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Boston Z, Khawaja I, Gurushankar M, Pandher M, Popovic A, Jain K, Prabhu R, Alwaal A. Medical malpractice after treatment of Peyronie's disease. J Sex Med 2025:qdaf040. [PMID: 40099761 DOI: 10.1093/jsxmed/qdaf040] [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: 11/15/2024] [Revised: 02/07/2025] [Accepted: 02/16/2025] [Indexed: 03/20/2025]
Abstract
BACKGROUND Peyronie's Disease is a fibrotic tunica albuginea disorder resulting in penile deformity. AIM This analysis provides an important investigation of medical malpractice cases related to the treatment of Peyronie's Disease. METHODS The LexisNexis+ and Westlaw databases were used to access all federal and state cases as well as jury verdicts and settlements. The databases were queried for the term "Peyronie Disease" and "Peyronie's Disease" between the years 1980 and 2024. One author manually reviewed all cases to find cases involving a patient suing the urologist or medical system after treatment for Peyronie's disease. Cases that did not sue the urologist in question and cases not directly pertaining to the consequences of Peyronie's disease were ruled out. Cases were categorized into reasons the plaintiff sued the defendant: infection, pain, deformity, erectile dysfunction, dysfunction of penile prosthesis, failure of informed consent, incorrect diagnosis, and improper surgical technique. OUTCOMES The main outcome was which chief allegations commonly lead to medical malpractice litigation. RESULTS Investigation of the LexisNexis+ database yielded 76 cases. The Westlaw database offered 165 cases. After exclusion criteria, 22 cases were included from the LexisNexis+ database and an additional seven cases not identified in LexisNexis were included from Westlaw for a total of 29 cases. Fifteen of the cases ruled in favor of the defendant. Thirteen cases ruled in favor of the plaintiff with awards ranging from $97 500 to $3 971 917. The most common cause for litigation included dysfunction of a penile prosthesis, which was a precipitating issue in 37.9% of cases. Patients experiencing post-treatment infection were alleged in 34.5% of cases. Failure of informed consent was alleged in 20.7% of cases. Improper surgical technique was alleged in 20.7% of cases. Among the cases that ruled in favor of the plaintiff, the most common chief allegations included dysfunction of penile prosthesis, failure of informed consent, infection, improper surgical technique, erectile dysfunction, deformity, and incorrect diagnosis. 37.9% of cases originated from the southern region of the United States. Of the 13 cases that ruled in favor of the plaintiff, 38.5% were from the South and 38.5% were from the West. CLINICAL IMPLICATIONS Urologists remain at risk of encountering medical malpractice litigation after treatment of Peyronie's Disease. STRENGTHS AND LIMITATIONS We used strict inclusion criteria to ensure consistency of analysis Peyronie's disease treatment. CONCLUSION This analysis identified that allegations were most common in Southern states, with the primary allegation being dysfunction of the penile prosthesis.
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Affiliation(s)
- Zachary Boston
- Rutgers New Jersey Medical School, Newark, NJ 07103, United States
| | - Imran Khawaja
- Rutgers New Jersey Medical School, Newark, NJ 07103, United States
| | | | - Meher Pandher
- Division of Urology, Department of Surgery, Rutgers New Jersey Medical School Newark, NJ 07103 United States
| | - Aleksandar Popovic
- Division of Urology, Department of Surgery, Rutgers New Jersey Medical School Newark, NJ 07103 United States
| | - Kunj Jain
- Division of Urology, Department of Surgery, Rutgers New Jersey Medical School Newark, NJ 07103 United States
| | - Rhea Prabhu
- Temple University Beasley School of Law, Philadelphia, PA 19122, United States
| | - Amjad Alwaal
- Rutgers New Jersey Medical School, Newark, NJ 07103, United States
- Division of Urology, Department of Surgery, Rutgers New Jersey Medical School Newark, NJ 07103 United States
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Wiborg MH, Krøijer R, Laursen BS, Lund L. Effects of therapy in experimental models of Peyronie's disease: a scoping review. Sex Med 2024; 12:qfae088. [PMID: 39807474 PMCID: PMC11726063 DOI: 10.1093/sexmed/qfae088] [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: 10/08/2024] [Revised: 12/17/2024] [Accepted: 12/25/2024] [Indexed: 01/16/2025] Open
Abstract
Background Peyronie's disease (PD) is a fibrotic disorder affecting the penile tunica albugínea, with unclear pathophysiology despite centuries of recognition. Aim This scoping review maps the effects of interventions in basic PD research, synthesizing evidence from in vivo and in vitro studies to guide future investigation. Methods In October-November 2023, a systematic search was conducted across PubMed, Embase (Ovid), Science of Web, and Scopus, following SRYCLE's guidelines. Relevant studies were screened for data on interventions targeting PD in vivo and in vitro, with no language or time restrictions. Outcomes Primary outcomes included changes in extracellular matrix (ECM) proteins, myofibroblast activity, and plaque size. Results Of 683 articles screened, 40 studies were included. Key interventions such as phosphodiesterase inhibitors and stem cell therapies reduced ECM proteins and myofibroblast activity, particularly in early-stage PD models. However, none of the studies adhered to the ARRIVE guidelines, highlighting a gap in reporting standards. Clinical translation Findings suggest potential benefits of early and multimodal treatment strategies, but further human trials are needed to bridge the gap in clinical practice. Strengths and limitations This review systematically synthesizes animal and cellular research on PD, highlighting significant preclinical findings. However, the lack of standardized reporting and limited human studies restricts direct clinical applicability. Conclusion Further research should prioritize adherence to reporting standards, optimize treatment timing, and explore combination therapies to advance PD management.
