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Hammad MAM, Barham DW, Simhan J, Nguyen T, Swerdloff D, Miller J, Hatzichristodoulou G, Sempels M, Andrianne R, Hotaling JM, Hsieh TC, Jones JM, Modgil V, Osmonov D, Pearce I, Perito P, Sadeghi-Nejad H, Suarez-Sarmiento A, Yafi FA, Gross MS. A multicenter evaluation of penile curvature correction in men with Peyronie's disease undergoing inflatable penile prosthesis placement. J Sex Med 2025; 22:349-355. [PMID: 39724925 DOI: 10.1093/jsxmed/qdae192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2024] [Revised: 11/24/2024] [Accepted: 12/11/2024] [Indexed: 12/28/2024]
Abstract
BACKGROUND Inflatable penile prosthesis (IPP) insertion is recommended for the treatment of patients with Peyronie's disease (PD) and significant erectile dysfunction (ED); adjunctive procedures can be used for residual curvature after IPP placement. AIM To assess the management of penile curvature correction in PD patients undergoing IPP procedures within a large multinational, multicenter cohort. METHODS A retrospective analysis was conducted on PD patients treated with IPP by 11 experienced prosthetic surgeons. Demographic, intraoperative, and postoperative data were analyzed to assess the improvement in penile curvature following IPP, including adjunctive correction techniques such as manual modeling, tunica albuginea plication, and grafting. OUTCOMES Curvature correction achieved after IPP placement and adjunctive procedures. RESULTS For 499 PD patients treated with IPP, median age was 62.0 [30.0, 91.0] years with mean follow-up of 16.5 (SD = 12.9) months. The mean preoperative curvature was 39.4° (SD = 17.8°), with dorsal curvature being most common. Among our cohort, 17.6% had IPP-only placement, while the majority of 82.4% patients underwent IPP along with adjunctive correction procedures. Specifically, manual modeling (with/without the "scratch" technique) was used in 74.7% of cases, tunica albuginea plication in 4.8%, grafting in 2%, and combined grafting and modeling in 0.8%. Patients who underwent grafting generally had fewer preoperative comorbidities and more severe preoperative curvatures of 60.0° [45.0°, 70.0°]. Grafting also provided the highest median curvature correction of 55.0° [48.8°, 73.8°], (P < .001). Plication achieved a median curvature correction of 40.0° [28.8°, 41.2°], whereas modeling resulted in a median curvature reduction of 26.0° [20.0°, 39.5°], (P < .001). CLINICAL IMPLICATIONS We observed that grafting, though less frequently used, provided more curvature correction in severe PD cases undergoing IPP. STRENGTHS AND LIMITATIONS Large cohort size and multinational participation are strengths, though retrospective design and general variability in surgical techniques are limitations. CONCLUSION Adjunctive techniques, including grafting, plication, and modeling provide options for tailoring curvature correction to disease severity and patient characteristics. Future prospective studies are needed to standardize and evaluate the comparative outcomes of these techniques.
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Affiliation(s)
- Muhammed A M Hammad
- Department of Urology, University of California, Irvine, Orange, CA 92868, United States
| | - David W Barham
- Department of Surgery, Urology Section, Brooke Army Medical Center, San Antonio, TX 78234, United States
| | - Jay Simhan
- Department of Urology, Fox Chase Cancer Center, Philadelphia, PA 19111, United States
| | - Tuan Nguyen
- Department of Urology, University of California, Irvine, Orange, CA 92868, United States
- Department of Urology, University of Medicine and Pharmacy, Ho Chi Minh City, 700000, Vietnam
| | - Daniel Swerdloff
- Department of Urology, Fox Chase Cancer Center, Philadelphia, PA 19111, United States
| | - Jake Miller
- Department of Urology, University of California, Irvine, Orange, CA 92868, United States
| | | | - Maxime Sempels
- Department of Urology, University Hospital of Liège, Liege, 4000, Belgium
| | - Robert Andrianne
- Department of Urology, University Hospital of Liège, Liege, 4000, Belgium
| | - James M Hotaling
- Division of Urology, Department of Surgery, University of Utah, Salt Lake City, UT 84132, United States
| | - Tung-Chin Hsieh
- Department of Urology, University of California, San Diego, La Jolla, CA 92093, United States
| | - James M Jones
- Department of Urology, Boston Medical Center, Boston, MA 02118, United States
| | - Vaibhav Modgil
- Manchester Andrology Centre, Manchester University, Manchester, M13 9WL, United Kingdom
| | - Daniar Osmonov
- Department of Urology, University Hospital Schleswig Holstein, Kiel, 24105, Germany
| | - Ian Pearce
- Manchester Andrology Centre, Manchester University, Manchester, M13 9WL, United Kingdom
| | - Paul Perito
- Perito Urology, Coral Gables, FL 33134, United States
| | | | | | - Faysal A Yafi
- Department of Urology, University of California, Irvine, Orange, CA 92868, United States
| | - Martin S Gross
- Department of Urology, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756, United States
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Kim DS, Yang HJ, Jeong HC, Moon KH, Lee DS, Song SH, Lee WK. Diagnosis and Management of Peyronie's Disease: A Clinical Consensus Statement and Recommendations from the Korean Society for Sexual Medicine and Andrology. World J Mens Health 2025; 43:50-59. [PMID: 39478653 PMCID: PMC11704158 DOI: 10.5534/wjmh.240200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2024] [Revised: 08/23/2024] [Accepted: 09/25/2024] [Indexed: 01/03/2025] Open
Abstract
Peyronie's disease is an acquired condition characterized by penile deformities caused by fibrosis of the penile tunica albuginea, leading to symptoms such as penile pain, erectile dysfunction, and other associated issues. Despite extensive research, the pathophysiology of this condition remains poorly understood, and standardized diagnostic and treatment protocols are lacking. While clinical guidelines from several professional societies exist, they do not consistently account for factors such as patient ethnicity, geography, and socioeconomic status. Thus, the Korean Society for Sexual Medicine and Andrology (KSSMA) aimed to develop recommendations tailored to clinical practice in Korea. These recommendations summarize the latest evidence, including clinical practice guidelines from various international professional societies, and represent the consensus opinion of an expert group within the KSSMA. They encompass all aspects of Peyronie's disease, including the definition, diagnosis, non-surgical interventions, and surgical treatment options.
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Affiliation(s)
- Dong Soo Kim
- Department of Urology, Kyung Hee University College of Medicine, Seoul, Korea
| | - Hee Jo Yang
- Department of Urology, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Hyun Cheol Jeong
- Department of Urology, Hallym University College of Medicine, Chuncheon, Korea
| | - Ki Hyuck Moon
- Department of Urology, Perfect Urology Clinic, Seoul, Korea
| | - Dong Sup Lee
- Department of Urology, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Seung Hun Song
- Department of Urology, CHA University of Medical Science, Pocheon, Korea
| | - Won Ki Lee
- Department of Urology, Hallym University College of Medicine, Chuncheon, Korea.
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Bole R, Alom M, Habashy E, Ahmed M, Ziegelmann M, Kohler T, Helo S. The clinical significance of imperfection: is idiopathic corporal asymmetry related to curvature during penile prosthesis placement? Int J Impot Res 2024; 36:820-824. [PMID: 36797455 DOI: 10.1038/s41443-023-00669-6] [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: 01/05/2023] [Revised: 01/23/2023] [Accepted: 01/27/2023] [Indexed: 02/18/2023]
Abstract
Patient satisfaction after inflatable penile prosthesis (IPP) has been linked to preexisting curvature; however the association with intraoperative asymmetric corporal measurements (ACM) has not been well described. We sought to identify incidence of ACM during IPP surgery, and relationship to penile curvature. A retrospective review of all patients undergoing primary IPP placement between 6/2019 and 6/2021 was performed. Logistic regression analysis was performed to identify factors associated with ACM and need for adjunct straightening techniques. A total of 273 patients underwent primary IPP. 27.8% had Peyronie's disease (PD) diagnosed preoperatively or detected intraoperatively. ACM was identified in 20.1% (55/273) patients. There was no significant difference in ACM in PD versus non-PD patients (p = 0.55). Most patients with ACM (78.2%, 43/55) underwent placement of asymmetric device. ACM did not predict need for invasive straightening maneuvers (p = 0.12). However ACM patients were significantly more likely to have mild residual curvature than those with symmetry (p < 0.0001). Our study is first to address management of idiopathic ACM and association with curvature, providing new insight into a common situation. While ACM was detected in 20%, it did not predict need for adjunct straightening techniques. Our findings may provide reassurance to urologists troubleshooting idiopathic ACM during corporal dilation during IPP surgery.
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Affiliation(s)
- Raevti Bole
- Department of Urology, Mayo Clinic Rochester, Rochester, MN, USA
- Glickman Urological & Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Manaf Alom
- Department of Urology, Mayo Clinic Rochester, Rochester, MN, USA
| | - Engy Habashy
- Department of Urology, Mayo Clinic Rochester, Rochester, MN, USA
| | - Mohammed Ahmed
- Department of Urology, Mayo Clinic Rochester, Rochester, MN, USA
| | | | - Tobias Kohler
- Department of Urology, Mayo Clinic Rochester, Rochester, MN, USA
| | - Sevann Helo
- Department of Urology, Mayo Clinic Rochester, Rochester, MN, USA.
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Altieri VM, Saldutto P, Verratti V, La Rocca R, Di Mauro E, Celentano G, Capece M, Morgera V, Cacace G, Vena W, Mastrangelo F, Napolitano L, Iacono F. Altieri modified Nesbit corporoplasty for the treatment of penile curvature: Comparison of local anesthesia vs loco-regional anesthesia on the clinical outcomes. Arch Ital Urol Androl 2024; 96:12957. [PMID: 39692419 DOI: 10.4081/aiua.2024.12957] [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: 08/23/2024] [Accepted: 08/31/2024] [Indexed: 12/19/2024] Open
Abstract
OBJECTIVE To compare the safety profile and clinical outcomes of Altieri-modified Nesbit corporoplasty using two different anesthesia methods including spinal anesthesia and local anesthesia. MATERIALS AND METHODS A total of 40 patients with congenital penile curvature (CPC) and Peyronie's disease (PD) underwent Altieri-modified Nesbit corporoplasty. Group 1 (n = 20) received spinal anesthesia, and Group 2 (n = 20) received local anesthesia. The patients were categorized into age groups (< 30 years, 31-45 years, 46-60 years, and 61-75 years) for analysis. Clinical outcomes, post-operative complications, hospital stay, pain levels, and other parameters were assessed. RESULTS The results showed that 2 patients (10%) reported postoperative complications, including headache, arterial hypotension, and penile foreskin necrosis from the spinal anesthesia group. Whereas, in the local anesthesia group, 1 patient (5%) reported scar phimosis. Further, post-operative pain was predominantly very mild, with 16 patients (80%) in the spinal anesthesia group and 14 patients (70%) in the local anesthesia group experiencing minimal discomfort. Age did not significantly impact hospital stay, post-operative intestinal disorders, constipation, lower urinary tract symptoms, voiding burning, or dysuria. CONCLUSIONS Spinal anesthesia may lead to more post-operative complications and longer hospital stays compared to local anesthesia. Age does not significantly affect most clinical outcomes but can influence post-operative pain in patients receiving local anesthesia.
