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Sexual Medicine Reviews Apr 2021Collagenase Clostridium histolyticum (CCH) is an injectable agent used to treat Peyronie's disease (PD) by enzymatically degrading the interstitial collagen in plaques.... (Review)
Review
INTRODUCTION
Collagenase Clostridium histolyticum (CCH) is an injectable agent used to treat Peyronie's disease (PD) by enzymatically degrading the interstitial collagen in plaques. CCH has been administered via multiple treatment protocols, in combination therapies, to patients with varying curvatures and in both the acute and stable phases of this condition.
OBJECTIVES
To review the current literature and provide an update on CCH as an injectable therapy for PD, as a singular therapy or in conjunction with combination therapies, and its associated complications. We provide a brief background of PD treatments, evaluate CCH efficacy in penile curvature reduction and subjective improvement in a variety of protocols, and compare combination therapies (penile traction, sildenafil), plaque location, and efficacy in both acute and stable diseases.
METHODS
We performed a systematic review of the existing PubMed literature pertaining to CCH injection therapy in the treatment of PD and compared the effectiveness to different treatment modalities.
RESULTS
CCH is a safe and effective injectable agent for all curvature directions in both acute and stable PD. It can be used in conjunction with multiple penile modeling techniques, in combination with sildenafil, and following a shortened administration protocol. Moderate to severe treatment-related adverse events occur at a rate of 9% and are typically managed conservatively.
CONCLUSION
Intralesional injections of CCH are FDA approved as a nonsurgical treatment for men with PD. The IMPRESS trials were instrumental in demonstrating the efficacy and safety of CCH and provided a standard protocol for administration. Additional studies are required to optimize treatment protocols and use in combination therapies. Further investigation of patients with ventral curvatures, hourglass deformities, and those in acute phase is needed. Natale C, McLellan D, Yousif A, et al. Review of Intralesional Collagenase Clostridium Histolyticum Injection Therapy and Related Combination Therapies in the Treatment of Peyronie's Disease (an Update). Sex Med 2021;9:340-349.
Topics: Humans; Injections, Intralesional; Male; Microbial Collagenase; Penile Induration; Penis; Treatment Outcome
PubMed: 32199788
DOI: 10.1016/j.sxmr.2020.01.005 -
International Journal of Impotence... Sep 2022Severe Peyronie's disease (PD) and concomitant erectile dysfunction (ED) may require plaque incision/excision and grafting (PIG) as an adjunct to penile prosthesis... (Review)
Review
Severe Peyronie's disease (PD) and concomitant erectile dysfunction (ED) may require plaque incision/excision and grafting (PIG) as an adjunct to penile prosthesis implantation (IPP). Currently, there is no available consensus on the best graft material to use. Our aim was to systematically review graft materials used as patches following PIG + IPP. Literature search was performed in March 2021. Only original articles in English with a series of 10 or more patients were included. Overall, a total of 17 studies were included, corresponding to a cohort of 662 patients. The mean age ranged from 45 to 65 years and most patients had curvatures >45°. Average penile lengthening ranged from 1 to 3.5 cm, average residual curvatures from 0 to 20% and decreased glans sensitivity from 0 to 20%. Eighty to 100% of patients were satisfied with cosmetic and functional results. PIG + IPP with the use of various grafts offers promising results for the treatment of patients suffering from severe PD with concomitant ED. Unfortunately, the absence of high quality and comparative studies makes it difficult to establish the optimum graft. Therefore, the level of experience of the surgical team with one or more methods should guide their choice.