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Affiliation(s)
- Majken Højrup Wiborg
- Department of Urology, Hospital South West Jutland, Region of Southern, 6700 Esbjerg, Denmark
- Department of Clinical Research, University of Southern Denmark, 5000 Odense, Denmark
- Clinic of Sexology, 6700 Esbjerg, Denmark
| | - Rasmus Krøijer
- Department of Surgical Gastroenterology, Hospital South West Jutland, Region of Southern, 6700 Esbjerg, Denmark
- Department of Regional Health Research, University of Southern Denmark, 5000 Odense, Denmark
| | - Birgitte Schantz Laursen
- Clinical Nursing Research Centre, Aalborg University Hospital, 9000 Aalborg, Denmark
- Sexology Research Centre, Department of Clinical Medicine, Aalborg University, 9000 Aalborg, Denmark
| | - Lars Lund
- Department of Clinical Research, University of Southern Denmark, 5000 Odense, Denmark
- Department of Urology, Odense University Hospital, 5000 Odense, Denmark
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Lethuillier V, Peyronnet B, Richard C, Bensalah CK, Mathieu R, Robin F, Faix A, Roux JL, Freton L. When fibrosis intersect: Association and risk factors between Peyronie's and Dupuytren's diseases. THE FRENCH JOURNAL OF UROLOGY 2024; 34:102759. [PMID: 39426569 DOI: 10.1016/j.fjurol.2024.102759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2024] [Revised: 10/14/2024] [Accepted: 10/14/2024] [Indexed: 10/21/2024]
Abstract
INTRODUCTION Peyronie's and Dupuytren's diseases are benign but are source of significant functional impairment leading to considerable suffering. In this study, the aim is to investigate the association between Peyronie's and Dupuytren's diseases as well as their common and specific risk factors. MATERIAL AND METHODS From July 2022 to March 2024, we conducted a multicentric observational study on 450 patients. Patients followed up for Peyronie's and/or Dupuytren's disease were given a questionnaire that included a consent form, in order to screen one or the other associated disease and explore all risk factors. RESULTS Among the 278 patients followed for Dupuytren's disease, 35 (12.3%) had Peyronie's disease. Of the 172 patients with initial Peyronie's disease, 50 (29.1%) were diagnosed with Dupuytren's disease. Eventually, 85 patients had both pathologies (18.9%). High blood pressure was significantly more prevalent in patients with both diseases, compared to subjects with Peyronie's disease only (37.7% vs. 38.4% vs. 24.4%; P=0.02). The same observation was made regarding smoking (62.3% vs. 60.7% vs. 48.8%; P=0.05) and daily alcohol consumption (52.9% vs. 41.7% vs. 35.8%; P=0.04). Patients diagnosed with isolated Dupuytren's disease were more likely to be diabetic (13.6% vs. 9.41%; P=0.42). Blue eyes and family history were significantly more often reported in Dupuytren's patients (33.9% vs. 22.8%; P=0.03; P<0.001). Ledderhose disease was significantly more prevalent in patients with both diseases or isolated Dupuytren's disease (21.2% vs. 12.4% vs. 3.3%; P=0.0003). CONCLUSION This study confirms the association between Peyronie and Dupuytren diseases. Smoking, alcohol daily consumption and hypertension are more prevalent in case of associated diseases. Blue eyes and family history are significantly more frequently found in case of Dupuytren's contracture. More powerful studies including a control group are necessary. LEVEL OF EVIDENCE: 2
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Affiliation(s)
| | | | | | | | | | - François Robin
- Département de rhumatologie, CHU de Rennes, Rennes, France
| | - Antoine Faix
- Département d'urologie, clinique Saint-Roch Montpellier, Montpellier, France
| | - Jean-Luc Roux
- Département d'orthopédie, clinique Saint-Roch Montpellier, Montpellier, France
| | - Lucas Freton
- Département d'urologie, CHU de Rennes, Rennes, France
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Alshuaibi M, Zugail AS, Lombion S, Beley S. New protocol in the treatment of Peyronie's disease by combining platelet-rich plasma, percutaneous needle tunneling, and penile modeling: Preliminary results. THE FRENCH JOURNAL OF UROLOGY 2024; 34:102526. [PMID: 37777436 DOI: 10.1016/j.purol.2023.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 07/03/2023] [Accepted: 09/08/2023] [Indexed: 10/02/2023]
Abstract
INTRODUCTION Intra-lesional injections of collagenase (Xiapex®) were the only non-invasive treatment option for Peyronie's disease (PD), until their withdrawal from the European market. OBJECTIVE To evaluate the feasibility, efficacy, and safety of a combined treatment of percutaneous needle tunnelling (PNT) with penile modelling (PM) and the injection of platelet-rich plasma (PRP) under general anesthesia in the treatment of PD. PATIENTS AND METHOD A prospective case series study included patients with PD in a stable phase who underwent this procedure between March 2020 and January 2023. The main outcome was an improvement in curvature. RESULT Thirty-six patients underwent this novel approach for the treatment of PD. The pretreatment mean±standard deviation (SD) curvature degree was 57.5±20.61° (range 20-90°). After the protocol, the mean curvature degree was 40.86±25.13° (range 0-90°). The curvature angle improved significantly (P=0.0001), with a mean improvement difference of 16.85±14.81° (range 0-50°) and a mean improvement percentage of 47.7±40.29% (range 0-100%). CONCLUSION Our preliminary experience suggests that PNT and PRP injections with PM are effective and safe for the treatment of penile deformity of PD. LEVEL OF EVIDENCE 4: case series study.
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Affiliation(s)
- M Alshuaibi
- Department of Urology, Clinique Turin, Groupe Almaviva Santé, Paris, France; Department of Urology, Faculty of Medicine, University of Ha'il, Ha'il, Saudi Arabia.
| | - A S Zugail
- Department of Urology, Clinique Turin, Groupe Almaviva Santé, Paris, France; Department of Urology, Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah, Saudi Arabia
| | | | - S Beley
- Department of Urology, Clinique Turin, Groupe Almaviva Santé, Paris, France
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Castiglione F, Çakır OÖ, Schifano N, Corona G, Reisman Y, Bettocchi C, Cellek S, Ilg MM. European Society of Sexual Medicine consensus statement on the use of animal models for studying Peyronie's disease. Sex Med 2023; 11:qfad046. [PMID: 37547872 PMCID: PMC10397421 DOI: 10.1093/sexmed/qfad046] [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: 04/12/2023] [Revised: 07/10/2023] [Accepted: 07/10/2023] [Indexed: 08/08/2023] Open
Abstract
Introduction Animal models are frequently used for translational research in Peyronie's disease (PD). However, due to lack of availability of guidelines, there is some heterogeneity in study design, data reporting, and outcome measures. Aim This European Society for Sexual Medicine consensus statement aims to provide guidance in utilization of animal models in PD research in a standardized and uniform fashion. Methods PubMed was searched for studies using animal models for PD. The following search terms were used: ("Peyronie's disease" OR "penile fibrosis" OR "penile curvature" OR "induration penis plastica" OR "erectile dysfunction") AND ("rodent" OR "mouse" OR "mice" OR "rat" OR "rabbit"). Outcomes This European Society for Sexual Medicine statement describes best practice guidelines for utilization of animals in PD research: power calculation, details of available models, surgical procedures, and measurement techniques, while highlighting possible pitfalls and translational limitations of the models. Results In total, 2490 studies were retrieved and 2446 articles were excluded. A total of 44 studies were included, of which 40 studies used rats, 1 study used both rats and mice, 1 study used a genetic mouse model, and 2 studies used rabbits. A significant number of the studies (70.5%) used transforming growth factor β 1 for induction of fibrosis. Oxford 2011 Levels of Evidence criteria could not be applied due to the nature of the studies. Conclusion Despite certain limitations of PD animal models presented, we aimed to provide guidance for their appropriate use in translational research, with the purpose of improving study quality and reproducibility as well as facilitating interpretation of reported results and conclusions.
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Affiliation(s)
| | - Onur Ö Çakır
- King's College London Hospital, London SE5 9RS, United Kingdom
| | - Nicolò Schifano
- King's College London Hospital, London SE5 9RS, United Kingdom
| | - Giovanni Corona
- Endocrinology Unit, Medical Department, Maggiore-Bellaria Hospital, Azienda USL, Bologna 40139, Italy
| | | | - Carlo Bettocchi
- Department of Urology, University of Bari, Bari 70121, Italy
| | - Selim Cellek
- Fibrosis Research Group, Medical Technology Research Centre, Anglia Ruskin University, Chelmsford, Essex CM1 1SQ, United Kingdom
| | - Marcus M Ilg
- Fibrosis Research Group, Medical Technology Research Centre, Anglia Ruskin University, Chelmsford, Essex CM1 1SQ, United Kingdom
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Halsey G, Sinha D, Dhital S, Wang X, Vyavahare N. Role of elastic fiber degradation in disease pathogenesis. Biochim Biophys Acta Mol Basis Dis 2023; 1869:166706. [PMID: 37001705 PMCID: PMC11659964 DOI: 10.1016/j.bbadis.2023.166706] [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: 10/28/2022] [Revised: 03/22/2023] [Accepted: 03/23/2023] [Indexed: 03/31/2023]
Abstract
Elastin is a crucial extracellular matrix protein that provides structural integrity to tissues. Crosslinked elastin and associated microfibrils, named elastic fiber, contribute to biomechanics by providing the elasticity required for proper function. During aging and disease, elastic fiber can be progressively degraded and since there is little elastin synthesis in adults, degraded elastic fiber is not regenerated. There is substantial evidence linking loss or damage of elastic fibers to the clinical manifestation and pathogenesis of a variety of diseases. Disruption of elastic fiber networks by hereditary mutations, aging, or pathogenic stimuli results in systemic ailments associated with the production of elastin degradation products, inflammatory responses, and abnormal physiology. Due to its longevity, unique mechanical properties, and widespread distribution in the body, elastic fiber plays a central role in homeostasis of various physiological systems. While pathogenesis related to elastic fiber degradation has been more thoroughly studied in elastic fiber rich tissues such as the vasculature and the lungs, even tissues containing relatively small quantities of elastic fibers such as the eyes or joints may be severely impacted by elastin degradation. Elastic fiber degradation is a common observation in certain hereditary, age, and specific risk factor exposure induced diseases representing a converging point of pathological clinical phenotypes which may also help explain the appearance of co-morbidities. In this review, we will first cover the role of elastic fiber degradation in the manifestation of hereditary diseases then individually explore the structural role and degradation effects of elastic fibers in various tissues and organ systems. Overall, stabilizing elastic fiber structures and repairing lost elastin may be effective strategies to reverse the effects of these diseases.
