Article

Penile Traction Therapy for Treatment of Peyronie's Disease: A Single-Center Pilot Study

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Abstract

Peyronie's disease (PD) is a fibrotic disorder of the penis whose etiopathophysiology remains unclear. At this time, there is no known reliable nonsurgical treatment. This study reviews our experience with external penile traction therapy to correct the deformity associated with this disorder. To evaluate prolonged external penile traction as a nonsurgical treatment for PD. Ten men with PD completed this noncontrolled pilot study of traction therapy using the FastSize Penile Extender. Nearly all (90%) had failed prior medical therapy. Traction was applied as the only treatment for 2-8 hours/day for 6 months. All subjects underwent pre- and post-treatment physical examination including measurement of stretched flaccid penile length (SPL) and biothesiometry. Curvature and girth were measured during erection before and after treatment with dynamic duplex ultrasound. Assessment of erectile and sexual function was further assessed with the International Index of Erectile Function and Quality of Life Specific to Male Erection Difficulties (QOL-MED) questionnaires. At 3 and 6 months post-treatment, SPL was measured and subjective assessment of deformity by the patient was recorded. Subjectively all men noted reduced curvature estimated at 10-40 degrees, increased penile length (1-2.5 cm) and enhanced girth in areas of indentation or narrowing. Objective measures demonstrated reduced curvature in all men from 10-45 degrees; average reduction for the group was 33% (51-34 degrees). SPL increased 0.5-2.0 cm and erect girth increased 0.5-1.0 cm with correction of hinge effect in four out of four men. International Index of Erectile Function-erectile function domain increased from 18.3-23.6 for the group. Changes in quality of life by QOL-MED were not found to be statistically significant in this small series. There were no adverse events including skin changes, ulcerations, hypoesthesia or diminished rigidity. Prolonged daily external penile traction therapy is a new approach for the nonsurgical treatment of PD. Further study appears warranted given the response noted in this pilot study.

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... Patients completed the PDQ during the baseline visit and at each study visit. The PDQ quantitatively assesses the physical and psychological symptoms of PD by providing information from We defined 'responders' to the PTT using the concept published by Levine et al. [13]: a 'composite responder' was a patient who experienced both a ≥20.0% improvement in penile curvature deformity and either an improvement in PDQ PD symptom bother domain score of ≥1 or a change from no sexual activity at screening to reporting sexual activity. ...
... Major changes were seen in the psychological and physical symptom domain of the PDQ (PS-PDQ) as well as the bother and distress domain (BD-PDQ), whereas there was no impact on the penile pain domain (PP-PDQ) score as patients were included in the stable phase of the disease with no pain. The PDQ-PS changed significantly (P < 0.001) from 12.3 to 7.8 (4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19) compared with baseline, and compared with the NIG in which there were no changes compared with baseline. In addition, the mean (range) PDQ-BD score improved significantly from 13.8 to 7.2 (5-16) Fig. 7. ...
... The results of the present study are consistent with previous studies in small series of patients, such as the pilot study by Levine et al. [13] of 10 patients with PD in which nearly all (90%) had failed prior medical therapy; PTT was applied for 2-8 h/day for 6 months. The PTT resulted in subjectively and objectively measured improvement in penile deformity, enhanced stretched flaccid length and erect girth, as well as improved sexual function, with no reported AEs. ...
Article
Objectives To evaluate the efficacy and safety of a new penile traction device (PTD) ‘Penimaster PRO’ in a group of patients with stable Peyronie's disease (PD) compared to a non‐intervention group in a multicentre study trial. Material and Methods 93 patients with chronic stable PD (without ED, no significant pain, and with a unidirectional curvature of at least 45 degrees being stable for more than 3 months) were recruited and followed for a 12‐week period. 47 patients were randomly assigned to ‘PeniMaster PRO’ group (PG) and 46 assigned to the non‐intervention group (NIG). Patients were asked to apply the PTD 3‐8 hours a day for 12 consecutive weeks with specific instructions regarding the progressive increase of traction force applied to the penis over time. The primary outcome of the study was to assess the change in the degree of curvature measured in the fully erect state after intracavernosal injection of Alprostadil at baseline, 1, 2 and 3 months. Other parameters such as the type of curvature, stretched penile length (SPL), Peyronie's Disease Questionnaire (PDQ), International Index of Erectile Function (IIEF‐EF) and adverse events were also assessed in each visit. Results 41 patients in PG and 39 in NIG completed the study. There was an overall reduction in curvature of 31.2 degrees (p<0.001) at 12 weeks compared to baseline in the PG, representing a 41.1% improvement from the baseline which significantly correlated with the number of daily hours the device was applied in a dose‐dependent manner. Those patients using the device less than 4 hours a day experienced a reduction of 15‐25 degrees (mean 19.7 degrees, 28.8% improvement, p<0.05), while patients using the device more than 6 hours a day experienced greater curvature reduction ranging from 20 to 50 degrees (mean of 38.4 degrees, 51.4% improvement, p<0.0001). In contrast, no significant changes in curvature were observed in the NIG. Furthermore, SPL increased significantly in PG compared to baseline and compared to the NIG, ranging from 0.5 to 3.0 cm (mean 1.8 cm, p<0.05 IIEF‐EF also improved in patients of the PG (mean of 5 points). Mild adverse events occurred in 43% of patients such as local discomfort and glans numbness. Conclusion The use of ‘Penimaster PRO’ PTD, a non‐invasive treatment should be offered to patients with stable PD for three consecutive months before performing any corrective surgery, as this provided a significant reduction of the curvature, increase in penile length and a significant improvement of the symptoms and bother induced by PD. This article is protected by copyright. All rights reserved.
... articles reported a duration over 24 months. 23,25,35,42 The mean penile curvature at baseline was between 31 34 and 80.8 32 degrees, being over 60 degrees in 6 (26.1%) studies. 24,26,28,29,32,42 As expected, penile curvature was predominantly dorsal in most studies. ...
... Seven (30.4%) papers reported the inclusion of patients with complex deformities. 22,23,24,26,27,29,35 The baseline characteristics of patients were reported in Table 2. ...
... Modeling was performed alone in 9 (39.1%) studies, 21,22,23,25,27,28,31,34,35 while concomitant treatments for PD were associated in 14 (60.9%) articles. ...
Article
Introduction Penile modeling to correct the penile curvature in Peyronie's disease (PD) may be achieved manually (intra-operatively or post-injection) or by using assisted devices (penile traction, vacuum device, or penile prosthesis). Objectives To evaluate the efficacy, safety, and satisfaction associated with penile modeling in patients with PD. Methods A PROSPERO registered (CRD42021241729) systematic search in MEDLINE and Cochrane Library was done following PRISMA. PICO: Studies were deemed eligible if they assessed patients with PD (P) undergoing modeling procedures (I) with or without a comparative group(C) evaluating the efficacy, safety, or patient satisfaction (O). Retrospective and prospective primary studies were included. The primary outcome measure is the change in penile curvature after modeling. The secondary outcome measures are the change in stretched penile length, adverse events, and patient satisfaction after modeling. Results A total of 23 studies, involving 1,238 patients were included. Most studies (13, 56.5%) evaluated penile traction therapy. The studies were of low and intermediate quality (mean Newcastle-Ottawa Scale score of 5.7 and mean Jadad score of 3.3) with a mean level of evidence of 3.4. The mean penile curvature at baseline was between 31 and 80.8 degrees. Nine (39.1%) studies found a significant improvement (P < .05) of penile curvature after penile modeling, ranging between 11.7, and 37.2 degrees. An increase in mean stretched penile length was reported in 7 (30.4%) articles, varying between 0.4, and 1.8 cm. Serious complications such as penile prosthesis malfunctions (3.3–11.1%) and urethral injuries (2.9%) were only reported for intra-operative manual modeling. Conclusion Although individual studies have noted improvement in penile curvature and stretched penile length, specific recommendations regarding penile modeling in PD cannot be provided due to limited evidence available. Further RCTs with adequate sample size, validated assessment tools, and longer follow-up are needed. Krishnappa P, Manfredi C, Sinha M et al. Penile Modeling in Peyronie's Disease: A Systematic Review of the Literature. Sex Med Rev 2021;XX:XXX–XXX.