Topics: Erectile Dysfunction; Humans; Male; Penile Implantation; Penile Induration; Penile Prosthesis; Penis
PubMed: 34718344
DOI: 10.1038/s41443-021-00479-8 -
International Journal of Molecular... Jan 2023Current literature has indicated that Peyronie's disease (PD) could be initiated by microtrauma and the subsequent inflammation episodes that follow. PD could be sorted... (Review)
Review
Current literature has indicated that Peyronie's disease (PD) could be initiated by microtrauma and the subsequent inflammation episodes that follow. PD could be sorted into acute or chronic status, and it can differ when selecting the clinical therapeutics. PD would cause pain and penile deformity to diseased men and impair their erectile function. Occasionally, surgical revision of the penis might be needed to correct the penile curvature. We find that there are limited effective options of intra-lesion injections for the PD plaques. By searching the databases and screening the literature with the PRISMA 2020 guideline, we observed that several preclinical studies that applied stem cell therapy in treating PD were fruitful in the acute phase. Although in the chronic phase of PD, erectile parameters were not significantly improved, and therefore, future studies might be better elevated in certain aspects, such as the sites selected for harvesting stem cells or changing the centrifugation forces. In this review, we concluded the contemporary understanding of inflammatory microenvironments in PD, the stem cell therapy in PD, and our perspectives on future studies. We concluded that there may be great potential in stem cell therapy for treating both acute and chronic phases PD.
Topics: Male; Humans; Penile Induration; Penis; Penile Erection; Injections; Stem Cells
PubMed: 36614220
DOI: 10.3390/ijms24010777 -
The Journal of Sexual Medicine Feb 2022Congenital penile curvature (CPC) is corrected surgically by various corporoplasty or tunica albuginea plication techniques, but the optimal surgical approach is not...
BACKGROUND
Congenital penile curvature (CPC) is corrected surgically by various corporoplasty or tunica albuginea plication techniques, but the optimal surgical approach is not well-defined.
AIM
To provide a comprehensive evaluation of the published literature pertaining to outcomes with penile plication and corporoplasty techniques for surgical management of CPC. To determine if plication or corporoplasty offers superior outcomes in surgical correction of CPC.
METHODS
A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Checklist. The following databases were queried from inception to March 18, 2020 to search for studies describing surgical treatment of CPC: Ovid MEDLINE(R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations and Daily, Ovid Embase, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews, and Scopus.
OUTCOMES
Objective and subjective postoperative outcomes including penile straightening, shortening, penile sensory changes, and reoperation rates for both corporoplasty and tunica albuginea plication were summarized.
RESULTS
Fifty-five articles comprising 2,956 patients with CPC who underwent a plication procedure (n = 1,375) or corporoplasty (n = 1,580) were included. The definition of "treatment success" varied widely and most often involved subjective patient reporting (22 studies; 40%) or objective assessment (15 studies; 27%). We considered curvature correction to be satisfactory if there was self-reported patient satisfaction or residual curvature after correction of <20˚. Reported rates of successful straightening ranged from 75 to 100% and 73 to 100% for plication and corporoplasty, respectively. A comprehensive and accurate assessment of surgical outcomes for CPC correction, such as satisfactory penile straightening, reoperation rates, glans sensory changes, and other complications was limited by significant inter-study heterogeneity with respect to the reporting of treatment outcomes.
CLINICAL IMPLICATIONS
While both plication and corporoplasty appear to be safe and effective options in the treatment of CPC, definitive conclusions cannot be drawn with respect to treatment superiority due to low-quality study design, methodology flaws, and significant heterogeneity in reporting.
STRENGTH & LIMITATIONS
This report represents the most comprehensive review of CPC surgical management. However, there is a significant lack of standardization in the reporting of treatment outcomes for CPC, thereby limiting the reliability of the published data summarization encompassed by our review.
CONCLUSION
Both plication and corporoplasty demonstrate high success rates and relatively low complication rates in the treatment of CPC, albeit with low-level evidence available in most research publications. Robust comparison of the surgical techniques used to correct CPC is limited by significant variation in reporting methods used in the literature. C. J. Britton, F. A. Jefferson, B. L. Findlay, et al. Surgical Correction of Adult Congenital Penile Curvature: A Systematic Review. J Sex Med 2022;19:364-376.
Topics: Adult; Humans; Male; Patient Satisfaction; Penile Induration; Penis; Reproducibility of Results; Treatment Outcome
PubMed: 34996726
DOI: 10.1016/j.jsxm.2021.11.017 -
Progres En Urologie : Journal de... Sep 2020The efficiency of extracorporeal shock waves (SW) for Peyronie's disease (PD) is controversial.