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Affiliation(s)
- Gregory Halsey
- Department of Bioengineering, Clemson University, SC 29634, United States of America
| | - Dipasha Sinha
- Department of Bioengineering, Clemson University, SC 29634, United States of America
| | - Saphala Dhital
- Department of Bioengineering, Clemson University, SC 29634, United States of America
| | - Xiaoying Wang
- Department of Bioengineering, Clemson University, SC 29634, United States of America
| | - Naren Vyavahare
- Department of Bioengineering, Clemson University, SC 29634, United States of America.
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Feyisetan O. Peyronie's Disease: A Brief Overview. Cureus 2023; 15:e37037. [PMID: 37143639 PMCID: PMC10153789 DOI: 10.7759/cureus.37037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2023] [Indexed: 04/04/2023] Open
Abstract
Peyronie's disease is an acquired connective tissue disease of the tunica albuginea of the penis which usually presents with penile curvature/deformity and a palpable penile plaque. It is more common in Caucasian men over the fifth decade of life, but it is an under-reported disease. Conservative and non-surgical options are supported by limited evidence except for intralesional injection of collagenase clostridium histolyticum and have limited success. The improved outcome of surgical treatment is accompanied by the risk of erectile dysfunction. This is a brief overview of Peyronie's disease, its impact on the patient, and the available treatment options.
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Sinaci CB, Çiçek Ç, Filinte G, Güven Ü. The Effect of Ex-Vivo Hyaluronic Acid on Myofibroblast and Collagen in Dupuytren Disease. J Hand Surg Asian Pac Vol 2022; 27:975-981. [PMID: 36476083 DOI: 10.1142/s2424835522500916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background: Dupuytren disease (DD) is characterised by increased myofibroblast/fibroblast activity and type3/type1 collagen ratios. Hyaluronic acid (HA) is major component of the extracellular matrix and some studies have showed that HA limits myofibroblast activity and decreases type3/type1 collagen ratio. The aim of this study is to determine the effect of the ex-vivo application of HA on cultured fibroblasts obtained from normal and diseased tissue from patients with DD. This is the initial step towards defining the use of HA as a new approach for medical treatment of DD. Methods: Tissue samples were obtained from both healthy forearm (C) and unhealthy palmar (D) fascia of patients undergoing surgery for DD. Tissue samples were cultured and divided into four groups depending on the addition of HA [C(HA-), C(HA+), D(HA-) and D(HA+)]. The tissues were evaluated using Western blot to detect effect of HA on myofibroblast (by measuring alpha smooth muscle actin [α-SMA) and on the ratio of type3/type1 collagen by measuring collagen type1 alpha 1 Chain (COL1A1) and collagen type3 alpha 1 Chain (COL3A1). Results: The rate of the average α-SMA value in the D(HA+) group was significantly lower compared to that of the D(HA-) group. The average ratio of type3/type1 collagen in the D(HA+) group was significantly lower compared to the D(HA-) group. Conclusions: The ex-vivo application of HA on cultured fibroblasts obtained from patients with DD resulted in a decrease in myofibroblast/fibroblast activity and type3/type1 collagen ratios. This may pave the way for clinical application of HA in the treatment of DD.
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Affiliation(s)
- Cem Berkay Sinaci
- Payaslı Clinic, Plastic Reconstructive and Aesthetic Surgery, Private Practice, Istanbul, Turkey
| | - Çağla Çiçek
- Department of Plastic Reconstructive and Aesthetic Surgery, Kartal Dr. Lütfi Kırdar City Hospital, Istanbul, Turkey
| | - Gaye Filinte
- Department of Plastic Reconstructive and Aesthetic Surgery, University of Health Science, Kartal Dr. Lütfi Kırdar City Hospital, Istanbul, Turkey
| | - Ülkügül Güven
- Department of Biochemistry, Genetic and Metabolic Diseases Research and Investigation Center, Marmara University School of Medicine, Istanbul, Turkey
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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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Dullea A, Efimenko I, Firdaus F, Griswold A, Arora H, Masterson T, Ramasamy R. Whole-Genome Sequencing Identifies Novel Heterozygous Mutation in ALMS1 in Three Men with Both Peyronie's and Dupuytren's Disease. Urology 2022; 166:76-78. [PMID: 35292292 PMCID: PMC9356975 DOI: 10.1016/j.urology.2022.02.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 02/21/2022] [Accepted: 02/27/2022] [Indexed: 11/30/2022]
Abstract
Peyronie's Disease (PD) is estimated to occur in up to 13% of males and has been associated with Dupuytren's Disease (DD). We identified 3 men with PD/DD and hypothesized that there may be a genetic association between the 2 diseases. Blood samples were collected from the participants and sent for whole genome sequencing. A rare non-synonymous mutation in the ALMS1 gene was identified in 3 men. Interestingly, ALMS1 is associated with TGF-b, and aberrant fibrosis. This pilot study generates the hypothesis that mutations in ALMS1 may predispose patients to development of PD/DD.
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Russell MC. An Overview of Dupuytren's Disease for Perioperative Nurses. AORN J 2021; 115:65-78. [PMID: 34958472 DOI: 10.1002/aorn.13574] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 05/07/2021] [Accepted: 05/19/2021] [Indexed: 11/11/2022]
Abstract
Dupuytren's disease is a fibroproliferative condition that causes shortening, thickening, and fibrosis of the palmar fascia and a flexion deformity of metacarpophalangeal and proximal interphalangeal joints. Although the etiology is unknown, a variety of risk factors, such as age greater than 50 years, male sex, family history, or tobacco and alcohol use may lead to disease development. At the present time there is no cure and symptoms may recur; however, surgical procedures (eg, limited fasciectomy) and nonsurgical treatment (eg, needle aponeurotomy, injection of collagenase clostridium histolyticum) can help patients manage the disease's symptoms. Patients may experience wound-healing complications after fasciectomy and skin fissures after needle aponeurotomy. Recurrence rates for needle aponeurotomy and collagenase clostridium histolyticum injection are similar. Perioperative nurses should provide individualized patient care during procedures, participate in effective team communication regarding patient needs, and provide patient education throughout the perioperative continuum.
