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Paulis G, Paulis A. Benign prostatic obstruction (BPO) as a possible risk factor for Peyronie's disease (PD). The influence of BPO and PD on mental health. Arch Ital Urol Androl 2023; 95:11481. [PMID: 37791559 DOI: 10.4081/aiua.2023.11481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 07/31/2023] [Indexed: 10/05/2023] Open
Abstract
Not available.
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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.
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Mitsui Y, Yamabe F, Hori S, Uetani M, Kobayashi H, Nagao K, Nakajima K. Molecular Mechanisms and Risk Factors Related to the Pathogenesis of Peyronie's Disease. Int J Mol Sci 2023; 24:10133. [PMID: 37373277 PMCID: PMC10299070 DOI: 10.3390/ijms241210133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 05/25/2023] [Accepted: 06/03/2023] [Indexed: 06/29/2023] Open
Abstract
Peyronie's disease (PD) is a benign condition caused by plaque formation on the tunica albuginea of the penis. It is associated with penile pain, curvature, and shortening, and contributes to erectile dysfunction, which worsens patient quality of life. In recent years, research into understanding of the detailed mechanisms and risk factors involved in the development of PD has been increasing. In this review, the pathological mechanisms and several closely related signaling pathways, including TGF-β, WNT/β-catenin, Hedgehog, YAP/TAZ, MAPK, ROCK, and PI3K/AKT, are described. Findings regarding cross-talk among these pathways are then discussed to elucidate the complicated cascade behind tunica albuginea fibrosis. Finally, various risk factors including the genes involved in the development of PD are presented and their association with the disease summarized. The purpose of this review is to provide a better understanding regarding the involvement of risk factors in the molecular mechanisms associated with PD pathogenesis, as well as to provide insight into disease prevention and novel therapeutic interventions.
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Affiliation(s)
- Yozo Mitsui
- Department of Urology, Toho University Faculty of Medicine, Tokyo 143-8540, Japan; (F.Y.); (S.H.); (M.U.); (H.K.); (K.N.); (K.N.)
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3
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Gelbard MK, Rosenbloom J. Fibroproliferative disorders and diabetes: Understanding the pathophysiologic relationship between Peyronie's disease, Dupuytren disease and diabetes. Endocrinol Diabetes Metab 2021; 4:e00195. [PMID: 33855203 PMCID: PMC8029506 DOI: 10.1002/edm2.195] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 09/18/2020] [Accepted: 09/26/2020] [Indexed: 12/23/2022] Open
Abstract
Introduction Fibrosis is characterized by dysregulation and accumulation of extracellular matrix. Peyronie's disease and Dupuytren disease are fibroproliferative disorders of the tunica albuginea of the penis and fascia of the hand, respectively. Chronic hyperglycaemia due to diabetes mellitus can also lead to tissue injury and fibrosis. A meta-analysis has shown a relationship between Dupuytren disease and diabetes (overall odds ratio, 3.1; 95% confidence interval, 2.7-3.5). This review explores commonalities in the pathogenesis of Peyronie's disease, Dupuytren disease and diabetes. Methods A search of the PubMed database was conducted using the search terms "diabetes" AND "Peyronie's disease"; and "diabetes" AND "Dupuytren." Results Genome-wide association and gene expression studies conducted with tissue from people with Peyronie's disease or Dupuytren disease identified signalling pathways associated with wingless-type mammary-tumour virus integration site signalling, extracellular matrix modulation and inflammation. Biochemical studies confirmed the importance of these pathways in the pathogenesis of fibrosis with Peyronie's disease and Dupuytren disease. Dysregulation of matrix metalloproteinase activity associated with extracellular matrix breakdown was implicated in fibroproliferative complications of diabetes and in the aetiology of Peyronie's disease and Dupuytren disease. A notable percentage of people with diabetes have comorbid Peyronie's disease and/or Dupuytren disease. Conclusions Studies have not been performed to identify fibroproliferative pathways that all 3 conditions might have in common, but data suggest that common pathways are involved in the fibroproliferative processes of Peyronie's disease, Dupuytren disease, and diabetes.
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Affiliation(s)
- Martin K. Gelbard
- Department of UrologyDavid Geffen School of Medicine at UCLALos AngelesCAUSA
| | - Joel Rosenbloom
- Department of Dermatology and Cutaneous BiologyThe Joan and Joel Rosenbloom Research Center for Fibrotic DiseasesSidney Kimmel Medical CollegeThomas Jefferson UniversityPhiladelphiaPAUSA
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De Rose AF, Mantica G, Bocca B, Szpytko A, Van der Merwe A, Terrone C. Supporting the role of penile trauma and micro-trauma in the etiology of Peyronie's disease. Prospective observational study using the electronic microscope to examine two types of plaques. Aging Male 2020; 23:740-745. [PMID: 30879382 DOI: 10.1080/13685538.2019.1586870] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES The etiopathogenesis of Peyronie's disease (PD) remains not clearly understood. The most accepted theory attributes the histological lesions of PD to the effects of trauma to the corpora cavernosum of the penis. The aim of our study is to verify whether similar histological features exist between these two tissues, providing new evidence in favor of the traumatic theory in the etiopathogenesis of Peyronie's disease. MATERIALS AND METHODS A prospective observational study was carried out at our institution from January 2013 to June 2018, involving patients having undergone surgery for PD and those with delayed surgery for penile trauma. Both excised PD and post-traumatic plaques were analyzed by blind pathologists with an 80kV potential acceleration electron microscope. RESULTS Five patients were identified with a post-traumatic plaque (Group 1) and therefore an equal number of PD patients were enrolled for Group 2. The ultrastructural characteristics of the two types of preparations were very similar. In all the samples we showed an inflammatory reaction of the structure of the tunica albuginea, a production of the disorganized extracellular matrix, a proliferation of inflammatory cells and fibroblasts. Furthermore, we have found an increase in the density and collagen deposits grouped in the extracellular space and within the fibroblasts. CONCLUSIONS These findings support the theory that attributes lesions and symptoms typical of PD to the effects of cavernous body trauma.
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Affiliation(s)
- Aldo Franco De Rose
- Department of Urology, Policlinico San Martino Hospital, University of Genova, Genova, Italy
| | - Guglielmo Mantica
- Department of Urology, Policlinico San Martino Hospital, University of Genova, Genova, Italy
- Department of Urology, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Bruna Bocca
- Department of Pathology, Policlinico San Martino Hospital, University of Genova, Genova, Italy
| | - Alexander Szpytko
- Department of Urology, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - André Van der Merwe
- Department of Urology, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Carlo Terrone
- Department of Urology, Policlinico San Martino Hospital, University of Genova, Genova, Italy
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5
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Abstract
Aim: The etiology of the disease of Peyronie is not certainly known. However, penile micro traumas are thought to be important in the pathogenesis of Peyronie's disease (PD) in genetically predisposed individuals. In this study, we aimed to determine the relationship of some trace element and heavy metals with PD.Material and methods: Thirty Peyronie patients and 26 healthy volunteers were included in the study. In individuals in both groups, levels of serum trace elements (Manganese [Mn], Cu, Cobalt (Co), zinc [Zn], Cd, and iron [Fe]) were determined separately by Atomic Absorption Spectrophotometer method in Yüzüncü Yıl University Central Research Laboratory.Results: Mn, Cu, Zn, and Fe levels in Peyronie patients were statistically significantly lower when compared to the healthy control group (p < .05). Cd and Co levels were similar for both groups but not statistically significant (p > .05).Conclusions: The changes in trace element levels are related to the etiopathogenesis of PD. We think that our study is the first from this aspect.
