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World Journal of Urology Jan 2017The objective was to evaluate high-level evidence studies of extracorporeal shock wave therapy (ESWT) for urological disorders. (Review)
Review
PURPOSE
The objective was to evaluate high-level evidence studies of extracorporeal shock wave therapy (ESWT) for urological disorders.
METHODS
We included randomized controlled trials reporting outcomes of ESWT in urology. Literature search on trials published in English using EMBASE, Medline and PubMed was carried out. The systematic review was performed according to PRISMA guidelines.
RESULTS
We identified 10 trials on 3 urological indications. Two of 3 trials on Peyronie's disease (PD) involving 238 patients reported improvement in pain; however, no clinical significant changes in penile deviation and plaque size were observed. Four studies on erectile dysfunction (ED) including 337 participants were included. Using International Index of Erectile Function (IIEF-EF) and erectile hardness scale (EHS) data suggested a significant positive effect of ESWT in phosphodiesterase-5 inhibitor (PDE-5i) responders in 2 of 4 trials and 3 of 4 trials, respectively. Three studies on chronic pelvic pain (CPP) engaging 200 men reported positive changes in National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI). There was considerable heterogeneity between trials both with regard to treatment techniques and outcome measures, making it difficult to compare results.
CONCLUSIONS
ESWT may resolve pain in PD patients, while evidence for reducing curvature and plaques size is poor. Effects of ESWT on IIEF in ED patients are inconsistent; however, data on EHS does imply that the treatment potentially may recover natural erection in PDE-5i responders. ESWT seems to be able to resolve pain in CPP patients in the short term. In all three disease entities, long-term outcome data are still warranted.
Topics: Chronic Pain; Erectile Dysfunction; Female; High-Energy Shock Waves; Humans; Male; Pelvic Pain; Penile Induration; Phosphodiesterase 5 Inhibitors; Randomized Controlled Trials as Topic; Treatment Outcome
PubMed: 27108421
DOI: 10.1007/s00345-016-1834-2 -
Frontiers in Medicine 2022Peyronie's disease (PD) is a chronic wound healing disorder, mainly involving tunica albuginea. Collagenase Clostridium Histolyticum (CCH) has shown its effectiveness in...
BACKGROUND
Peyronie's disease (PD) is a chronic wound healing disorder, mainly involving tunica albuginea. Collagenase Clostridium Histolyticum (CCH) has shown its effectiveness in treating PD, but its efficacy and safety remain controversial, which propelled us to conduct the first evidence-based research on this topic.
METHODS
We searched the Web of Science, PubMed, Embase, and ClinicalTrials.gov for related randomized controlled trials (RCTs). A systematic review and meta-analysis were performed to compare the penile curvature deformity (PCD), Peyronie's Disease Questionnaire peyronie's disease symptom bother (PDSB), penile pain score, total treatment-related adverse events (TAEs), and specific adverse events, including penile pain, penile edema, injection site pain, and contusion. Cochrane Collaboration's tool and Review Manager 5.3.0 version were applied, respectively, to evaluate the study quality and heterogeneity.
RESULTS
Four articles (five RCTs) with 1,227 patients were finally included in the meta-analysis. The results revealed that CCH had excellent efficacy in relieving PCD (weighted mean difference [WMD]: -318.77, < 0.001) and PDSB (WMD: -1.20, < 0.001) compared to the placebo group, but there was no difference in the penile pain score (WMD: -0.64, = 0.39) between the two groups. Furthermore, the incidence of TAEs in the CCH group was higher [odds ratio (OR): 12.86, < 0.001].
CONCLUSIONS
The current evidence suggests that CCH has a significant effect on treating PD. Considering that all these adverse events are acceptable and curable, CCH could slow the disease progression in the acute phase or act as a substitute for patients unable or unwilling to undergo surgery. However, the conclusion could not be certainly drawn until RCTs with a larger scale proved it.
PubMed: 35252236
DOI: 10.3389/fmed.2022.780956 -
Sexual Medicine Reviews Apr 2020Peyronie's disease is characterized by abnormal healing of the tunica albuginea (TA), resulting in the production of a fibrotic plaque that leads to penile curvature and...