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Zhang F, Qin F, Yuan J. Molecular Mechanisms and Current Pharmacotherapy of Peyronie's Disease: A Review. Front Pharmacol 2021; 12:643641. [PMID: 34093182 PMCID: PMC8173627 DOI: 10.3389/fphar.2021.643641] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 04/14/2021] [Indexed: 02/05/2023] Open
Abstract
Peyronie’s disease (PD) is a localized fibrotic lesion of the penis that has adverse effects on men’s health. In this review, we summarized the molecular mechanisms and pharmacotherapies of PD. A literature search was conducted using PubMed and Cochrane Library during 2001–2020. Although no oral or topical medication demonstrated efficacy in monotherapy of PD, several intralesional medications have yielded promising results. Currently, the effective strategy in management of PD should be combined modality therapy, including but not limited to pharmacotherapy, mechanical therapy, and psychotherapy. Meanwhile, basic research is still necessary to facilitate the development of novel and more reliable treatments. In future, more attention should be given simultaneously to epigenetic changes, inflammatory cytokines, the abnormal wound-healing process, and profibrotic and anti-fibrotic factors to provide more options for this refractory disease.
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Affiliation(s)
- Fuxun Zhang
- Andrology Laboratory, West China Hospital, Sichuan University, Chengdu, China.,Department of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Feng Qin
- Andrology Laboratory, West China Hospital, Sichuan University, Chengdu, China
| | - Jiuhong Yuan
- Andrology Laboratory, West China Hospital, Sichuan University, Chengdu, China.,Department of Urology, West China Hospital, Sichuan University, Chengdu, China
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13
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Gelbard MK, Rosenbloom J. Fibroproliferative disorders and diabetes: Understanding the pathophysiologic relationship between Peyronie's disease, Dupuytren disease and diabetes. Endocrinol Diabetes Metab 2021; 4:e00195. [PMID: 33855203 PMCID: PMC8029506 DOI: 10.1002/edm2.195] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 09/18/2020] [Accepted: 09/26/2020] [Indexed: 12/23/2022] Open
Abstract
Introduction Fibrosis is characterized by dysregulation and accumulation of extracellular matrix. Peyronie's disease and Dupuytren disease are fibroproliferative disorders of the tunica albuginea of the penis and fascia of the hand, respectively. Chronic hyperglycaemia due to diabetes mellitus can also lead to tissue injury and fibrosis. A meta-analysis has shown a relationship between Dupuytren disease and diabetes (overall odds ratio, 3.1; 95% confidence interval, 2.7-3.5). This review explores commonalities in the pathogenesis of Peyronie's disease, Dupuytren disease and diabetes. Methods A search of the PubMed database was conducted using the search terms "diabetes" AND "Peyronie's disease"; and "diabetes" AND "Dupuytren." Results Genome-wide association and gene expression studies conducted with tissue from people with Peyronie's disease or Dupuytren disease identified signalling pathways associated with wingless-type mammary-tumour virus integration site signalling, extracellular matrix modulation and inflammation. Biochemical studies confirmed the importance of these pathways in the pathogenesis of fibrosis with Peyronie's disease and Dupuytren disease. Dysregulation of matrix metalloproteinase activity associated with extracellular matrix breakdown was implicated in fibroproliferative complications of diabetes and in the aetiology of Peyronie's disease and Dupuytren disease. A notable percentage of people with diabetes have comorbid Peyronie's disease and/or Dupuytren disease. Conclusions Studies have not been performed to identify fibroproliferative pathways that all 3 conditions might have in common, but data suggest that common pathways are involved in the fibroproliferative processes of Peyronie's disease, Dupuytren disease, and diabetes.
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Affiliation(s)
- Martin K. Gelbard
- Department of UrologyDavid Geffen School of Medicine at UCLALos AngelesCAUSA
| | - Joel Rosenbloom
- Department of Dermatology and Cutaneous BiologyThe Joan and Joel Rosenbloom Research Center for Fibrotic DiseasesSidney Kimmel Medical CollegeThomas Jefferson UniversityPhiladelphiaPAUSA
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Rainer QC, Rodriguez AA, Bajic P, Galor A, Ramasamy R, Masterson TA. Implications of Calcification in Peyronie's Disease, A Review of the Literature. Urology 2021; 152:52-59. [PMID: 33476600 DOI: 10.1016/j.urology.2021.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 12/14/2020] [Accepted: 01/03/2021] [Indexed: 02/06/2023]
Abstract
A common characteristic of Peyronie's Disease (PD) is plaque calcification, which is associated with decreased response to treatments and higher rates of surgical intervention. Despite its prevalence in the PD population, the literature on plaque calcification is limited. While the diagnosis of PD is mostly clinical, imaging modalities such as ultrasound can be used to identify plaque calcification. The proper identification of plaque calcification is crucial for guiding management and setting therapeutic expectations for patients with PD. Herein we discuss what is known about PD plaque calcification, including epidemiology, etiology, diagnosis, and management.
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Affiliation(s)
| | | | | | - Anat Galor
- University of Miami Miller School of Medicine, Miami FL; Bruce W Carter VA Medical Center, Miami FL
| | | | - Thomas A Masterson
- University of Miami Miller School of Medicine, Miami FL; Bruce W Carter VA Medical Center, Miami FL.
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15
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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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16
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Ten Dam EJPM, van Driel MF, de Jong IJ, Werker PMN, Bank RA. Glimpses into the molecular pathogenesis of Peyronie's disease. Aging Male 2020; 23:962-970. [PMID: 31335242 DOI: 10.1080/13685538.2019.1643311] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Peyronie's disease (PD) is a fibroproliferative disease of the penis. Since little is known about the molecular pathogenesis of PD, we compared the biochemical make-up of PD plaques with normal tunica albuginea to clarify pathological processes in the scarred tissue. Protein and mRNA levels were measured in plaques and in unaffected pieces of the tunica albuginea. We investigated the presence of myofibroblasts, the deposition of collagens, and some key elements of Wnt and YAP1 signaling at protein level. The expression of 45 genes, all related to collagen homeostasis and extracellular matrix proteins, was quantified. In plaques, more myofibroblasts were present, and we observed an activation of Wnt signaling and YAP1 signaling. Increased levels of the collagens types I and III confirm the fibrotic nature of plaques. The mRNA ratio of collagen types III, IV, and VI to type I was increased. The expression of lysyl hydroxylase 3 was higher, whereas a decreased expression level was seen for fibronectin and cathepsin K. The biochemical composition of plaques was different from unaffected tunica albuginea: the relative and absolute abundance of various extracellular matrix proteins were changed, as well as the quality of collagen and the level of the collagen-degrading enzyme cathepsin K.
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Affiliation(s)
- Evert-Jan P M Ten Dam
- Department of Pathology & Medical Biology, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
- Department of Plastic Surgery, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - Mels F van Driel
- Department of Urology, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - Igle Jan de Jong
- Department of Urology, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - Paul M N Werker
- Department of Plastic Surgery, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - Ruud A Bank
- Department of Pathology & Medical Biology, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
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17
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Ziegelmann MJ, Bajic P, Levine LA. Peyronie's disease: Contemporary evaluation and management. Int J Urol 2020; 27:504-516. [PMID: 32253786 DOI: 10.1111/iju.14230] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 02/27/2020] [Indexed: 01/02/2023]
Abstract
Peyronie's disease is a common yet poorly understood condition characterized by penile pain, curvature, sexual dysfunction and psychological bother. Peyronie's disease represents a penile wound healing disorder, and is thought to arise from exuberant scarring in response to penile trauma in genetically predisposed men. In the absence of active treatment, the majority of men experience stable or worsening symptoms, with few reporting spontaneous resolution in penile curvature or other deformity. In contrast, penile pain improves or resolves in the majority of men. Treatment options vary based on symptom severity and stability. Several oral therapies are commonly prescribed, although to date there are no strong data to support any oral agents as monotherapy for Peyronie's disease. Other options including penile traction therapy and intralesional injections result in modest improvements for many patients, particularly when used early after symptom onset. Penile straightening through approaches, such as penile plication and plaque incision or partial excision and grafting, represent the most rapid and reliable approach to correct penile curvature once the symptoms have stabilized. Side-effects vary based on the type of surgery carried out, and include penile shortening, sensation changes and erectile dysfunction in the minority of men. In patients with drug refractory erectile dysfunction and Peyronie's disease, placement of a penile prosthesis will address both issues, and is associated with high levels of patient satisfaction. The current review provides a practical approach to the modern evaluation and management of patients presenting with Peyronie's disease.
