1
|
Loloi J, Schuppe K, Reddy RV, Rahman F, Bernstein A, Reddy P, Kulkarni N, Masterson T, Ramasamy R. A survey of exposure to the use of Xiaflex for the treatment of Peyronie's disease among United States urology residency programs. Int J Impot Res 2024; 36:155-159. [PMID: 37865716 DOI: 10.1038/s41443-023-00781-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 09/28/2023] [Accepted: 10/09/2023] [Indexed: 10/23/2023]
Abstract
Xiaflex® (collagenase clostridium histolyticum) is a Food and Drug Administration-approved treatment for patients with Peyronie's disease. Despite its approval and implementation, there is concern that urologists in training are offered minimal exposure to its use. Thus, the purpose of this study was to evaluate the exposure of urology residents to Peyronie's disease and its management, particularly Xiaflex®. A Google Forms survey regarding the exposure of residents to Peyronie's disease and use of Xiaflex® was created and disseminated through email to urology programs. Overall, 47 institutional responses were received. At 45 institutions (95.7%), residents receive training in directly evaluating and caring for patients with Peyronie's disease. At 46 institutions (97.9%), residents receive training in observing and/or performing surgical procedures for Peyronie's disease. Residents at 31 institutions (66.0%) receive observational or procedural training for non-surgical management of Peyronie's disease, specifically Xiaflex®. Residents receive non-surgical training from an academic faculty who is fellowship trained in sexual medicine at 25 institutions and an academic faculty not trained in sexual medicine at six institutions. There exists a glaring disparity in residency exposure to Xiaflex®. Further research is warranted to elucidate how programs can provide residents with further exposure to the use of Xiaflex® in patients with Peyronie's disease.
Collapse
Affiliation(s)
- Justin Loloi
- Department of Urology, Montefiore Medical Center, Bronx, NY, USA.
| | - Kyle Schuppe
- Washington State University Elson S. Floyd College of Medicine, Spokane, WA, USA
| | - Raghuram V Reddy
- Florida International University Herbert Wertheim College of Medicine, Miami, FL, USA
| | - Farah Rahman
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ari Bernstein
- Department of Urology, New York University Langone Health, New York, NY, USA
| | - Pritika Reddy
- Alabama College of Osteopathic Medicine, Dothan, AL, USA
| | - Nikhil Kulkarni
- Florida International University Herbert Wertheim College of Medicine, Miami, FL, USA
| | - Thomas Masterson
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ranjith Ramasamy
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| |
Collapse
|
2
|
Paulis G, Paulis A. Chronic prostatitis as possible risk factor for Peyronie's disease: Psychological, sexual and prostatitis-like symptoms in patients with PD. Arch Ital Urol Androl 2023:11406. [PMID: 37259816 DOI: 10.4081/aiua.2023.11406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 05/11/2023] [Indexed: 06/02/2023] Open
Abstract
OBJECTIVE This study aims to investigate a possible relationship between chronic prostatitis (CP) and Peyronie's disease (PD) and to characterize the psychological profile of patients suffering from PD, with or without concomitant CP. METHODS We included 539 patients with PD, of which 200 were found to have underlying CP. As a comparator population, we selected 2201 patients without PD, referring to our tertiary care clinic. In this population, we detected 384 subjects with CP. All 539 PD patients underwent photographic documentation of the penile deformation, and dynamic penile eco-color Doppler with plaque and volume measurements and answered the following questionnaires: the Generalized Anxiety Disorder-7, the Patient Health Questionnaire-9, the Visual Analog Scale for penile pain measurements, the International Index of Erectile Function (IIEF), and the NIH-Chronic Prostatitis Symptom Index. RESULTS The overall prevalence of chronic prostatitis in PD patients was 37.1% compared to a prevalence of 17.4% in the non-PD control population (OR = 2.79 and p < 0.0001). The severity of CP symptom total scores (NIH-CPSI) correlated significantly with the severity of erectile dysfunction (p < 0.0001). Significant anxiety was present in 89.2% of PD patients and it is more prevalent in PD patients with CP than in PD patients without CP (93.0% vs. 87.0%, respectively; p = 0.0434). Significant depression was detected in 57.1% of PD patients and it is more prevalent in PD patients with CP than in PD patients without CP (64.0% vs. 53.09%, respectively; p = 0.0173). CONCLUSION Chronic prostatitis (CP) and Peyronie's disease (PD) are frequently associated. Our results demonstrate the strong impact of chronic prostatitis on the mental status of PD patients. Anxiety and depression were significantly more pronounced in PD patients with CP than in PD patients without CP.