INTRODUCTION
The efficiency of extracorporeal shock waves (SW) for Peyronie's disease (PD) is controversial.
METHODS
A systematic review of the literature published between 2000 and 2019 was conducted using the PRISMA methodology. We used Medline data with the following.
KEYWORDS
"extracorporeal shock wave therapy" ; "Peyronie's disease"; "Sexuality"; Penile erection.
RESULTS
Thirteen articles were selected. Our review showed that SW were beneficial in terms of pain. Regarding plaques size and penile curvature, the results remain divergent.
CONCLUSION
SW may be useful in the management of pain in selected patients with PD. Its effectiveness on plaques size and penile curvature needs to be demonstrated through controlled and randomized trials. The population has to be targeted, and the treatment protocol must also be standardized.
Topics: Extracorporeal Shockwave Therapy; Humans; Male; Penile Induration
PubMed: 32370921
DOI: 10.1016/j.purol.2020.04.003 -
The Journal of Sexual Medicine Feb 2019Medical treatment of Peyronie's disease (PD) in terms of intralesional therapy is still a matter of debate. (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Medical treatment of Peyronie's disease (PD) in terms of intralesional therapy is still a matter of debate.
AIM
To compare the efficacy of different classes of intralesional therapy with a network meta-analysis (NMA) method.
METHODS
The search was conducted using documents published in PubMed, Scopus, and Web of Science databases until September 30, 2017. We included randomized controlled trials comparing at least 1 intralesional therapy with a placebo therapy or with another drug for the treatment of PD. All intralesional therapies have been considered: collagenase Clostridium histolyticum (CCH), hyaluronic acid, verapamil, and interferon α-2b.
MAIN OUTCOME MEASURE
Outcomes of the study are the mean change in penile curvature (PC) and in erectile function (EF) assessed with the International Index of Erectile Function questionnaire.
RESULTS
In total, 8 comparisons matched with the inclusion criteria, which includes 1,050 patients. With regard to PC (degree) improvement, hyaluronic acid and verapamil showed worse outcomes when compared with CCH (-6.66 and -2.30) and interferon α-2b (-6.75 and -2.38). When considering improvement in EF, hyaluronic acid, verapamil and interferon α-2b showed a slight increase in mean change when compared with CCH (+2.39, +1.77, and +0.65). Moreover, verapamil and interferon α-2b showed slightly worse mean change in comparison to hyaluronic acid (+0.62 and +1.74), whereas interferon α-2b was worse than verapamil (-1.12).
CLINICAL IMPLICATIONS
Based on this NMA, empirical therapy for PD should be avoided to offer the patients the best treatment in terms of level of evidence.
STRENGTHS & LIMITATIONS
In this NMA, we have provided, for the first time, evidence of the efficacy between different intralesional therapies for the treatment of PD. We were not able to compare all specific outcomes (ie, pain, plaque size, patient satisfaction) of PD, because of the lack of homogeneity across relevant studies. Moreover, because of the few included studies, a meta-regression analysis of predictive factors of treatment response was not calculated.
CONCLUSION
This is the first meta-analysis comparing all available intralesional treatments for PD. CCH and interferon α-2b showed the best outcome in terms of PC, whereas hyaluronic acid was most efficient in relation to EF. Russo GI, Cacciamani G, Cocci A, et al. Comparative Effectiveness of Intralesional Therapy for Peyronie's Disease in Controlled Clinical Studies: A Systematic Review and Network Meta-Analysis. J Sex Med 2019;16:289-299.
Topics: Adult; Humans; Hyaluronic Acid; Injections, Intralesional; Interferon alpha-2; Male; Microbial Collagenase; Network Meta-Analysis; Penile Erection; Penile Induration; Randomized Controlled Trials as Topic; Surveys and Questionnaires; Treatment Outcome; Verapamil
PubMed: 30692028
DOI: 10.1016/j.jsxm.2018.12.011 -
Actas Urologicas Espanolas Jun 2020Reduction in penile size is due to numerous conditions including Peyronie's disease, previous penile surgeries, diabetes, trauma, erectile dysfunction, pelvic surgery,...