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Affiliation(s)
- Matthew J Ziegelmann
- Division of Urology, Rush University Medical Center, Chicago, Illinois, USA.,Department of Urology, Mayo Clinic, Rochester, Minnesota, USA
| | - Petar Bajic
- Division of Urology, Rush University Medical Center, Chicago, Illinois, USA
| | - Laurence A Levine
- Division of Urology, Rush University Medical Center, Chicago, Illinois, USA
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18
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Prevalence of Peyronie and Ledderhose Diseases in a Series of 730 Patients with Dupuytren Disease. Plast Reconstr Surg 2020; 145:978-984. [DOI: 10.1097/prs.0000000000006642] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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19
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Basilius JR, Hotaling JM, Pastuszak AW. Unwinding Fibrosis in Peyronie's Disease. J Sex Med 2020; 17:835-837. [PMID: 32111535 DOI: 10.1016/j.jsxm.2020.01.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 01/10/2020] [Indexed: 01/19/2023]
Affiliation(s)
- Jacob R Basilius
- Division of Urology, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - James M Hotaling
- Division of Urology, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Alexander W Pastuszak
- Division of Urology, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA.
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20
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Abstract
Peyronie's disease (PD) is a devastating disease that affects up to 13% of adult men. While trauma to the erect penis is common prior to onset, it is clear that trauma alone is not sufficient to cause PD. Over the past 40 years, multiple lines of evidence have pointed to a genetic factor that predisposes some men to develop PD. Despite dramatic technological advances in the field of genetics, we have made little progress in identifying the genetic contributors to the disease. This review will critically evaluate the literature concerning the genetics of PD published to date. Particular focus will be placed on study design as much of the data are contradictory yet may still give some insight into the etiology of PD. The challenges in identifying the genetic underpinnings of PD will be discussed along with the potential mechanisms that can overcome these challenges.
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Affiliation(s)
- J Scott Gabrielsen
- Department of Urology, University of Rochester Medical Center, Rochester, NY, USA
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21
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Aita G, Ros CTD, Silvinato A, Bernardo WM. Peyronie's disease: clinical treatment. ACTA ACUST UNITED AC 2019; 65:1231-1239. [PMID: 31721953 DOI: 10.1590/1806-9282.65.10.1231] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2018] [Indexed: 01/07/2023]
Affiliation(s)
- Giuliano Aita
- Sociedade Brasileira de Urologia, Rio de Janeiro, RJ, Brasil
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22
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Increased Risk of Incident Disease in Men with Peyronie's Disease: Analysis of U.S. Claims Data. J Sex Med 2019; 15:894-901. [PMID: 29803352 DOI: 10.1016/j.jsxm.2018.04.640] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 03/26/2018] [Accepted: 04/13/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND The subsequent health risks associated with Peyronie's disease (PD) are unknown. AIM This cohort study assesses the risk of developing auto-immune conditions and common chronic health conditions after a diagnosis of PD. We hypothesize that an increase in auto-immune disease will be evident in men with PD, as has been suggested in smaller studies. METHODS We determined the longitudinal incidence of 13 auto-immune diseases and 25 common chronic conditions in a cohort from the Truven Health Analytics (Ann Arbor, Michigan, USA) database from 2007-2013. The cohort included men with 1 of 3 exposures in 2007: (1) men with PD, (2) men with erectile dysfunction (ED) but not PD, and (3) men without PD or ED, matched on age and follow-up duration. OUTCOMES To assess incidence, we utilized a Cox regression model adjusting for age, smoking, obesity, health care visits per year, urology visits per year, and years of follow-up. RESULTS We included 8,728 men with PD; 204,147 men with ED; and 87,280 controls. Men with PD had an increased risk of developing benign prostatic hyperplasia (hazard ratio [HR] 1.21, 95% CI 1.16-1.27), prostatitis (HR 1.21, 95% CI 1.12-1.31), and lower urinary tract symptoms (HR 1.10, 95% CI 1.05-1.16) when compared to both men with ED and age-matched controls without ED or PD even when controlling for the number of urology visits per year. Compared to controls, men with PD also had an increased risk of developing keloids. No significant risk for any auto-immune disease was observed. CLINICAL IMPLICATIONS Clinicians should have heightened awareness for these relevant co-morbidities when treating men with PD. STRENGTHS & LIMITATIONS Utilizing a claims database provides one of the largest cohorts of men with PD ever published but claims databases lack some individual patient data such as risk factors and demographic information relevant to PD, including: penile injury, history of urologic procedures, and other lifestyle factors. CONCLUSION Men with PD had a higher risk of benign prostatic hyperplasia, lower urinary tract symptoms, prostatitis, and keloids after a diagnosis of PD, but no increased risk of auto-immune conditions. These findings suggest a common etiology for these conditions that may manifest itself in diseases at different times in men's life cycle. Pastuszak AW, Rodriguez KM, Solomon ZJ, et al. Increased Risk of Incident Disease in Men with Peyronie's Disease: Analysis of U.S. Claims Data. J Sex Med 2018;15:894-901.
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23
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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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Patel DP, Christensen MB, Hotaling JM, Pastuszak AW. A review of inflammation and fibrosis: implications for the pathogenesis of Peyronie's disease. World J Urol 2019; 38:253-261. [PMID: 31190155 DOI: 10.1007/s00345-019-02815-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 05/17/2019] [Indexed: 01/07/2023] Open
Abstract
Peyronie's disease (PD) is a superficial fibrosing disorder that causes penile deformity and can interfere with sexual intercourse and reproduction, as well as diminish quality of life. While the exact mechanism of PD is still being investigated, there is likely a genetic component to the predisposition to penile plaque formation. Ultimately, however, perturbations in normal wound healing and aberrant deposition of extracellular matrix components lead to fibrotic tissue deposition. Fibrosis in PD is regulated by a complex pathway of inflammatory and fibrotic mediators. Currently there are no treatments for PD that address an underlying cause or disease progression. In this review, we provide an overview of the known inflammatory and fibrotic mediators of PD and explore the pathophysiology of other human superficial fibrosing disorders to develop further insights into PD.
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Affiliation(s)
- Darshan P Patel
- Division of Urology, Department of Surgery, Center for Reconstructive Urology and Men's Health, University of Utah School of Medicine, 30 N 1900 E, Rm # 3B420, Salt Lake City, UT, 84132, USA
| | - Michael B Christensen
- Division of Urology, Department of Surgery, Center for Reconstructive Urology and Men's Health, University of Utah School of Medicine, 30 N 1900 E, Rm # 3B420, Salt Lake City, UT, 84132, USA
| | - James M Hotaling
- Division of Urology, Department of Surgery, Center for Reconstructive Urology and Men's Health, University of Utah School of Medicine, 30 N 1900 E, Rm # 3B420, Salt Lake City, UT, 84132, USA
| | - Alexander W Pastuszak
- Division of Urology, Department of Surgery, Center for Reconstructive Urology and Men's Health, University of Utah School of Medicine, 30 N 1900 E, Rm # 3B420, Salt Lake City, UT, 84132, USA.