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Affiliation(s)
- Mustafa Gunes
- Health Sciences University, Derince Training and Research Hospital, Kocaeli, Turkey
| | - Rahmi Aslan
- Department of Urology, Medical Faculty, Yuzuncu Yıl University, Van, Turkey
| | - Recep Eryılmaz
- Department of Urology, Medical Faculty, Yuzuncu Yıl University, Van, Turkey
| | - Halit Demir
- Department of Chemistry, Science Faculty, Yuzuncu Yıl University, Van, Turkey
| | - Kerem Taken
- Department of Urology, Medical Faculty, Yuzuncu Yıl University, Van, Turkey
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Lledó García E, González García FJ, Martínez Holguin E, Hernandez Cavieres J, Polanco Pujol L, Jara Rascón J, Hernández Fernández C. Surgical implant options in patients with penile fibrosis due to infection or previous explants. Actas Urol Esp 2020; 44:268-275. [PMID: 32276860 DOI: 10.1016/j.acuro.2019.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 10/19/2019] [Indexed: 11/30/2022]
Abstract
Penile fibrosis due to previous penile infection and/or prosthesis explants entails situations of high surgical complexity. In these cases, reimplantation should follow an alternative scheme, aimed at minimizing perioperative and postoperative complications, as well as achieving maximum efficiency of the procedure and greater postoperative satisfaction of the patient and his partner. This article reviews the main surgical alternatives for these cases.
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Affiliation(s)
- E Lledó García
- Sección de Andrología y Cirugía Reconstructiva Uretro-Genital, Servicio de Urología, Hospital General Universitario Gregorio Marañón, Madrid, España.
| | - F J González García
- Sección de Andrología y Cirugía Reconstructiva Uretro-Genital, Servicio de Urología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - E Martínez Holguin
- Sección de Andrología y Cirugía Reconstructiva Uretro-Genital, Servicio de Urología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - J Hernandez Cavieres
- Sección de Andrología y Cirugía Reconstructiva Uretro-Genital, Servicio de Urología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - L Polanco Pujol
- Sección de Andrología y Cirugía Reconstructiva Uretro-Genital, Servicio de Urología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - J Jara Rascón
- Sección de Andrología y Cirugía Reconstructiva Uretro-Genital, Servicio de Urología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - C Hernández Fernández
- Sección de Andrología y Cirugía Reconstructiva Uretro-Genital, Servicio de Urología, Hospital General Universitario Gregorio Marañón, Madrid, España
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7
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Chakari W, Hesselfeldt J, Caspara CU. [Penis arcuatus]. Ugeskr Laeger 2018; 180:V04170325. [PMID: 29493499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Deviation of the penis may be congenital or acquired. The latter, also known as Peyronie's disease, is seen in 0.4-9% of patients. The aetiology is not fully understood, but the hypothesis is that microtrauma leads to scar tissue formation, plaques, which deform the penis. The disease is divided into a first, painful, progressive, inflammatory phase and a latter, steady, chronic phase. The symptoms are mainly sexual dysfunction and psychological problems. Surgery is recommended in congenital cases and in the chronic phase of Peyronie's disease, where the medical treatment has not been convincing.
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8
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Abstract
OBJECTIVES To investigate frailty as a predictor of surgical outcome in elderly patients undergoing penile prosthesis implantation. MATERIAL AND METHODS A total of 54 elderly patients, above 60 years of age, underwent penile prosthesis implantation between 2012 and 2014. Their data were collected and retrospectively analyzed. A modified frailty index (mFI) was calculated for each patient based on 11 risk factors from the Canadian Study of Health and Aging Frailty Index. The 1-year adverse outcomes were correlated with mFI, patients' and procedure's risk factors. RESULTS Mean age was 64.9 ± 5.2 years. No mortality was reported in our patients, however, one-year adverse outcomes were encountered in 43 (79.6%) patients. Among all studied variables, the 1-year adverse outcomes was not significantly association with mFI, but with preoperative glycosylated hemoglobin A1c (HbA1c) (p = 0.031) and associated Peyronie's disease (PD) (p = 0.000). HbA1c, dyslipidemia, hypertension, PD and duration of the procedure were predictive of infection complications (p < 0.05). Only PD and HbA1c sustained an independent significant impact. CONCLUSIONS mFI is not a predictive of post-penile prosthesis implantation adverse outcomes in elderly patients with impotence. Degree of diabetic control and association with PD was associated with the 1-year adverse outcomes and infection complications.
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Affiliation(s)
- Khaled Madbouly
- a Department of Urology , Prince Mohammed Bin Abdulaziz Hospital , Riyadh , Saudi Arabia
| | - Dulaim AlHajeri
- b Division of Urology , Department of Surgery, Faculty of Medicine, King Saud University , Riyadh , Saudi Arabia , and
| | - Mohamad Habous
- c Urology Department, Elaj Medical Group , Jeddah , Saudi Arabia
| | - Saleh Binsaleh
- b Division of Urology , Department of Surgery, Faculty of Medicine, King Saud University , Riyadh , Saudi Arabia , and
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9
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Abstract
Aetiopathogenesis and therapy for Peyronie's disease are summarized below. Aetiopathogenesis: (a) Plaque fibroblasts and their products provoke an immune response; (b) there are chromosomal differences between plaques and normal albuginea; (c) plaque fibroblasts are immortalized cells; (d) plaque fibroblasts demonstrate an impaired mitochondrial activity. These patterns provoke inflammation and they compel us to regard Peyronie's disease as being more similar to keloids than to scars. Therapy: Medical therapy plays a pivotal role in the management of Peyronie's disease and should be performed prior to any surgery. Intraplaque collagenase, intraplaque verapamil, intraplaque interferon, oral acetyl-L-carnitine, oral propionyl-L-carnitine and oral colchicine have proved effective in Peyronie's disease. With the exception of collagenase, these drugs have displayed a number of activities whose final result is to improve immune response, to inhibit inflammation and to inhibit fibroblast metabolism and replication. Therefore, the primitive replicative (rather than reactive) nature of the disease is confirmed; this knowledge may be of help in the identification of new non-surgical therapies for Peyronie's disease.