... Penile traction therapies and vacuum erections devices (VEDs) have been shown to successfully restore penile length in patients with short penises secondary to many conditions. These include hypoplastic penis, postoperative shortened penis, dysmorphophobia, and Peyronie's disease (PD) [9][10][11][12]. Despite the favorable results seen in patients with these conditions, to our knowledge there are no studies regarding VED use for postoperative corporal body lengthening after IPP implantation. ...
... Data regarding girth showed variation postoperatively when compared with the baseline, but at the end of follow-up, the dimensions remained not-statistically different from those obtained via the preoperative ICI [median 11 cm (range 9-12) vs. 11 cm (range 10-13); p = 0.36] (see Fig. 1b). No patient reported a shortening in the length compared to the baseline flaccid stretched measurements [median 14 cm (range 10-17) vs. 17 cm (range 13-23); p < 0.0001] while, more importantly, no statistical difference was seen between the baseline ICIinduced penile length and the measurements at the end of follow-up [median 17 cm (range [11][12][13][14][15][16][17][18][19] vs. 17 cm (range 13-23); p = 0.48] (see Fig. 1a). Table 3 summarizes intraoperative and postoperative complications. ...
... This is primarily seen in the maintenance of erect length and girth in our population over the course of the study. This is also seen in the increasing trend in the number of the pumps required to fully activate the device [1st activation: median 12 (range [8][9][10][11][12][13][14][15][16] vs. 48 weeks: median 24 (range 18-29); p < 0.0001). Unlike Henry et al., we did not report a reduction in postoperative pumps to activate the device in the first postoperative period. ...
Article
Full-text available
Penile shortening after inflatable penile prosthesis for erectile dysfunction is a common postoperative patient complaint and can reduce overall satisfaction with the procedure. In this prospective study we report our results regarding penile dimensions and patient satisfaction outcomes after 1 year of follow-up from AMS™LGX700® penile prosthesis implant with 6 months of vacuum erectile device therapy. Seventy-four selected patients with medically refractory erectile dysfunction underwent AMS™ LGX 700® IPP placement. Postoperatively, patients were assigned vacuum device therapy for 5 min twice daily. Follow-up continued for 1 year after surgery. Dimensional and functional results were assessed. Baseline median preoperative stretched penile length and girth were 14 cm (range 10–17) and 9 cm (range 7–12), respectively. At the end of the study penile median dimensional outcomes were 17 cm (range 13–23) for length and 11 cm (range 10–13) for girth while a median number of 24 pumps (range 18–29) to fully inflate the device was seen. Baseline median International Index of Erectile Function (IIEF-5) score was 9 (range 5–11), at 6 months 20 (range 18–26) and at 1 year was 25 (range 20–27) (p < 0.0001). Median Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) score at the end of the follow-up was 74 (range 66–78). Our postoperative rehabilitation program is feasible and should be recommended after prothesis surgery in order to increase overall satisfaction with the procedure. Penile postoperative dimensional outcomes were statistically significant improved and complications were negligible.
... Erectile function improvements met the criteria for being clinically significant in most men, and length improvements were larger than any previously reported ones with any mechanical device. 1,2,7,9,14 These findings are particularly notable given that RestoreX is the only mechanical device shown to achieve improvements with an average of 30 minutes of daily use compared with the 2 to 9 hours daily required with alternatives. 1,2,7,9 Although the exact mechanism for the more efficient improvements is not well studied, results may be attributable to the novel device changes that permit greater and more sustained traction forces than other designs ( Figure 1). ...
... 1,2,7,9,14 These findings are particularly notable given that RestoreX is the only mechanical device shown to achieve improvements with an average of 30 minutes of daily use compared with the 2 to 9 hours daily required with alternatives. 1,2,7,9 Although the exact mechanism for the more efficient improvements is not well studied, results may be attributable to the novel device changes that permit greater and more sustained traction forces than other designs ( Figure 1). ...
... To our knowledge, the present study is one of the few to report outcomes of any mechanical therapy on penile indentation or hourglass deformity. 1 These impairments can be particularly impactful for men with PD, as they often exacerbate penile instability, decrease girth, and can further impair erectile function. Of those with subjectively reported baseline indentation or hourglass, 59% felt that traction therapy improved outcomes, with 25% noting mild, 33% moderate, and 42% significant improvements. ...
Article
Full-text available
Background A randomized, controlled clinical trial evaluating the efficacy of RestoreX traction therapy in men with Peyronie’s disease (PD) has been completed, with the 3-month results previously reported. The present study presents outcomes from the open-label and follow-up phases of the original trial. Aim To report 6-month (open-label phase) and 9-month (follow-up phase) outcomes from a randomized, controlled trial (NCT03389854). Methods A randomized controlled trial was performed from 2017 to 2019 in 110 all-comer men with PD. Men were randomized 3:1 to RestoreX (PTT) or no therapy (control) for 3 months, followed by 3-month open-label and follow-up phases. Key outcomes included adverse events (AEs), changes in penile curvature and length, erectile function, and standardized and nonstandardized assessments of PD. Outcomes The primary outcomes are safety, penile length, penile curvature, Peyronie’s Disease Questionnaire, International Index of Erectile Function, and satisfaction. Results 6-month (n = 64) and 9-month (n = 63) outcomes were reported, with a mean duration of PTT use of 31.1 minutes. No significant AEs were reported, with temporary erythema and discomfort being most common and resolving within minutes. On intent-to-treat analysis, control-to-PTT men experienced significant length (1.7–2.0 cm) and curvature improvements (18–20%). PTT-to-PTT men also achieved additional length (0.6–0.8 cm) without further curvature improvements. An as-treated analysis of PTT use ≥15 minute/day demonstrated 2.0- to 2.3-cm length gains (largest of any PTT to date) and 18–21% curve improvement. All sexual function domains of the International Index of Erectile Function and Peyronie’s Disease Questionnaire were significantly improved (except orgasmic domain). 95% of men treated for 6 months experienced length gains (mean 2.0–2.2 cm), and 61% had curve improvements (16.8–21.4° [32.8–35.8%]). RestoreX was preferred 3–4:1 over all other PD treatments, and 100% preferred it over other PTT devices. Clinical Implications Use of RestoreX 30 minutes daily results in significant length and curve improvements in PD men without significant AEs. Strengths & Limitations Strengths include largest randomized study of PTT, blinded assessments, and inclusion of all-comers with few restrictions; limitations include sample size that precludes comparisons between treatment cohorts and lack of long-duration (>3–9 hours) treatment arm. Conclusion PTT with RestoreX results in significant improvements in length, curve, and subjective and objective measures of sexual function without significant AEs. RestoreX PTT represents a safe, conservative, low-cost option for managing men with PD. Joseph J, Ziegelmann M, Alom M, et al. Outcomes of RestoreX Penile Traction Therapy in Men With Peyronie’s Disease: Results From Open Label and Follow-up Phases. J Sex Med 2020;17:2462–2471.