INTRODUCTION
Reduction in penile size is due to numerous conditions including Peyronie's disease, previous penile surgeries, diabetes, trauma, erectile dysfunction, pelvic surgery, and aging. Elasticity of the tunica albuginea is adversely affected by any of the above. Fibrosis then triggers progressive erectile dysfunction OBJECTIVES: When a penile prosthesis is indicated, it is important to determine whether the penis has already diminished in size prior to insertion of the implant. Because a prosthesis only provides axial rigidity and is not associated with the enlargement of the penis, reflection of strategies to simultaneously enlarge the size of the penis while implanting a device is recommended.
MATERIAL AND METHODS
A systematic review of current scientific literature regarding procedures and tactics currently available for penile implants and enlargement was conducted.
RESULTS
The literature demonstrates that the evolution of penile implant surgery, accompanied by consideration of enlargement, has evolved through 5 fundamental techniques: Incision with Grafting; Sliding with Grafting; Modified Sliding without Grafting (MoST); Multiple Slit without Grafting (MUST); and the Egydio Paradigm for Tunica Expansion Procedures (TEP), a further evolution of previous strategies to achieve state of the art penile implantation accompanied by maximum penile enlargement. Evolving technology of tunica expansion procedures has led to diminution of the size of tunica defects and avoidance of grafts to prevent bulging and indentation, while developing solutions to preserve the strength of the tunica albuginea for firm positioning of the cylinders in the interior of the corpora cavernosa.
CONCLUSIONS
The evolution of these techniques is the transformation of larger tunica defects into smaller ones. While grafts are often used to reinforce the penile structure due to large defects, multiple incisions of the tunica albuginea are gaining popularity to promote girth and length enlargement without grafts and without the loss of tunica strength necessary to support the cylinders inside the corpora.
Topics: Humans; Male; Organ Size; Penile Implantation; Penile Prosthesis; Penis; Prosthesis Design; Urologic Surgical Procedures, Male
PubMed: 32278614
DOI: 10.1016/j.acuro.2019.10.015 -
Expert Opinion on Investigational Drugs Jul 2018The prevalence of sexual dysfunctions has increased over the last decades; despite a number of available treatments for erectile dysfunction (ED), premature ejaculation... (Review)
Review
INTRODUCTION
The prevalence of sexual dysfunctions has increased over the last decades; despite a number of available treatments for erectile dysfunction (ED), premature ejaculation (PE), and Peyronie's disease (PD), still several unmet therapeutic needs deserve to be fulfilled. The aim of this review is to detail on phase I and II clinical trials investigating novel medical treatments for ED, PE, and PD.
AREAS COVERED
We conducted a systematic review of the literature including both published and ongoing phase I and II registered trials focused on medical treatment of ED, PE, and PD during the last 5 years. A total of 35 trials have been identified. Most studies (63%) investigated ED treatments and 26% were still ongoing. Stem cells (SCs) therapy was assessed in 28% of trials.
EXPERT OPINION
SCs therapy represent a promising treatment for ED although only few patients have been treated to date. Likewise, the oral selective oxytocin receptor antagonists for treating PE showed excellent safety profile and deserve further investigations in phase III trials. Preliminary results of novel topical treatments for PD with fibrinolytic and antiinflammatory drugs are encouraging, but urgently need to be confirmed in large placebo-controlled trials.
Topics: Animals; Clinical Trials, Phase I as Topic; Clinical Trials, Phase II as Topic; Drug Design; Erectile Dysfunction; Humans; Male; Penile Induration; Premature Ejaculation; Prevalence; Stem Cell Transplantation
PubMed: 29969332
DOI: 10.1080/13543784.2018.1495707 -
Actas Urologicas Espanolas Oct 2017The low-intensity shockwave (LISW) therapy is a recently developed modality for treating erectile dysfunction. (Meta-Analysis)
Meta-Analysis Review
CONTEXT
The low-intensity shockwave (LISW) therapy is a recently developed modality for treating erectile dysfunction.
