The effect of penile traction device in men with Peyronie's disease on penile curvature, penile length, and erectile dysfunction: a systematic review and meta-analysis

Background

Peyronie's disease (PD) results in curvature, pain, and erectile dysfunction (ED). Penile traction devices (PTDs) are a non-invasive treatment option for PD by applying mechanical forces to elicit biochemical responses that reduce curvature and improve penile function. In the present study, we systematically reviewed and analyzed the literature investigating the use of PTD to treat PD.

Methods

We have conducted electronic and manual search strategies within the databases and included articles to find relevant studies. A total of Five studies met all the predefined inclusion criteria and were selected for inclusion in the review. Outcomes assessed are penile length, penile curvature, and erectile function (EF). The study population consisted of patients with PD, the intervention was penile traction therapy (PTT), the comparison was matched placebo or follow-up, and the study design was randomized controlled trials (RCTs) or cohort studies. The Cochrane risk of bias assessed the studies' quality for randomized studies and the Newcastle-Ottawa scale (NOS) for non-randomized observational studies. All statistical analyses were performed using R software. Results were considered statistically significant for P<0.05.

Results

Only five studies met inclusion and exclusion criteria and were published between 2014 and 2021. The sample sizes range [51-110], totaling 419, with a mean of 83.8 patients-the follow-up with a mean of 6.75 months. This meta-analysis evaluated the efficacy of PTD on curvature degree, penile length, and EF in patients. There is a significant positive effect on the curvature degree (P=0.0373), while there is no significant effect on penile length and EF (P=0.5315 and 0.1010), respectively. They are Indicating low heterogeneity with an estimated total heterogeneity of 0. Overall, the available evidence does not support the efficacy of the intervention for penile length or EF.

Conclusions

The current evidence suggests that PTDs can be a safe and effective treatment option for men with PD to reduce penile curvature. However, further research, including more RCTs with extended follow-up periods, is needed to fully understand their efficacy and determine the ideal timing and patient subtypes that would benefit from PTD.

Testicular microdissection following failed sperm aspiration: a single-center experience

OBJECTIVE

Azoospermia is a cause of infertility in a subgroup of infertile men. Sperm retrieval techniques including testicular sperm aspiration (TESA) and microscopic testicular sperm extraction (mTESE) are widely used. In this study, we have reviewed our findings regarding mTESE performed following a negative TESA outcome.

PATIENTS AND METHODS

This is a retrospective chart review study that included 41 infertile patients who underwent mTESE after a negative TESA outcome. Charts were reviewed for demographic data, type of infertility, and type of azoospermia. Hormone level analysis was done for follicle-stimulating hormone, luteinizing hormone, and testosterone. Testicular volume was estimated by ultrasound.

RESULTS

The study included 41 patients who underwent mTESE following a negative TESA outcome. Most patients had primary infertility (n = 32; 78%). Of the 41 patients, four had a previous history of either TESE or orchidopexy, and two had a history of varicocelectomy before the recent percutaneous TESA procedure. There was no significant association between sperm retrieval and the different surgical procedures that had been performed. Of the 41 patients, 27 had positive sperm retrieval by mTESE with a success rate of 65.9%.

CONCLUSIONS

The positive sperm retrieval rate of mTESE performed following a negative TESA outcome was reasonable (65.9%). No significant correlations were identified with all variables studied.

Sporadic giant renal angiomyolipoma: A case report and literature review of clinical presentation, diagnosis, and treatment options

Giant angiomyolipoma (AML) is uncommon benign renal neoplasm that occurs sporadic or in association with tuberous sclerosis syndrome. There is no specific cutoff tumor size and/or weight to define giant AMLs. Ovarian stimulation hormones might cause a marked increase in its size and subsequent bleeding risk. Incidental findings are not common in those patients as mass-associated symptoms always present. Computed tomography scan is the standard diagnostic imaging study except for tumors with poor fat content. According to the clinical presentation, site and side of renal involvement giant sporadic AMLs have different treatment options, for example, active surveillance, selective renal artery embolization, nephron-sparing surgery, and/or radical nephrectomy. In the present case report, we present a 22-year-old female with huge right renal mass (29 cm × 23 cm × 21 cm) and treated with right radical nephrectomy which proved to be renal AML on pathology examination.