... articles reported a duration over 24 months. 23,25,35,42 The mean penile curvature at baseline was between 31 34 and 80.8 32 degrees, being over 60 degrees in 6 (26.1%) studies. 24,26,28,29,32,42 As expected, penile curvature was predominantly dorsal in most studies. ...
... Seven (30.4%) papers reported the inclusion of patients with complex deformities. 22,23,24,26,27,29,35 The baseline characteristics of patients were reported in Table 2. ...
... Modeling was performed alone in 9 (39.1%) studies, 21,22,23,25,27,28,31,34,35 while concomitant treatments for PD were associated in 14 (60.9%) articles. ...
Article
Introduction Penile modeling to correct the penile curvature in Peyronie's disease (PD) may be achieved manually (intra-operatively or post-injection) or by using assisted devices (penile traction, vacuum device or penile prosthesis). To the best of our knowledge this is the first systematic review of the literature comprehensively evaluating penile modeling procedures. Objective To evaluate the efficacy, safety and satisfaction associated with penile modeling in patients with PD. Methods A PROSPERO registered (CRD42021241729) systematic search in MEDLINE and Cochrane Library was done in accordance with PRISMA. PICO: Studies were deemed eligible if they assessed patients with PD (P) undergoing modeling procedures (I) with or without comparative group(C) evaluating the efficacy, safety or patient satisfaction (O). Results A total of 23 studies, involving 1,238 patients were included in the systematic review. The majority (n=13) studied penile traction therapy and the least being manual modeling at home and manual modeling after collagenase injection (1 each). The studies were of low and intermediate quality (mean Newcastle-Ottawa Scale score of 5.7 and mean Jadad score of 3.3) with a mean level of evidence of 3.4. The mean penile curvature at baseline was between 31 and 80.8 degrees. Nine (39.1%) studies found a significant improvement (p<0.05) of penile curvature after penile modeling, ranging between 11.7 and 37.2 degrees. A increase in mean stretched penile length was reported in 7 (30.4%) articles, varying between 0.4 and 1.8 cm. Serious complications such as penile prosthesis malfunctions (3.3%-11.1%) and urethral injuries (2.9%) were only reported for intra-operative manual modeling. Conclusion Although individual studies have noted improvement in penile curvature and stretched penile length, specific recommendations regarding penile modeling in PD cannot be provided due to the inability to perform a pooled analysis of the included studies with significant heterogeneity and the absence of standardized methods to report complications and patient satisfaction. Further RCTs with adequate sample size, validated assessment tools and longer follow-up are needed. Disclosure Work supported by industry: no. A consultant, employee (part time or full time) or shareholder is among the authors (Boston Scientific).
... A summary of the relevant articles is summarized in Tables 1 and 2. The first published study on PTT was published by Levine and colleagues in 2008. 21 A pilot study was performed on 11 men with long standing PD (mean 29 months) utilizing the FastSize penile extender (Fastsize Medical, Allso Viejo, CA, USA). The patients were instructed to use traction for 2 h a day increasing the duration to 8 h a day, with the extender rods lengthened 0.5 cm every 2 weeks for 6 months. ...
... Oral therapies such as pentoxifylline, vitamin E, and colchicine were historically used. 2,5,21 However, none of those treatments have been shown to have a significant clinical benefit and therefore are not recommended as monotherapy by the AUA guidelines. 5 Intralesional treatments including intralesional injections (ILIs) such as interferon 2α and calcium channel blockers have been shown to have some benefit by reducing fibroblast proliferation and increasing collagenase activity in vitro, but clinical data has been mixed. ...
Article
Full-text available
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.
... The need for surgery was reduced in 40% of patients who would otherwise have been candidates for surgery and simplified the complexity of the surgical procedure (from grafting to plication) in one of three patients. The overall satisfaction rate was 85% (39). ...
Article
Full-text available
Peyronie's disease is the disease that results in an alteration in the curvature of the penis, which can lead to a shortening of length, pain in erection, or difficulties in penetration, thus leading the patient to psychological alterations due to loss of functionality such as aesthetic alteration. That is why there are several studies to define the best form of treatment, which currently continues to be the first choice surgical treatment. We present the most recommended therapies for Peyronie's disease and suggest an algorithm as a guide to direct therapy. We used the PubMed platform to review the literature related to Peyronie's disease. Various editorials were reviewed as well as original articles and reviews focusing on the various treatments as well as their indications and results. Peyronie's disease in which conservative or drug treatment does not have a response, surgical treatment with corporoplasty, penile prosthesis implantation or both may be indicated. Corporoplasty refers to both the plication of the tunica albuginea as well as the incision of the tunica with the placement of a graft. An accurate history should always be carried out to identify erectile dysfunction as well as to be able to guide you on the repercussions of the treatment. If refractory erectile dysfunction is present, placement of a penile prosthesis with or without further adjunctive straightening maneuvers is recommended. We reviewed the indications, advantages, disadvantages, and results of the available techniques, and proposed a surgical treatment algorithm. Penile shortening procedures are usually indicated in curvatures <60°, in penises with adequate length. Partial excision/incision and grafting are indicated for curvatures >60°, hourglass or hinge deformities, and short penises, if the patient's erectile function is adequate. The presence of “borderline” erectile function and/or ventral curvature tilts the choice toward shortening procedures, and refractory erectile dysfunction is an indication for penile prosthesis placement. An accurate risk/benefit assessment of the individual patient as well as meticulous patient counseling are critically important.
... A pilot study of 19 patients showed limited improvement in penile length, but increased satisfaction in men with traction therapy in men with curvatures less than 50° [84]. An earlier pilot study of 10 men found curvature reductions of 33% with traction therapy that required application 2 to 8 h a day for 6 months [85]. The prolonged daily use and the limited sample size may be factors contributing to the reported efficacy, which has not been reproduced by subsequent studies. ...
Article
Full-text available
Purpose of Review The goal of this article is to review the current management options for Peyronie’s disease (PD), focusing on the acute phase of the disease. Additionally, we aim to highlight the most recent literature on the subject. Recent Findings Contemporary studies suggest that there are promising novel therapies on the horizon for acute phase PD, such as topical H-100 gel and intralesional interferon-α2b and mycophenolate mofetil. Recent findings also suggest that intralesional collagenase Clostridium histolyticum (CCH) may be effective for the acute phase of PD, in addition to its conventional use in the chronic phase. Summary A variety of treatments have been proposed for PD, with more recent literature focusing on the acute phase. Novel topical therapies are on the horizon and may show promise. External mechanical therapies have shown clinically meaningful changes. CCH may have efficacy during the acute phase of PD. Other intralesional therapies are promising but still require additional large studies to confirm efficacy. Future research on the acute phase of PD may expand treatment options and impact disease management.
