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Translational Andrology and Urology Jun 2016Loss of penile length is a common complaint of men with Peyronie's disease (PD), both before and after corrective intervention, which has a significant negative effect... (Review)
Review
Loss of penile length is a common complaint of men with Peyronie's disease (PD), both before and after corrective intervention, which has a significant negative effect on patient quality of life. We sought to identify and describe the methods by which penile length can be preserved or increased. We conducted an extensive, systematic literature review, based on a search of the PUBMED database for articles published between 1990 and 2015. Articles with the key words "Peyronie's disease", "penile length" and/or "penile lengthening" were reviewed if they contained subjective or objective penile length outcomes. Only English-language articles that were related to PD and penile size were included. We found no evidence in the literature that medical therapy alone increases penile length. Classic inflatable penile prosthesis (IPP) placement, plication procedures, and the Nesbit procedure appear likely to maintain or decrease penile length. Plaque incision (PI) and grafting appears likely to maintain or increase penile length, but is complicated by risk of post-operative erectile dysfunction (ED). There are several surgical procedures performed concomitantly with IPP placement that may be suitable treatment options for men with comorbid ED, and consistently increase penile length with otherwise good outcomes concerning sexual function. These include the subcoronal penile prosthesis (scIPP), Egydio circumferential technique, the sliding technique, the modified sliding technique (MoST), and the multiple slice technique (MuST). In addition, adjuvant therapies such as penile traction therapy (PTT), post-operative inflation protocols, suspensory ligament relaxation, lipectomy, and adjuvant medical therapy for glans engorgement appear to increase subjective and/or objective penile length for men at high risk of decreased penile length after PD surgery. Considering the psychological burden of length loss in men with PD, providers with adequate volume and expertise should attempt, if possible, to maintain or increase penile length for men undergoing surgical intervention. There are several evidence-based, safe, and effective ways to increase penile length for these men and multiple emerging adjuvant therapies that may help ensure adequate length.
PubMed: 27298782
DOI: 10.21037/tau.2016.04.03 -
Translational Andrology and Urology Jun 2016Peyronie's disease (PD) is an acquired fibrotic disorder (disorganized collagen deposition) in the tunica albuginea. This scar tissue or "plaque" builds up in the tunica... (Review)
Review
BACKGROUND
Peyronie's disease (PD) is an acquired fibrotic disorder (disorganized collagen deposition) in the tunica albuginea. This scar tissue or "plaque" builds up in the tunica albuginea and results in penile deformities. PD can have a significant negative impact on mood and quality of life. Although the psychological impact of PD has generally been understudied, there has been a growing body of literature that has assessed the impact PD can have on men's mental health and relationships. The aim of this study is to review the current literature focused on the psychological and relationship impact of PD.
METHODS
We performed a MEDLINE search limited to English language literature using the terms: "Peyronie's Disease AND Psychological OR Psychosocial". Select references were then included for review.
RESULTS
The research in this area confirms the clinical impressions of men with PD, which is that depression and relationship distress is prevalent. Approximately 50% of men with PD suffer from depressive symptoms and upwards of 80% report distress related to PD. It appears that these rates remain relatively stable over time. High rates of relationship stress were also reported as over 50% of men reported that PD had negatively impacted their relationship. Qualitative work in this area helps us understand the nature of this distress. Regarding body image and self-esteem, men described themselves as "abnormal", "ugly", "disgusting", "like a cripple", and a "half man", and some of them described feelings of shame. Many men reported that they lost their sexual confidence, or ability to initiate sex with a partner, while most reported a decrease in sexual interest. Additionally, many men expressed a sense of stigmatization and isolation. This led to difficulties in speaking about their disease with sexual partners or healthcare professionals.
CONCLUSIONS
Taken in total, these studies indicate that those who actively treat PD should assess for distress or depressive symptoms. The standard assessment of PD could include the Peyronie's Disease Questionnaire (PDQ), and at least two questions on individual and relationship distress, or the use of a validated questionnaire to assess depression.
