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Peyronie’S Disease: A Guide to Clinical Management

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Abstract

Previously considered rare, Peyronie's disease affects nearly 10% of adult men. Recent advances in wound-healing disorders have substantially increased the understanding of Peyronie's disease and its pathophysiology. In Peyronie's Disease: A Guide to Clinical Management, international authorities review the current nonsurgical and surgical therapeutic options for dealing with this fibrotic disorder. A variety of state-of-the-art research techniques is discussed, including tissue analysis, cell culture of fibroblasts derived from Peyronie's plaques, and animal models that attempt to mimic the in vivo process of tunica albuginea fibrosis while also providing an opportunity for manipulation with novel therapeutic techniques. Although there is no cure for Peyronie's diseases, this text discusses treatments that may result in physical improvement or help to stabilize the scarring process. For those with a more advanced disease, surgical options to correct the deformity in an effort to make the patients functional again are reviewed. Also discussed are the many misconceptions about Peyronie's disease, so that a practicing physician will be able to diagnose, treat, or refer the patient more appropriately. As the first medical text on the subject, Peyronie's Disease: A Guide to Clinical Management provides an up-to-date summary of the etiology, natural history, and pathophysiology of this disease as well as presents a review of the available medical and surgical treatment options.

Chapters (23)

François Gigot de la Peyronie, the famous French general surgeon, is very well known among urologists regarding the disease called by his name: Peyronie’s disease. Because his father was also a surgeon, he followed his family tradition and became a doctor. He had gained most of his surgical skills during the civil wars in the 16th century. His academic career in France was outstanding. He was one of the two founders of the Royal Academy of Surgery. He was also the First Surgeon to King Louis XV. Even though he was a great surgeon and university professor, his legacy consists only of numerous case reports and not even one comprehensive textbook. However, his paper on induratio penis plastica attached his name and credit to the disease, and since then it has been called Peyronie’s disease. This chapter consists of the history of the disease, starting with early assumptions of its pathophysiology and treatment up to the current knowledge, which still has dilemmas.
Epidemiological studies of Peyronie’s disease (PD) reported the prevalence of this condition as much higher than once thought, highlighting the potential physical and psychosocial impact of the disease on society. For this reason, knowledge of the epidemiology of PD is important for allocating and managing health care resources and assessing intervention strategies. The true prevalence of PD is unknown; it is estimated as between 3.7% and 7.1%, but the actual prevalence of this disease may be higher because of patients’ reluctance to report this embarrassing condition to their physicians for cultural and psychological reasons. Several risk factors, such as hypertension, diabetes, hyperlipidemia, and smoking, have been suggested. The estimated prevalence of PD at younger ages is around 8% and shows a more acute onset and a lower incidence of associated erectile dysfunction. This chapter reviews the contemporary state of knowledge of the epidemiology of PD.
Research on the molecular and cellular pathophysiology of Peyronie’s disease (PD) and the potential implications for the discovery of novel therapeutic targets for this prevalent condition has lagged considerably behind the advances in surgical techniques. However, two animal models have been generated based on the injection in the tunica albuginea of the rat of either transforming growth factor-β1 (TGF-β1) or fibrin to induce PD-like plaques and on the extensive characterization of fibroblast cell cultures from the human tunica albuginea and the PD plaque. These in vivo and in vitro models of PD not only replicate key molecular pathways and cell differentiation processes operating in most other types of tissue fibrosis, but also are excellent tools to test and validate new antifibrotic approaches of wider applicability. The fibrogenic roles of TGF-β1, oxidative stress, fibrin, plasminogen activator inhibitor 1, myofibroblast differentiation, and others have started to be elucidated in the context of the PD plaque, and stem cells have been found in the tunica albuginea that may be involved in plaque calcification and ectopic osteogenesis. In addition, endogenous antifibrotic pathways have been found in the PD plaque, mainly the inducible nitric oxide synthase/nitric oxide/cyclic guanosine monophosphate cascade, antioxidant enzymes, anti-TGF-β1 factors, and others, that may maintain the plaque in cellular and molecular turnover, particularly in terms of collagen deposition/breakdown and myofibroblast differentiation/apoptosis. Both the modulation of these defense mechanisms and some antifibrotic agents utilized in other conditions are starting to be tested therapeutically in human PD or its models or are potential targets for experimental research.