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Affiliation(s)
- Giorgio Cavallini
- Operative Unit of Andrology, Società Italiana di Studi di Medicina della Riproduzione (SISMER), via Mazzini 12, 40138 Bologna, Italy.
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10
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Abstract
Apart from one report of phimosis, involvement of the penis has not been reported as a complication of chronic GVHD. We report a patient with recurrent chronic GVHD who developed skin discoloration of the penile shaft, together with erectile dysfunction consistent with Peyronie's disease. Histological features were consistent with sclerodermatous change. These features suggest that the penis may be a target organ in chronic GVHD.
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Affiliation(s)
- A P Grigg
- Clinical Haematology and Medical Oncology, The Royal Melbourne Hospital, Grattan Street, Parkville 3050, Australia.
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11
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Garaffa G, Trost LW, Serefoglu EC, Ralph D, Hellstrom WJG. Understanding the course of Peyronie's disease. Int J Clin Pract 2013; 67:781-8. [PMID: 23869679 DOI: 10.1111/ijcp.12129] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Accepted: 01/07/2013] [Indexed: 12/18/2022] Open
Abstract
AIMS To correct common misconceptions about Peyronie's disease (PD) that present obstacles to early recognition and treatment. METHODS The prevalence, natural disease course, psychosocial effects and treatment considerations for patients with PD were reviewed. RESULTS Studies over the past decade have shown that the prevalence of PD may be higher (up to 20%) than previously thought. PD can lead to emotional and relationship distress. Nearly 10% of men who present with PD are younger than 40. Both younger age and comorbid vascular disease have been associated with more severe and progressive PD. In the majority of patients, symptoms will either deteriorate or remain stable. PD is often associated with erectile dysfunction (ED). Effective, minimally invasive treatments used early in the disease course include unapproved and/or investigational intralesional injection therapy with verapamil, interferon (IFN) α-2b, or collagenase clostridium histolyticum (CCH). Surgical intervention is considered in patients with ED and/or penile deformity that impairs sexual functioning; however, preoperative discussion of appropriate expectations is important. DISCUSSION The availability of effective minimally invasive and surgical therapies for PD suggests that active management should be considered over a 'wait-and-see' approach. CONCLUSION Providing early intervention and improved education/awareness of PD as a chronic and progressive disorder may result in improved physical and psychosocial outcomes for PD patients. As general practitioners are often the first contact for men with PD, they are well positioned to recognise symptoms early and promptly refer patients for further evaluation and treatment.
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Affiliation(s)
- G Garaffa
- St Peter's Andrology Centre, UCL, London, UK
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12
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Zhu XB, Jiang R. [Peyronie's disease: an update]. Zhonghua Nan Ke Xue 2013; 19:355-359. [PMID: 23678718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Peyronie's disease is currently considered a wound healing disorder that presents with a fibrous inelastic scar of the tunica albuginea, which is believed to occur in genetically susceptible individuals following trauma to the penis. It is characterized by the development of a palpable scar, which in the erectile state causes a variety of deformities, erectile dysfunction and painful erections, and its pathogenesis is unclear. There are many therapeutic options and each has its advantages and disadvantages. This article outlines the advances in the recent studies of Peyronie's disease.
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Affiliation(s)
- Xiu-Bo Zhu
- Department of Urology, The Affiliated Hospital of Luzhou Medical College, Luzhou, Sichuan 646000, China.
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13
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Levine LA. The clinical and psychosocial impact of Peyronie's disease. Am J Manag Care 2013; 19:S55-S61. [PMID: 23544796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Peyronie's disease (PD) is characterized by the formation of palpable fibrotic tissue in the tunica albuginea of the penis. It is thought to manifest in response to recurrent microtrauma during erection in those with risk factors that may include wound-healing disorders. The initial stage of PD is thought to last from 6 to 18 months, and it is characterized by an inflammatory period with pain in approximately one-third of men. This initial phase is followed by a chronic phase when pain typically resolves and the deformity stabilizes with no additional plaque development. PD has been reported to develop in up to 9% of adult males according to published literature, but the incidence may be even higher. The most frequently affected age group is men between 50 and 59 years. Because of the associated penile deformity and effect on sexual relations, psychosocial distress is very common in those with PD. It has been reported to negatively affect self-image, sexual activity, intimacy, and mood, and it is often associated with depression and erectile dysfunction (ED). At this time, nonsurgical treatments are unreliable and have variable efficacy, and surgical treatments are reserved for those with disabling disfigurement. Moreover, surgery may result in loss of penile length and ED, and there are only a few physicians in the United States that perform such surgeries. There is a great need to increase awareness of PD in patients and general practitioners, to elucidate the pathogenesis of PD, and for the development of novel treatments for this disfiguring disease.
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Horstmann M, Grazioli A, Schwab C, Padevit C, John H. [Peyronie's disease-often a disabling disease for sexually active men]. Rev Med Suisse 2010; 6:1731-1735. [PMID: 21294308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Peyronie's disease is an acquired penile condition characterized by fibrous plaques between the tunica albuginea and the subtunical tissue of the corpora cavernosa. Plaques are considered responsible for the main symptoms: penile pain and deviation. Even though several risk factors and associations with other diseases are known its exact aetiology remains unclear. Most commonly discussed hypotheses are micro traumata, inflammatory and/or ischemic processes. Currently different treatment forms exist raging form systemic or local medical treatment, to physical applications and surgery. All treatment forms are symptom based and evidence based treatment remains difficult to establish. Because conservative treatment is of limited success in many patients especially with severe deviations surgery becomes necessary.
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Affiliation(s)
- M Horstmann
- Service d'urologie, Kantonsspital Winterthur.
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15
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McVary KT. Editorial comment on: The natural history of Peyronie's disease: an ultrasonography-based study. Eur Urol 2007; 53:650-1. [PMID: 17673363 DOI: 10.1016/j.eururo.2007.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Paez A, Mejias J, Vallejo J, Romero I, De Castro M, Gimeno F. Long-term patient satisfaction after surgical correction of penile curvature via tunical plication. Int Braz J Urol 2007; 33:502-7; discussion 507-9. [PMID: 17767754 DOI: 10.1590/s1677-55382007000400007] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2007] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To assess patient satisfaction and functional results at long term follow-up after surgical correction for Peyronie's disease (PD) and congenital penile curvature (CPC) with the technique of tunical plication. MATERIALS AND METHODS One hundred and two men operated for PD (n = 76) or CPC (n = 26) in four different departments of urology in public hospitals agreed to answer a six-question telephone questionnaire about treatment satisfaction. Tunica albuginea plication procedures represented the standard surgical approach. Subjects under investigation were correction of the deformity, feeling of bumps under the skin, pain during erection, penile sensory changes, development of erectile dysfunction (ED) and postoperative ability for complete vaginal intromission. Subjective response rates were compared using the chi square test on the basis of the etiology of the disease (CPC or PD). RESULTS Significant differences (p < 0.05) between patients with CPC and PD were noticed in the prevalence of postoperative penile deformity, sensory changes, ED and ability to complete vaginal intromission, PD patients always showing a more pessimistic view. No significant differences (p = ns) were detected in terms of unpleasant nodes under the penile skin or pain during erection. CONCLUSIONS Long-term outcome after surgical correction for PD and CPC with the technique of tunical plication can be poor. Probably patient expectations are above the real performance of surgical techniques. Preoperative information should be more exhaustive.
