Quality of life of patients with La Peyronie's disease undergoing local iontophoresis therapy: A longitudinal observational study

Novel grafting technique using femoral subcutaneous tissue in the surgical management of Peyronie's disease: A case report

INTRODUCTION

Peyronie's disease (PD) is characterized by fibrous plaque formation in the tunica albuginea, leading to penile curvature, painful erections, and erectile dysfunction (ED). Surgical treatment often requires grafting post-plaque excision to restore function. Although various graft materials are used, the use of femoral subcutaneous tissue for PD has not been documented yet. The objective is to explore the feasibility and potential benefits of this new graft material as an alternative for PD patients.

CASE PRESENTATION

A 52-year-old male with Peyronie's disease presented with penile curvature and painful erections. Physical examination revealed a penile plaque. After plaque excision, a femoral subcutaneous graft was placed. Postoperatively, the patient experienced no complications, including graft rejection, erectile dysfunction, or penile shortening, and resumed normal sexual function.

DISCUSSION

Femoral subcutaneous tissue was selected for its high vascularity, ease of harvesting, and low complication risk. Compared to commonly used grafts, it offers better perfusion and tissue integration, reducing the risk of PD recurrence and shortening.

CONCLUSION

This case highlights the successful utilization of femoral subcutaneous tissue as a graft for PD surgery, offering promising results. Further research is needed to validate its long-term efficacy compared to traditional grafts.

Investigating iontophoresis as a therapeutic approach for Peyronie's disease: a systematic review

INTRODUCTION

Iontophoresis therapy (IPT) is a noninvasive technique that uses electrical impulses to deliver charged molecules into the skin for controlled and targeted drug delivery. IPT has been explored as a noninvasive treatment option for Peyronie's disease (PD), but the current literature in this regard is still scarce.

OBJECTIVE

We aimed to systematically review the current literature on the application of IPT in the management of PD to provide a comprehensive evaluation and holistic outlook on the subject.

METHOD

A comprehensive search strategy was implemented in the following databases to retrieve research articles: PubMed (MEDLINE), Scopus, and Web of Science. Google Scholar was also manually searched. The search results were imported into Rayyan reference management for assessment based on the predefined inclusion criteria. The quality of the articles was evaluated by the proper JBI checklist (ie, per the study design), and the JBI grades of recommendation were used for grading the evidence.

RESULTS

A systematic search yielded 451 publications, 11 of which met the criteria to be included in this systematic review. The results demonstrated that IPT, usually with verapamil and dexamethasone, has shown promising results in treating PD. These methods can reduce pain, plaque size, and penile curvature while improving sexual function and quality of life with no serious adverse events. However, most studies had moderate to low quality, indicating a weak recommendation for a certain health management strategy.

CONCLUSION

Based on the extant literature, there is currently insufficient evidence to support the use of IPT for the management of PD. Placing it in the forefront of research can facilitate the management choices for PD even further, given its therapeutic potential.

The association between Peyronie's disease and depression: a scoping review

INTRODUCTION

Peyronie's disease (PD) can have an immense psychological impact, with depression being a reported possible, severe consequence. To date, no literature reviews have systematically and critically assessed the relationship between PD and depression.

OBJECTIVES

The study sought to identify and critically appraise the current literature on the association between PD and depression.

METHODS

Studies had to address men with PD or probable PD and assess depression or depressive symptoms. Quantitative and qualitative, peer-reviewed, primary, empirical studies written in English or Danish were included. According to the guidelines for scoping reviews and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews) guideline, we performed a systematic review of PubMed, PsycINFO, Embase, CINAHL, the Cochrane Library, and Web of Science. Reference lists of included studies were screened for additional sources. Gray literature was searched for in Google Scholar and Bielefeld Academic Search Engine. Data were charted using a data extraction form, and critical appraisal was performed using the QuADS (quality assessment with diverse studies) tool.

RESULTS

Thirteen studies were included. Most studies had a cross-sectional design, and also cohort studies and longitudinal observational studies without a control group were found. Depression was assessed mainly by validated questionnaires or diagnostic codes. Questionnaire studies found a prevalences of moderate to severe depression of 24% to 48%, while studies using diagnostic codes found depression in 4% to 37% of men with PD. The quality of the included studies varied from 38% to 82% of the maximum possible score in the QuADS assessment.

CONCLUSION

While most studies describe an association between PD and depression, the evidence is not comprehensive. The current literature is especially at risk of selection bias and the influence of confounding factors, and a direct causality between PD and depression cannot be established. Future research calls for more methodically rigorous studies as well as qualitative studies to understand the relationship.

An original mininvasive corporoplasty technique for penile curvature without circumcision

Objective: We describe an original minimally invasive penile plication technique with scrotal or infrapubic access, not requiring circumcision, for penile curvature of different severity and types. This technique can be used to correct both congenital and acquired curvatures, mono or bidirectional deformities. Materials and methods: Between 2012 and 2018 we treated 134 patients suffering from congenital curvature (33) and acquired curvature from Peyronie's disease (101). The average curvature was 62.2° (± 30.4°). Preoperative evaluation included prostaglandin E1 injection with photographic documentation and measurement of penile angulation, administration of IIEF- 15, vasoactive penile Doppler ultrasound, analysis of thermal and vibratory sensitivity with Genito-Sensory-Analyzer (GSA) and assessment of nocturnal penile stiffness with Rigiscan, performed twice, for a detailed evaluation of patient’s erectile function. Scrotal access was performed in patients with dorsal and/or lateral penile curvature; the infrapubic access was performed in patients with ventral curvature. After preparation and incision of Colles’ fascia, penis was partially degloved and an original plication technique called "binary corporoplasty" was performed at the site or sites established at preoperative assessment, with non-resorbable synthetic multifilament (Premicron®) suture. Results: Complete correction of penile curvature was achieved in 96.8 % of patients. No major complications were reported, and no patients suffered worsening in erectile function or in penile sensitivity. The average shortening of convex side was 1.65 cm (± 0.7 cm) and all patients report easy intercourse after correction. The average time of surgery was 46 minutes (± 11 min) and all procedures were performed as a day-hospital or ambulatory settings, with local anesthesia and light sedation. Overall satisfaction rate is 96%. Conclusions: This is a simple and rapid technique that perfectly corrects even the most severe and complex penile curvatures. In comparison to traditional techniques, such as Nesbit procedure, this technique is associated with low morbidity, a very low recurrence rate and a great aesthetic results. Aesthetic and functional patients’ satisfaction was excellent.