Despite centuries of recognition, the condition that is Peyronie’s disease remains a puzzle. Conventional wisdom suggests that trauma to the erect or semi-erect penis is the inciting event that sets off a cascade of events at the cellular level that results in localized fibrosis of the tunica albuginea. However, many questions remain unanswered at this juncture, among the most important of which are why do so few men manifest this condition? Why is there such an ethnic predilection? What are the cofactors that, along with penile trauma, lead to plaque development? Historically, cytokine overexpression, autoimmune, and genetic factors have been cited as contributors. This chapter endeavors to conduct an evidence-based assessment of the literature as it pertains to the pathophysiology of Peyronie’s disease. Furthermore, an effort is made to evaluate contemporary literature pertaining to novel concepts in Peyronie’s disease pathogenesis including nitric oxide synthase alterations, free radical generation, pathogen involvement, and animal model development. In conclusion, although plausible that the near future will see improved developments in our understanding of this condition, groundbreaking work will require research funding beyond that which is currently available.
The proper evaluation of the male patient with Peyronie’s disease (PD) involves a focused medical history as well as a detailed sexual history. Coupled with an extensive history of the disease, these components are crucial to the subjective assessment. The two main components of the objective assessment include the physical exam focusing on the penis, and evaluation of the patient at maximum erection with (preferred) or without duplex ultrasound. The most important component of the physical exam is assessment of the penis for length, deformity, and plaque. Erectile capacity is one of the most important parameters in the assessment of the man with PD. Duplex ultrasonography after injection with a vasoactive agent is the recommended means for evaluation of vascular flow parameters and erectile response, and it allows objective measurement of deformity in the erect state. The association between PD and erectile dysfunction has been firmly established. The patient’s response to pharmacological agents both before and after development of PD may factor into decisions regarding the direction of future therapy for both problems. Evaluation of the male with PD varies across clinical studies, and no standard currently exists. This chapter provides a framework for obtaining the subjective and objective information for the man presenting with PD.
This chapter reviews the possible effectiveness of oral agents as an option for treatment of Peyronie’s disease (PD). We present the rationale for use of these drugs and base our recommendations on levels of published evidence and the report by the International Consultation on Urological Diseases. A definitive and ideal medical therapy for PD has yet to be established and will not be until we completely understand the trigger mechanism and the maintenance process of fibrosis in the tunica albuginea. Several oral substances have been proposed with promises of success; however, these agents appear to lack robust scientific support for their benefit. Until new evidence is available, the indications for oral treatment in PD are recent onset of disease, painful plaque, and unstable plaque. An early trial of inexpensive, safe, and well-tolerated oral therapy may be offered with limited enthusiasm for a positive outcome.
Peyronie’s disease (PD) is a pathological condition of the penis that is most likely linked to the repetitive minor trauma that occurs during intercourse. The initial inflammatory process in some genetically susceptible individuals gives way to a subsequent persistent low-level autoimmune response. At the cellular level, this disorder involves increased deposition of collagen and glycosaminoglycans in the tunica albuginea of the penis, which leads to fibrosis and eventual plaque formation. The fibrous plaque can cause structural alterations in penile anatomy and sexual dysfunction. Experimental research in PD has invoked a role for cytokines and fibroblast activity, which has motivated clinicians to explore a number of nonsurgical and minimally invasive treatment options. With the experimental in vitro success of calcium channel blockers and interferons in counteracting the fibrotic process in PD, researchers have initiated a number of clinical studies with these agents. Both intralesional verapamil and interferon #x03B1;-2b have demonstrated significant clinical benefits to men with PD regarding a decrease in penile curvature and plaque size, reduction of penile pain on erection, and improved sexual function. Intralesional injection therapy can be initiated in most cases of PD but must be individualized to each man’s presentation based on the onset and severity of the disease, the patient’s motivations, and realistic expectations from this therapy.
Electromotive drug administration (EMDA) is a method of increasing the transport of drugs across barriers by means of an electric current. In patients with Peyronie’s disease, EMDA of verapamil into the tunica albuginea provides measurable drug levels in plaque tissue. Four clinical studies using different methods showed that EMDA of verapamil and dexamethasone is a safe and effective treatment for Peyronie’s disease, reducing plaque volume, penile deviation, and pain, and can contribute to the improvement in erectile capacity and sexual function.