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Fernández-Pascual E, González-García FJ, Angulo J, Cerezo E, Quintana LM, Turo J, Martínez-Ballesteros C, Carballido J, Martínez-Salamanca JI. Optimizing collagenase Clostridium histolyticum therapy for Peyronie's disease using a novel approach with percutaneous needle tunnelling. BJU Int 2019; 124:1055-1062. [PMID: 31033130 DOI: 10.1111/bju.14784] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVES To compare the efficacy and safety of a combined treatment of percutaneous needle tunnelling (PNT) and a modified collagenase Clostridium histolyticum (CCH) protocol (PNT/CCH) vs the modified protocol alone (CCH) in the treatment of Peyronie's disease (PD). PATIENTS AND METHODS A prospective registry of patients treated with a modified CCH protocol was maintained between June 2014 and February 2018. The last 50 patients received PNT as an adjuvant therapy (PNT/CCH), and their data were compared with those of the other 94 patients treated previously (CCH). PNT involves the creation of multiple holes made percutaneously in the plaque before each injection. The modified protocol consisted of two collagenase injections, at 1-week intervals, followed by penile modelling. Patients used penile traction therapy, tadalafil and pentoxifylline for the next 2 months and were followed up for 6 months. The main outcome was improvement of curvature. Secondary outcomes were improvements in erectile function, PD symptoms, stretched penile length and satisfaction. RESULTS Improvement in curvature was greater in patients in the PNT/CCH group than in the CCH group (mean ± sd 19.2 ± 6.1° vs 12.7 ± 5.0°; P < 0.001 [36.2 ± 12.5% vs 28.1 ± 14.5%; P = 0.001]). Compared with baseline, both interventions were associated with significant improvement in secondary outcomes. The main complications were ecchymosis, bruising and penile pain, with no significant differences between groups. CONCLUSIONS Treatment of PD with CCH using our modified protocol in combination with PNT is safe and more effective than the modified protocol alone, with the potential for improved cost-effectiveness.
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Affiliation(s)
- Esaú Fernández-Pascual
- Department of Urology, Hospital Universitario Puerta de Hierro-Majadahonda, Universidad Autónoma de Madrid, Madrid, Spain.,Lyx Institute of Urology, Madrid, Spain
| | | | - Javier Angulo
- Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | | | | | - Jorge Turo
- Department of Urology, Hospital Universitario Puerta de Hierro-Majadahonda, Universidad Autónoma de Madrid, Madrid, Spain
| | - Claudio Martínez-Ballesteros
- Department of Urology, Hospital Universitario Puerta de Hierro-Majadahonda, Universidad Autónoma de Madrid, Madrid, Spain.,Lyx Institute of Urology, Madrid, Spain
| | - Joaquín Carballido
- Department of Urology, Hospital Universitario Puerta de Hierro-Majadahonda, Universidad Autónoma de Madrid, Madrid, Spain
| | - Juan Ignacio Martínez-Salamanca
- Department of Urology, Hospital Universitario Puerta de Hierro-Majadahonda, Universidad Autónoma de Madrid, Madrid, Spain.,Lyx Institute of Urology, Madrid, Spain
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Uribe A J, Vélez H A, Zuleta T J, Uribe T C. Cavernosopatía traumática crónica. Un nuevo síndrome de fibrosis peneana. UROLOGÍA COLOMBIANA 2018. [DOI: 10.1016/j.uroco.2017.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Introdución La llamada genéricamente «enfermedad de Peyronie» es un diagnóstico que explica un porcentaje de ciertos estados de fibrosis peneana grave, pero se queda corta para abarcar la amplia gama de grises de la fibrosis peneana secundaria a microtrauma sexual repetido.Objectivo Describir un nuevo síndrome por trauma repetido en el pene al que se propone denominar «cavernosopatía traumática crónica» (CTC), con 4 componentes: fibrosis (leve, moderada o grave), disfunción eréctil, curvatura y fugas venosas peneanas.Materiales y métodos Se realizó un estudio de corte transversal en una base de datos de 128 pacientes que tenían al menos una ecografía de pene con vasoactivo y en los que se había detectado algún grado de fibrosis cavernosa según la clasificación de Levine. Se evaluó la presencia de disfunción eréctil, curvas y fugas venosas según el grado de fibrosis. El estudio contó con la aprobación del Comité de Ética en Investigación.Resultados Se estudió a 128 pacientes con fibrosis, con 51,3 años de edad promedio (DE = 13). El grado de fibrosis fue leve (Levine 1) en 30 (23,43%), moderado (Levine 2) en 23 (17,96%) y grave (Levine 3) en 75 (58,6%). Se demostró que, a mayor fibrosis, mayor disfunción eréctil, 66,6; 83,6 y 96% para Levine 1, 2 y 3, respectivamente (p ≤ 0,0001). La frecuencia de curvatura secundaria (n = 71) fue de 0; 4,2 y 95,7% para Levine 1, 2 y 3, respectivamente (p ≤ 0,0001). La frecuencia en los 44 pacientes con fugas cavernosas fue de 9; 20,4 y 70,4% (p = 0,0060) y en los 15 de fugas dorsales fue de 80; 13,3 y 6,6% (p < 0,0001) para Levine 1, 2 y 3 respectivamente. El grupo de 79 pacientes (64,03%) con mayor posibilidad de CTC, con presencia de 3 o 4 criterios que incluyeran curvatura secundaria y fuga cavernosa, tuvo un promedio de edad de 59,2 años (DE = 8,7), comparado con 41,7 años (DE = 11,7) en el grupo de menor posibilidad, diferencia estadísticamente significativa (p ≤ 0,0001).Conclusiones Proponemos que existe un síndrome de microtrauma repetido en el pene, que puede denominarse CTC, análogo a la encefalopatía traumática crónica, con 4 componentes: fibrosis cavernosa, disfunción eréctil, curvatura peneana y fugas venosas. La fibrosis es un continuum que el paciente recorre por fases leves y moderadas, a menudo inapreciables para los clínicos. Las curvaturas secundarias y las fugas cavernosas están relacionadas directamente con el grado de fibrosis y con mayor riesgo de disfunción eréctil. La edad empeora algunos factores de la CTC.
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Affiliation(s)
- Juan Uribe A
- Servicio de Urología, Hospital Pablo Tobón Uribe, Medellín, Colombia
| | - Alejandro Vélez H
- Servicio de Patología, Hospital Pablo Tobón Uribe, Medellín, Colombia
| | - John Zuleta T
- Servicio de Epidemiología, Hospital Pablo Tobón Uribe, Medellín, Colombia
| | - Carlos Uribe T
- Servicio de Medicina Sexual, Hospital Pablo Tobón Uribe, Medellín, Colombia
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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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Evidence-Based Medicine: Options for Dupuytren's Contracture: Incise, Excise, and Dissolve. Plast Reconstr Surg 2017; 139:240e-255e. [PMID: 28027258 DOI: 10.1097/prs.0000000000002857] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
LEARNING OBJECTIVES After studying this article, the participant should be able to: 1. Understand updates in the basic science, epidemiology, and treatment of Dupuytren's disease. 2. Understand treatment with needle aponeurotomy, collagenase, and fasciectomy. 3. Understand advanced needle techniques for Dupuytren's contracture. 4. Understand the safety and effectiveness of a new treatment, collagenase. SUMMARY The literature on Dupuytren's disease encompasses many specialties. Its treatment is generally by perforating, excising, or dissolving the affected tissues. This article reviews the changing understanding of this disease and treatment options.
