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The World Journal of Men's Health Jan 2024To investigate the efficacy of medical treatment options for Peyronie's disease (PD) including oral drugs, intralesional treatment and mechanical treatment compared with...
PURPOSE
To investigate the efficacy of medical treatment options for Peyronie's disease (PD) including oral drugs, intralesional treatment and mechanical treatment compared with placebo treatment using network meta-analysis (NMA).
MATERIALS AND METHODS
We searched the randomized controlled trials (RCTs) of PD in PubMed, Cochrane library, and EMBASE up to October 2022. RCTs included medical treatment options: oral drugs, intralesional treatment and mechanical treatment. Studies reporting at least one of the outcome measures of interest including curvature degree, plaque size, and structured questionnaires (International Index of Erectile Function, IIEF) were included.
RESULTS
Finally, 24 studies including 1,643 participants met our selection criteria for NMA. There was no statistically significant treatment compared to placebo of the curvature degree, plaque size, IIEF in Bayesian analysis. The SUCRA values of ranking probabilities for each treatment performance, which indicated that hyperthermia device ranked first in NMA. However, in frequentist analysis, 7 of mono treatments (coenzyme Q10 [CoQ10] 300 mg, hyperthermia device, interferon alpha 2b, pentoxifylline 400 mg, propionyl-L-carnitine 1 g, penile traction therapy [PTT], vitamin E 300 mg) and 2 of combination treatments ("PTT-extracorporeal shockwave treatment", "vitamin E 300 mg-propionyl-L-carnitine 1 g") were statistically significant for improvement of curvature degree, and 9 of mono treatments (CoQ10 300 mg, hyaluronic acid 16 mg, hyperthermia device, interferon alpha 2b, pentoxifylline 400 mg, propionyl-L-carnitine 1 g, verapamil 10 mg, vitamin E 300 mg, vitamin E 400 U) and 3 of combination treatments ("interferon alpha 2b-vitamin E 400 U", "verapamil 10 mg-antioxidants", "vitamin E 300 mg-propionyl-L-carnitine 1 g") were statistically significant in the improvement of plaque size.
CONCLUSIONS
At present, there is no clinical treatment alternatives that have been demonstrated to be effective compared to placebo. Nonetheless, as the frequentist approach has shown that a number of agents are efficacious, further research is expected to develop more effective treatment options.
PubMed: 37382281
DOI: 10.5534/wjmh.230016 -
BMC Urology Sep 2023The therapeutic role of extracorporeal shockwave therapy (ESWT) for Peyronie's disease (PD) has been controversial in a long term. We aimed to further evaluate the... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The therapeutic role of extracorporeal shockwave therapy (ESWT) for Peyronie's disease (PD) has been controversial in a long term. We aimed to further evaluate the therapeutic effect of ESWT for PD on the basis of available high-quality studies.
METHODS
The PubMed, CENTRAL and Embase databases were searched for articles published from January 1st, 2000 to December 31, 2022. Only randomized controlled trials (RCTs) using ESWT to treat PD were included. Meta-analysis and forest plots were carried out using Review Manager 5.4.1 software, and outcomes were reviewed by 2 authors independently. Using the Risk of Bias assessment form (ROB-2) by Cochrane Collaboration for quality assessment. PRISMA 2020 guidelines were used in this article to achieve the quantitative and qualitative synthesis of data.
RESULTS
A total of four RCTs were included. 151 patients in the ESWT group and 150 patients in the control group. The meta-analysis results showed that ESWT could significantly reduce plaque size (OR 2.59, 95%CI 1.15 to 5.85, P = 0.02) and relieve pain (MD -1.55, 95%CI -2.46 to -0.64, P = 0.0008); but it has no significant effect on reducing the penile curvature (OR 1.93, 95%CI 0.87-4.26, P = 0.11) and improving sexual function (MD 2.6, 95%CI -1.63 to 6.83, P = 0.23), there is also no significant difference in complication rates between groups (OR 2.94, 95%CI 0.66 to 13.03, P = 0.16). The risk of bias of results is low. The limitations of this study are that the number of included studies is too small, some experimental outcomes are missing, and the expression of outcomes is not unified.
CONCLUSIONS
For PD, ESWT can be considered as a safe short-term treatment, which can reduce plaque size and relieve pain, but cannot improve penile curvature and sexual function. Its long-term efficacy remains to be discussed.
REGISTRATION NUMBER
PROSPERO (ID: CRD42023436744).