PubMed: 27298775
DOI: 10.21037/tau.2016.05.14 -
Asian Journal of Andrology Jan 2013Peyronie's disease (PD) is most simply referred to as a fibrotic wound-healing disorder of the tunica albuginea. It is both a physically and psychologically devastating... (Review)
Review
Peyronie's disease (PD) is most simply referred to as a fibrotic wound-healing disorder of the tunica albuginea. It is both a physically and psychologically devastating disorder that causes penile deformity, curvature, hinging, narrowing and shortening, which may compromise sexual function. Although a variety of non-surgical treatments have been suggested, none to date offer a reliable and effective correction of the penile deformity. As a result, surgery remains the gold standard treatment option, offering the most rapid and reliable treatment which will be the focus of this article. We review the preoperative evaluation, surgical algorithm, graft materials and postoperative management of PD. Outcomes for tunical shortening, tunical lengthening and penile prosthesis placement for penile straightening are reviewed. Tunica albuginea plication is the preferred method of straightening for men with adequate rigidity and less severe disease defined as curvature less than 70° without narrowing/hinging. Men who have more severe, complex deformity, but maintain strong preoperative erectile function should be considered candidates for straightening with plaque incision or partial excision and grafting. Finally, for those men who have inadequate rigidity and PD, penile prosthesis placement with straightening is the best approach to address both problems.
Topics: Algorithms; Erectile Dysfunction; Fibrosis; Humans; Male; Penile Induration; Penile Prosthesis; Penis; Postoperative Care; Postoperative Complications
PubMed: 23178395
DOI: 10.1038/aja.2012.92 -
International Journal of Molecular... Jun 2023Peyronie's disease (PD) is a benign condition caused by plaque formation on the tunica albuginea of the penis. It is associated with penile pain, curvature, and... (Review)
Review
Peyronie's disease (PD) is a benign condition caused by plaque formation on the tunica albuginea of the penis. It is associated with penile pain, curvature, and shortening, and contributes to erectile dysfunction, which worsens patient quality of life. In recent years, research into understanding of the detailed mechanisms and risk factors involved in the development of PD has been increasing. In this review, the pathological mechanisms and several closely related signaling pathways, including TGF-β, WNT/β-catenin, Hedgehog, YAP/TAZ, MAPK, ROCK, and PI3K/AKT, are described. Findings regarding cross-talk among these pathways are then discussed to elucidate the complicated cascade behind tunica albuginea fibrosis. Finally, various risk factors including the genes involved in the development of PD are presented and their association with the disease summarized. The purpose of this review is to provide a better understanding regarding the involvement of risk factors in the molecular mechanisms associated with PD pathogenesis, as well as to provide insight into disease prevention and novel therapeutic interventions.
Topics: Male; Humans; Penile Induration; Phosphatidylinositol 3-Kinases; Quality of Life; Penis; Risk Factors
PubMed: 37373277
DOI: 10.3390/ijms241210133 -
Advances in Urology 2017Peyronie's disease (PD) is a chronic inflammation of tunica albuginea of the corpora cavernosa that causes an inelastic plaque resulting in penis deformation. Although... (Review)
Review
Peyronie's disease (PD) is a chronic inflammation of tunica albuginea of the corpora cavernosa that causes an inelastic plaque resulting in penis deformation. Although its etiology is not completely known, there is general consensus that PD is genetically transmitted and secondary to penile trauma. In recent years, numerous studies demonstrated the role played by oxidative stress in PD pathogenesis, and other studies have described successful use of antioxidants in PD treatment. Oxidative stress is an integral part of this disease, influencing its progression. In the early stages of PD, the inflammatory infiltrate cells produce high quantities of free radicals and proinflammatory and profibrotic cytokines, with consequent activation of transcription factor NF-B. While conservative therapies commonly used in the early stages of PD include oral substances (Potaba, tamoxifen, colchicine, and vitamin E), intralesional treatment (verapamil, interferon, steroids, and more recently collagenase clostridium histolyticum-Xiaflex), and local physical treatment (iontophoresis, extracorporeal shock wave therapy, and penile extender), the significant results obtained by emerging treatments with the antioxidants cited in this article suggest these therapeutic agents interfere at several levels with the disease's pathogenetic mechanisms. Antioxidants therapy outcomes are interesting for good clinical practice and also confirm the fundamental role played by oxidative stress in PD.