... This is followed by an increase in newly synthesized collagen. Levine et al [43] , in an uncontrolled study, applied this technique on 10 patients with PD whereby application of the the FastSize Penis Extender was the only treatment for 2-8 h/d for 6 mo. Penile curvature was reduced in all men from 10° to 45°, with an average reduction of 33% (range: 51°-34°). ...
... More recently traction devices are being studied for their pre-operative and post-operative use to augment outcomes from surgical procedures. Levine's group has studied the use of traction devices in men with Peyronie's disease and have shown improvement in patient satisfaction postoperatively after the use of PTD (33). Similarly, in early trials, pre-operative use of PTD has been shown to increase penile length prior to implantation of penile prosthesis and therefore allowing insertion of a larger caliber of cylinder (34). ...
Article
Penile elongation surgery is less commonly performed in the public sector, but involves a collaborative approach between urology and plastic surgery. Congenital and acquired micropenis are the classic surgical indications for penile elongation surgery. The goal of intervention in these patients is to restore a functional penis size in order to allow normal standing micturition, enable satisfying sexual intercourse and improve patient quality of life. Many men seeking elongation actually have normal length penises, but perceive themselves to be small, a psychologic condition termed ‘penile dysmorphophobia’. This paper will review the anatomy and embryology of congenital micropenis and discuss both conservative and surgical management options for men seeking penile elongation therapy.
... Concernant la maladie de Lapeyronie, et en dehors du traitement chirurgical, de nombreux traitements ont été testés, au sein d'études réalisées le plus souvent sur de faibles effectifs[7]-[16].Premièrement, il y a des traitements non invasifs de type Traction thérapie[17],[18], Lithotritie extracorporelle[19]-[21] et Iontophorèse (administration transdermique de combinaisons de principes actifs comme Vérapamil, Dexamethasone, Lidocaïne)[22],[23]. ...
Thesis
La chirurgie est le traitement de référence des déformations invalidantes de la verge. La pratique d’une chirurgie aussi spécifique nécessite une formation solide de l’opérateur à la fois théorique et pratique. Le Diplôme Inter Universitaire (DIU) de « Formation supérieure à la chirurgie de la verge de l’adulte » basée sur la pratique de l’apprenant, a comme originalité d’impliquer ce dernier à la fois comme aide et opérateur.Le but de ce travail a consisté en l’étude de tous les patients opérés dans le cadre de ce DIU, depuis la date de sa création, en 2008 et suivis au sein de la plateforme niçoise jusqu’à fin 2013. Seize patients ont été inclus et séparés en deux groupes: un groupe dit « Lapeyronie » et un second dit « Courbure congénitale ». Pour chaque patient des critères spécifiques pré-, per et post-opératoires ont été relevés. L’étude de ces critères a permis d’une part de comparer les différents résultats en fonction des critères évalués et d’autre part de mieux comprendre certaines suites opératoires. La déformation, qui est le motif premier de la consultation et la plainte principale, est corrigeable à 80% quelle que soit la technique chirurgicale. La satisfaction post-opératoire est de 70% tant sur l’échelle globale que sur le plan sexuel. Très peu de patients ont poursuivi la rééducation de façon assidue. Les apprenants ont tous été satisfaits de la qualité et des bénéfices de l’enseignement.Devant la présence de multiples techniques possibles et leurs résultats différents sur la correction de la déformation, le raccourcissement, le risque d’impuissance et le risque d’insensibilité, il est nécessaire d’établir une stratégie thérapeutique personnalisée. Le modèle typique de la prise en charge de ces patients au sein de ce DIU est détaillé avec un intérêt particulier au bilan d’imagerie (IRM de verge, Pharmaco-échodoppler pénien) en préopératoire mais aussi à celui de l’évaluation du profil psychologique du patient
... The PTT group also had better sexual function with 80% able to have penetrative sex after treatment compared to 15% of the control group [65•]. Studies have also demonstrated improvements in flaccid stretched penile length of up to 2 cm following PTT [66]. This is an underutilized treatment modality which is ideal for highly motivated men who are concerned about length loss. ...
Article
Full-text available
Purpose: To analyze the literature on the current treatment options for Peyronie's disease (PD). Recent findings: Intracavernosal injection therapy using collagenase clostridium histolyticum (CCH) has been widely adopted since its FDA approval in 2013. Based on the current evidence, it appears to be moderately efficacious for men with mild curvatures. Although a recent study has shown similar outcomes using a modified protocol requiring fewer injections, CCH remains an expensive medication. Surgery provides the most definitive treatment. The most common adverse effect following surgery is perceived loss of length. Length restoration procedures have recently been developed to address this with promising results reported in small series. There are a variety of medical treatment options for PD, with CCH getting the most attention for being the first drug to be FDA approved for PD treatment. It is the authors' opinion that the non-surgical therapy most likely to provide meaningful results is combination therapy utilizing oral, intralesional, and external traction therapy. Surgery remains the gold standard for definitive treatment.
... On the other hand, conservative treatment with oral medications such as vitamin E, paraaminobenzoate, and acetyl-L-carnitine is targeted at decreasing the inflammation within the tunica albuginea, [9,10]. In addition to pharmacologic measures, vacuum or traction devices are also widely available [11][12][13]. ...
Article
Full-text available
Despite various Peyronie’s disease (PD) treatment options, the literature is sparse regarding patient preference for available therapies. Our data explore resource and treatment choices made by PD men following diagnosis. A survey was mailed to 719 randomly selected PD men evaluated at our institution from 1990–2012. Questions included evaluation of treatments and preferred information resources. Results were summarized as a descriptive report with statistical analyses performed as indicated. A total of 162 men (median age 65) responded with median PD duration of 9.2 years. Information sources included medical websites (38.9%), physician (35.8%), and books (<1%). Overall, patients felt 72.5% (SD = 40) of physicians had a good understanding of PD. About 53.1% of men had tried at least one therapy with 37.2% trying two or more. In comparing therapies, most surgical patients reported improvement at 82.8%. Among a cohort of PD men responding to a mailed survey, medical websites were the most widely used source of information. Almost half of the patients chose not to pursue any form of therapy, while the remaining majority elected for non-operative intervention. These results suggest a need for greater patient and provider education on PD management.
... 39 European Association of Urology (EAU) guidelines state that 'PTT may reduce penile deformity and increase penile length.' 40 Preliminary studies have revealed that its regular use maybe associated with reduction in penile curvature, increase in flaccid penile length and improvement in penile pain. 41,42 A recent nonrandomized, controlled trial assessed the use of penile traction in the acute phase of PD, assessing not only the impact on curvature, length and sexual function, but also correlation with sonographic penile evaluation. This trial showed a mean improvement in penile curvature of 20°, decreased pain and improved sexual function, in addition to disappearance of sonographic plaques in 48% of patients. ...
Article
Full-text available
Peyronies disease (PD) is estimated to affect approximately 3–9% of men worldwide and maybe associated with pain, erectile dysfunction and penile deformity including shortening. The condition has significant debilitating effects on quality of life, self-esteem and psychological wellbeing in addition to sexual function. Surgical results add further to this by patients having dissatisfaction with various aspects of outcomes. Non-surgical management may allow patients to avoid the morbidities associated with surgery and still achieve improved functional and aesthetic outcomes. Several non-surgical options are currently being employed in the treatment of PD that may reduce or stabilize both objective measures (e.g. penile length and deformity) and subjective measures (including sexual function, pain and partner satisfaction). Nonsurgical management can allow patients to avoid the morbidities associated with surgery and still achieve improved functional and aesthetic outcomes. In this article we explore the current non-surgical management options for PD including oral, mechanical therapies, intralesional and topical treatments. We also briefly discuss future treatment options in the form of stem cell therapy.