Topical therapy for Peyronie’ s disease has been offered since the time of de laPeyronie. It would seem that, given the readily palpable location of a Peyronie’s plaque, direct application to the skin over the plaque would be a reasonable treatment option. Unfortunately, owing to the barrier effect of the skin and the vascularity of the underlying tissue layers, getting adequate levels of a topically applied agent to the underlying plaque has proved to be challenging. This chapter reviews the treatments that have been used as topical agents for Peyronie’s disease with particular focus on energy transfer methods to enhance drug penetration either alone or in combination with topical agents, including steroids, β-aminopropionitrile, verapamil creams, and liposomal superoxide dismutase gel. Clearly, the development of an easily applied therapy that has evidence of benefit for the patient with Peyronie’s disease would be much appreciated. For this to occur, further study of the pathogenesis of this disorder will be necessary to allow development of such topical agents.
Over the years, physicians have been searching for an effective way to treat Peyronie’s disease (PD). This disorder remains poorly understood. As a result, there is no straightforward reliable therapy. When it is felt that medical therapy is in order, it is best started at the early stages of acute inflammation, when the therapy can potentially prevent the evolution of fibrosis. A variety of combined treatments have been tried in the past appearing to give better results than monotherapy. Various types of energy transfer, including shockwave therapy, orthovoltage radiation, ultrasound, laser therapy, and shortwave diathermy, have been used for PD. The best reported clinical results have been obtained by combining laser therapy with shockwave therapy, especially for pain resolution. Treatment outcomes concerning reducing penile curvature and plaque resorption have been disappointing. Published reports have demonstrated the best results of combination therapy with shockwave therapy and intralesional injection of verapamil as this approach appears not only to reduce pain but also to improve penile deformity. This chapter reviews the results of nonsurgical combination therapy in the treatment ofPD.
Extracorporeal shockwave therapy (ESWT) has been on the rise for the treatment of Peyronie’s disease. There have been 21 original papers, 1 meta-analysis, and 2 review articles published. Analyzing these studies systematically, ESWT seems to have an effect on penile pain during erection and on the improvement of sexual function. It seems that pain resolves faster after ESWT treatment than during the course of natural history. The effect on plaque size and penile curvature is less impressive. The most recent studies do not provide evidence that ESWT has an effect on curvature and plaque size. Despite the lack of severe side effects, the data concerning efficacy published to date do not justify recognizing ESWT as an evidence-based, standard procedure for the treatment of Peyronie’s disease.
The Nesbit operation, first used for Peyronie’s disease in 1977, is still the most common operation performed to correct a penile curvature. Whereas there have been various modifications of the original technique over the years, the basic principle of shortening the tunica on the contralateral side to the plaque is applied. The operations are simple to perform, and the results are consistently excellent. This chapter describes the original technique and offers a comparison both with the modifications and with the alternative of grafting.
Peyronie’s disease, characterized by the formation of a fibrous plaque within the tunica albuginea of the corpora cavernosa, has long caused sexual dysfunction. Plication surgery has allowed a simple technique to correct the penile curvature caused by Peyronie’ s disease. The 16-dot plication technique corrects the penile curvature with a high level of patient satisfaction and yet can be performed under local anesthesia. Slight adjustments can be made during the procedure, which allows greater precision toward penile strengthening. The 16-dot penile plication procedure has an 85% long-term success rate for achieving a straight erection by patient reporting. Minimal complications are reported, with penile shortening (0.5–1.5 cm) reported at 41%. With a mean operative time of 45 min and the ability to perform the procedure under local anesthesia, the 16-dot plication procedure is an important tool for the urologist for treatment of Peyronie’s disease.
Penile straightening for Peyronie’s disease may be accomplished through a variety of approaches. For the man with satisfactory rigidity for coitus but deformity that interferes with intromission, there are two main approaches: tunica plication and grafting techniques. According to previously published surgical algorithms, tunica plication appears to be the optimum technique for the man with curvature less than 60° without narrowing resulting in a hinge effect. This chapter describes the tunica albuginea plication procedure with which I have had excellent results with respect to correcting the deformity, preservation of sexual function, and predictable penile shortening depending on the direction and degree of curvature.
