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Translational Andrology and Urology Jun 2021Residual curvature correction during penile prosthesis implantation (PPI) is usually needed in patients with severe erectile dysfunction (ED) and concomitant Peyronie's... (Review)
Review
A comprehensive narrative review of residual curvature correction during penile prosthesis implantation in patients with severe erectile dysfunction and concomitant Peyronie's disease.
Residual curvature correction during penile prosthesis implantation (PPI) is usually needed in patients with severe erectile dysfunction (ED) and concomitant Peyronie's disease (PD). The aim of the study was to assess the different existing techniques for treating residual penile curvature during PPI in patients with severe PD and ED. We generated a comprehensive narrative review of the literature until August 2020 on the use of PPI in combination with straightening reconstruction techniques, in treating patients with severe PD and ED. We included studies published in English, assessing the PPI as primary intervention in patients with PD and ED. Secondary research studies and studies with insufficient data were excluded from final analyses. We included a total of 33 clinical articles with 1,612 patients that assessed the effects of PPI combined with straightening surgical techniques for the treatment of severe PD and ED. Based on the severity of penile curvature, the concomitance of additional penile deformities (i.e., hourglass deformity), the penile length, the presence of previous penile operations and the surgeon's experience, four main categories of surgical techniques were identified: (I) PPI with plication of the penis on the convex side of the curvature, (II) transcorporeal plaque incision/excision, (III) PPI with plaque/tunical incision(s) on the concave side of the curvature and (IV) PPI with plaque incision/excision plus grafting. Patients with severe PD and ED can expect excellent outcomes with PPI and surgical correction of residual penile curvature and minimal side effects. Overall, all the above techniques seem to able to correct the residual penile curvature during prosthesis implantation. Grafting techniques seem to be favorable in patients with additional severe penile shortening. Still, no definite conclusions can be drawn regarding the superiority of one technique over the other.
PubMed: 34295752
DOI: 10.21037/tau-20-1236 -
Archivio Italiano Di Urologia,... Sep 2023The aim of study was to evaluate the impact of plaque calcification on symptoms of patients with Peyronie's disease (PD) and to evaluate mental health in PD patients...
Calcification in Peyronie's disease: Its role and clinical influence on the various symptoms and signs of the disease, including psychological impact. Our study of 551 patients.
BACKGROUND
The aim of study was to evaluate the impact of plaque calcification on symptoms of patients with Peyronie's disease (PD) and to evaluate mental health in PD patients with or without calcification.
METHODS
We performed a retrospective analysis of the clinical database of a single andrology clinic. We extracted 551 PD patients, and we sorted them into two groups: the first group included 201 PD patients with plaque calcification; the second group included 350 PD patients without plaque calcification. The inclusion criteria for both groups were as follows: aged between 21 and 81 years; thorough and available data on clinical history; baseline levels of blood glucose, glycosylated hemoglobin, cholesterol, and triglycerides; photographic documentation of the penile curvature; dynamic penile eco-color Doppler ultrasound with plaque measurements and volume calculation; and completion of the generalized anxiety disorder-7 questionnaire, patient health questionnaire-9 (for depression), visual analog scale for penile pain measurements, and the International Index of Erectile Function (IIEF) questionnaire.
RESULTS
Plaque calcification was present in 36.4% of cases. The presence of calcification affects the presence and severity of penile curvature. Calcification is associated with the presence of hypertension. In PD patients, the prevalence of significant anxiety and significant depression was 89.1% and 57.3%, respectively. Calcification is associated with the presence of anxiety and depression but does not lead to an increase in their prevalence.
CONCLUSIONS
In PD patients, the calcification was present in more than one third of cases. The size of the plaque calcification was < 15 mm in most cases. Calcification influences the presence of the curve and influences its severity. There was a prominent prevalence of anxiety and depression in PD patients.
Topics: Male; Humans; Young Adult; Adult; Middle Aged; Aged; Aged, 80 and over; Penile Induration; Retrospective Studies; Penis; Calcinosis; Hypertension; Treatment Outcome
PubMed: 37791557
DOI: 10.4081/aiua.2023.11549 -
World Journal of Plastic Surgery Jul 2022Surgical reconstruction is the gold standard of treatment for Peyronie's disease (PD). Grafting procedures provide satisfactory outcomes in patients with complex...