... Indications for intralesional therapy include patients with stable disease with curvature > 30 degrees and < 90 degrees, without isolated hourglass deformity or calcified plaque or plaque located proximal to the base of the penis, and with intact erectile function [11]. Penile traction and vacuum erection aids have demonstrated improvements in small observational studies [12,13]. Mechanical therapies are limited by application methods and demands. ...
Article
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Purpose of Review To highlight the surgical techniques of Peyronie plaque excision with grafting technique. We also sought to help the surgeon with important aspects of pre-operative and post-operative counseling. Recent Findings The pre-operative discussion is imperative in setting expectations and goals of care. The ideal graft has yet to be developed, but improvements have been made with decreased risks of infection and contracture rates. Summary We have learned that Peyronie’s disease is still a surgically treatable disease. Excision and grafting is a complex procedure, but with an appropriate technique, complex curvatures can be managed in trained hands. Patient selection is imperative in deciding whether concomitant penile prosthesis should be placed. Graft choice is left up to the operating surgeon, but use of non-autologous grafts appears to be increasing.
... 41 Our study revealed that VD (−300 mmHg) significantly increased penile length by 8.2% compared with the controls. Possible explanations for this increase include continuous traction-induced collagen realignment, 22,42 stimulation of fibroblasts 42 and soft cellular proliferation, 40,43 or tissue growth. 6,40 We combined anti-LOX with VD and investigated their effects on penile lengthening. ...
Article
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This study aimed to explore whether and how anti-lysyl oxidase (anti-LOX) combined with a vacuum device (VD) could promote penile lengthening and to evaluate the effect on erectile function. This study was performed on four groups of adult rats: control, anti-LOX, VD (negative pressure value of -300 mmHg), and anti-LOX + VD. Penile length was measured by a modified VD method and verified on exposed length data. Intracavernous pressure (ICP) and maximum ICP/mean arterial pressure (MAP) ratio were recorded to assess erectile function. For corpus cavernosum, LOX activity and concentrations of pyridinoline, desmosine, hydroxyproline, and elastin were analyzed; transmission electron microscope and Hart's elastin staining were performed to monitor microstructural changes. Anti-LOX and VD significantly lengthened the penis by 10.8% (3.75 mm) and 8.2% (2.48 mm) compared with the control group, respectively, while anti-LOX + VD achieved the longest penile size (40.58 ± 0.40 mm) which was 17.4% longer than the control group (34.58 ± 0.54 mm). After 1-week washout, no penile retraction was observed. Meanwhile, exposed penile length data confirmed that the penis in the anti-LOX + VD group was also significantly longer. Anti-LOX inhibited LOX activity to reduce pyridinoline level, which led the penile tunica albuginea remodeling. However, it had no effect on hydroxyproline, desmosine, and elastin levels. Moreover, anti-LOX had no impact on erectile function, which was determined by ICP and ICP/MAP ratio. These results suggest that anti-LOX elongates the penis by reducing pyridinoline, which induces tunica albuginea remodeling. This lengthening effect was more obvious when combined with a VD. All procedures had no impact on erectile function.
... Three small case series of penile traction and vacuum devices in patients with PD reported conflicting results, likely due to heterogeneity in the patient population and treatment protocols. In the first report, patients with stable disease used the traction device for 2-8 h per day for 6 months, and extender rods were lengthened by 0.5 cm every 2 weeks [27]. Ten patients were included and the mean curvature improvement was 17° (33%). ...
Article
Full-text available
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.
... It is followed by an increase in newly synthesised collagen. This concept has been applied in an uncontrolled study including 10 patients with Peyronie's disease in which the FastSize Penis Extender was applied as the only treatment for 2-8 h/d for 6 mo [36]. Penile curvature reduced in all men from 108 to 458, with an average reduction of 33% (range: 51-348). ...
Article
Context: Penile curvature can be congenital or acquired. Acquired curvature is secondary due to La Peyronie (Peyronie’s) disease. Objective: To provide clinical guidelines on the diagnosis and treatment of penile curvature. Evidence acquisition: A systematic literature search on the epidemiology, diagnosis, and treatment of penile curvature was performed. Articles with the highest evidence available were selected and formed the basis for assigning levels of evidence and grades of recommendations. Evidence synthesis: The pathogenesis of congenital penile curvature is unknown. Peyronie’s disease is a poorly understood connective tissue disorder most commonly attributed to repetitive microvascular injury or trauma during intercourse. Diagnosis is based on medical and sexual histories, which are sufficient to establish the diagnosis. Physical examination includes assessment of palpable nodules and penile length. Curvature is best documented by a self-photograph or pharmacologically induced erection. The only treatment option for congenital penile curvature is surgery based on plication techniques. Conservative treatment for Peyronie’s disease is associated with poor outcomes. Pharmacotherapy includes oral potassium para-aminobenzoate, intralesional treatment with verapamil, clostridial collagenase or interferon, topical verapamil gel, and iontophoresis with verapamil and dexamethasone. They can be efficacious in some patients, but none of these options carry a grade A recommendation. Steroids, vitamin E, and tamoxifen cannot be recommended. Extracorporeal shock wave treatment and penile traction devices may only be used to treat penile pain and reduce penile deformity, respectively. Surgery is indicated when Peyronie’s disease is stable for at least 3 mo. Tunical shortening procedures, especially plication techniques, are the first treatment options. Tunical lengthening procedures are preferred in more severe curvatures or in complex deformities. Penile prosthesis implantation is recommended in patients with erectile dysfunction not responding to pharmacotherapy. Conclusions: These European Association of Urology (EAU) guidelines summarise the present information on penile curvature. The extended version of the guidelines is available on the EAU Web site (www.uroweb.org/guidelines/). # 2012 European Association of Urology. Published by Elsevier B.V. All rights reserved
... 153 Encouraging investigation for using traction in PD was resulted from its efficacy in the treatment of Dupuytren's contracture 154 and supported by several subsequent reports. A preliminary has shown improvement in penile curvature ranged from 10 to 45°, 155 and another study has shown an overall improvement only of 4° in penile curvature. 156 A well-controlled study has shown in the arm of traction therapy a 20° decrease in penile curvature, and further, the need for surgery was decreased in 40% of men who would have been assigned for surgery. ...
Article
Background The treatment of Peyronie's disease (PD) remains a dilemma as the true pathogenesis of PD remains an enigma. Consequently, new molecules and therapies continue to evolve. The safety and efficacy of conservative treatment for PD have not yet established. Objectives To provide the available information of the status of conservative therapy for PD. Methods A systematic literature search was conducted using PubMed, EMBASE, and the Cochrane Library for English‐language journal articles between January 2000 and July 2019, using the terms “Conservative treatment for PD”, “medical treatment for PD”, “non‐invasive therapies for PD” and “minimally invasive therapies for PD". This systematic review was conducted in agreement with the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) system. We also manually reviewed references from selected articles. The risk of bias in the included RCTs was assessed using the Cochrane Risk of Bias Assessment tool (RoB 2). Results Conservative treatment is accepted as the initial treatment step in most of the cases. This kind of therapy includes various methods of treatment such as medical, non‐invasive, and minimally invasive therapies. Ideal management of PD is not yet available. It is not possible to assess the value of treatment without well‐designed, randomized, placebo‐controlled, large‐scale clinical studies. Conclusion Optimistically, in the near future, we may witness emergence of efficacious new agents and modalities to revolutionize medical, non‐invasive, and minimally invasive treatment of this devastating condition.