Shortening the convex part of the corpora cavernosa for the treatment of penile curvatures was recommended more than 150 yr ago. Almost a century later, the surgical technique for straightening congenital penile curvatures by removing ellipsoid wedges from the convex side of the tunica albuginea, known as the Nesbit corporoplasty, was described. The modified corporoplasty described in this chapter was developed for achieving a straight and smooth penile shaft after the repair. This technique also is based on the principle of shortening the convex part of the corpora cavernosa, but without removing segments from the tunica albuginea and without dissection of the neurovascular bundle and its mobilization. In this technique, the longitudinal incisions done to the tunica albuginea of the corpora cavernosa are closed horizontally for shortening the convex part. Then, the bulges at the ends of the closure lines are buried with inverting sutures to smooth the penile shaft. This easily learned and performed technique can be used in most patients with Peyronie’s disease who have a reasonable penile length for achieving excellent cosmetic and functional results.
The objective of surgical treatment for Peyronie’s disease is to restore a painless, straight, and natural erection that is sufficient for intercourse. Plication procedures are associated with penile shortening, especially in cases of excessive curvature or rotation. Grafting procedures may prevent penile shortening, but they are often associated with poor postoperative anatomical and functional results caused by graft shrinkage and postoperative graft-associated corporeal veno-occlusive dysfunction. Surgical straightening of penile curvature with tunica plication and tunica albuginea free grafts is a simple and highly efficacious treatment modality with excellent functional results. It is associated with minimal postoperative shortening and eliminates major immediate and late complications, including recurrent curvature. It preserves erectile capacity in men with preoperative normal erectile function. Initial long-term patient satisfaction data, with lasting cosmetic and functional results, indicate that the proposed technique may be used as the indicated procedure for successful surgical treatment of excessive congenital or acquired penile curvature malformation.
This chapter reviews the history of plaque incision, the physical bases for expansion of cylindrical tissue, the numerical relationship between tunica extensibility and angular penile deformity, the effects of diameter loss on corporeal function, the design and placement of relaxing incisions, and operative technique based on 15 yr of experience with more than 130 cases. Special attention is given to the deployment and testing of relaxing incision and the use of autologous temporalis fascia as a free graft. Overall, without consideration of angle orientation or narrowing, results showed 75% of patients were corrected, 20% improved, and 7% were rendered dependent on medication for erectile rigidity.
Multiple surgical procedures have been developed for the treatment of Peyronie’s disease. With these penile-straightening surgeries, two broad surgical categories have emerged. These categories are penile-shortening procedures (plication) and penile-lengthening procedures (penile grafting). With the penile-grafting procedures, different grafting materials have been used. Presented here is the use of the autologous saphenous vein graft. The venous graft has many advantages, including (1) similar thickness of the replacing tunica albuginea, (2) an endothelial lining that prevents hematoma formation, (3) elasticity of the graft, and (4) the wall of the saphenous graft can establish a blood supply from the lumen of the corpus cavernosum, thus preventing graft ischemia and contracture. Also, there is decreased inflammation or reaction to the graft because it is autologous. With careful patient selection, the saphenous vein graft for Peyronie’s disease is an excellent therapy for penile curvature.
This chapter reports long-term outcomes and the incidence of postoperative erectile dysfunction with the use of a xenographic porcine jejunal submucosal graft as a closure material for the tunica albuginea after Peyronie’s plaque incision. There were 122 patients with penile curvature of 60° or greater who underwent plaque incision with closure of the tunical defect with this material. Surgical correction of the penile curvature was achieved in 90% of the patients. At a mean follow-up of 36 mo, 79% of the patients maintained their same degree of potency as preoperative. Xenographic porcine jejunal submucosal grafts for the coverage of cavernosal defects after Peyronie’s plaque incision allow satisfactory clinical results.
