Defining predictors of response to intralesional verapamil injection therapy for Peyronie's disease.
ABSTRACT • To assess factors that predict penile curvature responses to intralesional verapamil (ILV) injection therapy for men with Peyronie's disease (PD).
• Men with PD for <1 year were assessed at baseline and after 3 months of bi-monthly ILV-injection therapy. Curvature was assessed at the time of maximum penile rigidity. • Univariate relationships were tested with correlation or chi-square analyses. • Multivariate analyses included logistic and linear regression. • We analysed curvature improvement, defined as a decrease of ≥10 ° from baseline. Additionally, the relationship between curvature outcomes and patient age and degree of baseline penile curvature were assessed.
• Data from 131 men were included and the rates of penile curvature change were:26% improved, 12% worsened, and 62% stable. • Age (r=-0.24, P < 0.01) and larger baseline penile curvature (r= 0.33, P < 0.01) were associated with improved curvature on univariate analysis. • On multivariate analysis (logistic regression), both age [odds ratio (OR) 0.93, P < 0.01, 95%CI 0.89-0.97] and larger baseline penile curvature (OR 1.07, P < 0.01, 95%CI 1.04-1.11) were associated with improvements in curvature after ILV-injection therapy. • Improvements in curvature were associated with age (≤40 years vs >40 years; OR 0.27, P < 0.05, 95%CI 0.10-0.75) and degree of penile curvature at baseline (≤30 ° vs >30 °; OR 9.12, P < 0.01, 95%CI 1.94-42.84) when dichotomized as indicated.
• Younger age and larger baseline penile curvature were predictive of favourable curvature outcomes. • Analysis of dichotomized variables suggests that age and baseline curvature thresholds may be important to consider when deciding on ILV as a therapeutic strategy for PD.
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ABSTRACT: We examined the use of intraplaque injection of verapamil for the treatment of Peyronie's disease through its effects on pain, curvature, indentation, sexual function and erectile capacity. A total of 156 men underwent treatment with intraplaque verapamil injection. Patients were assessed objectively, during dynamic penile duplex ultrasound, as well as subjectively using a questionnaire before and after initiation of the treatment protocol. Patients were also stratified by duration of disease before therapy and into 1 of 3 Kelami classification groups based on pretreatment plaque size and severity of curvature. Differences before and after treatment and among the Kelami classification groups were assessed. Of the 140 patients who completed treatment 73 (60%) had an objectively measured decrease in curvature while 79 (62%) reported a subjective decrease in curvature during the followup interview. After treatment 111 (83%) men reported an increase in girth, 107 (80%) an increase in rigidity distal to the plaque and 92 (71%) an improvement in sexual function. Among each Kelami class curvature was objectively measured to decrease in 41%, 68% and 62% of patients in classes I, II and III, respectively. There was no significant difference in response based on duration of disease (60% improvement versus 61% improvement for disease duration of less or greater than 1 year in duration, respectively). Mean followup was 30.4 months (range 10 to 81) and there was no reported recurrence of penile deformity in those men with an initial posttreatment positive response. Verapamil injection of Peyronie's plaques appears to be a clinically effective treatment option for pain and curvature and can contribute to subjective improvement in sexual function and erectile capacity. The low incidence of complications indicates that this therapy is also clinically safe.The Journal of Urology 09/2002; 168(2):621-5; discussion 625-6. · 3.70 Impact Factor
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ABSTRACT: For the practicing clinician, appreciating Peyronie's disease (PD) significant negative psychological impact is apparent. Despite this, there exists not a single study using validated instruments assessing this issue. To document the effect of PD on the psychosocial status of men. The Center for Epidemiological Studies Depression scale (CES-D) for evaluation of depression and the SF-36 for quality of life assessment. Men (N = 92; 54 +/- 11 years of age) presenting for PD evaluation completed the CES-D, Short Form-36 (SF-36), and an inventory regarding PD. Partners were not assessed. A vast majority of men (88%) had a partner with a mean partner age of 49 +/- 11 years. The median duration of PD at presentation was 12 (1-360) months. As a whole, 48% were classified as depressed on the CES-D (26% moderate, 21% severe). These subjects were then placed into groups according to the length of time since diagnosis of PD. Length-of-time groups were: 0-6 months, 6-12 months, 12-18 months, and >18 months. The percent of men scoring above the CES-D cutoff for depression remained consistently high with no significant difference across time since diagnosis groups. These results are supported by data from the Mental Health subscale (MHS) of the SF-36 (lower scores indicate lower mental heath). For the entire sample, the MHS standardized mean of 46.80 was significantly lower (P < 0.05) than the general male population standardized mean of 50. The MHS means stayed consistently low (no statistical difference) across time since diagnosis groups. Using validated instruments, we have demonstrated that 48% of men with PD have clinically meaningful depression that would warrant medical evaluation. This high level of depression stayed consistent across time since diagnosis. These data suggest that most men do not psychologically adjust to their diagnosis of PD and all men with PD should be considered appropriate mental health screening.Journal of Sexual Medicine 06/2008; 5(8):1985-90. · 3.51 Impact Factor
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ABSTRACT: The pathogenesis of Peyronie's disease still remains an enigma and few epidemiological studies are available. The purpose of this study was to determine the prevalence of Peyronie's disease in males older than 50 y. From 26 to 30 July 1998, 1071 men attended the 'Prostate Cancer Awareness Week of Santa Casa Hospital, Porto Alegre, Brazil'. In the prostate exam they also consented to be screened for Peyronie's disease. They underwent the 5-item International Index of Erectile Function (IIEF-5) questionnaire for evaluation of the erectile condition. The presence of a well-defined plaque in the penis was the diagnostic criterion for Peyronie's disease. The men were examined by five senior residents, under supervision by the staff Urologist. Men younger than 50 y as well as patients under intracavernous injection therapy for erectile dysfunction were excluded from the study. Chi2 test was used for statistical analysis. Nine hundred and fifty-four (89.1%) out of the 1071 men with a mean age of 62 y (ranging from 52 to 77) were included in the study. Peyronie's disease plaques were found in 35 men (3.67%). Eight hundred and forty-five (88.6%) were Caucasians. There was no significant statistical difference regarding age (P > 0.05). The presence of erectile dysfunction in the men with Peyronie's disease and without this condition, was 68.6% and 53.5%, respectively (P > 0.05). From this data we can conclude that the prevalence of Peyronie's disease is higher than in formerly reported studies. Further observations should be carried out in different communities and in other groups of patients in order to confirm our results.International Journal of Impotence Research 10/2001; 13(5):291-3. · 1.51 Impact Factor