... One of the earliest published investigations of PTT for PD came from Levine and colleagues in 2008 (128). In this retrospective study, 10 men underwent traction therapy for a mean of 4.5 hours per day for 6 months. ...
Article
Peyronie's disease (PD) is a relatively common condition that can result in significant penile deformity, sexual dysfunction, and psychological bother. Surgical straightening offers the highest probability of success during the stable phase of the disease. However, for men in the acute phase of PD or for those with less severe deformity who elect to avoid surgery, a variety of non-surgical treatment options are available. Oral therapies, including L-citrulline and pentoxifylline, are most useful as part of a combination regimen rather than as monotherapy. Intralesional therapy with IFN-α2b, verapamil, and collagenase clostridium histolyticum (CCH) can cause significant reduction in penile curvature, yet these results may not be clinically significant for men with more severe curvature. Further investigation into the timing of administration and optimal patient characteristics is required. Penile traction therapy offers a clinically significant improvement in penile length and curvature. However, this has traditionally required hours of daily therapy. Overall, a combination of oral, topical, injection and traction therapies may provide the most significant benefit among the non-surgical modalities for PD.
... В первом исследовании участвовали 10 пациен тов, которые носили устройство как минимум 2 ч в день. В этом маленьком наблюдательном исследовании у всех па циентов отмечали уменьшение искривления полового чле на в среднем на 33%, а также увеличение длины пениса [46]. Тракционная терапия была использована в качестве неоадъювантной и адъювантной терапии наряду с другими терапиями для БП, включая внутрибляшечные инъекции и пероральную медикаментозную терапию. ...
... The first published report was a 2008 pilot study by our group involving 10 patients who utilized PTT for 2-8 h daily for 6 months. 59 All patients had objective curvature improvement (10-45°) along with improvements in SPL (0.5-2 cm). A subsequent study by Gontero et al. reported a mean 1.3-cm SPL increase, although curvature was not significantly changed (31°pretreatment and 27°post-treatment). ...
Article
Peyronie’s disease is a common yet poorly understood condition characterized by penile pain, curvature, sexual dysfunction and psychological bother. Peyronie’s disease represents a penile wound healing disorder, and is thought to arise from exuberant scarring in response to penile trauma in genetically predisposed men. In the absence of active treatment, the majority of men experience stable or worsening symptoms, with few reporting spontaneous resolution in penile curvature or other deformity. In contrast, penile pain improves or resolves in the majority of men. Treatment options vary based on symptom severity and stability. Several oral therapies are commonly prescribed, although to date there are no strong data to support any oral agents as monotherapy for Peyronie’s disease. Other options including penile traction therapy and intralesional injections result in modest improvements for many patients, particularly when used early after symptom onset. Penile straightening through approaches, such as penile plication and plaque incision or partial excision and grafting, represent the most rapid and reliable approach to correct penile curvature once the symptoms have stabilized. Side‐effects vary based on the type of surgery carried out, and include penile shortening, sensation changes and erectile dysfunction in the minority of men. In patients with drug refractory erectile dysfunction and Peyronie’s disease, placement of a penile prosthesis will address both issues, and is associated with high levels of patient satisfaction. The current review provides a practical approach to the modern evaluation and management of patients presenting with Peyronie’s disease.
... Moreover, in this pilot study a 100% of patients reported some improvement in penile length with baseline of 0.5-2.5cm and no adverse events were reported (9). Subsequently, Gontero et al., showed results of PTT in men with a minimum of 12 months history of PD and penile curvature of less than 50°. ...
Chapter
INTRODUCTION: Conservative treatment for penile curvature in Peyronie’s disease (PD) by means of penile stretching is attractive compared to the available invasive treatments with risks for complications and failure. Therefore, penile stretching using penile traction therapy (PTT) or vacuum erection devices (VED) are used widely in the medical as well as in the commercial circuit. VED and PTT can be used in PD as stand-alone therapy and in combination with intralesional therapy. Many experimental and clinical studies have been conducted to assess the mechanism and effectivity of PTT and VED, however, clear guidelines are not yet available. METHODS: A PubMed search was performed of publications on PTT and VED in men with PD from inception through May 2019. RESULTS: PTT has been successful in primary penile lengthening and curvature correction in the acute phase of PD in vitro and in vivo studies. The duration and rhythm of its use appears to be of importance for optimal changes in penile curvature, length and girth. After surgical correction of PD, PTT has been shown to be effective in preserving penile length. The combination of PTT and intralesional injection therapies for PD treatment requires further investigation as the available clinical data are both contradictory and limited. There are fewer studies investigating VED and their role in PD management, but initial small trials suggest a role in curvature correction and penile lengthening as well. CONCLUSIONS: Penile stretching can be very effective in PD. Data suggest a role for PTT and VED in the management of PD as sole therapy, after surgery and during intralesional injection therapy. Further research is needed to be able to provide physicians with clarity about the optimal ways to deploy traction therapy in combination with other treatment options, and with guidelines for the most effective timing and duration of the use of the available traction devices.
... L'indication chirurgicale a été réduite chez 40 % des patients et a simplifié la procédure chez 1 patient sur 3. Une utilisation > 6h par jour semblait être un facteur positif chez les patients en phase aigüe (28). Pour être efficace, ce dispositif doit être porté de façon prolongée (2 à 8 heures par jour) pendant au moins 6 mois [97,98]. ...
Article
Introduction: Peyronie's disease is a common cause for consultation in urology. Many controversies surround its treatment. No French Guidelines have been published so far. The Committee of Andrology and Sexual Medicine of the French Association of Urology therefore offers a series of evidence-based recommendations. Materials and methods: These recommendations are made according to the ADAPTE method, based on European (EAU, ESSM), American (AUA, ISSM) and Canadian (CAU) recommendations, integrating French specificities due to the availability of treatments, and an update of the recent bibliography. Results: The assessment of the disease is clinical. Patients with functional impairment or significant psychological repercussions may be offered treatment. The benefits and drawbacks of each treatment should be explained to the patient. Regarding non-surgical treatments, no available treatment has market authorization in France. Vitamin E is not recommended. Analgesic (oral or low-intensity shock waves) or proerectile treatments may be offered as needed, as well as traction therapy. Due to the unavailability of collagenase injections, verapamil injections may be offered. Surgical treatments are to be considered in the stabilized phase of the disease, and consist of performing a plication, an incision-graft or the placement of a penile implant according to the patient's wishes, the curvature and the penis size, as well as erectile function. Combination treatments can be offered. Conclusion: The management of Peyronie's disease is complex, and the levels of evidence for treatments are generally low. The success of treatment will depend on the quality of the initial assessment, the patient's information and understanding of the expected effects, and the practitioner's experience.
