel-Hamid IA, Anis T. Peyronie's disease: perspectives on therapeutic targets. Expert Opin Ther Targets 2011; 15:913-29. [PMID: 21492024 DOI: 10.1517/14728222.2011.577419] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Peyronie's disease (PD) is an acquired benign connective tissue disorder of the penis, characterized by the development of fibrotic plaques, that can cause different degrees of bending, narrowing or shortening. Medical treatment for PD remains a major challenge. Impressive progress in our understanding of the molecular mechanisms of PD pathogenesis has uncovered several promising molecular targets for antifibrotic treatments. AREAS COVERED This review covers the literature pertaining to the exploration of therapeutic targets for PD. The search included: i) a MEDLINE search from 1941 to January 2011, limited to English-language medical literature, ii) relevant abstracts from 2009 and 2010, iii) relevant textbooks and iv) a pipeline search for therapeutics in development. EXPERT OPINION Rapid translational research depends on our ability to develop rational therapies targeted to penile tunical fibrosis, which necessitate a sound knowledge of the biology, biochemistry and the physiological role of fibroblasts, myofibroblasts and stem cells in PD. Much remains to be learned about the pathogenesis of PD. Although there are many interesting therapeutic targets, we are confronted with some questions when identifying new targets, or when validating potential therapeutic options.
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Mulhall JP, Barnas J, Kobylarz K, Mueller A. p53-Associated Parkin-like cytoplasmic protein (Parc) short-interfering RNA (siRNA) alters p53 location and biology of Peyronie's disease fibroblasts. BJU Int 2011; 106:1706-13. [PMID: 21078039 DOI: 10.1111/j.1464-410x.2010.09754.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE • To evaluate the impact of p53-associated Parkin-like cytoplasmic protein (Parc) short-interfering RNA (siRNA) on the location of p53 as well as the biology of Peyronie's disease (PD) plaque-derived fibroblasts after Parc knockdown. PATIENTS AND METHODS • Plaque tissue was excised from men with stable PD undergoing penile reconstructive surgery and used to produce cultured PD plaque-derived fibroblasts. • Immunofluorescence (IF) and reverse transcription-polymerase chain reaction (RT-PCR) were then used to define the location of p53 and Parc before and after siRNA. • Nuclear fractionation studies were used to assess the chronology of translocation of p53 from cytoplasm to nucleus on Parc knockdown. • The terminal transferase dUTP Nick end labelling (TUNEL) assay was used to assess the apoptotic indices of the PD fibroblasts after Parc knockdown. RESULTS • IF and PCR showed high cytoplasmic levels of p53 and Parc before siRNA. On IF, there was little or no p53 present within the nucleus before Parc knockdown. • After Parc siRNA, IF showed translocation of p53 to the fibroblast nucleus, while Parc levels dropped significantly, but what Parc remained was confined to the cytoplasm with none present in the nucleus. • Nuclear fractionation studies using RT-PCR confirmed this translocation phenomenon and showed the chronology of the event. All p53 had moved from the cytoplasm to the nucleus within 16 h of Parc siRNA. • On TUNEL assay, apoptotic indices increased dramatically after Parc siRNA. CONCLUSIONS • These data prove that Parc is a cytoplasmic anchor for p53 in PD plaque-derived fibroblasts and may be the primary cause of the stabilization and defunctionalization of p53 in these cells. • These findings support Parc as a novel target for PD pharmacotherapy, perhaps using human siRNA technologies once commercially available.
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Affiliation(s)
- John P Mulhall
- Department of Urology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
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Soh J, Kawauchi A, Kanemitsu N, Naya Y, Ochiai A, Naitoh Y, Fujiwara T, Kamoi K, Miki T. Nicardipine vs. Saline Injection as Treatment for Peyronie's Disease: A Prospective, Randomized, Single-Blind Trial. J Sex Med 2010; 7:3743-9. [DOI: 10.1111/j.1743-6109.2010.01924.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Piao S, Choi MJ, Tumurbaatar M, Kim WJ, Jin HR, Shin SH, Tuvshintur B, Yin GN, Song JS, Kwon MH, Lee SJ, Han JY, Kim SJ, Ryu JK, Suh JK. Transforming Growth Factor (TGF)-β Type I Receptor Kinase (ALK5) Inhibitor Alleviates Profibrotic TGF-β1 Responses in Fibroblasts Derived from Peyronie's Plaque. J Sex Med 2010; 7:3385-95. [DOI: 10.1111/j.1743-6109.2010.01753.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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