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Medical Sciences (Basel, Switzerland) Sep 2019Peyronie's disease is a condition that causes abnormal healing of the tunica albuginea, causing penile curvature. It is difficult to treat and its management is... (Review)
Review
Peyronie's disease is a condition that causes abnormal healing of the tunica albuginea, causing penile curvature. It is difficult to treat and its management is continuing to evolve. Proposed non-surgical treatments have included oral, topical, intralesional, extracorporeal shockwave, and traction therapy. The study of Peyronie's disease is made difficult by heterogeneity in the timing of presentation, severity and characteristics of deformity, and associated complaints. Moreover, meta-analyses of studies are difficult due to inconsistencies across study endpoints and the duration of treatments. This article reviews the current clinical evidence and guideline recommendations, with a focus on an improvement in penile curvature.
PubMed: 31540526
DOI: 10.3390/medsci7090096 -
Translational Andrology and Urology Mar 2013
Review
PubMed: 26816719
DOI: 10.3978/j.issn.2223-4683.2013.03.01 -
Sexual Medicine Dec 2019Surgical intervention in Peyronie's disease (PD) should ideally be delayed until the resolution of acute inflammatory phase. (Review)
Review
INTRODUCTION
Surgical intervention in Peyronie's disease (PD) should ideally be delayed until the resolution of acute inflammatory phase.
AIM
The objective of this review was to highlight the results of penile prosthesis to correct refractory erectile dysfunction (ED) in patients with PD, and the secondary procedures that may be required to correct the penile curvature.
METHODS
A systematic search on PubMed online database using Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations was done using the MeSH terms "Peyronie's disease" and "erectile dysfunction."
MAIN OUTCOME MEASURE
Success and satisfaction rates of various procedures.
RESULTS
The search yielded 324 language-specific (English and Spanish language) articles and 58 articles were retained for final review. The following variables were assessed in different studies: number of patients, types of secondary procedure to correct the curvature, satisfaction rates, and follow-up period.
CONCLUSION
The aim of the surgery in PD should be to achieve a functionally straight penis (<20 degree curvature) with good erection. Patients with refractory ED in PD are candidates for penile prosthesis. Secondary procedures, like manual modeling, plication, plaque incision, or excision grafting, may be required depending on the degree of penile curvature and penile length. In quest for the best graft, TachoSil graft seems to have gained popularity in Europe. Krishnappa P, Fernandez-Pascual E, Carballido J, et al. Surgical Management of Peyronie's Disease With Co-Existent Erectile Dysfunction. Sex Med 2019;7:361-370.
PubMed: 31540882
DOI: 10.1016/j.esxm.2019.08.009 -
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 -
Annals of Palliative Medicine Mar 2021Oral medication therapies are more conventional than other non-surgical therapies in the acute phase of Peyronie's disease (PD). Although the commonly used oral drugs...
BACKGROUND
Oral medication therapies are more conventional than other non-surgical therapies in the acute phase of Peyronie's disease (PD). Although the commonly used oral drugs for PD have shown poor or indeterminate outcomes, most patients prefer oral medications. The aim of this study was to evaluate the efficacy and safety of Scutellaria baicalensis extract for treating acute-phase PD patients and examine the practicality of treatment strategies for PD according to the disease course.
METHODS
This retrospective study was performed at our institution from 2005 to 2015 and analyzed the data of 261 patients with PD. The acute-phase PD patients received Scutellaria baicalensis extract for 6 months. After oral treatment, the patients with persistent curvature underwent surgical correction during the stable phase.
RESULTS
During this study period, 183 patients received oral treatment with Scutellaria baicalensis, and 78 patients did not. Compared to the untreated patients, treatment with Scutellaria baicalensis had a significant effect in improving the symptoms of acute-phase PD. The mean time required for stabilization also showed a significant statistical difference. Treatment with Scutellaria baicalensis was safe and well-tolerated. After the disease stabilized, 70 and 31 patients with significant penile curvature underwent surgical correction by 16- dot plication and great saphenous vein grafting procedures, respectively. At the one-year follow-up, complete penile straightening and penile length shortening were observed in 92.86% and 41.43% of the patients after 16-dot plication and in 87.10% and 25.81% of the patients after grafting procedures, respectively. The postoperative Erectile Function domain of the International Index of Erectile Function scales were maintained in all patients after the 16-dot plication procedure and decreased in 54.84% of the patients after the grafting procedure. Overall, 92.86% and 83.87% of the patients who received 16-dot plication and grafting procedures, respectively, were satisfied with the final surgical results.
CONCLUSIONS
Treatment with extract of Scutellaria baicalensis seems to be beneficial for improvements in symptoms of acute phase PD and acceleration of the disease stabilization. The 16-dot plication and great saphenous vein grafting procedure seem effective options in the surgical management of the stable phase after Scutellaria baicalensis administration in the acute phase of PD.
Topics: Humans; Male; Patient Satisfaction; Penile Induration; Plant Extracts; Retrospective Studies; Scutellaria baicalensis; Treatment Outcome
PubMed: 33615818
DOI: 10.21037/apm-20-2389 -
Sexual Medicine Apr 2021Plaque incision and graft (PIG) is suggested for the treatment of significant Peyronie's disease (PD), but most surgeons perform very few PIG surgeries annually, and the...