Article
Purpose: Peyronie's disease (PD) is a devastating condition resulting in penile deformity, erectile dysfunction (ED), pain and emotional distress. This prospective two institution study evaluates a multimodal surgical and mechanical combined approach in the definitive treatment of PD and concomitant ED. Materials and methods: 145 selected patients underwent endocavernosal disruption of the PD plaques via the "scratch technique" followed by inflatable penile prosthesis (IPP) insertion. Postoperatively, patients were assigned vacuum device therapy for 3 minutes twice daily in order to continue penile curvature correction. Follow-up continued for one year after surgery. Anatomical and functional results were assessed. Results: Patients with plaques in the proximal third, middle third and subcoronal areas of the penis had a mean residual curvature of 21.5 ± 4.5°, 17.3 ± 4.8° and 14.1 ± 3.1° respectively after surgery. After 24 weeks of vacuum therapy, penile curvature deviation decreased to 8.7 ± 2.5°, 9.1 ± 2.9° and 7.7 ± 0.9° respectively. Preoperative mean IIEF-5 score was 9.8 ± 2.3, at 6 months 18.9 ± 3.1 (p<0.001) and at 1 year was 24.1 ± 3.6 (p<0.001). Mean EDITS score at the end of the follow up was 64.6 ± 11.8. Operative and postoperative complications were minimal. Conclusions: Our novel combination of intraoperative and postoperative therapies in the treatment of patients with PD and IPP is safe and efficacious with excellent functional outcomes. Penile curvature corrections were statistically significant and complications were negligible.
Article
Over the past decade, there have been several advancements in the technologies available to treatment erectile dysfunction and Peyronie's disease. Vacuum erection devices, penile traction devices, low-intensity extracorporeal shockwave therapy, and penile prosthesis surgery have evolved and are changing the way we treat men's health. Although significant improvements have been made, further work is needed to standardize treatment, create universal algorithms for technological applications, and simply their use.
Chapter
Peyronie’s disease (PD) was first described by Francois de la Peyronie (1678–1747), who reported a series of patients with “rosary beads of scar tissue” causing curvature of the penis. Peyronie’s Disease is an acquired benign fibrotic disorder involving the tunica albuginea (TA) of the corpora cavernosa of the penis leading to the formation of fibrous inelastic plaques [1]. Peyronie’s Disease is believed to occur in the genetically susceptible individuals and is associated with penile curvature, pain and worsening of erectile function. Peyronie’s Disease has an estimated prevalence of 3–9% in adult men and is frequently associated with cardiovascular risk factors including diabetes, hypertension, dyslipidaemia, and low serum testosterone levels [2–5].
Article
Objectives: To evaluate the outcomes in men undergoing Collagenase Clostridium histolyticum (CCH) with concurrent penile traction therapy (PTT) for the treatment of Peyronie's Disease (PD). Methods: We identified patients treated with CCH between March 2014 and July 2016. Patients were recommended to perform modeling and PTT between injection series. A final curve assessment was performed after patients completed CCH. A prospective database was maintained, including patient reported frequency and duration of PTT. Statistical analysis was performed to evaluate outcomes based on use and duration of PTT. Results: 51 patients completed CCH and had complete objective data available for analysis. Mean(SD) baseline curvature was 66.7 (25.0) degrees, and mean(SD) improvement post-CCH was 20.9 (17.3) degrees (p<0.0001). Thirty-five (69%) men reported daily PTT for a mean(SD) of 9.8 (6.3) hours per week. No significant difference was identified in the degree of curve improvement based on frequency or duration of PTT (p=0.40). Similarly, no associations between PTT and functional outcomes including intercourse restoration and surgery prevention were identified. Stretched penile length (SPL) increased non-significantly by a mean(SD) of +0.4 (1.5) cm in the PTT group, compared with -0.35 (1.5) in the non-PTT group (p=0.21). Conclusions: The current series represents a "true to life" experience, wherein utilization patterns, attrition, and compliance issues are relevant factors impacting efficacy.PTT utilization with the Andropenis? declined in both frequency and duration with subsequent injection series, and there was no significant difference in curve improvement or SPL with a mean 10 hours of weekly concurrent PTT.
Article
Introduction: Penile Traction Therapy (PTT) is increasingly being recognized as a viable non-surgical approach to Peyronie's Disease (PD). The goal of this article is to review the current literature on PTT with attention to traction protocols, devices, and outcomes. Areas Covered: Literature on the pathophysiology of PD, PTT as primary and adjunctive treatment for PD, perioperative use of PTT, and Vacuum Erection Devices are all reviewed. Pertinent literature was obtained from the PubMed database. The key words: "penile traction," "mechanotransduction," and "Peyronie's Disease" were searched and results were narrowed down based on relevance to the review. Expert Commentary: PTT appears beneficial but the true magnitude of effect is difficult to discern. Most studies are not randomized, have small sample sizes, lack control arms, or have varying traction protocols. Patient compliance is critical and new devices and traction protocols are needed to maximize the benefit of PTT.
Article
Introduction Penile traction therapy (PTT) and vacuum erection devices (VED) are nonsurgical conservative treatment options that have been used in the treatment of various urologic and sexual disorders such as Peyronie's Disease (PD) and Erectile Dysfunction (ED). Recently expanded uses for these therapies now include penile lengthening and with surgical interventions such as penile prosthesis surgery (PPS) and radical prostatectomy (RP). These devices can be used as both monotherapy or combination therapy. Objectives To review the indications and clinical studies for PTT and VED. Methods A literature search was conducted using PubMed to identify relevant studies addressing PTT, VED, and their indications. Searched terms included penile traction therapy, penile traction device, vacuum erection device, Peyronie's disease, penile prosthesis, radical prostatectomy, subjectively small penis, penile lengthening, erectile dysfunction. Results PTT with dynamic traction devices has shown favorable benefits for PD in many studies. The benefits of VED for PD cannot be confirmed due to limited studies with poor quality. In posterior urethroplasty, VED shows promise postoperatively, with additional trials also needed. In PPS, both PTT and VED have had positive findings in pre- and postoperative treatment. In RP patients, VED use has had positive outcomes while new literature shows beneficial effects of dynamic PTT and provides a basis for future studies. VED use does not show great benefit in patients with small penis, however PTT does have some positive findings. In ED, VED has a history of successful use and PTT has promising new data available. Conclusion PTT and VED have been utilized in urologic and sexual conditions with various success. Several promising areas utilizing both PTT and VED are being studied, however, more research needs to be done in these areas prior to becoming a standard treatment. Mehr J, Santarelli S, Green TP, et al. Emerging Roles of Penile Traction Therapy and Vacuum Erectile Devices. Sex Med Rev 2021;XX:XXX–XXX.
Chapter
Recently, men with even normal-sized penis are increasingly interested in penile augmentation or lengthening surgery. Although these surgical procedures give additional penile length compared to original size and some satisfaction with new lengthening penis, surgical treatment can result in serious complications including troublesome anatomical deformities and erectile functional changes. Since men who are considering lengthening of the penis are concerned about postsurgical complications, it is a challenge to perform a surgical procedure. Therefore, much less invasive medical treatment such as penile traction therapy should be applied firstly than surgical modalities. Outcome of penile traction therapy using penile traction device is similar with gaining length from usual surgical procedure, but adverse events are reported nearly none except mild traction pain. Candidates for penile lengthening devices could not be listed definitely, but it might be candidates in case of shortened penis after retropubic surgery or Peyronie’s disease, before penile prosthesis reinsertion and adjuvant therapy after penile lengthening surgery. Since the research data about penile traction therapy in safety and efficacy are still insufficient at the present time, there is a need for scientific research to perform prospective randomized clinical trials on large cohorts. All of the men who applied penile traction device did not gain satisfactory penile length, but this may be helpful to the patients who want penile lengthening therapy without serious complication.