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Affiliation(s)
- Vincenzo Maria Altieri
- Department of Medicine and Health Sciences "V. Tiberio", University of Molise, Campobasso; Department of Urology, Humanitas Gavazzeni, Bergamo .
| | | | - Vittore Verratti
- Department of Psychological, Health and Territorial Sciences, University "G. D'Annunzio" Chieti-Pescara, Chieti.
| | - Roberto La Rocca
- Unit of Urology, Department of Neurosciences, Reproductive Sciences, and Odontostomatology University of Naples "Federico II".
| | - Ernesto Di Mauro
- Unit of Urology, Department of Neurosciences, Reproductive Sciences, and Odontostomatology University of Naples "Federico II".
| | - Giuseppe Celentano
- Unit of Urology, Department of Neurosciences, Reproductive Sciences, and Odontostomatology University of Naples "Federico II".
| | - Marco Capece
- Unit of Urology, Department of Neurosciences, Reproductive Sciences, and Odontostomatology University of Naples "Federico II".
| | - Vincenzo Morgera
- Unit of Urology, Department of Neurosciences, Reproductive Sciences, and Odontostomatology University of Naples "Federico II".
| | - Gianluigi Cacace
- Unit of Urology, Department of Neurosciences, Reproductive Sciences, and Odontostomatology University of Naples "Federico II".
| | - Walter Vena
- Department of Urology, Humanitas Gavazzeni, Bergamo.
| | - Francesco Mastrangelo
- Unit of Urology, Department of Neurosciences, Reproductive Sciences, and Odontostomatology University of Naples "Federico II".
| | - Luigi Napolitano
- Unit of Urology, Department of Neurosciences, Reproductive Sciences, and Odontostomatology University of Naples "Federico II".
| | - Fabrizio Iacono
- Department of Medicine and Health Sciences "V. Tiberio", University of Molise, Campobasso.
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Paulis G, De Giorgio G, Paulis A. Clinical Presentation of Peyronie's Disease: A Retrospective Study of 564 Cases. Diagnostics (Basel) 2024; 14:1125. [PMID: 38893650 PMCID: PMC11172383 DOI: 10.3390/diagnostics14111125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Revised: 05/26/2024] [Accepted: 05/28/2024] [Indexed: 06/21/2024] Open
Abstract
Peyronie's disease (PD) affects the penile albuginea, resulting in penile deformity, pain, erectile dysfunction (ED), and an anxious-depressive state. PD diagnosis involves a thorough medical history, penile palpation, documentation of the penile deformation, a dynamic penile echo color Doppler ultrasound (PCDU), and the completion of questionnaires for the evaluation of pain, ED, and psychometric tests. The aim of this study was to evaluate the symptoms of PD and their prevalence in PD patients in the active phase who had access to our andrology clinic. Inclusion criteria: availability of data on patients diagnosed with PD, including detailed medical history, blood tests, penile palpation, photographic documentation of penile deformity, and penile PCDU. Exclusion criteria: PD patients in the stable phase or those without the specified tests and data mentioned above. Our study found a higher prevalence of PD in younger patients (24.2%), a higher coexistence of PD with chronic prostatitis (35.6%), a higher percentage of cases of association between penile deformity and penile curvature (84.4%), a higher prevalence of "significant anxiety" (88.4%), a higher presence of plaque calcification (35.6%), and the detection of a longer duration of the first phase of PD (>18 months). The most frequently observed type of penile curvature was dorsal, followed by left lateral, right lateral, and, less commonly, ventral. We observed a significant statistical correlation between patient age and IIEF score, indicating that patients over the age of 40 years are at a higher risk of experiencing ED. We found a strong statistical relationship between VAS score and age. As age increases, the VAS score decreases, suggesting that younger patients reported more penile pain compared to those who were older than 40 years. Furthermore, we found that penile pain has a significant impact on the psychological state of PD patients. We also found that 38.8% of PD patients suffered from severe anxiety. In relation to this, psychotherapy should be integrated into PD treatment to improve the quality of life and treatment adherence.
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Affiliation(s)
- Gianni Paulis
- Department of Urology and Andrology, Peyronie’s Care Center, Castelfidardo Clinical Analysis Center, 00185 Rome, Italy
| | - Giovanni De Giorgio
- Section of Ultrasound Diagnostics, Department of Urology and Andrology, Castelfidardo Clinical Analysis Center, 00185 Rome, Italy;
| | - Andrea Paulis
- Bambino Gesu’ Children’s Research Hospital, IRCCS (Istituti di Ricovero e Cura a Carattere Scientifico), 00165 Rome, Italy;
- Neurosystem for Applied Psychology and Neuroscience, Janet Clinical Centre, 00195 Rome, Italy
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Kozub A, Suleja A, Chłosta M, Kupilas A, Pradere B, Rivas JG, Rajwa P, Miszczyk M. Current trends in non-surgical management of Peyronie's disease-A narrative review. Andrology 2024; 12:505-517. [PMID: 37593783 DOI: 10.1111/andr.13512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 07/21/2023] [Accepted: 07/25/2023] [Indexed: 08/19/2023]
Abstract
Peyronie's disease (PD) is a connective tissue disorder affecting the tunica albuginea. It can cause pain and penile deformation, and its prevalence increases with age. Although surgery is the gold standard for the chronic phase of the disease, there are several conservative treatment methods available, and the optimal management of the acute phase of the disease remains a matter of debate. In this article, we aim to summarize the recent trends in research on the subject of non-surgical treatment of PD. The search was performed in PubMed, Scopus, and Web of Science databases and included studies in English published between 2012 and 2022 investigating the clinical outcomes of non-surgical PD management in humans. We have identified 20 distinct conservative treatment strategies. Among the oral therapeutics, only the use of phosphodiesterase type 5 inhibitors is currently recommended for clinical use in patients with concomitant erectile dysfunction. The use of collagenase from Clostridium histolyticum is supported by the best quality evidence in terms of intralesional injections for patients suffering from significant penile curvature; however, interferon alpha-2b can also be an option in such patients. Among other non-invasive methods, extracorporeal shockwaves can be useful for pain reduction, and penile traction therapy can lead to a reduction in penile curvature and plaque size. Despite a wide range of non-surgical methods available for PD treatment, the majority are not supported by sufficient scientific evidence, and the treatment efficacy is underwhelming. Further research on the subject of non-surgical management of PD is highly warranted.
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Affiliation(s)
- Anna Kozub
- IIIrd Department of Radiotherapy and Chemotherapy, Maria Sklodowska-Curie National Research Institute of Oncology (MSCNRIO), Gliwice, Poland
| | - Agata Suleja
- IIIrd Department of Radiotherapy and Chemotherapy, Maria Sklodowska-Curie National Research Institute of Oncology (MSCNRIO), Gliwice, Poland
| | - Marcin Chłosta
- Department of Urology, Jagiellonian University, Collegium Medicum, Krakow, Poland
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Andrzej Kupilas
- Department of Urology and Urooncology, City Hospital, Gliwice, Poland
| | - Benjamin Pradere
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Urology, University of Tours, Tours, France
| | - Juan Gómez Rivas
- Department of Urology, Hospital Clínico San Carlos, Madrid, Spain
| | - Paweł Rajwa
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Urology, Medical University of Silesia, Zabrze, Poland
| | - Marcin Miszczyk
- IIIrd Department of Radiotherapy and Chemotherapy, Maria Sklodowska-Curie National Research Institute of Oncology (MSCNRIO), Gliwice, Poland
- Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
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Larson H, Savage J, Brearton K, Warner R, Ziegelmann M, Kohler T, Trost L. Outcomes of collagenase Clostridium histolyticum in men with ventral curvatures: an updated series. J Sex Med 2024; 21:169-174. [PMID: 38141054 DOI: 10.1093/jsxmed/qdad167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 10/23/2023] [Accepted: 11/30/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND The efficacy and safety of collagenase Clostridium histolyticum (CCH) have been demonstrated in the treatment of men with Peyronie's disease (PD); however, the pivotal clinical trials excluded men with ventral penile curvature. AIM The study sought to evaluate outcomes of CCH treatment in men with ventral curvatures secondary to PD. METHODS Men with PD treated with CCH were identified from a prospective database. Patients received up to 4 series of CCH injections using a progressively modified protocol over time. Results were compared between those with baseline ventral vs nonventral penile curvatures. OUTCOMES Changes in penile curvature, Peyronie's Disease Questionnaire scores, International Index of Erectile Function scores, nonstandardized assessments, and adverse events. RESULTS A total of 560 men with PD (85 ventral curvature, 475 nonventral curvature) were included in the analysis. Baseline median curvature was 60.0° (interquartile range, 48.8°-75.0°) in the ventral cohort and 65.0° (interquartile range, 45.0°-80.0°) in the nonventral cohort. Median change from baseline penile curvature was -25.0° in the ventral cohort vs -24.0° in the nonventral cohort (P = .08, between-group comparison), which corresponded to curvature reductions of 44.7% and 33.6%, respectively (P = .03). In the subset of patients who completed CCH treatment (ie, received 8 injections or discontinued early because of patient satisfaction with curvature reduction), median change from baseline was -35.0° in the ventral cohort vs -25.0° in the nonventral cohort (P < .05); median percent improvement was 48.3% and 37.5%, respectively (P = .11). Median change from baseline in Peyronie's Disease Questionnaire and International Index of Erectile Function domain scores and adverse events were similar between cohorts, with the exception of possibly higher hematoma rates in the nonventral group (50% vs 37%; P = .05). No urethral injuries were sustained in either cohort. CLINICAL IMPLICATIONS Data support the use of CCH for the treatment of ventral as well as nonventral penile curvatures in men with PD. STRENGTHS AND LIMITATIONS Study strengths are the inclusion of a general clinical population of men with PD, the prospective design, and the relatively large series of men with ventral curvature. Limitations include the single-center and observational nature of the study. CONCLUSION CCH was safe and effective in the treatment of both ventral and nonventral penile curvatures in men with PD.
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Affiliation(s)
- Henry Larson
- Brigham Young University, Department of Physiology and Developmental Biology, Provo, UT 84602, United States
| | - Joshua Savage
- Male Fertility and Peyronie's Clinic, Orem, UT 84057, United States
| | - Klint Brearton
- Male Fertility and Peyronie's Clinic, Orem, UT 84057, United States
| | - Riley Warner
- Male Fertility and Peyronie's Clinic, Orem, UT 84057, United States
| | | | - Tobias Kohler
- Mayo Clinic, Department of Urology, Rochester, MN 55905, United States
| | - Landon Trost
- Brigham Young University, Department of Physiology and Developmental Biology, Provo, UT 84602, United States
- Male Fertility and Peyronie's Clinic, Orem, UT 84057, United States
- Mayo Clinic, Department of Urology, Rochester, MN 55905, United States
- CURE PD, Orem, UT 84057, United States
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Paulis G, Paulis A. Calcification in Peyronie's disease: Its role and clinical influence on the various symptoms and signs of the disease, including psychological impact. Our study of 551 patients. Arch Ital Urol Androl 2023; 95:11549. [PMID: 37791557 DOI: 10.4081/aiua.2023.11549] [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: 06/27/2023] [Accepted: 07/14/2023] [Indexed: 10/05/2023] Open
Abstract
BACKGROUND The aim of study was to evaluate the impact of plaque calcification on symptoms of patients with Peyronie's disease (PD) and to evaluate mental health in PD patients with or without calcification. METHODS We performed a retrospective analysis of the clinical database of a single andrology clinic. We extracted 551 PD patients, and we sorted them into two groups: the first group included 201 PD patients with plaque calcification; the second group included 350 PD patients without plaque calcification. The inclusion criteria for both groups were as follows: aged between 21 and 81 years; thorough and available data on clinical history; baseline levels of blood glucose, glycosylated hemoglobin, cholesterol, and triglycerides; photographic documentation of the penile curvature; dynamic penile eco-color Doppler ultrasound with plaque measurements and volume calculation; and completion of the generalized anxiety disorder-7 questionnaire, patient health questionnaire-9 (for depression), visual analog scale for penile pain measurements, and the International Index of Erectile Function (IIEF) questionnaire. RESULTS Plaque calcification was present in 36.4% of cases. The presence of calcification affects the presence and severity of penile curvature. Calcification is associated with the presence of hypertension. In PD patients, the prevalence of significant anxiety and significant depression was 89.1% and 57.3%, respectively. Calcification is associated with the presence of anxiety and depression but does not lead to an increase in their prevalence. CONCLUSIONS In PD patients, the calcification was present in more than one third of cases. The size of the plaque calcification was < 15 mm in most cases. Calcification influences the presence of the curve and influences its severity. There was a prominent prevalence of anxiety and depression in PD patients.