Penile reconstruction for Peyronie’s disease may require advanced techniques of plaque incision or partial excision when the deformity is severe. This technically challenging procedure is indicated for men with good-to-excellent preoperative erectile capacity and erect penile curvature exceeding 60° or unstable penis or hinge effect caused by severe indentation or hourglass deformity. Various grafts have been used historically, including fat, dermis, fascia, vein, and more recently, processed cadaveric tissue that can be “taken off the shelf,” which can shorten operative time and avoid a second incision at the donor site. These procedures require attention to detail in defining the deformity, careful elevation of the neurovascular bundle, incision or partial excision of the plaque, and proper sizing of the graft to repair the tunical defect. A comprehensive informed consent is critical to detail possible postoperative issues, including loss of penile length, diminished sexual sensation, incomplete or recurrent curvature, and, most important, erectile dysfunction. This chapter describes the plaque incision/partial excision procedure using the modified “H” incision and pericardial grafting technique.
This single geometrically determined incision is a standardized procedure that may be used for the correction of any penile curvature whether or not associated with tunical constriction regardless of plaque characteristics, resulting in maximum penile length gain.
Surgical management of Peyronie’s disease remains an area of evolving technique. Although few surgeons agree on the optimal procedure, most are comfortable with the concept that the chosen procedure should be as minimally invasive as possible and restore shape and function with the lowest risk to the individual. Currently, there exists no best procedure able to accomplish all of these ideal end points. Most surgeons experienced in management of Peyronie’s disease utilize a wide range of procedures, from plications to incisions and excisional techniques with grafts obtained from either autologous or exogenous sources. In this chapter, we report on our experience with an intracorporal incisional technique directed at men with small, discrete, dorsally located penile plaques. The ability for us to incise the scar from the interior of the corpora reduces pain and limits the need for us to widely mobilize the neurovascular bundle in these men.
Peyronie’s disease (PD) is an incurable, chronic condition producing scarring fibrosis of the tunica albuginea and is associated with penile deformity and erectile dysfunction. Although men afflicted with PD usually have a number of treatment options, those who also present with erectile dysfunction (ED) arising from it are not easily treated. Surgical straightening procedures that have been used to treat PD may not restore erectile function, and failure to straighten the penis with corrective surgery may be the result of erectile inadequacy during the postoperative period. For those men with PD and associated ED, penile prosthesis implantation will provide penile rigidity and straightening. This chapter discusses penile prosthesis implantation as a surgical option for patients with PD, placing emphasis on the choice of devices and surgical techniques. Implant choices are critical in the success of these procedures, and modeling to attain maximum straightening is the preferred method for correcting penile deformity after prosthesis implantation. Newer techniques hold the promise of high success rates and low morbidity.
... Prevalence can range based on study design or inclusion of patients with different comorbidities within the study population (e.g., older age, diabetes, and ED). In addition, the actual occurrence of this disease within the population may be higher due to patients' reluctance to come to their physician for treatment and diagnosis of this embarrassing condition [25]. Limited understanding of PD in the medical community may also contribute to underdiagnosis. ...
... Regardless of the fact that patients reported a wide array of penile symptoms, fewer than half of PD patients reported seeking treatment. Many patients may be reluctant to come to their physician for treatment and diagnosis of this embarrassing condition [25]. Several factors have been identified that predict which patients are more inclined to delay treatment, including older age, being in a long-term relationship, having a partner, being heterosexual, and the presence of simple penile deformity [35]. ...
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Purpose. To estimate the US prevalence of Peyronie's disease (PD) from patient-reported data and to identify diagnosis and treatment patterns. Methods. 11,420 US males ≥18 years old completed a brief web-based survey regarding the presence of PD, past treatments, and penile symptoms (Phase 1). Phase 1 respondents with PD diagnosis, history of treatment, or PD-related symptoms then completed a disease-specific survey (Phase 2). Results. Estimated prevalence of PD ranged from 0.5% (diagnosis of PD) to 13% (diagnosis, treatment, or penile symptoms). Thirty-six percent of Phase 2 participants reported that penile symptoms interfered with sexual activities. Of participants who sought treatment for penile symptoms (n = 128), 73% initially saw a primary care physician, 74% did not receive treatment from their first doctor, and 92% were not diagnosed with PD. Conclusions. PD may be underdiagnosed/undertreated in the US. Improved awareness is needed of PD symptoms and treatment options among health care professionals.
... There are various surgical options to solve this problem, [15]. There are huge interet to treat this disease worldwide [16] and also comprehensive books published in the topic [17], [18]. ...