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Aliperti LA, Mehta A. Peyronie’s Disease: Intralesional Therapy and Surgical Intervention. Curr Urol Rep 2016; 17:60. [DOI: 10.1007/s11934-016-0622-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Paulis G, Romano G, Paulis A. Prevalence, psychological impact, and risk factors of erectile dysfunction in patients with Peyronie's disease: a retrospective analysis of 309 cases. Res Rep Urol 2016; 8:95-103. [PMID: 27486570 PMCID: PMC4958366 DOI: 10.2147/rru.s109319] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Peyronie's disease (PD) is a chronic inflammatory disease involving the tunica albuginea of the penis. Erectile dysfunction (ED) is a possible invalidating symptom of PD. The aim of this study was to evaluate the prevalence, psychological impact, and risk factors of ED in patients with PD. The study was conducted by carrying out a retrospective analysis of the clinical records of 309 patients with PD who visited our andrology clinic. All patients underwent the following tests: body mass index, common blood tests and hormone assays, questionnaire for erectile function assessment, dynamic penile color Doppler ultrasonography, imaging of the penis at maximum erection with photographic poses according to Kelâmi, psychosexual impact evaluation with PD Questionnaire (symptom bother score), evaluation of depression symptoms with the Patient Health Questionnaire-9, and evaluation of the intensity of penile pain with the pain intensity numeric rating scale. ED was observed in 37.5% of the cases. We divided the cases into two groups: group A (PD + ED), 116 cases, and group B (PD without ED), 193 cases. After multivariate analysis, we concluded that the following comorbidities are independent risk factors for ED: dyslipidemia, obesity, chronic prostatitis, benign prostatic hyperplasia, and autoimmune diseases. A depressive disorder was observed in 62.4%, and it was more frequent in patients with PD + ED (91.37% versus 45.07% group B). Sexual bother was greater in group A compared with group B (9.7 versus 7.6). Intensities of depressive symptoms and sexual bother were significantly higher compared with cases with no curvature when the bend angle was ≥30°. Our study confirms that an integrated psychological support with medical treatment is needed in patients with PD.
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Affiliation(s)
- Gianni Paulis
- Department of Surgical Sciences, Andrology Center, Regina Apostolorum Hospital, Albano L., Italy
- Department of Uro-Andrology, Peyronie’s Disease Care Center, Rome, Italy
| | - Gennaro Romano
- Department of Urologic Oncology, Section of Avellino, Italian League Against Cancer, Avellino, Italy
| | - Andrea Paulis
- Section of Psycho-Sexology, Peyronie’s Disease Care Center, Rome, Italy
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Ostrowski KA, Gannon JR, Walsh TJ. A review of the epidemiology and treatment of Peyronie's disease. Res Rep Urol 2016; 8:61-70. [PMID: 27200305 PMCID: PMC4857830 DOI: 10.2147/rru.s65620] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Introduction Peyronie’s disease (PD) has significant effect on patients and their partners. We provide a current review of the epidemiology as well as the nonsurgical and surgical treatment of PD. Materials and methods Review of literature pertaining to PD with focus on epidemiology and treatment options. Conclusion PD is common and likely underreported. The availability of new and highly effective treatment options will catalyze patient awareness and subsequently the prevalence of disease.
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Affiliation(s)
| | - John R Gannon
- Department of Urology, University of Washington, Seattle, WA, USA
| | - Thomas J Walsh
- Department of Urology, University of Washington, Seattle, WA, 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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Abstract
INTRODUCTION Peyronie disease (PD) is a progressive fibrotic disorder of the penile tunica albuginea that results in fibrotic penile plaques and can lead to penile deformity. Characterized by aberrant fibrosis resulting in part from the persistence of myofibroblasts and altered gene expression, the molecular factors underpinning PD and other related fibrotic diatheses are just being elucidated. A genetic link to PD was first identified three decades ago using pedigree analyses. However, the specific genetic factors that predispose patients to aberrant fibrosis remain unknown, and the relations between these fibrotic conditions and other heritable diseases, including malignancy, are uncharacterized. AIM To review the current landscape linking molecular and genetic factors to aberrant fibrosis in PD and related fibrotic diatheses, including Dupuytren disease. METHODS Review and evaluation of the literature from 1970 to the present for genetic factors associated with PD were performed. MAIN OUTCOME MEASURES Data describing the genetic factors associated with PD were obtained. RESULTS We describe the known structural chromosomal abnormalities and single-nucleotide polymorphisms associated with fibrotic diatheses and discuss the spectrum of differential gene expression data comparing normal tissues with those derived from men with PD or Dupuytren disease. We discuss epigenetic mechanisms that might regulate gene expression and alter predisposition to fibrosis. CONCLUSION Although the current understanding of the genetic factors associated with PD is limited, significant advances have been made during the past three decades. Further research is necessary to provide a more comprehensive understanding of the landscape of genetic factors responsible for the development of PD.
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Paulis G, Cavallini G, Barletta D, Turchi P, Vitarelli A, Fabiani A. Clinical and epidemiological characteristics of young patients with Peyronie's disease: a retrospective study. Res Rep Urol 2015; 7:107-11. [PMID: 26185748 PMCID: PMC4501350 DOI: 10.2147/rru.s85708] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The average age of men affected by Peyronie’s disease (PD) is approximately 50–55 years, but cases have been reported even in adolescence. Several studies have already investigated the presence of PD in young men, and these studies reported a PD prevalence that varies between 1.5% and 10.8%. Having noticed a greater number of young patients in our centers in recent years, we decided to carry out a retrospective study to evaluate the prevalence of PD in patients aged <40 years, as well as to investigate any possible difference in evolution based on the age of PD patients. We selected a sample of patients (n=271) with a similar time of onset of disease. We then stratified all 271 patients into two groups: group A (age <40 years [n=46]) and group B (age ≥40 years [n=225]). All 271 patients were evaluated for the following variables: penile plaque volume, degree of penile curvature, penile pain, and erectile function. Plaque volume was measured in cm3 by dynamic penile color Doppler sonography after administration of intracavernosal alprostadil 10 mcg. The number of younger patients was 46, accounting for 16.9% of the whole sample. Our study showed more frequent appearance and greater progression of penile curvature in younger patients. The average angle of penile curvature and average score of penile pain intensity in the younger men were significantly higher than in patients aged ≥40 years (P=0.025 and P=0.0001, respectively). In the younger patients, not only was the pain more intense (visual analog scale [VAS] of 5.2 versus 3.8), but it was also more frequently present than in patients aged ≥40 years (78.2% versus 62.2%) (P=0.042). We may conclude that since PD in young patients has a more acute onset and a greater possibility of progression, it should be treated conservatively as soon as it is diagnosed.
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Affiliation(s)
- Gianni Paulis
- Regina Apostolorum Hospital, Andrology Center, Rome, Italy ; Castelfidardo Medical Team, Peyronie's Disease Care Center, Rome, Italy
| | | | - Davide Barletta
- Department of Urology, Andrology Center, San Matteo Hospital, Pavia, Italy
| | - Paolo Turchi
- Azienda ASL 4 Prato - Andrology Service, Prato, Italy
| | | | - Andrea Fabiani
- Department of surgery, Section of Urology and Andrology, ASUR Marche 9, Macerata, Italy
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Abstract
Peyronie's disease (PD) has a significant impact on the quality of life of both patients and their partners due to the compromised sexual function and physical deformation resulting from the condition. PD is a connective tissue disorder marked by fibrotic healing of the tunica albuginea, leading to penile deformities including curvature, shortening, loss of girth, hourglass appearance, and hinging. Despite the multiple medical therapies available, surgery is the gold standard of treatment once the plaque has stabilized. We present a review of the disease process, preoperative evaluation, operative planning, surgical treatments with outcomes and complications, and nascent developments in surgical management and graft development. Options include tunical lengthening procedures, tunical shortening procedures, and penile prosthesis. Decision-making is governed by degree of curvature, erectile function, and associated penile deformities. In cases with curvature of less than 60-70 degrees, adequate penile length, and no hourglass deformity, patients are candidates for tunical shortening procedures. Patients with curvature greater than 60-70 degrees, penile hourglass or hinge-destabilizing deformities, and adequate erectile function should be counseled with regard to tunical lengthening procedures. Patients with poor preoperative erectile function should undergo inflatable penile prosthesis placement, with possible secondary straightening procedures. Technique selection should be based upon surgeon preference, expertise, and experience, as evidence does not necessarily support one procedure over another.