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Affiliation(s)
- Alvaro Paez
- Department of Urology, Fuenlabrada Hospital, Madrid, Spain.
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17
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Affiliation(s)
- N Djakovic
- Urologie, Kinderurologie und Poliklinik, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69124 Heidelberg.
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18
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Bekos A, Arvaniti M, Hatzimouratidis K, Moysidis K, Tzortzis V, Hatzichristou D. The natural history of Peyronie's disease: an ultrasonography-based study. Eur Urol 2007; 53:644-50. [PMID: 17673362 DOI: 10.1016/j.eururo.2007.07.013] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2007] [Accepted: 07/09/2007] [Indexed: 01/28/2023]
Abstract
OBJECTIVES To define ultrasonographic patterns reflecting different states of Peyronie's disease (PD) and to use them to evaluate the natural history of the disease. MATERIAL AND METHODS Diagnosis of PD was based on medical and sexual history, physical examination, intracavernosal injection test, and penile ultrasonography. Patients with penile fracture history were excluded from the study. Three groups were formed according to ultrasonographic patterns: solitary hyperechoic lesion without acoustic shadow (group A), moderately hyperechoic multiple scattered calcified lesions with acoustic shadows (group B), dense calcified hyperechoic plaque with acoustic shadow (group C). All patients entered a watchful waiting protocol for 1 yr followed by a new penile ultrasonography. RESULTS Ninety-five 95 patients with PD were included in the study (mean age, 57.2+/-9.1 yr; mean duration of disease, 12.9+/-8.9 mo). Risk factors associated with cardiovascular disease were present in 79 of 95 patients (83.16%). Eleven (11.6%), 35 (36.8%), and 49 (51.6%) patients were classified into groups A, B and C, respectively. At the end of the study, in group A, reduction of fibrotic lesions and curvature angle was noticed in 9 of 11 (81.8%) patients, whereas plaque formation was noticed in 2 of 11 (18.2%) patients. In group B, plaque and curvature reduction was noticed in 15 of 35 (42.9%) and 12 of 35 (34.3%) respectively, whereas in the rest a dense calcified plaque was noticed. In group C, no ultrasonographic evidence of improvement was noticed; curvature angle was reduced in 4 of 49 (8.2%), owing to the extension of the plaque circumferentially. Significant hemodynamic changes were noticed at the two time points tested (30.53% diagnosed with vascular disease at baseline vs. 46.32% at the end of the study, p=0.03). CONCLUSIONS Corporal ultrasonography in patients with PD allows objective evaluation and classification of disease. The density of echogenic areas and presence of acoustic shadows are predictors of disease stability.
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Affiliation(s)
- Athanasios Bekos
- Center for Sexual and Reproductive Health, Department of Urology, Papageorgiou General Hospital, Aristotle University of Thessaloniki, Greece
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19
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Abstract
Peyronie's disease (PD) is characterized by the onset of fibrous plaque inside the tunica albuginea of the penile corpora cavernosa that can cause pain and bending during the erection, making intercourse difficult or impossible. Evidence of the literature supports the autoimmune etiology of PD and suggests genetic and familiar conditions, penile traumatisms, and a history of genital tract diseases as risk factors, but no definitive conclusions arise about the pathogenesis of the disease. Few randomized trials demonstrated that medical therapies, such as vitamin E, colchicine, potassium aminobenzoate, tamoxifen, and injection therapy with verapamil, can stabilize the acute phase of the disease. Extracorporeal shock wave therapy and iontophoresis cannot be considered first-line or gold standard therapies. Satisfactory results have been published with the Nesbit operation in large series with low-stage disease, whereas plication procedures have shown significant relapse rates. A high incidence of long-term penile retractions has been reported in high-stage disease treated with plaque incision and simple graft insertion. Malleable, soft, or inflatable prostheses combined with graft implantation have given the best results in terms of penile straightening and lengthening and patient satisfaction. In conclusion, the etiopathogenesis of PD is not yet clearly understood, no medical therapy is fully effective, and surgery remains the gold standard in patients with severe deformity and/or erectile dysfunction.
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Affiliation(s)
- F Sasso
- Department of Urology, Catholic University Medical School, Rome, Italy
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20
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Abstract
We attempted in this study to investigate the prevalence of Peyronie's disease (PD) among diabetic patients with erectile dysfunction (ED). Two-hundred and six diabetic patients were further evaluated in this study. Forty-two (20.3%) patients had PD. There were significant associations between PD and risk factors of age, obesity and smoking. All patients with PD had also ED. Penile curvature was present in 82.1% of all patients with PD. Of the patients with PD, 25.4% had pain with or without erection. Significant associations between PD and ED and ED duration were detected. This study confirmed the high prevalence of PD among diabetic patients with ED. Further work is needed probing the mechanisms through which diabetes affects the pathogenesis of ED and PD.
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Affiliation(s)
- M Arafa
- Andrology, Sexology and STD's Department, Cairo University Hospital, Cairo, Egypt
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21
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Simon HB. On call. Peyronie's disease. I have an embarrassing problem. Over the past year or so, my erections seem to have become crooked. My sex life is fine, but I want to know if it's a serious problem and if I should see a doctor. Harv Mens Health Watch 2006; 10:8. [PMID: 16865807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
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Gonzalez-Cadavid NF, Rajfer J. Mechanisms of Disease: new insights into the cellular and molecular pathology of Peyronie's disease. ACTA ACUST UNITED AC 2006; 2:291-7. [PMID: 16474811 DOI: 10.1038/ncpuro0201] [Citation(s) in RCA: 118] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2004] [Accepted: 05/10/2005] [Indexed: 12/24/2022]
Abstract
Peyronie's disease (PD) is characterized by fibrotic plaques in the penile tunica albuginea that cause curvature of the erect penis, and is often accompanied by pain and/or erectile dysfunction. This condition affects up to 9% of men. Treatment is mainly surgical, as pharmacologic therapy has limited efficacy. The pathophysiology of PD is poorly understood, but development of two rat models, extrapolation of what is known about the molecular pathology of other fibrotic conditions, and emphasis on the role of myofibroblasts and adult stem cells are helping to clarify etiology and identify new pharmacologic targets. Recent studies demonstrate a role for oxidative stress and cytokine release-primarily transforming-growth-factor beta1-in development of PD fibrotic plaques. There is evidence indicating that these profibrotic factors interact with antifibrotic defense mechanisms, such as decrease of myofibroblast accumulation, elimination of reactive oxygen species by inducible nitric oxide synthase and neutralization of transforming-growth-factor beta1 by decorin, such that some plaques are in dynamic turnover. Injury to the erect penis is thought to trigger PD by inducing extravasation of fibrin and subsequent synthesis of transforming-growth-factor beta1. Despite the lack of statistical support for a causal association between trauma and PD, it is possible that undetected microtrauma is involved. It is not known whether ossification of PD plaques is linked to fibrosis progression or is a manifestation of an alternative pathway. Both processes seem to be related to activation of fibroblast/myofibroblast differentiation in the tunica albuginea and to osteogenic commitment of stem cells in this tissue.