INTRODUCTION
Plaque incision and graft (PIG) is suggested for the treatment of significant Peyronie's disease (PD), but most surgeons perform very few PIG surgeries annually, and the number of PD cases requiring PIG is inadequate to maintain the necessary skills and completely master the procedure.
AIM
To develop and validate a new 3D-printed model of a curved penis and graft to simulate PIG surgery. This is the first PIG surgical training simulator described in the medical literature.
METHODS
A 3D-printed model of the corpora cavernosa with a 60-degree curvature and an associated urethra was created using a flexible filament of thermoplastic polyurethane. Twenty-two urologists from Brazil were recruited to perform simulated surgery on the 3D model. The participants included 12 senior-level and 10 trainee-level urologists.
MAIN OUTCOME MEASURES
Evaluation of the device was based on a 15-item questionnaire using a 5-point Likert-type scale for each item.
RESULTS
Each participant performed one simulated surgery with the 3D-printed model. All participants agreed that the simulation should be implemented into training programs. Participants ranked all content validity components ≥4.41 and all face validity components ≥3.83. The mean usability score was 4.25, and the overall experience scores were 4.75 (senior) and 5.0 (trainee).
CONCLUSION
Senior and trainee urologists evaluated this first reported simulated PIG training model for penile curvature correction as an acceptable tool for training and maintaining necessary PIG skills. This model may improve PIG training and surgeon skill, thereby improving patient safety and outcomes. A Miranda. 3D-Printed Flexible Penile Model Simulator for Plaque Incision and Graft for Peyronie's Disease. Sex Med 2021;9:100318.
PubMed: 33588369
DOI: 10.1016/j.esxm.2020.100318 -
Frontiers in Pharmacology 2022Scarring diseases, such as Peyronie's disease (PD), usually lead to disorders in the immune system. Previous studies suggested that the PD process was regulated by...
Scarring diseases, such as Peyronie's disease (PD), usually lead to disorders in the immune system. Previous studies suggested that the PD process was regulated by immune signaling. However, the pathogenetic mechanism remains incompletely characterized. This article used bioinformatic approaches to identify hub genes, key pathways and key immune-related genes that play essential roles in PD pathogenesis. Two Gene Expression Omnibus (GEO) datasets, GSE126005 and GSE146500, were used to analyse the transcriptional profiling in both PD and normal samples. R software was applied to examine the difference in the expression of hub genes and key immune-related genes. The candidates for hub genes were further validated through protein-protein interactions (PPIs), gene correlation, and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analyses. In addition, candidate miRNA‒mRNA pairs were functionally assessed. A total of 39 candidate genes were identified, the expression levels of which in PD fibroblast cells were different from those in normal cells (16 showed reduced expression in PD and 21 candidates overexpressed in PD). We found that these genes could interact with each other through PPI analysis. According to the functional enrichment analysis, the candidates may regulate some major biological processes, including cytokine‒cytokine receptor interactions and the JAK-STAT signaling pathway. IL6, IL21R, IFNE, CXCL2, EGF, and ANGPTL5 were identified as key immune-related genes. The findings may help understand the role of immunologic contributors in PD, thus shedding light on the development of more effective strategies to prevent and treat this kind of disease.
PubMed: 36561343
DOI: 10.3389/fphar.2022.1019358 -
Revista Da Associacao Medica Brasileira... 2019
Topics: Administration, Topical; Anti-Inflammatory Agents, Non-Steroidal; Combined Modality Therapy; Extracorporeal Shockwave Therapy; Humans; Interferon alpha-2; Iontophoresis; Male; Microbial Collagenase; Penile Induration; Practice Guidelines as Topic; Vasodilator Agents; Verapamil; Vitamin E
PubMed: 31721953
DOI: 10.1590/1806-9282.65.10.1231 -
Biologics : Targets & Therapy 2015Peyronie's disease is a localized connective tissue disease characterized by an active, inflammatory phase and a stable, quiescent phase, with the eventual development... (Review)
Review
Peyronie's disease is a localized connective tissue disease characterized by an active, inflammatory phase and a stable, quiescent phase, with the eventual development of collagenous plaques within the tunica albuginea of the penis. Risk factors primarily associated with Peyronie's disease include Dupuytren's contracture, penile trauma, and family history. A variety of treatment strategies have been utilized, including oral and topical agents, electromotive drug administration, intralesional injections, extracorporeal shockwave therapy, penile traction, and surgery. However, most of these strategies are ineffective, with surgery being the only definitive treatment. Collagenase clostridium histolyticum is a newly US Food and Drug Administration-approved agent for intralesional injection. It is thought to downregulate many of the disease-related genes, cytokines, and growth factors and degrade collagen fibers. It also suppresses cell attachment, spreading, and proliferation. Collagenase clostridium histolyticum has been clinically proven to be a safe and effective therapeutic option, demonstrating decreases in penile curvature and plaque consistency, as well as increases in patient satisfaction. During clinical evaluation, the Peyronie's Disease Questionnaire was validated as an effective tool for assessing treatment outcomes.
PubMed: 26491251
DOI: 10.2147/BTT.S65619 -
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