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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] [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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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.
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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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Paulis G, Paulis A, Perletti G. Congenital penile curvature as a possible risk factor for the onset of Peyronie's disease, and psychological consequences of penile curvature. Arch Ital Urol Androl 2023; 95:11238. [PMID: 36924365 DOI: 10.4081/aiua.2023.11238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 02/17/2023] [Indexed: 03/17/2023] Open
Abstract
OBJECTIVE To investigate a possible relationship between a history of congenital penile curvature (CPC) and Peyronie's disease (PD), and to characterize the psychological profile of patients suffering from PD, with or without concomitant CPC. METHODS We included 519 patients with Peyronie's disease (PD), of which 73 were found to have underlaying CPC. As a comparator population, we selected 2166 patients without PD, referring to our tertiary care clinic. In this population we detected 15 subjects with CPC. All patients completed the GAD-7 (Generalized-Anxiety-Disorder - 7 questions) and the PHQ-9 (Patient-Health-Questionnaire - 9 questions) questionnaires. RESULTS The overall prevalence of CPC in PD-patients was 14.07%, compared to a prevalence of 0.69% in the non-PD control population (p < 0.00001). Moderate-to-severe anxiety was found to be present in 89.4% of all PD-patients. Significantly higher proportions of patients with CPC associated with PD showed severe anxiety, compared to patients with PD alone (57.5% vs. 36.7%, respectively, p = 0.0008). Moderate- severe depression was found to be present in 57.8% of all PD- patients. Significantly higher proportions of PD patients with a history of CPC showed severe depression, compared to patients with PD alone (13.6% vs. 3.36%, respectively, p < 0.0002). GAD-7 median scores were significantly higher in patients with more severe penile curvatures (> 45°; p = 0.029). We did not detect a statistically significant difference between PHQ-9 medi- an scores based on the severity of PD (p = 0.53). Analysis of PHQ-9 and GAD-7 median scores showed significantly worse depressive and anxious symptoms in younger patients (p < 0.001 and p = 0.0013, respectively). CONCLUSIONS The presence of congenital-penile-curvature may represent a risk factor for the subsequent onset of Peyronie's disease. Moderate/severe anxiety and moderate/severe depression were reported in a high fraction of cases. Anxiety was significantly higher in patients with more severe penile-curvatures, and depression was present independently of the degree of penile curvature. Depression and anxiety were found to be more severe in younger subjects.
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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.
| | - Gianpaolo Perletti
- Department of Biotechnology and Life Sciences, Section of Medical and Surgical Sciences, University of Insubria, Varese.
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Allen-Brady KL, Christensen MB, Sandberg AD, Pastuszak AW. Significant familial clustering of Peyronie's disease in close and distant relatives. Andrology 2022; 10:1361-1367. [PMID: 35770847 PMCID: PMC9481671 DOI: 10.1111/andr.13223] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 06/08/2022] [Accepted: 06/23/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Peyronie's disease (PD) has previously been observed to co-aggregate in a small number of first-degree relative pairs (e.g., father-son). However, the familial aggregation of PD in more distant relatives, as well as the aggregation of Dupuytren's disease (DD) in probands and relatives, has not been thoroughly investigated. OBJECTIVE This study explored the evidence for familial clustering of PD and DD in close and distant relatives. MATERIALS AND METHODS The Utah Population Database, which includes genealogy information linked to electronic medical records (available since 1995), was used to identify men and their relatives with PD and DD based on ICD9/10 codes. All cases were required to have high-quality genealogy data. We estimated relative risk (RR) of PD and DD in first- through fifth-degree relatives compared to matched population rates of disease. We also investigated the average relatedness of cases compared to the average relatedness of sets of matched controls. Outcome measures include estimation of relative risk and excessive relatedness as measured by a Genealogical Index of Familiality (GIF) analysis. RESULTS We analyzed 307 individuals with PD, and their first- through fifth-degree relatives. Approximately 0.12% of the population had PD, 95% of these were diagnosed over the age of 30 years (age range: 10-92 years), and 1.3% of PD probands had a comorbid diagnosis of DD. RR estimates for PD were significant for first- and fifth-degree relatives. RR estimates for DD were significant only for probands. The average relatedness of cases was significantly greater than matched controls, even after removing first- and second-degree relatives. We also found that 74.9% of identified PD probands belonged to pedigrees with a statistical excess of PD. CONCLUSION Despite the low prevalence of PD in our healthcare records, the results provide evidence that support a genetic contribution to at least a subset of PD cases.
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Affiliation(s)
- Kristina L Allen-Brady
- Genetic Epidemiology, Department of Epidemiology, University of Utah, Salt Lake City, Utah, USA
| | - Michael B Christensen
- Division of Urology, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | | | - Alexander W Pastuszak
- Division of Urology, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA
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13
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Testosterone replacement therapy and erectile dysfunction. Int J Impot Res 2022; 34:698-703. [PMID: 34997198 DOI: 10.1038/s41443-021-00512-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 11/03/2021] [Accepted: 11/24/2021] [Indexed: 11/08/2022]
Abstract
Testosterone (T) deficiency and erectile dysfunction (ED) are independently functionally and socially impairing, and their concurrence in men can be challenging to treat. Successful management requires an understanding of the mechanisms through which T underlies normal erectile function. While the literature elucidating some of these mechanisms is vast (e.g., androgen regulation of the activity of nitric oxygen synthase and phosphodiesterase type 5) for others it is scarce (e.g., catalysts of castration-induced corporal fibrosis). The randomized controlled trial data for the efficacy of T replacement as mono- or combination therapy to treat ED has been conflicting. Positive results were frequently not clinically meaningful. Meta-analyses have been helpful in illuminating trends that seem to be promising. Consensus is still lacking in several areas, such as the threshold of low T severity for which replacement therapy is most beneficial; the timing for initiating combination therapy; and the duration of treatment.
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Loftus CJ, Rajanahally S, Holt SK, Raheem OA, Ostrowski KA, Walsh TJ. Treatment Trends and Cost Associated With Peyronie's Disease. Sex Med 2020; 8:673-678. [PMID: 33036960 PMCID: PMC7691870 DOI: 10.1016/j.esxm.2020.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 08/08/2020] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Providers may use several treatment options for patients with Peyronie's disease; however, it is unclear whether practice patterns have evolved over recent years and if this has impacted cost. AIMS To investigate trends in the treatment of Peyronie's disease over time and the associated costs using a national, commercial insurance claims database. METHODS A retrospective cohort study was conducted using claims from the Truven MarketScan database from 2007 to 2018 for men with Peyronie's disease. Cost was estimated as either the sum of prescription oral or injectable treatment costs or as the single net cost associated with the operative procedure. MAIN OUTCOME MEASURES Frequency of use of various treatments for Peyronie's disease and associated costs were assessed as trends over the timeline by year. RESULTS The estimated annual incidence of Peyronie's disease in this population rose from 61 to 77 per 100,000 patients over the included years, and the percent annual treatment rate rose from 17.8% to 26.2%. Colchicine was the most commonly prescribed oral agent in 2007 used in 22% of treated individuals; by 2018, pentoxifylline was the most common prescribed oral agent used in 33%. In 2007, 11% of treated patients received intralesional verapamil; however, by 2018, 24% received injectable collagenase, whereas <1% received intralesional verapamil. The mean annual, per-individual cost of Peyronie's disease treatment increased from $1,531 in 2007 to $10,339 in 2018. The cost increase was greatest for injectable therapies, which rose from $811 per individual in 2007 to $16,184 in 2018, a 19-fold increase. CONCLUSIONS Diagnosis and treatment of Peyronie's disease is increasing over time. Pentoxifylline has become the most common oral prescription, whereas injectable collagenase has become most common injection. The mean cost associated with Peyronie's disease treatment increased more than 5 times from 2007 to 2018 corresponding with Federal Drug Administration's approval of injectable collagenase. Loftus CJ, Rajanahally S, Holt SK, et al. Treatment Trends and Cost Associated With Peyronie's Disease. Sex Med 2020;8:673-678.
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Affiliation(s)
| | | | - Sarah K Holt
- Department of Urology, University of Washington Medical Center, Seattle, WA
| | - Omer A Raheem
- Department of Urology, Tulane University School of Medicine, New Orleans, LA
| | - Kevin A Ostrowski
- Department of Urology, University of Washington Medical Center, Seattle, WA
| | - Thomas J Walsh
- Department of Urology, University of Washington Medical Center, Seattle, WA
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Kadioglu A, Dincer M, Salabas E, Culha MG, Akdere H, Cilesiz NC. A Population-Based Study of Peyronie's Disease in Turkey: Prevalence and Related Comorbidities. Sex Med 2020; 8:679-685. [PMID: 33243422 PMCID: PMC7691981 DOI: 10.1016/j.esxm.2020.09.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 09/17/2020] [Accepted: 09/23/2020] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Peyronie's disease (PD) prevalence varies between 0.39% and 20% and studies on PD prevalence are limited. AIM This study aims to determine the prevalence of PD in males aged ≥30 years in Turkey and to evaluate etiological factors associated with it. METHODS The study was conducted in 12 regions of Turkey according to the Eurostat Nomenclature of Territorial Units for Statistics 1 classification and included 1,208 patients. Survey questionnaires including questions about demographic features and basic health status as well as about diagnosis and etiology of PD were put forth to the volunteers who agreed to participate in the study. Diagnosis of probable PD was established by evaluating the questionnaires. Patients with a diagnosis of congenital penile curvature were excluded from the group with PD. Chi-square test, Fisher's exact test, and Mann-Whitney U test were used. MAIN OUTCOME MEASURE The primary outcome analyzed in this article was the prevalence rate of PD in Turkey and the associated comorbidities. RESULTS The prevalence of PD was determined as 5.3%. The rates of participants with PD were found to be the highest in the 50-59 years group (27%) and in the North-East Region (20%). Compared with participants without PD, participants with PD were older (median: 52 interquartile range [41-64] vs 45 [37-55]; P < .001) and the rates of smokers (73% vs 60.9%; P = .036) and those having diabetes mellitus (17.5% vs 9.2%; P = .045), hypertension (14.3% vs 6.9%; P = .041), and heart failure were higher (7.9% vs 2.5%; P = .027). Male with PD symptoms preferred their partners on top during sexual intercourse (15.2% vs 34.1%; P < .001). This is the first study to evaluate premature ejaculation prevalence and related comorbidities with face-to-face interviews. CONCLUSION The prevalence of PD was 5.3% in Turkey. Besides advanced age, smoking, position of sexual intercourse, and presence of comorbidities especially diabetes mellitus, hypertension, and heart failure were the factors associated with PD prevalence. Kadioglu A, Dincer M, Salabas E, et al. A Population-Based Study of Peyronie's Disease in Turkey: Prevalence and Related Comorbidities. Sex Med 2020;8:679-685.