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Abstract
OBJECTIVE To test some hypotheses about risk factors for Peyronie's disease (PD). PATIENTS AND METHODS In a case-control study, 82 patients with PD, consecutively diagnosed at the first author's institution, were compared with 246 men visiting the same institution for dermatological diseases. Univariate and multivariate logistic regression analyses were used to assess the data. RESULTS From the multivariate logistic regression analysis the risk factors for PD were: a history of genital and/or perineal injuries, transurethral prostatectomy, cystoscopy, diabetes mellitus, hypertension, lipoma, propranolol in therapy, Dupuytren's contracture in the medical history, ever having smoked, alcohol consumption, fibromatous lesions of the genital tract of the partner, and surgical intervention on the genital tract of the partner. CONCLUSION The results of the present study are in line with the hypothesis that, in addition to genetic predisposition, trauma of the penis and systemic vascular diseases are risk factors for PD. Smoking and alcohol consumption also seem to have some role in the development of the disease.
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Affiliation(s)
- Milan D Bjekic
- City Department for Skin and Venereal Diseases, School of Medicine, Belgrade University, Belgrade, Serbia and Montenegro
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24
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Abstract
The investigation of medical options for the treatment of Peyronie's disease is lacking controlled clinical trials with uniform standardized assessments and objective measures of deformity, including curvature and circumference. A key to defining the beneficial effects of various medical therapies lies in standardizing the evaluation of the Peyronie's patient across various studies so that the proposed benefits can be confirmed and applied to all populations. Furthermore, basic science research into the pathophysiology of this disorder is likely to yield new insights into potential treatment options and direct future therapies.
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Abstract
AIM To investigate the clinical characteristics of patients with Peyronie's disease (PD) and diabetes mellitus (DM). METHODS During an 8-year period, a total of 307 men seen at our outpatient clinic were diagnosed with PD. Clinical characteristics, penile deformities and the erectile status of patients with PD and DM together (n=102) were retrospectively analyzed and compared to patients with PD alone with no risk factors for systemic vascular diseases (n=97). RESULTS The prevalence of PD among men with DM and sexual dysfunction was 10.7%. The mean age of diabetic patients with PD was (55.9+/-8.9) years; in the no risk factor group it was (48.5+/-9.0) years (P < 0.05). The median duration of DM was 5 years. The majority of diabetic patients with PD (56.0%) presented in the chronic phase (P < 0.05), and they were more likely to have a severe penile deformity (>60 degrees) than the no risk factor group (P < 0.05). In the diabetic group, the most common presenting symptom was penile curvature (81.4%), followed by a palpable nodule on the shaft of the penis (22.5%) and penile pain with erection (14.7%). A total of 19.6% of patients were not aware of their penile deformities in the diabetic group. Erectile function, provided by history and in response to intracavernosal injection and a stimulation test, was significantly diminished in patients with PD and DM (P < 0.05). CONCLUSION DM probably exaggerates the fibrotic process in PD. Diabetic patients with PD have a higher risk of severe deformity and erectile dysfunction (ED). PD seems to be a silent consequence of DM and should be actively sought in diabetic men.
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Affiliation(s)
- A Tefekli
- Department of Urology, Istanbul University, Istanbul Medical Faculty, Istanbul 34390, Turkey
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Dmitriev DG, Permiakov OV. [Cavernous vegetative innervation and hemodynamics in patients with fibroplastic induration of the penis and erectile dysfunction]. Urologiia 2005:40-4. [PMID: 16281839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Different versions on pathogenesis of Peirony's disease (PD) and erectile dysfunction in this disease made us to investigate cavernous innervation and hemodynamics in patients with fibroplastic induration of the penis. We have detected characteristic changes of cavernous electric activity and histochemical picture in biopsies of all our patients with PD. Of them, 61% had cavernous hemodynamic disorders. Our findings suggest that early affection of cavernous innervation may trigger PD pathogenesis and erectile dysfunction in this disease.
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Abstract
There is a wide variety of topics covered in this section. The epidemiology, aetiology and clinical evaluation of the deformity in Peyronie's disease is described, followed by a discussion of recent advances in the biology of diabetes-associated bladder complications. Bladder cancer and its molecular prognostic factors are presented, and the section ends with an in-depth presentation of an evidence-based approach to the understanding of the pharmacological class effect in the management of prostatic diseases.
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Hassoba H, El-Sakka A, Lue T. Role of increased transforming growth factor beta protein expression in the pathogenesis of Peyronie's disease. Egypt J Immunol 2005; 12:1-8. [PMID: 16734133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Transforming growth factor beta (TGF-beta) has been implicated in many chronic fibrotic conditions such as pulmonary and hepatic fibrosis. Inhibition of TGF-beta activity can prevent the development of chronic hepatitis and mesangial proliferative glomerulonephritis. We postulated that TGF-beta might play a role in the pathogenesis of Peyronie's disease (a localized connective tissue disorder that primarily affects the tunica albuginea and adjacent erectile tissue of the penis). Tissue from the tunica albuginea of thirty-five Peyronie's patients (study group) and from eight patients without Peyronie's disease who had undergone penile prosthesis surgery for organic impotence (control group) were subjected to histological study using Hart and Trichrome stains and Western blotting for the detection of TGF-beta protein expression. TGF-beta1 protein expression was detected in 30 patients (85.7%), while only 8 (22.8%) and 6 (17.1%) patients showed TGF-beta2 and TGF-beta3 protein expression, respectively. All tissue from Peyronie's patients showed a variety of histological changes of the tunica, ranging from chronic inflammatory cellular infiltration to complete calcification and ossification of the tissues. The most prominent changes observed were focal or diffused ellastosis, fenestration, and disorganization of the collagen bundles. One patient in the control group showed fibrosis of the tunica albuginea and protein expression of TGF-beta1 and TGF-beta2. This patient had undergone surgery for the revision of his prosthesis twice. However, the other seven patients showed normal histologic patterns of the tunica albuginea and no protein expression for TGF-beta1, TGF-beta2, or TGF-beta3. In conclusion, TGF-beta1 protein expression is significantly associated with Peyronie's disease and may be a direct cause for its development. This finding may be of help in the prevention and treatment of this disease.