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Affiliation(s)
- Uwais B Zaid
- Department of Urology, UCSF School of Medicine, 400 Parnassus Ave, UC Clinics, San Francisco, CA, 94143, USA,
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Hussein AA, Alwaal A, Lue TF. All about Peyronie's disease. Asian J Urol 2015; 2:70-78. [PMID: 29264123 PMCID: PMC5730743 DOI: 10.1016/j.ajur.2015.04.019] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Revised: 01/31/2015] [Accepted: 02/10/2015] [Indexed: 12/27/2022] Open
Abstract
Peyronie's disease (PD) is an acquired connective tissue disorder of the tunica albuginea of the corpus cavernosum, characterized by excessive fibrosis and plaque formation. PD can result in significant physical and psychological morbidity; as it may prevent intercourse and cause adverse impacts on partner relationships. The exact etiology and pathophysiology remain unclear, and many misconceptions about the disease associations, course and treatment exist. The disease has two distinct stages. The acute stage is characterized by pain, and disease may progress during this stage. Non-surgical managements at this stage aim to alleviate pain and stabilize the disease. Results for non-surgical treatment are often conflicting. The chronic stage occurs 6–12 months later, where pain disappears and the deformity stabilizes. Surgical treatment is reserved for significant deformity or with inability to penetrative intercourse. The choice of the surgical technique depends on the length of the penis, degree of deformity, erectile function, patients' expectations and surgeon's preference.
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Affiliation(s)
- Ahmed A Hussein
- Department of Urology, University of California, San Francisco, CA, USA.,Department of Urology, Cairo University, Egypt
| | - Amjad Alwaal
- Department of Urology, University of California, San Francisco, CA, USA.,Department of Urology, King Abdul Aziz University, Saudi Arabia
| | - Tom F Lue
- Department of Urology, University of California, San Francisco, CA, USA
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Werker PM. Dupuytren disease. Plast Reconstr Surg 2015. [DOI: 10.1002/9781118655412.ch59] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Hussein AA, Alwaal A, Lue TF. WITHDRAWN: All about Peyronie’s disease. Asian J Urol 2015. [DOI: 10.1016/j.ajur.2015.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Ventimiglia E, Capogrosso P, Colicchia M, Boeri L, Serino A, La Croce G, Russo A, Capitanio U, Briganti A, Cantiello F, Mirone V, Damiano R, Montorsi F, Salonia A. Peyronie's disease and autoimmunity—a real-life clinical study and comprehensive review. J Sex Med 2015; 12:1062-9. [PMID: 25630575 DOI: 10.1111/jsm.12825] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Although heavily investigated over the last decades, Peyronie's disease (PD) pathogenesis remains unclear. AIM We sought to investigate the association between PD and autoimmune diseases (ADs) in men seeking medical help for sexual dysfunction in the real-life setting. METHODS Complete sociodemographic and clinical data from a homogenous cohort of 1,140 consecutive Caucasian-European men were analyzed. Health-significant comorbidities were scored with the Charlson Comorbidity Index and ADs were stratified according to International Classification of Diseases, Ninth Revision classification. MAIN OUTCOME MEASURES Descriptive statistics and multivariate logistic regression models tested the association between ADs and PD. RESULTS PD was diagnosed in 148 (13%) of the 1,140 men; of PD patients, 14 (9.5%) had a comorbid AD; conversely, the rate of ADs in non-PD patients was significantly lower (χ(2) = 24.7; P < 0.01). Both patient age and AD comorbidity achieved multivariable independent predictor status for PD (odds ratio [OR]: 1.05; P < 0.01 and OR: 4.90; P < 0.01, respectively). CONCLUSIONS Our observational findings showed that ADs are highly comorbid with PD in a large cohort of same-race individuals seeking medical help for sexual dysfunction in the real-life setting.
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Affiliation(s)
- Eugenio Ventimiglia
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
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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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Medical Management of Peyronie’s Disease: a 2014 Update. CURRENT SEXUAL HEALTH REPORTS 2014. [DOI: 10.1007/s11930-014-0021-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Abstract
OBJECTIVE Peyronie's disease (PD) is a progressive fibrotic disorder of the penis that is characterized by formation of collagen plaques on the tunica albuginea of the penis that may result in penile deformity, pain (typically early in the disease course), and often occurs in conjunction with erectile dysfunction. This review's purpose is to raise awareness of PD among primary care physicians, who are likely to provide the initial diagnosis and information to patients. METHODS PubMed was searched for articles related to epidemiology, diagnosis, and management of PD. Reference lists of relevant articles were also examined for further pertinent research. Following the goals of this review, references were selected based on their appropriateness for a primary care audience. RESULTS The symptoms of PD may physically limit intercourse and impose a severe physical and psychological burden. The course of PD includes an early 'inflammatory' phase that may last 1-18 months and a subsequent 'stable' phase. In the early phase, patients may experience penile pain as the tunical plaque develops. During the stable phase, the plaque becomes more organized, penile curvature stabilizes, and the pain usually subsides. Currently, there are no US Food and Drug Administration approved therapies that have shown significant efficacy for PD. Nonsurgical treatment options are often used to manage PD with variable success. Most studies of nonsurgical management of PD are small, poorly controlled, and include patients in variable disease stages. Surgical treatment of PD is reserved for stable patients with erectile dysfunction and penile deformity that impairs sexual function. CONCLUSION PD is frequently undiagnosed. Even when PD is correctly identified, choice of treatment is problematic, based on the limited currently available clinical data demonstrating clinical benefits associated with treatment. Newer medications in clinical testing seem to offer some potential benefit for men with PD, though further research is necessary.
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Affiliation(s)
- Martin M Miner
- Miriam Hospital Men's Health Center, Warren Alpert School of Medicine, Brown University , Providence, RI , USA
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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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Knobloch K. [Penis deviation with or without pain in Peyronie's disease--an update]. MMW Fortschr Med 2012; 154:45-6. [PMID: 23173285 DOI: 10.1007/s15006-012-1343-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Paulis G, Brancato T, D'Ascenzo R, De Giorgio G, Nupieri P, Orsolini G, Alvaro R. Efficacy of vitamin E in the conservative treatment of Peyronie's disease: legend or reality? A controlled study of 70 cases. Andrology 2012; 1:120-8. [DOI: 10.1111/j.2047-2927.2012.00007.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2012] [Revised: 07/22/2012] [Accepted: 07/25/2012] [Indexed: 12/16/2022]
Affiliation(s)
- G. Paulis
- Andrology Service; Regina Apostolorum Hospital; Albano Laziale; Rome; Italy
| | - T. Brancato
- Complex Operative Unit of Urology; Regina Apostolorum Hospital; Albano Laziale; Rome; Italy
| | - R. D'Ascenzo
- Complex Operative Unit of Urology; Regina Apostolorum Hospital; Albano Laziale; Rome; Italy
| | | | - P. Nupieri
- Complex Operative Unit of Urology; Regina Apostolorum Hospital; Albano Laziale; Rome; Italy
| | - G. Orsolini
- Complex Operative Unit of Urology; Regina Apostolorum Hospital; Albano Laziale; Rome; Italy
| | - R. Alvaro
- Department of Public Health and Cellular Biology; University of Rome ‘Tor Vergata’; Rome; Italy
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