OBJECTIVE
To assess the efficacy of LISW therapy for treating erectile dysfunction as described in the literature.
ACQUISITION OF EVIDENCE
Two independent reviewers identified studies eligible for a systematic review and meta-analysis of various sources written in English and Spanish, using the databases of PubMed, EMBASE and Web of Science. We excluded studies on Peyronie's disease. We employed the DerSimonian-Laird method for defining heterogeneity, calculating the grouped standard deviation of the mean (SDM). The primary objective of this review is to assess efficacy based on the change in the International Index of Erectile Function (IIEF-EF) over baseline at 1 month from the start of treatment, both for the treatment arm and the placebo arm. The secondary objective is focused on analysing IIEF-EF at 3-6 months from the start of the therapy.
SUMMARY OF THE EVIDENCE
The pooled data of 636 patients from 12 studies showed that treatment with LISW resulted in a significant increase in IIEF-EF at 1 month with respect to baseline (SDM, -2.92; P=.000), to a greater degree than placebo (SDM, -.99; P=.000). The IIEF-EF at 3-6 months for the treated patients was significantly greater than baseline (SDM, -2.78; P=.000). Only one study compared the efficacy of placebo at 3-6 months versus baseline (SDM, -9.14). The comparison between LISW and placebo favours active treatment (SDM, 2.53; P=.000) at 1 month. There are insufficient data in the literature to assess the response over placebo at 3-6 months.
CONCLUSIONS
According to the literature, treatment with LISW for erectile dysfunction is effective, both in the short and medium term. LISW has been described as more effective than placebo in the short term. The long-term efficacy data are insufficient. More studies are needed to explain the role of this therapy according to specific causes of erectile dysfunction.
Topics: Erectile Dysfunction; Extracorporeal Shockwave Therapy; Humans; Male; Randomized Controlled Trials as Topic; Severity of Illness Index; Treatment Outcome
PubMed: 27521134
DOI: 10.1016/j.acuro.2016.07.005 -
Therapeutic Advances in Urology 2024Penile shortening, frequently resulting from end-stage Peyronie's disease (PD), has a negative impact on patients' sexual activity and overall quality of life,... (Review)
Review
Risk and benefits of penile length preservation techniques during penile prosthesis implantation: a systematic review by the young academic urologists sexual and reproductive health working group.
BACKGROUND
Penile shortening, frequently resulting from end-stage Peyronie's disease (PD), has a negative impact on patients' sexual activity and overall quality of life, especially when accompanied by Erectile dysfunction (ED). Various surgical techniques have been described to manage concomitant ED and penile shortening through penile prosthesis (PP) implantation.
OBJECTIVES
To evaluate the benefits and risks of different penile length preservation techniques during PP implantation.
DESIGN
A systematic review of the available literature on the use of penile length preservation maneuvers in conjunction with PP implantation was conducted.
DATA SOURCES AND METHODS
For this systematic review, three databases (Medline, Embase and Cochrane) and clinical trial.gov were queried for relevant publications from 1 January 1990 to 1 September 2022. The review process followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines.
RESULTS
The qualitative analysis included 15 relevant articles involving 1186 adult patients who underwent penile length preservation techniques during PP implantation. Penile lengthening of 1-7 cm was reported. Overall, postoperative complications were described in up to 21.7% of cases. Only five studies reported functional outcomes, showing a significant improvement in postoperative period based on the administered questionnaire (e.g. IIEF - International Index of Erectile Function, EDITS - Erectile Dysfunction Inventory of Treatment Satisfaction).
CONCLUSION
Penile length preservation procedures appear to offer a viable option for managing acquired penile shortening, particularly in cases of PD. However, they are associated with a significant risk of complications. Proper patient selection, thorough discussion of risks and benefits, and referral to high-volume centers are mandatory to achieve optimal outcomes and minimizing complications.
TRIAL REGISTRATION
PROSPERO database registration CRD42022360758.
PubMed: 38205393
DOI: 10.1177/17562872231215177