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Affiliation(s)
- Ates Kadioglu
- Department of Urology, Istanbul University, Istanbul School of Medicine.
| | - Murat Dincer
- Department of Urology, Bagcilar Training & Research Hospital
| | - Emre Salabas
- Department of Urology, Biruni University Hospital
| | | | - Hakan Akdere
- Department of Urology, Trakya University, School of Medicine
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Di Maida F, Cito G, Lambertini L, Valastro F, Morelli G, Mari A, Carini M, Minervini A, Cocci A. The Natural History of Peyronie's Disease. World J Mens Health 2020; 39:399-405. [PMID: 32648381 PMCID: PMC8255406 DOI: 10.5534/wjmh.200065] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 06/08/2020] [Accepted: 06/10/2020] [Indexed: 02/06/2023] Open
Abstract
Peyronie's disease (PD), a fibrotic disorder of the tunica albuginea fully described in 1793 by French physician Francois de la Peyronie, is characterized by pain, plaque formation, penile deformity, and ultimately sexual function decline. The epidemiological data on PD vary considerably across previous studies, with recent evidence reporting a prevalence of up to 9%. PD is generally divided into two different phases: active or acute and stable or chronic. Plaque formation generally occurs during the acute phase, while during chronic phase pain usually tends to complete resolution and penile deformity stabilizes. PD's pathophysiology is still subject of great discussion. Tunical mechanical stress and microvascular trauma are major contributory factors. However, better understanding of the molecular pathophysiology of this condition remains paramount towards an in-depth comprehension of the disorder and the development of newer and more effective disease-targeted interventions. In this review we provide a detailed overview of natural history of PD, specifically focusing on clinical manifestations and the underlying molecular regulation patterns.
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Affiliation(s)
- Fabrizio Di Maida
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Gianmartin Cito
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Luca Lambertini
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Francesca Valastro
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | | | - Andrea Mari
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Marco Carini
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Andrea Minervini
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Andrea Cocci
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy.
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Harvey N, Pearce I. At what cost is collagenase clostridium histolyticum viable for treating Peyronie's disease in a public healthcare system? Andrology 2020; 8:1304-1311. [DOI: 10.1111/andr.12830] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 05/19/2020] [Accepted: 05/21/2020] [Indexed: 01/30/2023]
Affiliation(s)
- Neil Harvey
- Urology Department Stepping Hill Hospital Stockport NHS Foundation Trust Poplar Grove UK
| | - Ian Pearce
- Urology Department Manchester Royal Infirmary Manchester University Hospitals Foundation Trust Manchester UK
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Segundo A, Glina S. Prevalence, Risk Factors, and Erectile Dysfunction Associated With Peyronie's Disease Among Men Seeking Urological Care. Sex Med 2020; 8:230-236. [PMID: 32007472 PMCID: PMC7261680 DOI: 10.1016/j.esxm.2019.11.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 10/27/2019] [Accepted: 11/03/2019] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION Peyronie's disease (PD) is a connective tissue disorder of the penis characterized by an abnormality in collagen structure of penile tunica albuginea. AIM We sought to investigate the prevalence, risk factors, and the relationship between erectile dysfunction (ED) and PD in male patients aged 30-80 years seeking urological care. METHODS This is a cross-sectional study using data collected from October 2016 to October 2017 in an outpatient clinic associated with the Brazilian Public Health System. All men aged 30 to 80 years were invited to participate. Data collected were related to the clinical history and sexual habits of patients using the International Index of Erectile Function, in addition to the physical examination of the penis and laboratory parameters. MAIN OUTCOME MEASURE Descriptive statistics and multivariate logistic regression models tested the prevalence, risk factors, and the relationship between ED and PD in male patients. RESULTS The study included 656 individuals, who were distributed as per age, marital status, race, educational level, and income. Of these participants, 86 (13.11%) presented with fibrous plaques compatible with PD at the physical examination. Among the risk factors evaluated, PD was associated with diabetes, smoking, and obesity in 43.02, 64.17, and 26.74% of patients, respectively. The presence of penile plaques compatible with PD was more prevalent in men with ED, history of penile trauma, and complaint of penile deformity. There was a higher prevalence of plaques in the distal penis. CONCLUSION The PD among the studied population was associated with risk factors such as diabetes, smoking, and obesity. Other clinical characteristics, such as history of penile trauma, penile deformity, and ED, were reported in patients with PD. There was a higher prevalence of plaques in the distal penis, specifically in the corona of the glans penis. The prevalence of PD was different from that in the published literature, our results show that numbers thus more studies are needed. Segundo A, Glina S. Prevalence, Risk Factors, and Erectile Dysfunction Associated With Peyronie's Disease Among Men Seeking Urological Care. Sex Med 2020;8:230-236.
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Affiliation(s)
- Antonio Segundo
- Department of Urology, Faculdade Medicina ABC, Santo André, Brazil.
| | - Sidney Glina
- Department of Urology, Faculdade Medicina ABC, Santo André, Brazil
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Moussa M, Abou Chakra M, Moussa Y. Advances in stem cell therapy for the treatment of Peyronie's disease. Intractable Rare Dis Res 2020; 9:10-13. [PMID: 32201669 PMCID: PMC7062597 DOI: 10.5582/irdr.2019.01130] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Peyronie's disease (PD) is a connective tissue disorder of the penis characterized by fibrosis and plaque formation within the tunica albuginea. PD is characterized by painful penile curvature that impairs sexual intercourse. Stem cell therapy is one of the recent non-invasive treatment options for patients with PD and it has promising results. Stem cells are undifferentiated cells that are capable of self-renewal and differentiation, promoting the repair of tissues via their immunomodulatory and anti-inflammatory action. Adipose-derived stem cells (ADSC) are used most widely due to their abundant tissue source and ease of isolation. Multiple studies have indicated the efficacy of stem cell therapy as a potential treatment for fibrotic diseases. Clearly, ADSCs may represent a way to treat and prevent PD in both rat and human models. Further clinical studies are needed to confirm the efficacy of stem cell therapy for PD in humans.
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Affiliation(s)
- Mohamad Moussa
- Department of Urology, Zahraa Hospital, University Medical Center, Lebanese University, Beirut, Lebanon
| | - Mohamad Abou Chakra
- Department of Urology, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
- Address correspondence to:Mohamad Abou Chakra, Department of Urology, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon. E-mail:
| | - Yasmin Moussa
- Clinic of Dermatology, Dr. Brinkmann, Schult & Samimi-Fard, Gladbeck, Germany
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Peyronie's Disease Intervention Studies: An Exploration of Modern-Era Challenges in Study Design and Evaluating Treatment Outcomes. J Sex Med 2020; 17:364-377. [PMID: 31932258 DOI: 10.1016/j.jsxm.2019.11.271] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 11/26/2019] [Accepted: 11/28/2019] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Peyronie's disease (PD) is characterized by pain, deformity, sexual dysfunction, and psychological bother. Several treatments are available with varying levels of efficacy, and significant limitations exist with the currently available literature. AIM To explore modern-era methodological challenges inherent to PD research as they pertain to intervention studies. METHODS We performed a critical review of the PD intervention literature to identify common methodological challenges with emphasis on aspects of patient assessment and treatment outcomes, study design, and statistical analysis. The key objective was to provide an impetus on which to build future research protocols, rather than focus on weaknesses with any individual studies. MAIN OUTCOME MEASURE Expert opinion was used to summarize limitations with commonly reported objective outcomes such as penile curvature, girth, and length along with imaging modalities and objective questionnaires. Appropriate study design and statistical analysis were also reviewed to discuss common pitfalls in the PD literature. RESULTS There are multiple shortcomings inherent to studying objective PD outcomes such as penile curvature, girth, and length. These include lack of standardized protocols for preintervention and postintervention assessment, interobserver and intraobserver variability, and lack of consistent definitions for what defines an objective outcome as clinically "meaningful" for patients. Similarly, imaging studies including penile ultrasound are subject to marked variation, thereby limiting their utility to measure predefined primary or secondary study outcomes including cavernosal artery hemodynamics and penile plaque size. Objective and validated questionnaires such as the Peyronie's Disease Questionnaire and International Index of Erectile Function require that patients have recently engaged in sexual activity, which is challenging for many patients as a result of penile deformity with PD. Finally, careful study design and statistical analysis (including appropriate study power) are imperative to ensure reliable results. Current shortcomings in the majority of studies contribute to the low level of evidence available for most PD interventions. CLINICAL IMPLICATIONS Future PD intervention studies should focus on optimizing study design and statistical analysis. Furthermore, authors must incorporate standardized protocols for assessing preintervention and postintervention outcomes. STRENGTH & LIMITATIONS The current analysis and recommendations for future study are based on the expertise and opinion of the manuscript authors. CONCLUSION Multiple areas of weakness in study design, statistical analysis, and patient outcomes assessment limit the reliability of data derived from PD intervention studies in the modern era. The global themes identified herein should serve as a basis upon which to build future research protocols. Ziegelmann MJ, Trost LW, Russo GI, et al. Peyronie's Disease Intervention Studies: An Exploration of Modern-Era Challenges in Study Design and Evaluating Treatment Outcomes. J Sex Med 2020;17:364-377.
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Osman MM, El-Khatib FM, Roberts NH, Huynh LM, Yafi FA. The Gut Microbiome and Men’s Sexual Health. CURRENT SEXUAL HEALTH REPORTS 2019. [DOI: 10.1007/s11930-019-00230-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Sharma KL, Alom M, Trost L. The Etiology of Peyronie's Disease: Pathogenesis and Genetic Contributions. Sex Med Rev 2019; 8:314-323. [PMID: 31540807 DOI: 10.1016/j.sxmr.2019.06.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 06/06/2019] [Accepted: 06/11/2019] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Peyronie's disease (PD) is a chronic fibrosing condition that contributes to penile deformity, curvature, and pain. Initial familial studies demonstrated potential genetic links to PD. Since that time, very few investigations have significantly advanced the science in this area. Hence, there is a large opportunity and significant need to better study the underlying genomics and pathogenesis of PD. AIM To summarize the current genomic literature relevant to PD. METHODS A review was performed of all PubMed-indexed literature from 1970-2018 relating to the pathophysiology and genetics of PD. Key findings were categorically summarized to include epidemiology, risk factors, inheritance patterns, chromosomal instability, genetic associations, epigenetics, differential gene expression, and preclinical models of PD. MAIN OUTCOME MEASURES Summary of the current literature on the genetics of PD. RESULTS PD is a common condition and has several known risk factors and comorbid disease associations. Although men with PD are believed to be genetically predisposed, there are likely several subtypes of the condition, each with varied pathophysiological disorders and contributing factors. Available data suggest that PD is associated with underlying genetic instability, including dysregulation of genes relating to fibrosis and cellular degradation, thus, resulting in abnormal plaque development and penile deformity. Preclinical models, including cell cultures and rat models, demonstrate several consistencies with PD clinical and histopathologic characteristics; however, an ideal model with spontaneous development of PD is lacking. CONCLUSION Based on limited data, PD likely represents a heterogeneous condition, with both heritable and environmentally-driven epigenetic factors contributing to its development and progression. However, there remains a significant gap in the literature on the underlying cause and pathophysiology of the condition, suggesting a substantial need for further investigation and study. Sharma KL, Alom M, Trost L. The Etiology of Peyronie's Disease: Pathogenesis and Genetic Contributions. Sex Med Rev 2020;8:314-323.