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Affiliation(s)
- Howayda Hassoba
- Departments of Clinical Pathology, Suez Canal University, Egypt
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Abstract
PURPOSE This study was performed to determine whether patients with penile fracture or a long history of forcefully bending the erect penis (taqaandan), as models of acute and chronic penile trauma, had an increased rate of Peyronie's disease (PD). MATERIALS AND METHODS The study included 193 surgical cases of penile fracture (average followup 85 months), 150 cases of long history of taqaandan, and 50 cases of PD. All 3 groups of patients were interviewed and physically examined. RESULTS Signs of PD were found in only 1 case of long-term taqaandan and in no case of penile fracture. None of the 50 cases of PD had a history of penile fracture. CONCLUSIONS Severe, acute trauma of penile fracture and moderate, chronic buckling injury of taqaandan are not associated with later development of PD. These findings question whether the hypothesis that trauma, trauma-induced smoldering inflammatory cascade and aberrant wound healing are the main causes of PD. Alternative, plausible, evidence based explanations should be sought for the etiology of PD. Any theory on the etiology of PD should provide an explanation for total lack of occurrence of PD following the trauma of penile fracture.
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Affiliation(s)
- Javaad Zargooshi
- Department of Urology, Kermanshah University of Medical Sciences, Kermanshah, Iran.
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Abstract
Circumcision, priapism, phimosis, Peyronie's disease, orchitis, epididymitis, and testicular torsion are conditions of the male penis and testicles that warrant increased attention by health care providers in practice. Healthy outcomes for penile and testicular disorders can be achieved through education, enhanced screening, and adequate comprehensive treatment. Penile and testicle disorders provide researchers and clinicians with many opportunities for research and practice that can improve the condition of men's health.
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Affiliation(s)
- Tim Wren
- Department of Adult Health Nursing, Louisiana State University Health Sciences Center School of Nursing, 1900 Gravier Street, New Orleans, LA 70112, USA.
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Zhao F, Li H. [Advances in the research of Peyronie's disease]. Zhonghua Nan Ke Xue 2004; 10:378-81. [PMID: 15190836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
The incidence of Peyronie's disease has continuously increased during the last 30 years. Because of the better understanding of the basic sciences of the disease, earlier diagnosis and improved medical and surgical treatment, currently patients with Peyronie's disease have a wider range of therapeutic options and may experience a better prognosis, with only few of them in need of prosthesis surgery. This paper reviews the pathogenesis, pathology, diagnosis and treatment of Peyronie's disease.
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Affiliation(s)
- Fujun Zhao
- Department of Urinary Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China.
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Abstract
Peyronie's disease has no known cause; recent understanding of the molecular mechanisms involved and the development of an animal model will aid the medical management of early disease. The medical management of chronic disease is futile as the delicate tunical architecture cannot regenerate. Surgical correction of the penile deformity is required in a minority of patients, and a choice lies between a Nesbit operation and a plaque incision and venous patch in patients who are concerned with penile shortening.
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Affiliation(s)
- D J Ralph
- St Peter's Hospitals and The Institute Of Urology, London, UK.
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Abstract
Despite centuries of recognition, Peyronie's disease remains somewhat of an enigma. Conventional wisdom suggests that trauma to the erect or semierect penis is the inciting event that sets off a cascade of events at the cellular level that results in localized fibrosis of the tunica albuginea. However, many questions remain unanswered at this juncture among the most important of which are why do so few men manifest this condition? Why is there such an ethnic predilection? What are the cofactors that along with penile trauma lead to plaque development. Historically, cytokine overexpression, autoimmune and genetic factors have been cited as contributors. This treatise endeavors to conduct an evidence-based assessment of the literature as it pertains to the pathophysiology of Peyronie's disease. Furthermore, an effort is made to evaluate contemporary literature pertaining to novel concepts in Peyronie's disease pathogenesis including NOS alterations, free radical generation, microarray analysis, pathogen involvement and animal model development. In conclusion, it is likely that in the near future we will see dramatic developments in our understanding of this condition.
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Affiliation(s)
- J P Mulhall
- Department of Urology, Weill Medical College of Cornell University, New York Presbyterian Hospital, New York 10021, USA.
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Hauck EW, Hauptmann A, Haag SM, Weidner W. [New Insights into the Etiological Pathogenesis of Peyronie's Disease]. Aktuelle Urol 2003; 34:387-91. [PMID: 14579185 DOI: 10.1055/s-2003-43172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This paper reviews the current knowledge of the etiological pathogenesis of Peyronie's disease. De la Peyronie himself supposed a connection with venereal diseases. Herein, infectious, traumatic, autoimmune and genetic causes are discussed. An important hypothesis is that the recurrent microtraumatisation of the tunica albuginea during sexual intercourse leads to small lesions that activate processes of wound healing and development of fibrotic plaque. According to recent data, an association with the antigens of the HLA-system could be ruled out. Transforming growth factor beta (TGF-beta) seems to have an important impact due to its increased expression in the plaque. Furthermore it is possible to induce a condition similar to Peyronie's disease by intratunical injection of cytomodulin - a substance with TGF-beta-like activity - in an animal model. As in other fibrotic diseases, an imbalance between nitric oxide (NO) and reactive oxygen species (ROS) seems to be of importance. The most important new insights were gained from cell-culture models in which increased expression of basic fibroblast growth factor (bFGF), as well as a change in cell cycle regulation (p53) and cytogenetic instability were observed.
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Affiliation(s)
- E W Hauck
- Justus-Liebig-Universität Giessen, Klinik und Poliklinik für Urologie und Kinderurologie, Giessen
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36
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Abstract
OBJECTIVES To investigate the role of fibrin in inducing fibrosis in the tunica albuginea (TA) of the rat penis, to develop a new animal model for Peyronie's disease (PD). MATERIALS AND METHODS The TA of rats (five per group per period) were injected with either saline, fibrin, transforming growth factor-beta1 (TGF-beta1) or TGF-beta1 plus fibrin; the rats were killed at 1, 3, and 6 weeks after injection. Images were analysed quantitatively from tissue sections stained for collagen (Masson trichrome), fibrin (Verhoeff's stain) and elastin (Hart's stain), and immunostained for TGF-beta1, inducible nitric oxide synthase (iNOS), heme oxygenase 1 (HO1), alpha-smooth muscle actin (ASMA), apoptosis (TUNEL) and plasminogen activator inhibitor (PAI). Collagen fibre organization was characterized by electron microscopy. Human PD plaque tissue and normal human TA were assayed for fibrin by immunohistochemistry in nine samples. RESULTS At 1 week after injection of fibrin into the rat TA, only oedema was present; at 3 weeks, the oedema developed into a characteristic fibrotic PD-like plaque. The injection of TGF-beta1 into the TA also induced oedema in the TA at 1 and 3 weeks but there was very little evidence of a recognisable plaque at either time. Injection with TGF-beta1 plus fibrin resulted in oedema at 1 week but at 3 weeks there was a smaller plaque than with fibrin only. At 6 weeks the induced plaques in the fibrin-only and fibrin + TGF-beta1 groups persisted, and were comparable with those elicited at this time by TGF-beta1 alone. The control animals showed no pathology at any of the sample times. At 3 weeks the PD plaque induced by injection with fibrin alone had not only greater expression of TGF-beta1 than the TA of the animals receiving TGF-beta1 alone, but also greater levels of other markers of fibrosis, e.g. HO1 (reactive oxygen species), ASMA (presence of myofibroblasts), apoptosis, and PAI (inhibitor of fibrinolysis). iNOS, a known antifibrotic agent, was also increased. In human PD plaque tissue, fibrin was detected by immunohistochemistry in all nine specimens. CONCLUSIONS These results suggest that fibrin, when introduced into the TA of the rat penis, acts as a potential profibrotic protein, possibly via the local release of TGF-beta1, and induces a plaque not only histologically similar to that induced by TGF-beta1 but to that of the human condition. Because fibrin can extravasate from the blood into the human TA after an injury to the TA, and because fibrin persists in the plaque tissue, we hypothesise that fibrin may play a key role in the pathogenesis of human PD.