INTRODUCTION
Peyronie's disease is characterized by abnormal healing of the tunica albuginea (TA), resulting in the production of a fibrotic plaque that leads to penile curvature and considerable psychological impact. Precise knowledge of various surgical techniques is of fundamental importance for proper management of the patient.
AIM
To compare results (including surgical success on quality of life and sexual satisfaction and complications) between 2 different techniques: with TA incision vs without TA incision.
METHODS
The search was performed according to PRISMA in PubMed and Embase through September 2018. Key words searched were ["Peyronie" or "Peyronie's disease" or "penile curvature" or "penile induration"] and ["technique" or "surgery" or "surgical"] and ["quality of life" or "sexual quality of life" or "sexual satisfaction" or "outcome" or "outcomes"].
MAIN OUTCOME MEASURE
Thirty-one articles were considered for this review. The main outcomes were reported descriptively.
RESULTS
The most significant results included penile straightening (88.5% vs 70.9% favoring not opening TA), perception of a palpable nodule (13.2% vs 27.4% favoring not opening TA), and loss of sensibility (11% vs 20% favoring not opening TA). Neither a prospective randomized study nor a direct comparison study has been performed for these techniques. There is no consensus among the studies on how to measure results. Subjective criteria were primarily used for evaluation, and there is a paucity of objective tools to quantify the outcomes.
CONCLUSION
There is no consensus on which technique achieves better results or fewer complications; therefore, the decision on which technique to use is a matter of surgeon preference. Studies comparing distinctive techniques and either opening or not opening the tunica albuginea should be performed to support surgical decision making. In addition, guidelines that could assist in the standardization of criteria should be investigated in future studies, with the aim of better evaluating outcomes. Barbosa, ARG, Takemura LS, Cha JD, et al. Surgical Treatment of Peyronie's Disease: Systematic Review of Techniques Involving or Not Tunica Albuginea Incision. Sex Med Rev 2020;8:324-332.
Topics: Humans; Male; Patient Satisfaction; Penile Induration; Quality of Life; Sexual Health; Urogenital Surgical Procedures
PubMed: 31570315
DOI: 10.1016/j.sxmr.2019.08.002 -
Progres En Urologie : Journal de... Dec 2020Clinical trials of cell therapy for erectile dysfunction (ED) and Peyronie's disease (PD) were recently conducted after preclinical studies.
INTRODUCTION
Clinical trials of cell therapy for erectile dysfunction (ED) and Peyronie's disease (PD) were recently conducted after preclinical studies.
AIMS
The aims of this study are to give an update on biotherapy for ED and PD and to describe the regulatory framework for these therapies.
MATERIALS AND METHODS
A literature review was performed through PubMed and Clinical.trials.gov addressing cell therapy for ED and PD and using following keywords "erectile dysfunction", "Peyronie's disease", "stem cell", and "platelet-rich plasma".
RESULTS
Preclinical studies in rodent models have shown the potential benefit of cell therapy for ED after radical prostatectomy or caused by metabolic diseases, and PD. The tissues used to obtain the therapeutic product were bone marrow, adipose tissue and blood (PRP, platelet-rich plasma). Mechanism of action was shown to be temporary and mainly paracrine. Four clinical trials were published concerning ED after radical prostatectomy and in diabetic patients and one for PD. Eleven clinical trials including three randomized trials are currently going on. Preclinical and preliminary clinical results suggested the possibility to improve spontaneous erectile function and response to pharmaceutical treatment in initially non-responder patients. This effect is mediated by an improvement of penile vascularization. A reduction of penile curvature without side effect was noted after injections into the plaque of PD patients. Most of these therapeutic strategies using autologous cells were considered as "Advanced Therapy Medicinal Products" with strict regulatory frameworks imposing heavy constraints, in particular in case of "substantial" modification of the cells. The regulatory framework remains unclear and more permissive for PRP and cell therapy processes with extemporaneous preparation/injection and no "substantial" modifications.