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Mulhall JP, Matsushita K, Nelson CJ. Testosterone Levels Are Not Associated With Magnitude of Deformity in Men With Peyronie's Disease. J Sex Med 2019; 16:1283-1289. [PMID: 31303573 DOI: 10.1016/j.jsxm.2019.05.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 05/20/2019] [Accepted: 05/29/2019] [Indexed: 01/02/2023]
Abstract
INTRODUCTION There are some data suggesting that there is a relationship between the magnitude of Peyronie's disease (PD)-associated penile curvature and low serum testosterone. AIM To evaluate the relationship between PD associated penile deformity and total testosterone (TT) and free testosterone (FT) levels. METHODS We identified patients diagnosed with PD who had early morning TT measurements. Because laboratories have different reference values, we analyzed testosterone values 2 ways, as raw values and as standardized values (TT and FT values converted into z-scores for each laboratory). Deformity assessment was conducted during an intracavernosal injection-induced rigid erection. The association between T levels and magnitude of penile curvature was analyzed in a number of ways. First, an independent measure t-test tested differences in curvature degree by TT groups (low T: <300 ng/dL; normal T: ≥300 ng/dL). Second, an association was sought between T levels based on quartiles of the normal range (<300, 300-450, 450-600, and >600 ng/dL). These analyses were conducted for both TT and FT levels and using both raw and standardized T values. Third, multivariable analysis using multiple linear regression was performed in an attempt to define predictors of the degree of penile curvature. Factors entered into the model included: TT level, FT level, patient age, race (white vs other), number of co-morbidities, body mass index, presence of erectile dysfunction, duration of PD, and prostatectomy (yes vs no). MAIN OUTCOME MEASURES The relationship between T levels and the magnitude of penile curvature. RESULTS 184 subjects met all study criteria. Average age was 54 ± 12 years. Mean TT level was 425 ± 176 ng/dL, and mean curvature magnitude was 35° ± 19°. The percent of subjects in the first through fourth TT quartiles was 26%, 34%, 24%, and 16%. As a continuous variable, there was no association between TT levels (r = -0.01, P = .95) or FT levels (r = -0.08, P = .30) and the curvature magnitude. When examining TT groups, there was no difference in mean curvature between the low TT group and the normal TT group (35.4° ± 17° vs 34° ± 20°, P = .70). When analyzing the TT and FT levels standardized into z-scores, there was no association between degree of curvature and TT z-scores (r = -0.003, P = .95) and FT z-scores (r = -0.08, P = .43). There was also no association between testosterone levels and degree of curvature in the multivariable model. CONCLUSIONS There does not appear to be any association between testosterone levels and the magnitude of PD-associated penile deformity. Mulhall JP, Matsushita K, Nelson CJ. Testosterone Levels Are Not Associated With Magnitude of Deformity in Men With Peyronie's Disease. J Sex Med 2019;16:1283-1289.
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Affiliation(s)
- John P Mulhall
- Sexual & Reproductive Medicine Program, Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
| | - Kazuhito Matsushita
- Sexual & Reproductive Medicine Program, Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA; Department of Urology, Juntendo University, Graduate School of Medicine, Tokyo, Japan
| | - Christian J Nelson
- Departments of Psychiatry/Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
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Habous M, Malkawi I, Han E, Farag M, Muir G, Abdelwahab O, Nassar M, Mahmoud S, Santucci R, Binsaleh S. Peyronie's Disease is common in poorly controlled diabetics but is not associated with the Metabolic Syndrome. Urol Ann 2019; 11:252-256. [PMID: 31413501 PMCID: PMC6676820 DOI: 10.4103/ua.ua_164_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Purpose: The purpose of the study is to investigate if metabolic syndrome (MS) and other comorbidities are associated with Peyronie's disease (PD). Methods: A total of 1833 patients retrospectively investigated and divided into two groups: Group A – PD patients (n = 319) and Group B – non-PD patients (n = 1303). The two groups were fully evaluated for diabetes mellitus (DM) with the glycated hemoglobin (HbA1c), hypertension (HTN), dyslipidemia (DL), obesity by measuring body mass index, total testosterone (T), penile vascular circulation measuring Peak systolic velocity (PSV) as indicator of arterial supply, end-diastolic velocity (EDV) as indicator of venous output, and finally, smoking. Results: The presence of diabetes was significantly correlated with PD (P = 0.005). Patients with diabetes had a 7% higher incidence of PD. However, patients with the highest HbA1c level of >8.5 had an increased odds ratio of 1.6 (P = 0.025, confidence interval [CI] =1.061–2.459) of having PD. Increased age was significantly correlated with PD (P = 0.025). For each year of life, the likelihood of having PD increases by an odds ratio of 1.019, or 2% per year (P = 0.001, CI = 1.004–1.027). Unexpectedly, DL (P = 0.006) and smoking (P = 0.041) were associated with lower incidences of PD. Patients with DL or smoking had a 5%–7% lower incidence of PD with an odds ratio of 0.6 (P = 0.006, CI = 0.410–0.864). HTN (P = 0.621) and the total number of comorbidities (P = 0.436) were not correlated with PD. Mean serum T values were statistically (P = 0.43) but not clinically significant among patients with Peyronie's versus patients without Peyronie's (4.62 vs. 4.38 ng/ml). Neither low PSV (Fisher's exact test P = 0.912) nor abnormal EDV (Fisher's exact test P = 0.775) was correlated with the finding of PD. Conclusions: While MS was not associated with PD, diabetes, particularly poorly controlled diabetes, was associated with an increased rate. Further research into the interaction of PD and metabolic disease is warranted.
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Affiliation(s)
- Mohamad Habous
- Department of Urology and Andrology, Elaj Medical Centers, Jeddah, Saudi Arabia
| | - Ibraheem Malkawi
- Detroit Medical Center, Michigan State University, East Lansing, Michigan, USA
| | - Esther Han
- Detroit Medical Center, Michigan State University, East Lansing, Michigan, USA
| | - Mohammed Farag
- Department of Urology, Al-Azhar Faculty of Medicine, Assiut, Egypt
| | - Gordon Muir
- Department of Urology, King's College, London, UK
| | | | - Mohammed Nassar
- Department of Urology and Andrology, Elaj Medical Centers, Jeddah, Saudi Arabia
| | - Saad Mahmoud
- Department of Urology and Andrology, Elaj Medical Centers, Jeddah, Saudi Arabia
| | - Richard Santucci
- Detroit Medical Center, Michigan State University, East Lansing, Michigan, USA
| | - Saleh Binsaleh
- Division of Urology, Department of Surgery, Faculty of Medicine, King Saud University, Riyadh, Saudi Arabia
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Sun AJ, Li S, Eisenberg ML. The Impact of Clostridium Histolyticum Collagenase on the Prevalence and Management of Peyronie's Disease in the United States. World J Mens Health 2018; 37:234-239. [PMID: 30588781 PMCID: PMC6479092 DOI: 10.5534/wjmh.180073] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 09/09/2018] [Accepted: 09/21/2018] [Indexed: 01/17/2023] Open
Abstract
Purpose We evaluated the impact of collagenase clostridium histolyticum (CCH) on rates of diagnosis, treatment, and corporal rupture in Peyronie's disease (PD). We examined the impact of CCH on cost of PD treatment. Materials and Methods We extracted data on PD diagnosis (ICD-9 607.95 and ICD-10 N48.6), corporal rupture (ICD-9 959.13 and ICD-10 S39.840A), CCH use (J0775), penile injections (CPT 54200), and corporal rupture repair from 2008 to 2016 in men over 40 years old using the Clinformatics® Data Mart Database (3.7 to 4.9 million males). We analyzed for prevalence of PD, rates of PD treatments, cost associated with treatment, and rates of corporal rupture and repair by year. Results The prevalence of PD was 0.29% in 2013 and did not increase after CCH entered the market in 2014. An average of 2.52% of men with PD received treatment before CCH, compared with 3.75% after (p<0.0001). Penile injection rates increased (1.34% vs. 2.61%, p<0.0001), while rates of surgical treatments decreased between these periods. There was no change in rate of corporal rupture in men with PD before (0.024%) and after (0.024%) CCH. Overall, only 20.0% of corporal ruptures were repaired. After CCH entered practice, a significant increase in cost occurred (p=0.013). Conclusions The prevalence of men with PD did not change after CCH. However, more men with PD received treatment due to an increase in penile injections. The cost of treating PD increased after CCH became available. The overall prevalence of corporal rupture did not change after CCH entered the market.
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Affiliation(s)
- Andrew J Sun
- Department of Urology, Stanford University, Stanford, CA, USA
| | - Shufeng Li
- Department of Urology, Stanford University, Stanford, CA, USA
| | - Michael L Eisenberg
- Department of Urology, Stanford University, Stanford, CA, USA.,Department of Obstetrics and Gynecology, Stanford University, Stanford, CA, USA.
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Morgado A, Morgado MR, Tomada N. Penile lengthening with porcine small intestinal submucosa grafting in Peyronie's disease treatment: long-term surgical outcomes, patients’ satisfaction and dissatisfaction predictors. Andrology 2018; 6:909-915. [DOI: 10.1111/andr.12522] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 06/11/2018] [Accepted: 06/12/2018] [Indexed: 12/25/2022]
Affiliation(s)
- A. Morgado
- Serviço de Urologia; Centro Hospitalar São João; Porto Portugal
- Faculdade de Medicina da Universidade do Porto; Porto Portugal
| | - M. R. Morgado
- Faculdade de Medicina da Universidade do Porto; Porto Portugal
| | - N. Tomada
- Nuno Tomada Urologia e Cirurgia Reconstrutiva; Porto Portugal
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The relationship between penile deformity, age, psychological bother, and erectile dysfunction in a sample of men with Peyronie's Disease (PD). Int J Impot Res 2018; 30:171-178. [PMID: 29795530 DOI: 10.1038/s41443-018-0029-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 02/13/2018] [Accepted: 02/20/2018] [Indexed: 01/19/2023]
Abstract
The aim of the present study was to investigate which PD specific factors (e.g., degree of penile curvature, levels of pain) cause most distress and to further explore whether there are specific subgroups of patients that report particularly high levels of psychological distress. Data were available for N = 119 men with a clinical diagnosis of PD presenting at a private Uro-Andrology in Germany. The strongest complaint of men with PD was being bothered by the look of the penis as opposed to being distressed by the pain (3.48 vs. 2.11). 75.4% reported having significantly less intercourse due to PD and for 61.4% this was very bothersome. Plaque size correlated positively with the level of symptom bother (r = 0.73, p < 0.05). Furthermore, men with a stronger curvature reported more concerns regarding size and form of the penis (r = 0.18, p < 0.05), more overall sexual dissatisfaction (r = -0.38, p < 0.001), and more PD related psychological and physiological symptoms (r = 0.58, p < 0.001). 44.4% of patients had a concurrent ED. Highest level of symptom bother was reported by men with a a strong curvature and a comorbid ED. Clinicians should pay special attention to patients presenting with extreme penile deformity and impaired sexual functioning, as they show the highest levels of psychological distress. Here, additional psychosexual support might be necessary.