PubMed: 28744308
DOI: 10.1155/2017/4653512 -
Research and Reports in Urology 2023The clinical landscape of Peyronie's disease is everchanging. There has been growing interest in non-invasive therapeutic options that could assist patients with... (Review)
Review
The clinical landscape of Peyronie's disease is everchanging. There has been growing interest in non-invasive therapeutic options that could assist patients with achieving a meaningful reduction in penile curvature without surgical intervention. These therapies are wide-ranging in terms of their mechanisms of action, efficacies, and short- and long-term safety profiles. Recently, an abundance of outcomes literature on longstanding and novel non-surgical treatment modalities has been published. For sexual medicine providers hoping to offer patients the most up-to-date and evidence-based treatments for the management of Peyronie's disease, it can be challenging to gain a thorough understanding of this body of literature. In this clinical management review, the workup and current theories on the pathophysiology of Peyronie's disease are reviewed, and the most recent outcomes data on the currently available non-surgical treatment modalities are presented. With an accurate understanding of the current landscape of Peyronie's disease treatment, sexual health providers will be able to better evaluate and engage in evidence-based shared decision-making with their patients.
PubMed: 36756281
DOI: 10.2147/RRU.S278796 -
Sexual Medicine Apr 2023Peyronie's disease has an impact on men's mental and physical health.
BACKGROUND
Peyronie's disease has an impact on men's mental and physical health.
AIM
We sought to translate the Peyronie's Disease Questionnaire into Danish, adapt it to the Danish cultural setting, and test it in a Danish population.
METHODS
Translation of the Peyronie's Disease Questionnaire was performed according to the guidelines for adapting health status measures for use in languages other than the source language by Beaton et al. The validated American Peyronie's Disease Questionnaire was developed to monitor patient symptoms after an intervention and to inspire a subsequent dialogue about physical and psychological symptoms with a healthcare provider, thereby allowing the patient and the healthcare professional to choose the best treatment. The expert committee agreed on a Danish version after cross-cultural adaptation. The Danish Peyronie's Disease Questionnaire was sent by electronic mail to a preselected group of 41 men with Peyronie's disease.
OUTCOMES
After completing the questionnaire, 32 men participated in a video interview regarding the questionnaire and were asked to identify any problematic fields or areas open to misunderstanding.
RESULTS
The Peyronie's Disease Questionnaire underwent major modifications in light of the comments of the first 10 respondents. Thereafter, only minor changes were made until data saturation was reached after 27 of the 32 respondents had been interviewed. In 87% of respondents Peyronie's disease bothered from the last time they had intercourse, and 93% of the men experienced being bothered by having intercourse less often. Peyronie's disease made 73% of respondents feel bodily discomfort, and 88% had intercourse less often than they used to have due to Peyronie's disease.
CLINICAL IMPLICATIONS
The Peyronie's Disease Questionnaire is a valuable tool in the crucial task of addressing Peyronie's disease, providing insight into the mental and sexual health problems as well as physical challenges faced by patients.
STRENGTHS AND LIMITATIONS
The interviewer's modest experience in conducting interviews is believed to have been duly compensated for by continuous and accumulating learning-while-doing process because the same interviewer conducted all of the interviews and did so consecutively.
CONCLUSIONS
Danish men expressed satisfaction with the questionnaire and found it valuable as a tool when visiting the doctor for the first time.