Collapse
Affiliation(s)
- Gianni Paulis
- Peyronie's Care Center, Department of Uro-Andrology, Castelfidardo Clinical Analysis Center, Rome.
| | - Andrea Paulis
- Neurosystem Center for applied Psychology and Neuroscience, Janet Clinical Centre, Rome.
| |
Collapse
|
3
|
Paulis G, Pisano F, Palmieri A, Cai T, Palumbo F, Giammusso B. Urologists' knowledge base and practice patterns in Peyronie's disease. A national survey of members of the italian andrology society. Arch Ital Urol Androl 2021; 93:348-355. [PMID: 34839643 DOI: 10.4081/aiua.2021.3.348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 08/09/2021] [Indexed: 11/23/2022] Open
Abstract
Peyronie's disease is a chronic inflammatory disease involving the formation of plaque in the tunica albuginea of the corpora cavernosa, resulting in penis deformity. It is often associated with penile pain, especially in younger patients, but it is not rare for pain to be absent; the disease is also associated with erectile dysfunction and a depressive state in a large percentage of cases. OBJECTIVE Aim of our study was to explore the basic knowledge base and diagnostic and therapeutic practice patterns in Peyronie's disease (PD) of a large number of physicians belonging to the Italian Andrology Society (SIA). METHODS Our survey is based on two questionnaires which were e-mailed to the members of the SIA. The first questionnaire explored diagnostic and therapeutic practice patterns of SIA physicians, while the second questionnaire focused on their knowledge of the disease, as well as their training and level of experience in the specific field. We then planned to compare our outcomes with similar PD surveys from other countries. RESULTS The first questionnaire was answered by 142 SIA physicians. The second questionnaire was answered by 83 SIA physicians. Most respondents (74.6%) chose penile ultrasonography as first-line diagnostic approach and 47.1% prefer to perform a color Doppler ultrasound after pharmaco-induced erection. Concerning the therapeutic practice patterns in active stage of the disease, most respondents (99.29%) prefer conservative medical therapy. Additionally, most respondents (64.78%), when failure of conservative treatment had been established, considered surgical treatment necessary, specifically corporoplasty, which may be associated with other techniques. CONCLUSIONS The results of our survey show that, in comparison to their foreign counterparts, Italian SIA uro-andrologists have a more proactive diagnostic approach right from when patients first present. When PD is still in its active stage, SIA uro-andrologists mostly opt for medical therapy. In advanced disease or if conservative treatment fails, our survey indicates a greater preference for surgical treatment. Answers to the theoretical knowledge questions showed that SIA physicians have a good understanding of the disease's etiology, epidemiology, and clinical picture, and of the appropriate indications for treatment.
Collapse
Affiliation(s)
- Gianni Paulis
- Peyronie's Care Center, Department of Uro-Andrology, Castelfidardo Medical Team, Rome.
| | - Francesca Pisano
- Peyronie's Care Center, Department of Uro-Andrology, Castelfidardo Medical Team, Rome.
| | - Alessandro Palmieri
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples.
| | - Tommaso Cai
- Department of Urology, Santa Chiara Regional Hospital, Trento.
| | | | | |
Collapse
|
4
|
The Prevalence and Predictors of Penile Pain in Men with Peyronie's Disease. Sex Med 2021; 9:100398. [PMID: 34246855 PMCID: PMC8360927 DOI: 10.1016/j.esxm.2021.100398] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 04/21/2021] [Accepted: 06/04/2021] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Penile pain is one of the most stressful symptoms in men with Peyronie's disease (PD). AIM To evaluate the prevalence, clinical presentation and risk factors associated with penile pain in men with PD as well as to assess the psychosocial impact. METHODS We revised our institution's database of men diagnosed with PD. The information collected included penile pain assessments, and the scores of the PD Questionnaire (PDQ), Self-Esteem and Relationship Questionnaire (SEAR) and Center for Epidemiologic Studies Depression Scale Questionnaire (CES-D). Descriptive and comparative statistics were used. Logistic regression analyses were performed to evaluate predictive factors associated with penile pain. MAIN OUTCOME MEASURES Penile pain descriptive assessment and factors associated with penile pain in men with PD. Comparison of SEAR, CES-D and PDQ domain scores of men with and without penile pain. RESULTS 431 men with PD were included for this analysis with a mean age of 55.9 years. Penile pain was reported by 36.7%; 65.2% of those had painful erection, 7% pain with flaccid state only, and 20% in both stages. The median pain severity was 3 with erection and 1 with flaccid stage. After adjusted logistic regression analyses, advanced age was associated with less pain (OR 0.94, P ≤ 0.001). Men with penile pain had no significant difference in CES-D and SEAR mean scores compared to men without penile pain. The PDQ scores for the physical/psychological symptoms domain and the bother domain were significantly higher in men with penile pain (12 vs 8.7; P < 0.01 and 9 vs 7.1; P < 0.01 respectively). Men with penile pain had a higher rate of clinically significant bother scores than men without penile pain (52% vs 35%, P ≤ 0.001). CONCLUSION Penile pain is common in men with PD. It was more common in young men and was associated with physical and psychological bothers in this population. Flores JM, Salter CA, Nascimento B, et al. The Prevalence and Predictors of Penile Pain in Men with Peyronie's Disease. Sex Med 2021;9:100398.