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Gabrielson AT, Alzweri LM, Hellstrom WJ. Collagenase Clostridium Histolyticum in the Treatment of Peyronie's Disease: Review of a Minimally Invasive Treatment Option. World J Mens Health 2017; 35:134-145. [PMID: 28879693 PMCID: PMC5746484 DOI: 10.5534/wjmh.17033] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 09/01/2017] [Indexed: 12/23/2022] Open
Abstract
Peyronie's disease (PD) is an inflammatory disorder characterized by an abnormal collagen deposition in the tunica albuginea of the penis, leading to fibrous and non-compliant plaques that can impede normal erection. Although pharmacological treatments are available, only intralesional injection therapy and surgical reconstruction have demonstrated tangible clinical efficacy in the management of this condition. Intralesional injection of collagenase clostridium histolyticum (CCH) has come to the forefront of minimally invasive treatment of PD. In this review, the authors provide an update on the safety, efficacy, and indications for CCH. The efficacy of CCH will be assessed on the basis of improvement in the severity of penile fibrosis, curvature, and pain. Numerous well-designed clinical trials and post-approval studies involving more than 1,500 patients have consistently demonstrated the efficacy and tolerability of CCH in the treatment of PD. CCH significantly decreases penile curvature and plaque consistency, as well as improves quality of life. Post-approval studies continue to demonstrate the efficacy of CCH despite broader inclusion criteria for treatment, such as the case with acute phase disease and atypical plaque deformities (i.e., ventral plaques, hourglass narrowing). CCH continues to be the gold standard for non-surgical management of stable phase PD, in the absence of strong evidence supporting oral therapy agents and ongoing evaluation of extracorporeal shockwave therapy. However, recent studies are beginning to provide precedent for the use of CCH in the management of acute phase and atypical PD.
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Affiliation(s)
- Andrew T Gabrielson
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Laith M Alzweri
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Wayne Jg Hellstrom
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA.
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Factors Associated With Erectile Dysfunction and the Peyronie's Disease Questionnaire in Patients With Peyronie Disease. Urology 2017; 107:155-160. [DOI: 10.1016/j.urology.2017.05.029] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 05/10/2017] [Accepted: 05/16/2017] [Indexed: 12/31/2022]
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Prevalence of Peyronie's Disease-Like Symptoms in Men Presenting With Dupuytren Contractures. Sex Med 2017; 5:e135-e141. [PMID: 28676223 PMCID: PMC5562496 DOI: 10.1016/j.esxm.2017.06.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Revised: 05/09/2017] [Accepted: 06/04/2017] [Indexed: 11/24/2022] Open
Abstract
Introduction Peyronie's disease (PD) and Dupuytren contractures (DC) are often comorbid and are believed to have a similar underlying pathophysiologic mechanism. Aim To investigate the prevalence of PD-like symptoms (PDLS) in men with DC. Methods From October 2013 to December 2016, men who were seen and evaluated for DC were offered the opportunity to participate in an anonymous survey. The survey assessed several basic demographic and sexual health factors and included items from the International Index of Erectile Function and the Erection Hardness Scale. Men who reported PDLS were asked a series of questions derived from the Peyronie's Disease Questionnaire and for their opinions on theoretical treatment modalities for sexual problems and penile deformity. Main Outcome Measure Prevalence of PDLS in men with DC. Results One hundred forty men with DC were invited to participate; 85 surveys were returned (response rate = 61%). Twenty-two respondents (26%, 95% confidence interval = 17–35) reported PDLS. Approximately one fourth of all respondents had an Erection Hardness Scale score lower than 3. The most common specific PDLS concerns were penile curvature (91%), length loss (55%), narrowing (36%), and hinging (32%). In men with PDLS, 73% felt at least a little bothered by the symptoms when attempting sexual activity and 40% reported having sex less frequently because of the symptoms. Just 27% of men with PDLS had ever used a treatment for a sexual concern. In terms of treatments for penile deformities, 64% of men with PDLS expressed an interest in treatment administered in the form of an in-office procedure; 41% were potentially amenable to a surgical procedure. Conclusion The prevalence of PDLS in men with DC is similar to the prevalence of DC in men diagnosed with PD. A substantial number of these men have distress and would consider standard-of-care treatments for PD. Shindel AW, Sweet G, Thieu W, et al. Prevalence of Peyronie's Disease-Like Symptoms in Men Presenting With Dupuytren Contractures. Sex Med 2017;5:e135–e141.
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Chung E, Ralph D, Kagioglu A, Garaffa G, Shamsodini A, Bivalacqua T, Glina S, Hakim L, Sadeghi-Nejad H, Broderick G. Evidence-Based Management Guidelines on Peyronie's Disease. J Sex Med 2017; 13:905-23. [PMID: 27215686 DOI: 10.1016/j.jsxm.2016.04.062] [Citation(s) in RCA: 134] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Revised: 03/19/2016] [Accepted: 03/27/2016] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Despite recent advances in our knowledge and treatment strategies in Peyronie's Disease (PD), much remained unknown about this disease. AIM To provide a clinical framework and key guideline statements to assist clinicians in an evidence-based management of PD. METHODS A systematic literature search was conducted to identify published literature relevant to PD. The search included all relevant articles published up to June 2015, including preclinical studies and published guidelines. References used in the text were assessed according to their level of evidence, and guideline recommendations were graded based on the Oxford Centre for Evidence-Based Medicine Levels of Evidence. Owing to the paucity of larger series and randomized placebo-controlled trials with regard to surgical intervention, guideline statements are provided as clinical principle or expert opinion. MAIN OUTCOME MEASURES This literature was discussed at a panel meeting, and selected articles with the highest evidence available were used to create consensus guideline statements for the Fourth International Consultation on Sexual Medicine guidelines on PD. RESULTS In addition to existing Third International Consultation on Sexual Medicine guidelines on PD, seven new summary recommendations were created. CONCLUSION A greater understanding of the scientific basis of PD is greatly needed to address our understanding of the pathophysiology, clinical epidemiology, psychosocial, and diagnostic assessment as well as treatment strategies.
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Affiliation(s)
- Eric Chung
- Department of Urology, University of Queensland, Princess Alexandra Hospital, Brisbane, QLD, Australia; AndroUrology Centre, St. Andrew's War Memorial Hospital, Brisbane, QLD, Australia.
| | - David Ralph
- Institute of Urology, University College London Hospital, London, UK
| | - Ates Kagioglu
- Department of Urology, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Guilio Garaffa
- Institute of Urology, University College London Hospital, London, UK
| | | | - Trinity Bivalacqua
- James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Sidney Glina
- Instituto H. Ellis and Department of Urology, Ipiranga Hospital, Sao Paulo, Brazil
| | - Lawrence Hakim
- Department of Urology, Cleveland Clinic Florida, Weston, FL, USA
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Abstract
INTRODUCTION Peyronie's disease (PD) is a fibrotic diathesis of the tunica albuginea that results in penile plaque formation and penile deformity, negatively affecting sexual and psychosocial function of both patients and their partners. In this review, we discuss the PD literature and PD treatment options, with special emphasis on potential future therapies. METHODS The PD literature was reviewed, and articles of interest were identified using keyword search in PubMed. Articles evaluating investigational and novel PD treatments were emphasized. RESULTS Existing PD treatment modalities are diverse and include oral, topical, intralesional, mechanical, and surgical therapies. Surgical treatment has high success rates and is indicated in men with significant, stable deformity. The United States Food and Drug Administration-approved intralesional collagenase Clostridium histolyticum injection therapy is a minimally invasive option with demonstrated efficacy in PD. Other nonsurgical therapies have been reported, including Botox and stem cell therapy, but these currently have little or equivocal evidence to support their efficacy. CONCLUSIONS Further research is essential to develop novel, safe, and effective minimally invasive PD treatment options. This work is ongoing, with the promise of specific, targeted, and highly effective therapies on the horizon.
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Affiliation(s)
- Aylin N Bilgutay
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA
| | - Alexander W Pastuszak
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA; Center for Reproductive Medicine, Baylor College of Medicine, Houston, TX, USA
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Stuntz M, Perlaky A, des Vignes F, Kyriakides T, Glass D. The Prevalence of Peyronie's Disease in the United States: A Population-Based Study. PLoS One 2016; 11:e0150157. [PMID: 26907743 PMCID: PMC4764365 DOI: 10.1371/journal.pone.0150157] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 02/10/2016] [Indexed: 11/22/2022] Open
Abstract
Peyronie's disease (PD) is a connective tissue disorder which can result in penile deformity. The prevalence of diagnosed PD in the United States (US) has been estimated to be 0.5% in adult males, but there is limited additional information comparing definitive and probable PD cases. We conducted a population-based survey to assess PD prevalence using a convenience-sample of adult men participating in the ResearchNow general population panel. Respondents were categorized according to PD status (definitive, probable, no PD) and segmented by US geographic region, education, and income levels. Of the 7,711 respondents, 57 (0.7%) had definitive PD while 850 (11.0%) had probable PD. Using univariate logistic regression modeling, older age (18-24 vs 24+) (OR = 0.721; 95% CI = 0.570,0.913), Midwest/Northeast/West geographic region (South vs Midwest/Northeast/West) (OR = 0.747; 95% CI = 0.646,0.864), and higher income level (<25K vs 25K+) (OR = 0.820; 95% CI = 0.673,0.997) were each significantly associated with reduced odds of having a definitive/probable PD diagnosis compared with no PD diagnosis. When all three variables were entered in a stepwise multivariable logistic regression, only age (OR = 0.642; 95% CI = 0.497, 0.828) and region (OR = 0.752; 95% CI = 0.647, 0.872) remained significant. This study is the first to report PD prevalence by geographic region and income, and it advocates that the prevalence of PD in the US may be higher than previously cited. Further, given the large discrepancy between definitive PD cases diagnosed by a physician and probable cases not diagnosed by a physician, much more needs to be done to raise awareness of this disease.
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Affiliation(s)
- Mark Stuntz
- Deerfield Institute, New York, New York, United States of America
| | - Anna Perlaky
- Deerfield Institute, New York, New York, United States of America
| | - Franka des Vignes
- Formerly at Deerfield Institute, New York, New York, United States of America
| | - Tassos Kyriakides
- Yale Center for Analytical Services, Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Dan Glass
- Deerfield Institute, New York, New York, United States of America
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Hellstrom WJG, Feldman RA, Coyne KS, Kaufman GJ, Smith TM, Tursi JP, Rosen RC. Self-report and Clinical Response to Peyronie's Disease Treatment: Peyronie's Disease Questionnaire Results From 2 Large Double-Blind, Randomized, Placebo-Controlled Phase 3 Studies. Urology 2015. [PMID: 26199168 DOI: 10.1016/j.urology.2015.04.047] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To evaluate the clinical usefulness of the Peyronie's Disease Questionnaire (PDQ). The relationship between subject-reported changes in PDQ psychosexual symptoms and clinical response to Peyronie's disease (PD) treatment was examined. MATERIALS AND METHODS Combined data from the collagenase Clostridium histolyticum phase 3 study program, IMPRESS (Investigation for Maximal Peyronie's Reduction Efficacy and Safety Studies) I and II, were examined. Changes in the PDQ PD symptom bother, psychological and physical symptoms, and penile pain were examined relative to changes in the penile curvature deformity, including penile curvature absolute mean and percent change. PDQ changes relative to sexual function, including International Index of Erectile Function overall satisfaction and erectile function domains, and treatment responder status, including global assessment of PD and composite responder status, were also assessed. Individual PDQ questions were examined to provide a clinical perspective on the change in psychosexual symptoms experienced by men with PD during treatment. RESULTS Improvement in PDQ PD symptom bother and psychological and physical symptoms was significantly correlated with clinical improvement in penile curvature deformity (P ≤.0008) and sexual function (P <.0001). Significant differences in PD symptom bother and psychological and physical symptoms improvement were found between treatment responders vs nonresponders (P <.02). PDQ penile pain improvement among subjects reporting baseline pain ≥4 was significantly correlated with clinical improvement in sexual function (P ≤.0004) and was found to be greater in treatment responders vs nonresponders (P = .003). CONCLUSION The utility of the PDQ for monitoring PD-specific psychosexual symptom severity, progression, and treatment response, both clinically and in trials of men with PD, was supported.