CONCLUSIONS
First results on cell therapy for ED and PD are promising. The regulatory framework can significantly change according to cell preparations and origins leading to various constraints. This regulatory framework is crucial to consider for the choice of the procedure.
Topics: Biological Therapy; Clinical Trials as Topic; Erectile Dysfunction; Humans; Male; Penile Induration; Stem Cell Transplantation
PubMed: 32826194
DOI: 10.1016/j.purol.2020.05.002 -
Asian Journal of Andrology 2020With the onset of a metabolic syndrome epidemic and the increasing life expectancy, erectile dysfunction (ED) has become a more common condition. As incidence and...
With the onset of a metabolic syndrome epidemic and the increasing life expectancy, erectile dysfunction (ED) has become a more common condition. As incidence and prevalence increase, the medical field is focused on providing more appropriate therapies. It is common knowledge that ED is a chronic condition that is also associated with a myriad of other disorders. Conditions such as aging, diabetes mellitus, hypertension, obesity, prostatic hypertrophy, and prostate cancer, among others, have a direct implication on the onset and progression of ED. Characterization and recognition of risk factors may help clinicians recognize and properly treat patients suffering from ED. One of the most reliable treatments for ED is penile prosthetic surgery. Since the introduction of the penile prosthesis (PP) in the early seventies, this surgical procedure has improved the lives of thousands of men, with reliable and satisfactory results. The aim of this review article is to characterize the epidemiology of men undergoing penile prosthetic surgery, with a discussion about the most common conditions involved in the development of ED, and that ultimately drive patients into electing to undergo PP placement.
Topics: Diabetes Complications; Diabetes Mellitus; Erectile Dysfunction; Humans; Hypertension; Impotence, Vasculogenic; Male; Pelvic Bones; Penile Implantation; Penile Induration; Penile Prosthesis; Penis; Prostatectomy; Prostatic Neoplasms; Radiation Injuries; Radiotherapy; Reoperation; Spinal Cord Injuries; Vascular Diseases; Wounds and Injuries
PubMed: 31793443
DOI: 10.4103/aja.aja_124_19 -
Endocrinology, Diabetes & Metabolism Apr 2021Fibrosis is characterized by dysregulation and accumulation of extracellular matrix. Peyronie's disease and Dupuytren disease are fibroproliferative disorders of the...
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.
Topics: Chronic Disease; Diabetes Complications; Diabetes Mellitus; Dupuytren Contracture; Extracellular Matrix; Fascia; Female; Fibrosis; Genome-Wide Association Study; Hand; Humans; Hyperglycemia; Male; Matrix Metalloproteinases; Penile Induration; Penis; Signal Transduction
PubMed: 33855203
DOI: 10.1002/edm2.195 -
The Journal of Sexual Medicine Apr 2016Penile prosthesis implantation has emerged as a definitive treatment to restore sexual function to the motivated man with erectile dysfunction. Substantial improvements... (Review)
Review
INTRODUCTION
Penile prosthesis implantation has emerged as a definitive treatment to restore sexual function to the motivated man with erectile dysfunction. Substantial improvements in the design of inflatable devices have been made since they first became available more than four decades ago.
AIM
To review the history of the penile prosthesis, the indications, preoperative evaluation, and patient and partner satisfaction. The current approaches to addressing intra- and postoperative complications, provide an understanding of prosthesis infection, and placement of these devices will be reviewed.
METHODS
A committee of worldwide experts in this field was assembled during the 2015 International Consultation on Sexual Medicine (ICSM) and performed a systematic review of the peer-reviewed published medical literature pertaining to penile prosthesis. Particular attention was given to higher level trials when available. Recommendations are based upon the Oxford Criteria.
MAIN OUTCOME MEASURES
Unfortunately there is limited level 1 and 2 evidence, and where expert opinion was utilized, the decision was unanimous within the committee with a goal of presenting a clinically relevant guideline pertaining to penile prostheses.