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Affiliation(s)
- H H Davila
- Department of Urology, UCLA School of Medicine, Los Angeles, CA, USA
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Ogbeide DO, Adebayo SB. Peyronie's disease. Who is at risk? Saudi Med J 2002; 23:1546-7. [PMID: 12518211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023] Open
Affiliation(s)
- Danny O Ogbeide
- Department of Family & Community Medicine, Armed Forces Hospital, Riyadh, Kingdom of Saudi Arabia
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Affiliation(s)
- T F Lue
- University of California at San Francisco, Department of Urology, San Francisco, California 94143-0738, USA.
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39
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Abstract
Peyronie's disease is an inflammatory condition characterized by the formation of fibrous, noncompliant nodules in the tunica albuginea which can impede tunical expansion during penile erection, leading to deformity and bending. While the cause of this disease is thought to be due to microvascular trauma and abnormal wound healing, other hypotheses include genetic predisposition. In this review the pathophysiology of Peyronie's disease is discussed as well as current hypotheses regarding its origin.
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Affiliation(s)
- R B Moreland
- Department of Urology and Physiology, Boston University School of Medicine, Boston, Massachusetts, USA
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40
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Abstract
Patients with Peyronie's disease usually present soon after the onset of the disease with penile pain and deformity when they develop an erection. They are middle-aged men and a palpable plaque is usually present. A good clinical history and examination are all that are necessary to manage most patients with Peyronie's disease. Further investigation is only required in those men with erectile dysfunction or where surgery is indicated.
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Affiliation(s)
- J P Pryor
- The Lister Hospital, Chelsea Bridge Road, London, UK.
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Affiliation(s)
- L S Hakim
- Section of Sexual Medicine, Male Infertility and Prosthetics, Cleveland Clinic, Florida, USA.
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Abstract
PURPOSE We discuss the clinical appearance and natural outcome of Peyronie's disease. MATERIALS AND METHODS During an 8-year period 307 men with Peyronie's disease were evaluated, and clinical characteristics, risk (factors), penile deformities, erectile status and outcome were analyzed. RESULTS Mean patient age plus or minus standard deviation was 52.8 +/- 9.3 years (range 23 to 76). Penile deformity, pain on erection and palpable nodule were the most common (85%) presenting symptoms, usually in different combinations. The remaining 15% of men (mean age 59.4 +/- 6.5 years) were not aware of the penile deformity and were diagnosed during standard evaluation for erectile dysfunction. Dorsal (45.6%) and lateral (29.3%) were the most common curvatures. The degree of deformity was less than 30 degrees in 42.7% of patients, 31 to 60 degrees in 38.8% and greater than 60 degrees in 18.6%. At least 1 risk factor for systemic vascular disease was identified in 67.5% of patients, and hypercholesterolemia and diabetes were the most common. Patients with at least 1 risk factor had a significantly higher risk for severe penile deformity. Of the men 54.4% complained of erectile dysfunction and the probability of diminished erectile capacity was 86.7% in patients older than 60 years, with Peyronie's disease for more than 12 months and at least 1 risk factor. Of 63 patients presenting with the acute phase of disease penile deformity deteriorated in 30.2%, did not change in 66.7% and resolved spontaneously in 3.2% without any treatment after a mean followup of 8.4 months. CONCLUSIONS Our data show that penile deformities are disabling (greater than 30 degrees) in 62.5% of cases. Risk factors, such as serum lipid abnormalities, diabetes and hypertension, seem to have significant impact on the severity of symptoms and outcome. Patients must be informed that Peyronie's disease is progressive in 30.2% without treatment and spontaneous resolution is rare.
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Affiliation(s)
- Ates Kadioglu
- Department of Urology, Medical Faculty of Istanbul, University of Istanbul, Turkey
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Abstract
OBJECTIVE To investigate epidemiological and clinical features of Peyronie's disease in an unselected group of patients not seen by a urologist before. PATIENTS AND METHODS A series of 134 consecutive cases with Peyronie's disease was evaluated regarding to the age at diagnosis, the symptoms and signs of the disease, and the site and formation of the scar. The medical history which could be possibly related with the onset of the disease was investigated as well. RESULTS The disease mainly affected middle-aged men. While all men had a palpable scar, only 51 (38%) had noticed the induration. Curvature (mean: 35 degrees) appeared in 87 men (65%) and caused sexual dysfunction due to severe penile deformity in 16 men (11.9%). 53 patients (39.5%) referred painful erections. In 11 men (8.2%) the onset of the disease was noticed after auto-injections of vaso-active drugs for the treatment of previous erectile dysfunction, while 18 (13.4%) had a history of penile trauma during sexual intercourse or manipulation. No specific relation with diabetes mellitus and Duputren's contracture was identified. Scars, like elongated indurations with vague bounds, were mainly formed (77.6%) in the dorsal midline. CONCLUSIONS The mean age of patients at diagnosis, the site of penile scars, and the activities of the affected men could advocate the hypothesis that trauma is the main causal factor for Peyronie's disease. In 21.6% of the patients, the lesion occurred after a traumatic activity. Sexual dysfunction due to severe penile curvature affected a small proportion of the patients. Thus, due to the diminution of pain spontaneously or after treatment, the patients with Peyronie's disease may have a normal life with satisfactory sexual function. In some selected cases surgery offers an effective result.
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Affiliation(s)
- P Perimenis
- Department of Urology, University Hospital of Patras, Greece.