Topics: Male; Humans; Penile Induration; Extracorporeal Shockwave Therapy; Penis; Databases, Factual; Pain
PubMed: 37700253
DOI: 10.1186/s12894-023-01320-8 -
International Journal of Impotence... Sep 2023The efficacy of many non-surgical treatments for Peyronie's disease is unclear. This systematic review aims to critically assess the currently available options and... (Review)
Review
The efficacy of many non-surgical treatments for Peyronie's disease is unclear. This systematic review aims to critically assess the currently available options and provide a recommendation for treatment based on this. A systematic literature search utilising the Medline (Pubmed), Embase, global health and Cochrane library databases was conducted up to May 2021. All randomised controlled trials assessing non-surgical treatment modalities for Peyronie's Disease were included. Individual study risk of bias was evaluated using the Cochrane tool and GRADE was used to assess evidence strength. Outcome measures were the change in penile curvature (degrees), plaque size (volume or size), International Index of Erectile Function score, pain scores and change in penile length. Prospero registration number: CRD42017064618. Amongst the 5549 articles identified, 41 studies (42 reports) were included. Seven different oral treatment options including vitamin E supplementation showed evidence for improving outcomes such as penile curvature and plaque size. Of the intralesional treatments, Collagenase Clostridium Histolyticum showed evidence for improving penile curvature (Range: 16.3-17 degrees, moderate level certainty of evidence). Intralesional Interferon demonstrated some improvement in curvature (Range: 12-13.5 degrees), plaque size (Range: 1.67-2.2 cm) and pain, whilst intralesional calcium channel blockers such as Verapamil showed variable evidence for changes in the plaque size and pain. Extracorporeal Shockwave Therapy consistently demonstrated evidence for improving penile pain in stable disease, and two mechanical traction devices improved curvature. Iontophoresis, topical medications, and combination therapies did not demonstrate any consistent improvements in outcome measures. Intralesional options demonstrate the best potential. Overall, results varied with few high-quality randomised trials present.
Topics: Male; Humans; Penile Induration; Treatment Outcome; Microbial Collagenase; Penis; Pelvic Pain
PubMed: 36289392
DOI: 10.1038/s41443-022-00633-w -
Medical, non-invasive, and minimally invasive treatment for Peyronie's disease: A systematic review.Andrology Mar 2021The treatment of Peyronie's disease (PD) remains a dilemma as the true pathogenesis of PD remains an enigma. Consequently, new molecules and therapies continue to...
BACKGROUND
The treatment of Peyronie's disease (PD) remains a dilemma as the true pathogenesis of PD remains an enigma. Consequently, new molecules and therapies continue to evolve. The safety and efficacy of conservative treatment for PD have not yet established.
OBJECTIVES
To provide the available information of the status of conservative therapy for PD.
METHODS
A systematic literature search was conducted using PubMed, EMBASE, and the Cochrane Library for English-language journal articles between January 2000 and July 2019, using the terms "Conservative treatment for PD", "medical treatment for PD", "non-invasive therapies for PD" and "minimally invasive therapies for PD". This systematic review was conducted in agreement with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) system. We also manually reviewed references from selected articles. The risk of bias in the included RCTs was assessed using the Cochrane Risk of Bias Assessment tool (RoB 2).
RESULTS
Conservative treatment is accepted as the initial treatment step in most of the cases. This kind of therapy includes various methods of treatment such as medical, non-invasive, and minimally invasive therapies. Ideal management of PD is not yet available. It is not possible to assess the value of treatment without well-designed, randomized, placebo-controlled, large-scale clinical studies.
CONCLUSION
Optimistically, in the near future, we may witness emergence of efficacious new agents and modalities to revolutionize medical, non-invasive, and minimally invasive treatment of this devastating condition.
Topics: Animals; Combined Modality Therapy; Conservative Treatment; Humans; Male; Penile Induration
PubMed: 33098745
DOI: 10.1111/andr.12927 -
Translational Andrology and Urology Nov 2023Peyronie's disease (PD) results in curvature, pain, and erectile dysfunction (ED). Penile traction devices (PTDs) are a non-invasive treatment option for PD by applying...
BACKGROUND
Peyronie's disease (PD) results in curvature, pain, and erectile dysfunction (ED). Penile traction devices (PTDs) are a non-invasive treatment option for PD by applying mechanical forces to elicit biochemical responses that reduce curvature and improve penile function. In the present study, we systematically reviewed and analyzed the literature investigating the use of PTD to treat PD.
METHODS
We have conducted electronic and manual search strategies within the databases and included articles to find relevant studies. A total of Five studies met all the predefined inclusion criteria and were selected for inclusion in the review. Outcomes assessed are penile length, penile curvature, and erectile function (EF). The study population consisted of patients with PD, the intervention was penile traction therapy (PTT), the comparison was matched placebo or follow-up, and the study design was randomized controlled trials (RCTs) or cohort studies. The Cochrane risk of bias assessed the studies' quality for randomized studies and the Newcastle-Ottawa scale (NOS) for non-randomized observational studies. All statistical analyses were performed using R software. Results were considered statistically significant for P<0.05.
RESULTS
Only five studies met inclusion and exclusion criteria and were published between 2014 and 2021. The sample sizes range [51-110], totaling 419, with a mean of 83.8 patients-the follow-up with a mean of 6.75 months. This meta-analysis evaluated the efficacy of PTD on curvature degree, penile length, and EF in patients. There is a significant positive effect on the curvature degree (P=0.0373), while there is no significant effect on penile length and EF (P=0.5315 and 0.1010), respectively. They are Indicating low heterogeneity with an estimated total heterogeneity of 0. Overall, the available evidence does not support the efficacy of the intervention for penile length or EF.