RESULTS
Penile prosthesis has undergone an evolution over the past 40 years resulting in a more effective and reliable treatment for advanced erectile dysfunction not responding to less invasive methods including oral treatment with PDE5 inhibitors, vacuum erection device, and intracorporal injection therapy. It should be considered an appropriate treatment option for the man who wishes to restore erectile function and who understands the potential risk of mechanical failure and infection, both of which are less common now as a result of improvements made in device design as well as surgical protocols adhered to in the operating room. Patients must be clearly informed of the risks associated with penile prosthesis including mechanical failure, infection, shortening of the penis, change in sensation and configuration of the penis, as well as injury to local structures. Intraoperative complications are unusual but do occur and can usually be addressed intraoperatively to allow placement of the device at the time of initial surgery. Postoperative complications may also be addressed when they occur but may require more advanced reconstructive surgical techniques. Men with Peyronie's disease, corporal fibrosis due to infection, trauma, prior prosthesis explantation, priapism, and men who have undergone construction of a neophallus may require additional advanced maneuvers to obtain optimum results with a penile prosthesis.
CONCLUSION
Penile prosthesis remains as an important, viable, and effective treatment for male erectile dysfunction that does not respond to other less invasive approaches or when these approaches are contraindicated or not acceptable to the patient. These devices provide the patient with the ability to engage in penetrative sexual activity without interfering with urination, ejaculation, sensation, or orgasm. Although mechanical failure can occur, the current devices are more reliable as a result of design modifications. Infection remains the most dreaded complication but since the introduction of antibiotic and hydrophilic coatings, infection is less common. Overall, patient and partner satisfaction appear to be reasonably high when a penile prosthesis is used to restore erectile function.
Topics: Adult; Erectile Dysfunction; History, 20th Century; Humans; Male; Penile Implantation; Penile Prosthesis; Penis; Postoperative Complications; Plastic Surgery Procedures; Referral and Consultation; Treatment Outcome
PubMed: 27045255
DOI: 10.1016/j.jsxm.2016.01.017 -
European Urology Dec 2018Conservative therapies for Peyronie's disease (PD) aim to treat early-stage disease by improving clinical outcomes such as penile curvature, penile length erectile...
CONTEXT
Conservative therapies for Peyronie's disease (PD) aim to treat early-stage disease by improving clinical outcomes such as penile curvature, penile length erectile dysfunction, and pain.
OBJECTIVE
To summarise the available evidence regarding injection and mechanical therapies for PD treatment.
EVIDENCE ACQUISITION
An extensive search of Medline, Embase, and Scopus databases retrieved English-language articles up to 15 May 2018. The systematic review protocol was registered on PROSPERO (CRD42017077050). Inclusion criteria were as follows: adults with early or chronic PD receiving treatment with injection therapy, penile traction, or a vacuum device.
EVIDENCE SYNTHESIS
Fifty-two articles were selected according to the inclusion criteria-17 comparative studies and 35 cohort studies-analysing the effects of calcium channel blockers (verapamil, nicardipine), collagenase Clostridium histolyticum (CCH), interferon α-2b (IFNα-2b), hyaluronic acid (HA), onabotulinum toxin A, thiocolchicine, penile extender devices, and vacuum devices. Qualitative data from these studies suggest a clinically significant effect of CCH and IFNα-2b injection therapy to decrease penile curvature and conserve penile length. Verapamil and HA performed well in single-arm or case-control studies. Studies of penile traction and vacuum devices in patients with PD demonstrated some benefits in terms of curvature and penile length but only in small, underpowered, nonrandomised studies. Studies of onabotulinum toxin A injections or thiocolchicine showed significant improvements in penile curvature, but only in studies of single-arm or case-control design.
CONCLUSIONS
CCH and IFNα-2b injected into stable PD plaques can decrease penile curvature; CCH can also improve penile length. However, based on available data, strong conclusions cannot be drawn for other treatments, including calcium channel blockers, HA, or mechanical therapies.
PATIENT SUMMARY
Our systematic review of injection therapies provides evidence for improvements in penile curvature for patients with Peyronie's disease. No robust evidence is available to support the use of other local treatments including calcium channel blockers, hyaluronic acid, or mechanical therapies.