BACKGROUND
Surgical reconstruction is the gold standard of treatment for Peyronie's disease (PD). Grafting procedures provide satisfactory outcomes in patients with complex curvature, short penile length, and without previous erectile dysfunction (ED). We aimed to compare two different grafting methods of reconstruction in patients with PD.
METHOD
Fifty-two PD patients at Imam-Reza hospital of Mashhad from October 2011 to January 2019 with stable plaque, penile angulation of >60˚, complex curvature, and without ED who consented to cooperate, included in our study and divided into two groups. The first group consists of 26 patients, undergone grafting through a double-Y incision and a single saphenous graft placed within the incision. For the second group, two smaller saphenous vein grafts were placed in the two parallel incisions. ED assessed pre- and post-operational via the International index of erectile function. Penile angulation less than 20 degrees was considered a favorable outcome. Patients followed for 18 months, and sacculation, penile shortening, post-operation infection, and penile hypoesthesia were assessed as complications. We used a paired t-test to compare these two groups.
RESULTS
ED was 25% and 12% in the first and the second group, respectively. Statistics showed no difference between the two groups regarding pre and post-operational ED (=0.1). Regarding complications during follow-up, sacculation occurred in four patients of the first group and none of the second group patients but no significant difference (=0.23).
CONCLUSION
We found no superiority to declare between these two procedures, although regarding the small sample size of our study, further evaluations are needed to establish more reliable results.
PubMed: 36117889
DOI: 10.52547/wjps.11.2.62 -
Basic and Clinical Andrology Dec 2023Peyronie's disease affects up to 9% of men and is often accompanied by pain and/or erectile dysfunction. It is characterized by an inflammatory process that is the...
Which inflammatory marker, between systemic immune-inflammation index and neutrophil to eosinophil ratio, is associated with Peyronie's disease and are there any implications for a better understanding of its mechanisms?
BACKGROUND
Peyronie's disease affects up to 9% of men and is often accompanied by pain and/or erectile dysfunction. It is characterized by an inflammatory process that is the grassroots of the subsequent fibrosis stage. There is an unmet need to evaluate its onset and progression. Among the newly proposed biomarkers of inflammation, authors developed a novel systemic immune-inflammation index (SII) based on lymphocyte, neutrophil, and platelet counts. Similarly, a recent study reported that a neutrophil-to-eosinophil ratio (NER) represents systemic inflammation.
RESULTS
A 49-patient group with Peyronie's disease as confronted with 50 well-matched for age and BMI controls. As laboratory evaluation of inflammation, SII, NER and the eosinophil to neutrophil ratio (ENR) were studied. As a likely risk factor for the presence of Peyronie's disease, a higher prevalence of hypercholesterolemia, hyperglycemia and hypertension was discovered in the patients compared to controls. A significant difference was found in the median values of the NER between the two selected groups, i.e., 32.5 versus 17.3 (p = 0.0021). As expected, also ENR was significantly different. The receiver operating characteristic curves for SII, ENR and NER were 0.55, 0.32 and 0.67, respectively, highlighting the best performance of NER. The cut-off for NER was 12.1, according to the Youden test.
CONCLUSIONS
According to our results, any evaluation of circulating eosinophil, evaluated as NER, beyond being a signature of immuno-inflammatory response, help assess tissue homeostasis, since eosinophils are now considered multifunctional leukocytes and give a picture of the inflammatory process and repair process belonging to Peyronie's disease.
PubMed: 38110896
DOI: 10.1186/s12610-023-00213-y -
Therapeutic Advances in Urology 2019Peyronie's disease is a disorder of abnormal and dysregulated wound healing leading to scar formation in the tunica albuginea of the penis. Penile traction therapy has... (Review)
Review
Peyronie's disease is a disorder of abnormal and dysregulated wound healing leading to scar formation in the tunica albuginea of the penis. Penile traction therapy has emerged as an attractive therapeutic option for men with Peyronie's disease in both the acute and chronic phases. Currently, clinical studies are limited by lack of randomization, small cohorts, and lack of patient compliance with therapy. Despite these shortcomings, studies have shown a potential benefit with minimal morbidity. Specifically, penile traction may help to preserve or increase penile length and reduce penile curvature when used as monotherapy or as adjuvant therapy for surgical and intralesional treatments. Further study is necessary to define patient characteristics that are predictive of improved outcomes, determine the duration of treatment needed for clinical effect, and improve patient compliance.