CONCLUSIONS
The current evidence suggests that PTDs can be a safe and effective treatment option for men with PD to reduce penile curvature. However, further research, including more RCTs with extended follow-up periods, is needed to fully understand their efficacy and determine the ideal timing and patient subtypes that would benefit from PTD.
PubMed: 38106680
DOI: 10.21037/tau-23-310 -
Arab Journal of Urology 2021To review recent literature pertaining to collagenase clostridium histolyticum (CCh)and other intralesional (IL) therapies for the treatment of Peyronie's disease (PD). (Review)
Review
OBJECTIVE
To review recent literature pertaining to collagenase clostridium histolyticum (CCh)and other intralesional (IL) therapies for the treatment of Peyronie's disease (PD).
METHODS
A systematic search of literature was performed using MEDLINE and PubMed.'Peyronie's Disease Clostridium Histolyticum', 'Peyronie's Disease Intralesional', 'Peyronie'sDisease Causes', and 'Atypical Peyronie's Disease' were used as query entries. Inclusion criteriarequired English text from 1980 onwards and have a full text available. Records were reviewed for study power, accuracy, and relevance to our research topic. The review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria.
RESULTS
Recent literature supports the notion that CCh is the most effective IL treatment forpatients with typical and atypical PD. The capstone CCh study was the IMPRESS trial thatshowed a 34% reduction in curvature with a mean (SD) - 17.0 (14.8)° reduction with IL CCh,while men in the placebo saw an average 18.2% decrease in penile bend with a mean (SD) - 9.3 (13.6)° per person (P < 0.001). A shortened protocol for IL CCh treatment offered a 31.4%reduction in curvature, while decreasing cost and office visits, potentially increasing patientcompliance. Lastly, literature shows CCh is used most in atypical cases, with ~64.8% of patients being treated with CCh, probably because of the high efficacy and safetyprofile that it offers. Serious complications associated with CCh include urethralinjury, corporal rupture, and penile fracture.
CONCLUSION
Since the approval of CCh by the United States Food and Drug Administration in2013, it has been a staple in the treatment of PD, and here we report the continuedsuperiority of this therapy. CCh is an effective, minimally invasive option in most PDpopulations; however, recent changes have made CCh unavailable for commercial use outside the United States, impacting many patients who have previously benefited.
PubMed: 34552787
DOI: 10.1080/2090598X.2021.1957411 -
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 -
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 -
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 -
Andrology Jan 2022Hyaluronic acid is a glycosaminoglycan widely used in the fields of orthopedics, ophthalmology, and aesthetic medicine due to its significant ability to reduce the... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Hyaluronic acid is a glycosaminoglycan widely used in the fields of orthopedics, ophthalmology, and aesthetic medicine due to its significant ability to reduce the synthesis of pro-inflammatory proteins and its activity against oxidative stress, a feature of many degenerative illnesses.
OBJECTIVES
The objective of the present review is to provide a comprehensive narrative review of the most recent literature on the use of hyaluronic acid in andrology in order to facilitate the use of this therapeutic device in the common clinical practice of many physicians. Specific conditions covered in the review are Peyronie's disease, premature ejaculation, and penile enlargement.
MATERIALS AND METHODS
A broad and comprehensive literature search included Medline, EMBASE, and the Cochrane Libraries, with no time restriction up to December 2020 and restricted to English language publications. Unpublished studies were not included. The study was registered as "The role of hyaluronic acid in andrology: A systematic review and meta-analysis" in PROSPERO with the ID CRD42021223416.
DISCUSSION AND CONCLUSION
Hyaluronic acid is a valid choice for the treatment of Peyronie's disease in terms of the resolution of the acute phase of the disease and of contributing to stabilizing the disease as a bridge to potential surgery. Data, furthermore, suggest that hyaluronic acid is frequently associated with an overall clinical improvement, allowing the patient to resume normal sexual activity. With regard to premature ejaculation, data suggests hyaluronic acid-based treatments were effective in prolonging intra-vaginal ejaculation time. Furthermore, hyaluronic acid was found to be safe and well-tolerated, with main adverse events limited to local discomfort, ecchymosis, papule formation, and glans numbness, all of which were reported to resolve spontaneously. Last, with regard to penile enlargement, the overall perception of experts is that hyaluronic acid may be an extremely well-tolerated compound with potential for application in specific areas of male sexual health that are often neglected as compared to more common, and relatively simpler to treat, conditions.
Topics: Andrology; Humans; Hyaluronic Acid; Male; Penile Diseases; Penile Induration; Premature Ejaculation; Treatment Outcome
PubMed: 34297894
DOI: 10.1111/andr.13083