Topics: Conservative Treatment; Humans; Injections; Male; Penile Induration; Penis; Recovery of Function; Traction; Treatment Outcome; Urological Agents; Vacuum
PubMed: 30237020
DOI: 10.1016/j.eururo.2018.07.005 -
World Journal of Urology May 2024Platelet-rich plasma (PRP) as a regenerative therapy has gained interest in the field of andrology for the treatment of erectile dysfunction (ED) and Peyronie's disease...
PURPOSE
Platelet-rich plasma (PRP) as a regenerative therapy has gained interest in the field of andrology for the treatment of erectile dysfunction (ED) and Peyronie's disease (PD). This systematic review aims to critically evaluate the current evidence on the use of PRP for these conditions.
METHODS
We performed a systematic literature search according to the PRISMA guidelines using PubMed and Scopus databases in December 2023. Studies were included if they evaluated the effect of PRP therapy for ED or PD in humans.
RESULTS
We identified 164 articles, 17 of which were included, consisting of 11 studies on ED, 5 studies on PD, and 1 study on both. We included four randomized controlled trials, 11 prospective cohort studies, and three retrospective cohort studies including a total of 1099 patients. The studies on ED and PD generally showed small to moderate benefits with mild and transient side effects and no major adverse events were reported. General limitations included variations in PRP protocols, small sample sizes, short follow-up periods, and lack of control groups except in the three randomized trials on ED and the one on PD.
CONCLUSION
The literature on PRP therapy in andrology is limited and difficult to interpret due to variations in protocols and methodological drawbacks. Further research is necessary to determine the optimal preparation and treatment protocols for PRP therapy and clarify its effectiveness in andrology.
Topics: Humans; Penile Induration; Platelet-Rich Plasma; Male; Erectile Dysfunction
PubMed: 38811395
DOI: 10.1007/s00345-024-05065-3 -
Urology Practice Jan 2018The discovery of biological targets in the fibrosis pathway has led to the advent of many potential therapies for fibrotic diseases. During the last 2 decades an... (Review)
Review
INTRODUCTION
The discovery of biological targets in the fibrosis pathway has led to the advent of many potential therapies for fibrotic diseases. During the last 2 decades an increasing number of large, randomized studies on antifibrotic medications in urology have evaluated its efficacy, safety and long-term outcomes. Although there are many established therapeutics with antifibrotic properties, we focused on the 6 antifibrotic agents that are most currently relevant to the field of urology, including clostridial collagenase histolyticum, mitomycin C, halofuginone, triamcinolone acetonide, verapamil and interferon. We evaluate and summarize the existing published literature on these antifibrotic drugs with a particular emphasis on their safety and efficacy in urological diseases.
METHODS
Using the MEDLINE® database, Cochrane Library Central Search, Web of Science and Google Scholar we reviewed all published articles from 1976 to 2016 using the search terms antifibrotics and urology. The literature was searched for pharmaceuticals with antifibrotic properties and efficacy in urological disease, and the 6 most extensively researched drugs were documented. These antifibrotic drugs were then individually reviewed using the databases previously mentioned, and the safety, efficacy and long-term outcomes of each drug were analyzed and summarized.
RESULTS
Our search yielded 63 peer reviewed publications on the use of antifibrotic agents in the field of urology. Clostridial collagenase histolyticum has been studied the most thoroughly in this group, with 19 articles and Food and Drug Administration approval for use in Peyronie's disease. The majority of the publications was prospective or randomized controlled studies. Mitomycin C and triamcinolone acetonide can reduce urethral stricture recurrence at a mean followup period of 1 to 2 years and mitomycin C has been effective in curing recurrent bladder neck contractures. Halofuginone and verapamil have shown efficacy for Peyronie's disease and urethral stricture.
CONCLUSIONS
This systematic review summarizes the existing literature on the use of antifibrotic drugs for urological disease. Safety, efficacy and long-term outcomes for each drug are evaluated for various disease types and current recommendations for use are reviewed. This systematic review also details the potential therapeutic roles of several antifibrotic medications for treating common urological conditions and diseases, showing that they can be important, useful and effective additions to the urologist's armamentarium.
PubMed: 37300208
DOI: 10.1016/j.urpr.2016.11.011