Collapse
|
5
|
Krakhotkin DV, Ralph DJ, Blecher GA, Chernylovskyi VA, Greco F, Bakurov EE, Bugaev RA. Management of residual penile curvature after penile prosthesis placement. Asian J Androl 2021; 23:129-134. [PMID: 33106463 PMCID: PMC7991822 DOI: 10.4103/aja.aja_62_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Residual penile curvature is a common situation following the implantation of a penile prosthesis in patients with Peyronie's disease. Currently, there is a variety of options for the correction of residual curvature, including penile modeling, plication techniques, as well as tunical incision/excision with or without grafting. A literature search of PubMed and Medline databases was conducted from 1964 until 2020, using search terms for all articles in the English language. In this article, we provide a review of the techniques and the outcomes, according to the published literature.
Collapse
Affiliation(s)
- Denis V Krakhotkin
- Central District Hospital, Outpatient Department, Kamenolomni, Rostov Region 346480, Russia
| | - David J Ralph
- University College London St Peter's Andrology Centre and University College London Hospitals, London W1G 6BJ, United Kingdom
| | - Gideon A Blecher
- Monash University, Department of Surgery, Melbourne 3168, Australia.,The Alfred Hospital, Department of Urology, Melbourne 3004, Australia
| | | | - Francesco Greco
- Department of Urology, Humanitas Gavazzeni, Bergamo 24125, Italy
| | - Evgeny E Bakurov
- Department of Surgery No. 1, Rostov Regional Hospital ROKB 1, Rostov-on-Don 344015, Russia
| | - Ruslan A Bugaev
- Central District Hospital, Outpatient Department, Kamenolomni, Rostov Region 346480, Russia
| |
Collapse
|
6
|
|
7
|
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.
Collapse
Affiliation(s)
- J Scott Gabrielsen
- Department of Urology, University of Rochester Medical Center, Rochester, NY, USA
| |
Collapse
|
8
|
Li J, Wang S, Qin F, Zhu M, You X, Wu C, Fu F, Yuan J. Reduction in Peyronie's-like plaque size using a vacuum erection device in a rat model of Peyronie's disease via the TGF-β/SMAD signalling pathway. Andrologia 2018; 50:e13051. [PMID: 29806152 DOI: 10.1111/and.13051] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 03/22/2018] [Accepted: 04/15/2018] [Indexed: 02/06/2023] Open
Affiliation(s)
- Jinhong Li
- Andrology Laboratory; West China Hospital; Sichuan University; Chengdu China
- Department of Urology; Institute of Urology; West China Hospital; Sichuan University; Chengdu China
| | - Shuzhen Wang
- Laboratory of Infectious Disease and Vaccine; West China Hospital; Sichuan University; Chengdu China
| | - Feng Qin
- Andrology Laboratory; West China Hospital; Sichuan University; Chengdu China
| | - Mengli Zhu
- Andrology Laboratory; West China Hospital; Sichuan University; Chengdu China
| | - Xuanhe You
- Andrology Laboratory; West China Hospital; Sichuan University; Chengdu China
| | - Changjing Wu
- Andrology Laboratory; West China Hospital; Sichuan University; Chengdu China
| | - Fudong Fu
- Andrology Laboratory; West China Hospital; Sichuan University; Chengdu China
| | - Jiuhong Yuan
- Andrology Laboratory; West China Hospital; Sichuan University; Chengdu China
- Department of Urology; Institute of Urology; West China Hospital; Sichuan University; Chengdu China
| |
Collapse
|
9
|
Reed-Maldonado AB, Alwaal A, Lue TF. The extra-tunical grafting procedure for Peyronie's disease hourglass and indent deformities. Transl Androl Urol 2018; 7:S1-S6. [PMID: 29644164 PMCID: PMC5881200 DOI: 10.21037/tau.2017.12.03] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background To describe a novel, tunica-sparing surgical technique—extra-tunical grafting (ETG)—for the treatment of penile indent and hourglass (HG) deformities and to describe patient-reported outcomes after the ETG procedure. Methods An IRB-approved, retrospective chart review of ETG patients was performed to collect data including pre-operative deformity, operation performed, and post-operative patient-reported perception of deformity, erectile function, penile sensation, and overall satisfaction with the ETG operation. The indications for surgery were difficulty with sexual intercourse due to deformity and/or poor cosmesis of the penis. Pre-operatively all patients had erections adequate for intercourse with or without medications. The ETG procedure is performed through a ventral longitudinal penile skin incision. The dissection is continued to the level between Dartos and Bucks fascia, circumferentially for HG deformity and focally for indent deformity. The neurovascular bundle (NVB) is left undisturbed. A cadaveric fascia graft is applied, singly or in multiple layers, to fill the exposed tunical depressions. Our preferred graft material is Tutoplast Suspend® (Coloplast, Minneapolis, MN, USA). The graft is sutured into position with multiple interrupted, long-lasting absorbable