PubMed: 30956689
DOI: 10.1177/1756287219838139 -
Translational Andrology and Urology Jun 2016Penile traction therapy (PTT) is a new therapeutic option for men with Peyronie's disease (PD). However, it has a long history of use in other fields of medicine... (Review)
Review
Penile traction therapy (PTT) is a new therapeutic option for men with Peyronie's disease (PD). However, it has a long history of use in other fields of medicine including bone, skin, skeletal muscle, and Dupuytren's. Mechanotransduction, or gradual expansion of tissue by traction, leads to the formation of new collagen tissue by cellular proliferation. As a molecular result, continuous extension of the fibrous plaque causes significant increases in collagenase and metalloproteinases, and, ultimately, to fibrous plaque softening and extension. This hypothetical knowledge has been supported by recent well designed experimental studies. Furthermore, several clinical papers have provided promising results on the use of PTT in PD patients. It has been shown in some series that the use of PTT significantly increases flaccid and stretched penile lengths and results in significant penile curvature improvement when compared to baseline. Furthermore, the use of PTT concomitantly with either verapamil or interferon α-2b has also been shown to be an effective therapy. Additionally, the beneficial effect of PTT on penile length before or after penile surgery in men with corporal fibrosis has been described. Finally, as a minimally invasive alternative treatment option to penile augmentation surgery in men with dysmorphophobia, PTT use has shown promising results by several experts. Studies have shown that PTT provides an acceptable, minimally invasive method that can produce effective and durable lengthening of the penis in men complaining of a small/short penis. There are, however, several criticisms related to the designs of the reported studies, such as small sample size and selection bias. Well-designed studies with larger numbers of patients and longer follow-up periods are, however, needed to establish the true benefits of PTT.
PubMed: 27298777
DOI: 10.21037/tau.2016.03.25 -
Asian Journal of Andrology 2020Penile prosthesis implantation is the gold standard of surgical therapy for patients with medication-refractory erectile dysfunction. However, this umbrella definition... (Review)
Review
Penile prosthesis implantation is the gold standard of surgical therapy for patients with medication-refractory erectile dysfunction. However, this umbrella definition includes significant heterogeneity and associated risk profiles that should be candidly discussed and addressed perioperatively. Factors associated with operative success and patient satisfaction are often surgery specific; however, risk profiling via patient selection, preoperative optimization, proper device selection, and intraoperative consideration are highly correlated. Some examples of common risk profiles include comorbidity(ies) such as cardiovascular disease, diabetes mellitus, prior abdominal surgery, Peyronie's disease, and psychological risk factors. Similarly, integration of surgeon- and patient-amenable characteristics is key to decreasing risk of infection, complication, and need for revision. Finally, patient risk profiling provides a unique context for proper device selection and evidence-based intraoperative considerations.
Topics: Cardiovascular Diseases; Comorbidity; Diabetes Mellitus; Erectile Dysfunction; Humans; Male; Mental Disorders; Patient Satisfaction; Patient Selection; Penile Implantation; Penile Induration; Penile Prosthesis; Postoperative Complications; Prosthesis-Related Infections; Reoperation; Risk Assessment; Surgical Wound Infection
PubMed: 31489849
DOI: 10.4103/aja.aja_92_19 -
Asian Journal of Andrology Jan 2008The present paper provides a review of the available non-surgical treatments for Peyronie's disease (PD). A review of published literature on oral, intralesional,... (Review)
Review
The present paper provides a review of the available non-surgical treatments for Peyronie's disease (PD). A review of published literature on oral, intralesional, external energy and iontophoresis therapies for PD was performed, and the published results of available treatment options reviewed. The authors recommendations for appropriate non-surgical management of PD are provided. Although there are many published reports that show the efficacy of non-surgical therapies for PD, there is a lack of large scale, multicenter controlled clinical trials, which makes treatment recommendations difficult. Careful review of the literature does suggest that there are treatment options that make scientific sense and appear to stabilize the disease process, reduce deformity, and improve function. Offering no treatment at all will encourage our patients to pursue alternative treatments, which might do harm, and misses the opportunity to do some good. Clearly further work is necessary to develop safe and effective non-surgical treatments for PD.