PubMed: 36970583
DOI: 10.1093/sexmed/qfac022 -
Internal Medicine (Tokyo, Japan) Sep 2018Mondor's disease (MD) is a rare disease that manifests with a palpable cord-like induration on the body surface. In general, MD is a self-limited, benign... (Review)
Review
Mondor's disease (MD) is a rare disease that manifests with a palpable cord-like induration on the body surface. In general, MD is a self-limited, benign thrombophlebitis that resolves in four to eight weeks without any specific treatment. Cases of MD can be roughly categorized into three different groups based on the site of the lesion as follows: original MD of the anterolateral thoracoabdominal wall, penile MD with dorsum and dorsolateral aspects of the penis, and axillary web syndrome with mid-upper arm after axillary surgery. The diagnosis of MD is rather straightforward and based on a physical examinations. However, some case occur "secondary" with another underlying disease, including malignancy, a hypercoagulative state, and vasculitis. Therefore, it is critical to identify MD precisely, evaluate any possible underlying disease, and avoid any unnecessary invasive tests or treatment. In this paper, we comprehensively review the clinical characteristics of MD.
Topics: Arm; Humans; Male; Penile Diseases; Rare Diseases; Thrombophlebitis
PubMed: 29780120
DOI: 10.2169/internalmedicine.0495-17 -
Turkish Journal of Urology May 2022In computed tomography examinations performed for various reasons, calcified Peyronie's dis-ease can be incidentally detected. In this study, we aimed to evaluate the...
OBJECTIVE
In computed tomography examinations performed for various reasons, calcified Peyronie's dis-ease can be incidentally detected. In this study, we aimed to evaluate the frequency of calcified Peyronie'sdisease incidentally detected in patients with abdominal computed tomography.
MATERIAL AND METHODS
The images of male patients undergoing abdominal computed tomography betweenJanuary 2019 and January 2020 were retrospectively evaluated for the presence of calcified Peyronie's dis-ease. 1968 patients remained after subtracting computed tomography scans for insufficient evaluation of the penis, evaluated for the presence of calcified Peyronie's disease by two radiologists based on consensus. Thelocalization, side, and the number of plaques were recorded.
RESULTS
The computed tomography examination of 1968 patients revealed calcified Peyronie's disease in 130 (6.6%) patients. Peyronie's disease was bilateral in 73 patients (56.1%), and unilateral in 57 (43.9%). A single plaque was observed in 44 (33.9%) patients, and multiple plaques in 86 (66.1%). The plaques werelocated in the middle portion of the penis in 98, proximal penis in 92, and distal penis in 31 cases.
CONCLUSION
Calcified Peyronie's disease is incidentally detected on computed tomography examinations at a rate not rare. Peyronie's disease tends to be multiple, bilateral, and localized in the middle portion of thepenis.
PubMed: 35634937
DOI: 10.5152/tud.2022.21346 -
Arab Journal of Urology Sep 2013To review the contemporary knowledge of the pathophysiology of Peyronie's disease (PD). (Review)
Review
OBJECTIVE
To review the contemporary knowledge of the pathophysiology of Peyronie's disease (PD).
METHODS
Medline was searched for papers published in English from 2000 to March 2013, using the keywords 'Peyronie's disease' and 'pathophysiology'.
RESULTS
More than 300 relevant articles were identified for the purpose of this review. Unfortunately only a few studies had a high level of evidence, and the remaining studies were not controlled in their design. Many theories have been proposed to explain the cause of PD, but the true pathogenesis of PD remains an enigma. Identifying particular growth factors and the specific genes responsible for the induction of PD have been the ultimate goal of research over the past several decades. This would provide the means to devise a possible gene therapy for this devastating condition. We discuss present controversies and new discoveries related to the pathophysiology of this condition.
CONCLUSION
PD is one of the most puzzling diseases in urology. The pathogenesis remains uncertain and there is still controversy about the best management. The pathogenesis of PD has been explored in animal models, cell cultures and clinical trials, but the results have led to further questions. New research on the aetiology and pathogenesis of PD is needed, and which will hopefully improve the understanding and management for patients with this frustrating disease.
PubMed: 26558092
DOI: 10.1016/j.aju.2013.06.006