sutures to achieve the desired penile shaft contour. The urethra is excluded from the graft. Results From October 2013 to June 2017, 36 patients had the ETG procedure for HG and/or indent with or without penile curvature. Results with a minimum of 6 months of follow-up could be extracted for 18 of the patients. One was excluded as he required concurrent excision of a large calcified tunical plaque, which necessitated incision into the tunica albuginea (TA). Follow-up was between 6 and 44 months (average 21 months). All patients reported satisfactory resolution of the HG or indent. No patient reported worsened erectile function. Two patients (11.8%) reported slight penile hypoesthesia, with one of these having had multiple previous penile degloving surgeries for trauma. Ten of the patients reported being “very satisfied” and six reported being “satisfied” with the procedure. One was neutral. All reported that they would recommend the ETG procedure to a friend, and all would repeat the same surgery again. Conclusions The ETG procedure is a straightforward approach to HG and indent deformities to correct the penile deformity and to provide structural support to prevent penile buckling during intercourse. The procedure does not violate the TA and does not require dissection of the NVB. Thus, ETG carries a very low risk of de novo impotence or hypoesthesia as highlighted by this patient series. With such low risk and high patient-reported satisfaction rates, the ETG procedure is a valuable surgical technique for the treatment of complex penile deformities.
Collapse
Affiliation(s)
| | - Amjad Alwaal
- Department of Urology, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Tom F Lue
- Department of Urology, University of California, San Francisco, CA, USA
| |
Collapse
|
10
|
Paulis G, Paulis A, Romano G, Barletta D, Fabiani A. Rationale of combination therapy with antioxidants in medical management of Peyronie's disease: results of clinical application. Res Rep Urol 2017; 9:129-139. [PMID: 28791261 PMCID: PMC5530853 DOI: 10.2147/rru.s141748] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Peyronie's disease (PD) is a connective tissue disorder involving the tunica albuginea of the corpora cavernosa of the penis. We have published several studies describing a "combined therapy" for PD patients, but the present study aims to clearly demonstrate how the association between various antioxidants in PD treatment can significantly increase the likelihood of therapeutic success. We used the following substances: silymarin, ginkgo biloba, vitamin E, bilberry, topical diclofenac sodium, and pentoxifylline (PTX). We analyzed the therapeutic impact and possible side effects of one or more antioxidants in patients with early-stage PD. To clearly prove that it is possible to achieve better results when combining more than one agent, we designed this study with five treatment groups, corresponding, respectively, to the administration of a single oral antioxidant; two oral antioxidants; three oral antioxidants; five oral antioxidants + local diclofenac; and five oral antioxidants + local diclofenac + PTX by perilesional injection. One hundred and twenty patients were assigned to five groups of treatment designed according to the abovementioned study aim. Outcomes after 6 months of treatment showed that combined antioxidant therapy is effective in treating PD. Statistical analysis showed significant differences between the treatment groups with regard to: improvement and disappearance of penile pain; percentage of reduction in the volume of penile plaque; reduction in penile curvature; recovery of erectile function in patients with erectile dysfunction; increase in the International Index of Erectile Function score; and reduction of psychosexual impact. Furthermore, we observed that the clinical efficacy of combined therapy is greater when topical use of diclofenac gel and perilesional injection of PTX are added to oral treatment with more than one antioxidant. Although several articles have already been published reporting the effectiveness of combined treatment in PD, this is the first study clearly proving how, as the number of substances used in treatment rises, a proportionally greater therapeutic effect is achieved.
Collapse
Affiliation(s)
- Gianni Paulis
- Department of Surgical Sciences, Andrology Center, Regina Apostolorum Hospital, Rome, Italy.,Department of Uro-Andrology, Peyronie's Disease Care Center, Rome, Italy
| | - Andrea Paulis
- Section of Psycho-Sexology, Peyronie's Disease Care Center, Rome, Italy
| | - Gennaro Romano
- Department of Urologic Oncology, Section of Avellino, Italian League against Cancer, Avellino, Italy
| | - Davide Barletta
- Department of Urology, Andrology Center, San Matteo Hospital, Pavia, Italy
| | - Andrea Fabiani
- Department of Surgery, Section of Urology and Andrology, Macerata, Italy
| |
Collapse
|