Topics: Animals; Arginine; Carnitine; Collagenases; Combined Modality Therapy; Electric Stimulation Therapy; Humans; Male; Penile Induration; Pentoxifylline; Randomized Controlled Trials as Topic; Traction
PubMed: 18087647
DOI: 10.1111/j.1745-7262.2008.00351.x -
The Journal of Sexual Medicine Oct 2018Plaque incision and grafting (PIG) for Peyronie's disease (PD) is not devoid of complications such as erectile dysfunction and penile sensory changes.
INTRODUCTION
Plaque incision and grafting (PIG) for Peyronie's disease (PD) is not devoid of complications such as erectile dysfunction and penile sensory changes.
AIM
To define the rate and chronology of penile sensation loss after PIG surgery and to define predictors of such.
METHODS
The study population consisted of patients with PD-associated penile curvature who underwent PIG surgery with at least 6 months of follow-up. Demographics and PD factors were recorded. Patient had preoperative assessment of penile sensation and deformity. Postoperative follow-up occurred at 1 week, 1 month, 6 months, and 1 year after surgery. Neurovascular bundle elevation was conducted with loupe magnification.
MAIN OUTCOME MEASURE
Penile sensation was evaluated with a biothesiometer and graded on a patient-reported visual analog scale (0-10) in which 0 defined a completely numb area and 10 defined perfect sensation. The degree of sensation loss was defined as extensive (any 1 area >5 cm), major (2-5 cm), and minor (≤2 cm). The penile sensation loss distribution was defined as focal (1 site) or diffuse (>1 site).
RESULTS
63 patients were analyzed. Mean age was 56 ± 10 years. Mean duration of PD at the time of PIG was 15 ± 7 (12-38) months. 75% had curvature alone, and 25% had hourglass/indentation deformities. Mean primary curvature was 64˚ ± 28˚. The mean operation duration was 3.5 ± 1.8 hours. 21% had some degree of sensation loss at 1 week, 21% at 1 month, 8% at 6 months, and 3% at 12 months. Only 1 patient (1.5%) at 2 years continued to have extensive sensation loss on the glans and distal shaft with a very elevated sensitivity threshold. Using multivariable analysis, the only predictor of penile sensation loss ≥6 months was a duration of operation >4 hours (odds ratio = 2.1; 95% confidence interval = 1.2-3.0; P < .01).
CLINICAL IMPLICATIONS
The study highlights the need during patient consent to discuss penile sensation loss. Patients should be informed that rates of penile sensation loss ranges from 2-30% and most patients will have complete resolution of any sensation loss within one year of follow-up.
STRENGTH AND LIMITATIONS
To our knowledge no other studies have described the chronology and severity of penile sensation following PIG, our study demonstrates the utility of biothesiometry in measuring penile sensation before and after PIG. Number of patients and absence of control group represent a limitation.
CONCLUSION
Sensation loss is not uncommon after PIG surgery. It decreases in frequency and severity with time with only rare cases occurring >12 months. Longer operations appeared to be more likely associated with sensation loss. Terrier JE, Tal R, Nelson CJ. Penile sensory changes after plaque incision and grafting surgery for Peyronie's disease. J Sex Med 2018;15:1491-1497.
Topics: Adult; Aged; Humans; Male; Middle Aged; Penile Induration; Penis; Urologic Surgical Procedures, Male
PubMed: 30195564
DOI: 10.1016/j.jsxm.2018.07.020 -
Urology Journal Dec 2015
Topics: Erectile Dysfunction; Humans; Male; Penile Implantation; Penile Induration; Penile Prosthesis; Penis
PubMed: 26706741
DOI: No ID Found