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Affiliation(s)
- Wayne J G Hellstrom
- Department of Urology, Tulane University Health Sciences Center, New Orleans, LA.
| | - Robert A Feldman
- Connecticut Clinical Research Center and Urology Specialists, Middlebury, CT
| | | | | | - Ted M Smith
- Auxilium Pharmaceuticals, Inc., Chesterbrook, PA
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Dell’Atti L. Tadalafil once daily and intralesional verapamil injection: A new therapeutic direction in Peyronie's disease. Urol Ann 2015; 7:345-9. [PMID: 26229323 PMCID: PMC4518372 DOI: 10.4103/0974-7796.152048] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 06/24/2014] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION The aim of this study was to evaluate the combination of intralesional verapamil injection (IVI) therapy with and tadalafil in men affected by Peyronie's disease (PD). MATERIALS AND METHODS In this study, 59 patients diagnosed with PD, were divided into three groups. Group A (GA) counted 23 patients treated with IVI; Group B (GB) treated 19 patients with tadalafil 5 mg once a day, and Group C (GC) treated 17 patients with IVI and tadalafil for 3 months. There were assessed at baseline and follow-up: Erectile function, presence and severity of painful erections, penile plaque size and penile curvature degree. RESULTS After 3 months pain resolved completely in 57% cases of GA, 61% of GB and 76% of GC; the final mean curvature degree further decreased in all groups without statistically significant differences; mean plaque size remained stable in GA: 1.57 versus 1.59 at baseline (P = 0.364) and GB: 1.51 versus 1.52 at baseline (P = 0,265), while a further decrease was evident in GC: 1.46 versus 1.58 at baseline (P = 0.03). Mean International Index of Erectile Function-5 score further improved significantly in the group treated with verapamil plus tadalafil: 23.1 versus 14.4 of GA and 18.2 of GB (P ≤ 0.01). CONCLUSIONS The association of IVI and tadalafil showed better pain control while reducing penile curvature and erectile function, improving the quality of life.
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Affiliation(s)
- Lucio Dell’Atti
- Department of Urology, University Hospital S. Anna, Ferrara, Italy
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Bilgutay AN, Pastuszak AW. PEYRONIE'S DISEASE: A REVIEW OF ETIOLOGY, DIAGNOSIS, AND MANAGEMENT. CURRENT SEXUAL HEALTH REPORTS 2015; 7:117-131. [PMID: 26279643 DOI: 10.1007/s11930-015-0045-y] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Peyronie's Disease (PD) is a superficial fibrosing disorder of the penis resulting in plaque formation and penile deformity. Once considered rare, PD has more recently been found in up to 13% of men, and can negatively affect sexual and psychosocial function of both patients and their partners. While the etiology of PD is unclear, it is thought to result from an inciting traumatic event followed by aberrant fibrosis or dysregulated wound healing. The evaluation of men presenting with PD includes a detailed history and physical exam, focusing on the penis in both the flaccid and erect states. PD is often associated with erectile dysfunction (ED), as well as several other comorbidities. Laboratory testing is not needed to diagnose PD, although given the associations between PD and systemic diseases including hypogonadism, diabetes, and cardiovascular disease, screening and work-up for these conditions in men with PD may be warranted. Treatment modalities for PD are diverse and include oral, topical, intralesional, mechanical, and surgical therapies. Oral, topical, and mechanical therapies generally have little evidence supporting their efficacy. Several intralesional therapies, including interferon α2b and collagenase Clostridium hystiolyticum have demonstrated efficacy in the treatment of PD. Surgical treatment, indicated in men with significant, stable deformity, includes plication of the tunica albuginea, plaque incision/excision and grafting, and placement of inflatable penile prosthesis (IPP) with or without additional maneuvers to achieve desired results, and has high success rates.
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Affiliation(s)
- Aylin N Bilgutay
- Scott Department of Urology, Baylor College of Medicine, Houston, TX
| | - Alexander W Pastuszak
- Scott Department of Urology, Baylor College of Medicine, Houston, TX ; Center for Reproductive Medicine, Baylor College of Medicine, Houston, TX
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Goldstein I, Hartzell R, Shabsigh R. The Impact of Peyronie's Disease on the Patient: Gaps in Our Current Understanding. JOURNAL OF SEX & MARITAL THERAPY 2015; 42:178-190. [PMID: 25405853 DOI: 10.1080/0092623x.2014.985351] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Peyronie's disease results in a fibrous inelastic scar or hard plaque of the tunica albuginea of the penis that causes penile curvature deformity during erection that can be painful, distressing, and an impediment to sexual intercourse. In this article, the authors examine the knowledge gaps and research needs regarding the effect of Peyronie's disease on the patient's physical and psychological quality of life and on interpersonal relationships. On PubMed, the authors used the search terms Peyronie's disease, psychological, psychotherapy, male sexual dysfunction, partner, comorbid disease, satisfaction, and pain. Four categories describing the effect of Peyronie's disease were identified: (a) sexual dysfunction due to pain and altered penile shape, (b) psychological effects, (c) partner and relationship effects, and (d) effects of treatment options for Peyronie's disease. Results indicate that the examination of interventions aimed at education, coping, relationship distress, and sex therapy that may significantly improve patient quality of life is a core unmet need in Peyronie's disease. For many patients, the effect of Peyronie's disease is functional and psychological. Both aspects should be evaluated and treated in patients, which may require a referral. The physical pain, emotional distress and isolation, and partner and relationship discord that may be present require more attention.
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Affiliation(s)
- Irwin Goldstein
- a San Diego Sexual Medicine , Alvarado Hospital , San Diego , California , USA
| | - Rose Hartzell
- a San Diego Sexual Medicine , Alvarado Hospital , San Diego , California , USA
| | - Ridwan Shabsigh
- b Department of Surgery , St. Barnabas Hospital , Bronx , New York , USA
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Kirby EW, Verges D, Matthews J, Carson CC, Coward RM. Low testosterone has a similar prevalence among men with sexual dysfunction due to either Peyronie's disease or erectile dysfunction and does not correlate with Peyronie's disease severity. J Sex Med 2015; 12:690-6. [PMID: 25580982 DOI: 10.1111/jsm.12805] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Low testosterone (T) has been suggested as a risk factor for Peyronie's disease (PD) that may correlate with disease severity. Low T is common in men with sexual dysfunction but its role in the pathogenesis of PD remains unclear. AIM The aim of this study was to compare the prevalence of low T (<300 ng/dL) in patients presenting with PD or erectile dysfunction (ED), as well as disease severity between men with PD and either low T or normal T (≥300 ng/dL). METHODS Retrospective review of 300 men with either PD or ED was conducted. Men were excluded for combined PD and ED, psychogenic ED, or prior T use. For men with PD, plaque size, degree of curvature, and surgical correction rate were compared. MAIN OUTCOME MEASURES The main outcome measures were (i) mean T levels in men with PD or ED and (ii) plaque size, degree of curvature, and surgical correction rates among men with PD and either low T or normal T. RESULTS Eighty-seven men with PD and 98 men with ED were identified. Men with PD had mean total T and free T of 328 ng/dL and 11.5 ng/dL, while men with ED had mean levels of 332 ng/dL and 12.1 ng/dL, respectively (P > 0.05). Of PD men, 52.9% had low T, compared with 45.9% of men with ED (P = 0.35). T levels did not correlate with plaque size or degree of curvature in the PD group (P > 0.05). CONCLUSIONS Men with sexual dysfunction characterized by either PD or ED had similarly low T levels, and low T did not correlate with PD severity or surgical correction rate. The comparable prevalence of low T in men with PD or ED suggests the high rate of low T in PD men may be related to a common process among men with abnormal erectile physiology and not specifically causative in plaque formation.
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Affiliation(s)
- E Will Kirby
- Department of Urology, University of North Carolina, Chapel Hill, NC, USA
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Hartzell R. Psychosexual Symptoms and Treatment of Peyronie's Disease Within a Collaborative Care Model. Sex Med 2014; 2:168-77. [PMID: 25548648 PMCID: PMC4272248 DOI: 10.1002/sm2.45] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Peyronie's disease (PD) can be emotionally and sexually debilitating for patients and may negatively impact partner relationships. AIMS This study aims to present an ongoing collaborative care model for patients with PD and to discuss the critical need for integration of patient care among sexual medicine physicians and mental health practitioners or sex therapists. METHODS PubMed searches using the terms "Peyronie's disease" and "natural history," "treatment," "psychosexual," "depression," "relationship," and "partner" were conducted. Expert opinion based on review of the relevant published literature and clinical experience was used to identify meaningful treatment targets for patients with PD within a collaborative care model. MAIN OUTCOME MEASURE Characteristics of PD, medical treatment, and important assessment and treatment targets, including physical, emotional, psychosexual, and relationship concerns, from peer-reviewed published literature and clinical experience. RESULTS PD can result in significant patient and partner distress and relationship disruption. Sex therapy interventions may be directed at acute emotional, psychosexual, and relationship problems that occur during the initial diagnosis of PD, the period following minimally invasive or surgical treatment for PD, or recurring problems over the lifelong course of the disease. Sex therapy to improve self-acceptance, learn new forms of sexual intimacy, and improve communication with partners provides comprehensive treatment targeting emotional, psychosexual, and relationship distress. Ongoing communication between the mental health practitioner and physician working with the patient with PD about key assessments, treatment targets, and treatment responses is necessary for coordinated treatment planning and patient care. CONCLUSIONS Men with PD are more likely now than in the past to see both a sexual medicine physician and a mental health practitioner or sex therapist, and the integration of assessments and treatment planning is essential for optimal patient outcomes.
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Salem EA, Elkady EH, Sakr A, Maarouf AM, Bendary L, Khalil S, Shahin A, Kamel H. Lingual Mucosal Graft in Treatment of Peyronie Disease. Urology 2014; 84:1374-7. [DOI: 10.1016/j.urology.2014.07.042] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Revised: 07/11/2014] [Accepted: 07/24/2014] [Indexed: 11/27/2022]
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Marchalik D, Wright H, Hill F, Vora A. Use of intralesional collagenase in the treatment of peyronie’s disease: A review. World J Clin Urol 2014; 3:364-369. [DOI: 10.5410/wjcu.v3.i3.364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2014] [Revised: 06/16/2014] [Accepted: 07/15/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To review the relevant literature in an effort to examine the body of evidence available to date.
METHODS: Ovid MEDLINE search database was queried using MeSH terms “penile induration”, “peyronie’s disease”, “Collagenases” and “Collagenase” using various permutations. No temporal parameters were employed.
RESULTS: In all, 5 relevant clinical trials were isolated from 34 results. These trials were analyzed using the Oxford Centre for Evidence-Based Medicine criteria. They were further examined based on study design and methods; the primary and secondary outcomes were reviewed for treatment efficacy and collagenase-related side effects.
CONCLUSION: Intralesional collagenase appears to be safe and effective in the non-surgical treatment of Peyronie’s disease. However, the data remains limited and further inquiries into the safety of collagenase, treatment standardization and standardized outcomes reporting remain necessary. Furthermore, studies comparing intralesional collagenase to alternative medical and surgical therapy will be important in guiding the future treatment decision process.