Full-text available
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A pilot study is performed for Peyronie’s disease by oncothermia principle with a specially developed so called androthermia device. The case-studies and the preliminary efficacy results are promising, and show the feasibility of the new method to treat Peyronie’s disease in various stages.
... [24][25][26] In men with both PD and ED, it is important to consider that both organic and psychogenic factors may contribute to both conditions, which can impact treatment approaches. 27 In summary, while numerous risk factors have been implicated in the development of PD, additional work is required to strengthen these associations. Furthermore, a more complete understanding of the molecular pathways that may link these disease states is essential in establishing and expanding the growing network of interactions between PD and other conditions. ...
Article
Peyronie’s disease (PD) is a superficial fibrosing disorder of the penis resulting in plaque formation and penile deformity. Once considered rare, PD has more recently been found in up to 13 % of men, and can negatively affect sexual and psychosocial function of both patients and their partners. While the etiology of PD is unclear, it is thought to result from an inciting traumatic event followed by aberrant fibrosis or dysregulated wound healing. The evaluation of men presenting with PD includes a detailed history and physical examination, focusing on the penis in both the flaccid and erect states. PD is often associated with erectile dysfunction (ED), as well as several other comorbidities. Laboratory testing is not needed to diagnose PD, although given the associations between PD and systemic diseases including hypogonadism, diabetes, and cardiovascular disease, screening and workup for these conditions in men with PD may be warranted. Treatment modalities for PD are diverse and include oral, topical, intralesional, mechanical, and surgical therapies. Oral, topical, and mechanical therapies generally have little evidence supporting their efficacy. Several intralesional therapies, including interferon α2b and collagenase Clostridium histolyticum, have demonstrated efficacy in the treatment of PD. Surgical treatment, indicated in men with significant, stable deformity, includes plication of the tunica albuginea, plaque incision/excision and grafting, and placement of inflatable penile prosthesis (IPP) with or without additional maneuvers to achieve desired results, and has high success rates.
... PD is not a rare condition, and reports indicate that up to 1% of men are affected. Most cases reported have been in white men, usually during the fifth and sixth decades of life, but there are reports of PD as early as the teenage years and into the ninth decade [2][3][4]. ...
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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.
... There are various surgical options to solve this problem [15]. There is huge interest in treating this disease worldwide [16] and there are also comprehensive books published on the topic [17, 18]. The transdermal electrophoresis [19] could be effective for the treatment combined with definite drug-therapy called " trasdermal electromotive drug-therapy " (EMDTA) [20]. ...
Full-text available
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Peyronie's disease is characterized by a scarring fribrosis within the tunica albugina of the penis that could lead to penile length loss, narrowing, curvature, erectile dysfunction, pain with erection.
Article
Peyronie's disease (PD), more commonly known as penile curvature, is caused by plaque formation in the connective tissue of the penis. PD affects 0.3% to 8.9% of men, most commonly between ages 40 and 60 years and can cause significant psychological distress, regardless of severity. There is a rich history behind the initial reports of PD, initial beliefs about pathogenesis, and initial treatment. This article aims to discuss the history of PD as well as the evolution of causes and treatments throughout time up to present-day theories of pathogenesis and treatment.
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Several reported advantages of the robotic-assisted laparoscopic approach to the treatment of clinically localized prostate cancer include superior results for erectile function as one of the critical outcomes of radical prostate surgery. This article provides a critical assessment of the evidence that exists for erectile function outcomes based on a systematic literature review. We found that the low methodological and reporting quality of existing studies did not appear well suited to guide clinical practice. A new framework of prospective investigation using validated patient self-assessment instruments would seem critical to the future advancement of this field.
Article
Penile shortening following radical prostatectomy and straightening procedures for Peyronie's disease can be a devastating and unwelcome side effect of these operations. The majority of men undergoing radical prostatectomy for prostate cancer have a measured loss of penile length, which also can occur in men with Peyronie's disease and may be exacerbated by surgery. Recent studies have investigated the mechanisms resulting in penile shortening, and various treatments have emerged to prevent and treat postoperative penile shortening. This article reviews the recent literature on penile length loss after radical prostatectomy and following correction of penile deformity for Peyronie's disease.
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