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Gholami SS, Lue TF. Correction of penile curvature using the 16-dot plication technique: a review of 132 patients. J Urol 2002; 167:2066-9. [PMID: 11956440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
PURPOSE We review the results of 132 cases of congenital and acquired penile curvature corrected with our 16 or 24-dot, minimal tension technique using multiple parallel plications performed under papaverine induced erection. MATERIALS AND METHODS Chart and telephone interviews were conducted on 132 consecutive patients 16 to 79 years old who underwent penile plication between December 1995 and November 2000. Patient data as well as outcomes were analyzed. RESULTS We were unable to contact 8 patients. Of the patients 16 had congenital penile curvature, including 4 in whom the Nesbit procedure performed elsewhere had failed, and 116 had Peyronie's disease, including 8 in whom a previous Nesbit procedure had failed. Preoperative complaints included persistent penile pain with erection for more than 1 year in 15 of 132 cases, difficult intercourse or partner discomfort in 106 and poor self-image in 11. Curvature ranged from 30 to 120 degrees. Erections were evaluated preoperatively with duplex ultrasound after intracavernous injection and self-stimulation. Of the patients 63% had good erections, 25% moderate erections requiring sildenafil and 12% poor erections requiring injection therapy. Foreskin edema necessitating subsequent circumcision and an organized hematoma requiring evacuation occurred in 1 case each. At 6 months 93% of patients reported straight erections and 7% reported almost straight but acceptable erections. Recurrence of curvature was reported by 15% of patients at a mean of 2.6 years of followup. Four patients reported worsening of erectile function after the procedure. CONCLUSIONS Penile plication is a simple, safe method to correct congenital and acquired penile curvature. Using a minimal tension parallel plication technique, excellent durable results can be attained. This simplified repair avoids the neurovascular bundles and has a minimal to no detrimental affect on erectile function. Preoperative counseling must be given regarding penile shortening and the palpable small bumps from the nonabsorbable sutures.
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Affiliation(s)
- Shahram S Gholami
- Department of Urology, University of California, San Francisco, California
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Jordan GH. Treatment of Peyronie's disease. J Urol 2002; 167:2074. [PMID: 11956442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
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La Pera G, Pescatori ES, Calabrese M, Boffini A, Colombo F, Andriani E, Natali A, Vaggi L, Catuogno C, Giustini M, Taggi F. Peyronie's disease: prevalence and association with cigarette smoking. A multicenter population-based study in men aged 50-69 years. Eur Urol 2001; 40:525-30. [PMID: 11752860 DOI: 10.1159/000049830] [Citation(s) in RCA: 106] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVES We present a multicenter, population-based epidemiological survey aimed at assessing the prevalence of Peyronie's disease (PD) and its potential risk factors in the general population. METHODS In each of the ten centers throughout Italy, a uroandrologist contacted all the men in the age range 50-69 years registered with a general practitioner (GP). The subjects recruited were evaluated on the basis of their medical history, including alcohol consumption and cigarette smoking. The following questionnaires were administered: IIEF, IIPSS symptom score, premature ejaculation and PD. RESULTS All the subjects registered with a GP were invited to participate in the study. Of the 1,180 subjects, 647 (53%) entered over survey. In this population, 46 cases of PD were identified, accounting for a prevalence of 7.1%. The prevalence rate increased with age even if the trend is not statistically significant. The multivariate analysis showed a significant correlation between cigarette smoking and PD, with an odds ratio (OR) of 4.6 (CL 95%) confidence limit 1.506- 14.287). Smoking as single variable had an OR of 7.2 (95% CL 2.34-24.93). No significant association was observed between PD and the other variables such as cardiovascular diseases, diabetes, hypertension and alcohol consumption. CONCLUSIONS PD is a much more frequent condition in the general population than previously reported. According to our results, cigarette smoking may be considered a risk factor for developing PD. If further and more targeted studies confirm that giving up smoking may reduce the risk of developing PD, then there will be new prospects for primary and secondary prevention and for curbing the progression of the disease.
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Peyronie's disease. Embarrassing but treatable. Mayo Clin Health Lett 2001; 19:6. [PMID: 11692630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
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Abstract
We present 2 cases of Peyronie's disease in patients with scleroderma. This association is uncommon, and our patients' symptoms and disease course differed from that typical for Peyronie's disease. We suggest a more conservative approach when treating patients whose penile curvature is associated with a systemic disease such as scleroderma.
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Affiliation(s)
- T Y Chen
- Department of Urology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
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Diagne M, Gueye SM, Ba M, Konan PG, Diop AG, Ndiaye MM, Ndiaye IP, Mensah A. [Peyronie's disease and peripheral neuropathies]. Dakar Med 2000; 43:234-7. [PMID: 10797972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
The association between Peyronie's disease and diabetes mellitus or Dupuytren's disease is well described in the literature with a certain frequency. Through our 10 patients with Peyronie's disease, when have noticed that only one of them is undergoing diabetes mellitus and no one has Dupuytren's disease. But 7 of them presented clinical and/or electromyographical signs of peripheral neuropathy. So after clinical examination in neurology and urology, we performed measurement of motor conduction velocity of tibial posterior nerves and peroneal nerves, then, we measured sensitive vetocity of sural nerves and dorsal nerve of the penis and we studied the cortical somesthesic evoked potential of the internal hontous nerve and the sympathetic evoked response of the skin. So we hypothesize that peripheral neuropathy with or without autonomic disorders might be an etiological co-factor of Peyronie's disease.
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Affiliation(s)
- M Diagne
- Département d'Explorations Foncitonnelles du Système Nerveux, CHU Fann Dakar, Sénégal
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Hellstrom WJ, Bivalacqua TJ. Peyronie's disease: etiology, medical, and surgical therapy. J Androl 2000; 21:347-54. [PMID: 10819440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
Peyronie's disease remains an enigma. With the recent introduction of an animal model for Peyronie's disease, the entry of a number of double-blind placebo-controlled clinical trials, and the application of new molecular diagnostic methods, the investigation of this wound-healing disorder of the penile tunica albuginea should illuminate many of the unknowns. Investigators need to be open to innovations in other fields of medicine involving idiopathic fibrosing conditions in other organ systems, eg, Dupuytren's contracture, keloids, hypertrophic scarring, etc. Applications from these other disciplines will undoubtedly widen our scope about Peyronie's disease. While a minority of patients respond with observation alone, most authorities recommend at least a trial of medical therapy with a safe, inexpensive, and well-tolerated agent, as early-stage disease is reputedly more likely to respond better than patients with established, longstanding Peyronie's plaques. The reintroduction of intralesional therapies (verapamil and interferon alpha-2b) provides the clinician with an alternative minimally invasive intervention that has promising possibilities. In severe fibrotic or calcified plaques or with major structural abnormalities, the judicious use of surgery with or without grafting materials and a penile prosthesis can restore many men back to their previous level of high esteem and provide both partners an excellent quality of life.
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Affiliation(s)
- W J Hellstrom
- Department of Urology, Tulane University School of Medicine, New Orleans, Louisiana 70112, USA.
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