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Jordan GH, Carson CC, Lipshultz LI. Minimally invasive treatment of Peyronie's disease: evidence-based progress. BJU Int 2014; 114:16-24. [DOI: 10.1111/bju.12634] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Gerald H. Jordan
- Department of Urology; Eastern Virginia Medical School; Norfolk VA USA
| | - Culley C. Carson
- Division of Urologic Surgery; University of North Carolina; Chapel Hill NC USA
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Gelbard M, Hellstrom WJ, McMahon CG, Levine LA, Smith T, Tursi J, Kaufman G, Goldstein I. Baseline Characteristics from an Ongoing Phase 3 Study of Collagenase Clostridium Histolyticum in Patients with Peyronie's Disease. J Sex Med 2013; 10:2822-31. [DOI: 10.1111/jsm.12312] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Ibrahim F, Sian TC, Shanggar K, Razack AH. Muslim prayer movements as an alternative therapy in the treatment of erectile dysfunction: a preliminary study. J Phys Ther Sci 2013; 25:1087-91. [PMID: 24259921 PMCID: PMC3818777 DOI: 10.1589/jpts.25.1087] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Accepted: 04/19/2013] [Indexed: 11/24/2022] Open
Abstract
[Purpose] Our objective was to assess the effect of salat and mimicking salat movements and postures on subjects with erectile dysfunction. [Methods] Ten volunteers were recruited in this study. Subjects who were Muslims (Group I) were asked to perform their daily salat and a new intervention of an additional 12 movement cycles of salat for three sessions a week. Non-Muslim subjects (Group II) were taught to mimic salat movements, and were asked to perform a total of 12 movement cycles without reading the recitation for three sessions a week. An International Index for Erectile Function 5 (IIEF-5) questionnaire was given to the subjects before and after the intervention of performing salat or mimicking salat movements and postures. A nocturnal electrobioimpedance volume assessment (NEVA) device was used to measure the nocturnal penile tumescence (NPT) parameters over two consecutive nights. A nonparametric test was conducted to find the significant NPT parameters. [Results] The results showed that all measured parameters improved significantly, with the largest change observed in the maximum percent volumetric change over the baseline (from 138 to 222%). [Conclusion] This preliminary study suggests that the alternative approach of salat and mimicking salat movements and postures, may have beneficial effects for ED patients.
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Affiliation(s)
- Fatimah Ibrahim
- Medical Informatics and Biological Micro-Electro-Mechanical
Systems (MIMEMS) Specialized Lab, Department of Biomedical Engineering, Faculty of
Engineering, University of Malaya
| | - Tee Chee Sian
- Department of Surgery, Faculty of Medicine, University of
Malaya
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El-Sakka AI, Salabas E, Dinçer M, Kadioglu A. The pathophysiology of Peyronie's disease. Arab J Urol 2013; 11:272-7. [PMID: 26558092 PMCID: PMC4442979 DOI: 10.1016/j.aju.2013.06.006] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2013] [Revised: 06/09/2013] [Accepted: 06/09/2013] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE To review the contemporary knowledge of the pathophysiology of Peyronie's disease (PD). METHODS Medline was searched for papers published in English from 2000 to March 2013, using the keywords 'Peyronie's disease' and 'pathophysiology'. RESULTS More than 300 relevant articles were identified for the purpose of this review. Unfortunately only a few studies had a high level of evidence, and the remaining studies were not controlled in their design. Many theories have been proposed to explain the cause of PD, but the true pathogenesis of PD remains an enigma. Identifying particular growth factors and the specific genes responsible for the induction of PD have been the ultimate goal of research over the past several decades. This would provide the means to devise a possible gene therapy for this devastating condition. We discuss present controversies and new discoveries related to the pathophysiology of this condition. CONCLUSION PD is one of the most puzzling diseases in urology. The pathogenesis remains uncertain and there is still controversy about the best management. The pathogenesis of PD has been explored in animal models, cell cultures and clinical trials, but the results have led to further questions. New research on the aetiology and pathogenesis of PD is needed, and which will hopefully improve the understanding and management for patients with this frustrating disease.
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Key Words
- (i)NOS, (inducible) nitric oxide synthase
- DM, diabetes mellitus
- ED, erectile dysfunction
- EF, erectile function (domain)
- FGF, fibroblast GF
- Fibrosis
- GF, growth factor
- MMP, matrix metalloproteinase
- PD, Peyronie’s disease
- Pathophysiology
- Peyronie’s disease
- ROS, reactive oxygen species
- TA, tunica albuginea
- Tunica albuginea
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Affiliation(s)
| | - Emre Salabas
- Department of Urology, Faculty of Medicine, Istanbul University, Turkey
| | - Murat Dinçer
- Department of Urology, Faculty of Medicine, Istanbul University, Turkey
| | - Ates Kadioglu
- Department of Urology, Faculty of Medicine, Istanbul University, Turkey
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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: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [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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Levine LA. Peyronie's disease: A contemporary review of non-surgical treatment. Arab J Urol 2013; 11:278-83. [PMID: 26558093 PMCID: PMC4442988 DOI: 10.1016/j.aju.2013.03.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Revised: 03/11/2013] [Accepted: 03/16/2013] [Indexed: 12/14/2022] Open
Abstract
In this review I discuss the current non-surgical treatment options for Peyronie’s disease (PD), which remains a therapeutic dilemma for the treating physician. This is despite a large array of treatments that have been used since the time of de la Peyronie in the mid-18th century. Part of the problem with finding an effective treatment is the incomplete understanding of the aetiopathophysiology of this scarring disorder. Published articles in peer-reviewed journals were assessed, recognising that most of the reported trials are compromised by being single-centre studies with no placebo control. Various treatment options have emerged, most with limited and unreliable benefit, but a few treatments have shown a consistent, albeit incomplete, response rate. Currently the only scientifically sensible oral agents appear to be pentoxifylline, l-arginine, and possibly the phosphodiesterase type-5 inhibitors. The current intralesional injection treatment options include verapamil and interferon, with a reported benefit in reducing deformity and improving sexual function. Intralesional clostridial collagenase is in the midst of phase-3 trial analysis by the USA Food and Drug Administration. External mechanical traction therapy has recently emerged as a technique to reduce the curvature, recover lost length, and possibly obviate surgery. Currently there is no clear, reliable and effective non-surgical treatment for PD, but it appears that several of the available treatments can reduce the deformity and improve sexual function, and might at least stabilise the disease process.
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Mandava SH, Trost LW, Hellstrom WJG. A critical analysis of the surgical outcomes for the treatment of Peyronie's disease. Arab J Urol 2013; 11:284-93. [PMID: 26558094 PMCID: PMC4442995 DOI: 10.1016/j.aju.2013.03.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Revised: 03/22/2013] [Accepted: 03/25/2013] [Indexed: 11/30/2022] Open
Abstract
Peyronie’s disease (PD) is a relatively common condition, which can impair sexual function and result in emotional and psychological distress. Despite an abundance of minimally invasive treatments, few have confirmed efficacy for improving penile curvature and function. Surgical therapies include many different techniques and are reserved for patients with stable disease of ⩾12 months’ duration. We searched PubMed for all articles from 1990 to the present relating to the surgical management of PD. Preference was given to recent articles, larger series, and those comparing various techniques and/or materials. Outcomes were subsequently analysed and organised by surgical technique and the graft material used. Available surgical techniques include plication/corporoplasty procedures, incision and grafting (I&G), and placing a penile prosthesis with or without adjunctive procedures. Although several surgical algorithms have been reported, in general, plication/corporoplasty procedures are reserved for patients with adequate erectile function, simple curvatures of <60°, and with no deformities (hour-glass, hinge). I&G are reserved for complex curvatures of >60° and those with deformities. Penile prostheses are indicated for combined erectile dysfunction and PD. Overall outcomes show high rates of improved curvature and patient satisfaction, with mildly decreased erectile function with both plication and the I&G procedure (I&G >plication) and decreases in penile length (plication >I&G). Surgical management of PD remains an excellent treatment option for patients with penile curvature precluding or impairing sexual activity. Surgical algorithms are available to assist treating clinicians in appropriately stratifying surgical candidates. Additional research is needed to identify optimal surgical techniques and materials based on patient and disease characteristics.
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Affiliation(s)
| | - Landon W Trost
- Tulane University Medical Center, New Orleans, LA, USA ; Mayo Clinic Rochester, MN, USA
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Mobley EM, Fuchs ME, Myers JB, Brant WO. Update on plication procedures for Peyronie's disease and other penile deformities. Ther Adv Urol 2013. [PMID: 23205060 DOI: 10.1177/1756287212448224] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Plication techniques are not a panacea for deformities associated with Peyronie's disease or congenital curvature. However, they do provide certain advantages, both theoretic and real, over competing procedures such as grafting. Depending on the technique, plication procedures have minimal risk of de novo erectile dysfunction, minimal risk of injury to the dorsal neurovascular bundle, and may be used for a variety of angulation deformities, including multiplanar curvature and severe degrees of curvature. A variety of incisions may be used, including the classic circumcision with degloving but also ventral raphe, dorsal penile inversion, and penoscrotal. These may be helpful in preventing postoperative morbidity and in sparing the prepuce if desired. Plication may also be combined with procedures such as penile prosthesis for correction of residual curvature. Lastly, despite its complications, plication techniques are very well tolerated, are relatively simple to perform and result in the very high satisfaction rates.
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Shiraishi K, Shimabukuro T, Matsuyama H. The prevalence of Peyronie's disease in Japan: a study in men undergoing maintenance hemodialysis and routine health checks. J Sex Med 2012; 9:2716-23. [PMID: 22897619 DOI: 10.1111/j.1743-6109.2012.02868.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION The incidence of Peyronie's disease (PD) in the general population is believed to be as high as 20%. However, most of the data concerning the prevalence of PD have been obtained from Caucasian populations. AIM The aim of this study was to examine the prevalence of PD in Asia and among men undergoing hemodialysis and discuss the pathophysiology of PD. METHODS A total of 1,090 men who received a routine health check at our hospital (control group) as well as 130 male patients undergoing maintenance hemodialysis were enrolled. The diagnosis of PD was based on a palpable penile plaque. MAIN OUTCOME MEASURES Hemodialysis patients were asked about their sexual activity and completed the International Index of Erectile Function-5 questionnaires. The differences between patients' and hemodialysis-associated factors, comorbidities, and medications were statistically assessed for patients with and without PD. RESULTS The prevalence of PD was significantly increased among hemodialysis patients (12 patients: 9.2%) relative the control group (six men: 0.6%) (P<0.0001, odds ratio: 18.4). In both groups, the plaques were primarily allocated dorsally. In the hemodialysis patients with PD, the frequency of masturbation (P<0.05) and the incidence of moderate or severe erectile dysfunction (P<0.01) were significantly higher than those among hemodialysis patients without PD. In comparison with patients without PD, the number of acetate dialysate users was significantly higher among patients with PD (P<0.05), and none of the PD patients used angiotensin-related antihypertensive drugs (P<0.05). CONCLUSIONS The prevalence of PD in healthy Japanese men is low (0.6%), which suggests the existence of racial differences in the prevalence of PD. Moreover, these results indicate that hemodialysis increases the incidence of PD. The differences in the characteristics between male hemodialysis patients with and without PD provide new insights into the pathophysiology and therapeutic window of PD.
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Affiliation(s)
- Koji Shiraishi
- Department of Urology, Yamaguchi University School of Medicine, Department of Urology, UBE Industries Central Hospital, Ube, Yamaguchi, Japan.
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