Chapter
Peyronie's disease (PD) is a disorder of healing in the tunica albuginea of the penis, which can result in pain, curvature and lumps in the penis, as well as erectile dysfunction. Aetiological theories include micro-trauma and poor wound healing on a background of vascular risk factors. A plethora of medical therapies have been tried for PD, but few have shown any real benefit, and none have been shown to reliably resolve the curvature associated with the disease. Topical, mechanical and injectable agents have also been described, with some promising emerging therapies, but surgery currently remains the mainstay of curvature resolution. In this chapter, all the currently available non-surgical treatment options for Peyronie's disease are reviewed, along with their evidence base.
Article
Introduction: The field of sexual medicine is continuously advancing, with novel outcomes reported on a regular basis. Given the rapid evolution, updated guidelines are essential to inform practicing clinicians on best practices. Aim: To summarize the current literature and provide clinical guidelines on penile traction therapy, vacuum erection devices, and penile revascularization. Methods: A consensus panel was held with leading sexual medicine experts during the 2015 International Consultation on Sexual Medicine (ICSM). Relevant literature was reviewed and graded based on Oxford criteria to develop evidence-based guideline and consensus statements. Main outcome measures: The development of clinically relevant guidelines. Results: Penile traction therapy is a viable therapy to modestly improve penile length as a primary therapy, before penile prosthesis placement in men with decreased penile length or after surgery for Peyronie's disease. It also might have a role in the acute phase of Peyronie's disease but has inconsistent outcomes in the long-term phase. Vacuum erection devices are effective in creating an erection satisfactory for intercourse, even in difficult-to-treat populations. They also might be used in the post-prostatectomy setting to maintain penile length but have insufficient evidence as a penile rehabilitation therapy. For vasculogenic erectile dysfunction, men with suspected arterial insufficiency can be evaluated with penile Duplex Doppler ultrasonography and confirmatory angiography. Penile revascularization procedures have consistently demonstrated benefits in very select patient populations; however, inadequate data exists to suggest the superiority of one technique. Men with vascular risk factors are likely poor candidates for penile revascularization, although veno-occlusive dysfunction and age are less significant. Therapies for treating primary veno-occlusive dysfunction are not recommended and should be reserved for clinical trials. Conclusions: Since the prior ICSM meeting, multiple developments have occurred in external mechanical devices and penile revascularization for the treatment of erectile and sexual dysfunction. Sexual medicine clinicians are encouraged to review and incorporate recommendations as applicable to their scope of practice.
Article
Introduction Peyronie’s disease (PD) is a disorder of the tunica albuginea from disordered and excessive deposition of collagen resulting in a palpable scar, pain, erect penile deformity and erectile dysfunction that significantly impacts patients both physically and emotionally. Areas Covered Several treatment options have been described for PD, including shockwave therapy, traction therapy, both oral and intralesional pharmacological options, and surgery. This review seeks to examine the data for different types of non-surgical treatments for PD. We review how various treatment modalities impact several relevant clinical endpoints for Peyronie’s disease, including effects on pain, penile curvature, plaque formation, and erectile function. We performed a literature search using PubMed and SCOPUS while referencing AUA, EAU, and CUA guidelines for management of Peyronie’s Disease for studies published 1980-2020. Expert opinion Intralesional collagenase injections have the strongest evidence and are the only FDA approved intralesional treatment for PD. Penile traction therapy (PTT) is low risk and may be beneficial in patients willing to invest significant time using the devices. Furthermore, oral combination therapy with other modalities may provide some benefit. Further investigation is required to better understand pathophysiology of PD and clarify the therapeutic utility of existing treatments, potentially with a multimodal strategy.
Article
Introduction: Peyronie's disease (PD) is a debilitating condition that affects a sizable number of men worldwide. Current treatment options consist of oral therapy, intralesional injections, and surgery. Penile stretching has been used as a treatment for PD, including penile traction therapy (PTT) and vacuum erection devices (VEDs), with numerous trials completed or underway. Aim: To present and summarize the current literature on penile stretching for the treatment of PD. Methods: Using PubMed, we performed a literature review of studies from January 1990 through July 2018 that focused on penile stretching for PD management. PTT and VED were included in the search criteria. Main outcome methods: Penile curvature correction was effective, and stretched penile length was improved. Results: PD therapies that use penile stretching as a mechanical intervention to alter tissue characteristics were studied. PTT has been successful in primary penile lengthening and curvature correction in the acute phase of PD. PTT also improved length retention in men undergoing plication and incision/grafting procedures. Combination of PTT and intralesional injection therapy for PD treatment requires further investigation. There are fewer studies investigating VEDs and their role in PD management, but initial small trials suggest a role in curvature correction and penile lengthening. Conclusions: Penile stretching is an effective therapy for PD. Data from limited trials suggest a role for PTT and VEDs in the management of PD, although further research is needed. Cowper MG, Burkett CB, Le TV et al. Penile Stretching as a Treatment for Peyronie's Disease: A Review. Sex Med Rev 2019;7:508-515.
Article
Die Induratio penis plastica (IPP) ist ein typisches, aber heterogenes Krankheitsbild mit den klassischen penilen Symptomen Plaquebildung, peniler Schmerz, Deviation, Verkürzung des Penis und erektile Dysfunktion. Die Ätiologie ist unklar. Mikrotraumen werden als Ursache einer nachfolgenden, evtl. genetisch bedingten atypischen Wundheilung mit Bildung eines fibrotischen unelastischen Narbengewebes im Bereich der Tunica albuginea diskutiert. Eine kausale medikamentöse Therapie ist deshalb nicht möglich, obwohl vielfältige konservative Therapieoptionen klinisch eingesetzt werden. Die chirurgische Korrektur einer Penisverkrümmung ist in der Phase der stabilen Erkrankung das primäre Operationsziel. Unterschiedliche Operationsverfahren werden abhängig von Deviationsgrad, Penislänge und erektiler Funktion durchgeführt. Dieser Artikel gibt eine Übersicht über den aktuellen Stand der Diagnostik sowie konservativer und chirurgischer Therapieoptionen.
Article
Peyronie’s disease is not a rare disorder, and it can be devastating to the affected man. Although the gold-standard treatment of Peyronie’s disease is surgery in the stable phase, nonoperative management is preferred by some men and is the only treatment option in the acute phase of the disease, when surgery is contraindicated. No oral or topical therapy has been shown to be efficacious when administered alone, but some evidence supports their use as part of a combination therapy regimen. Intralesional therapies, particularly collagenase clostridium histolyticum (CCH), have shown promise. Mechanical therapies can provide benefit when applied for prolonged periods of time, improving penile curvature, indentation, and even restoring length. Regardless of the modality chosen, patient counselling is paramount, as recovery of the penis to its predisease state is highly unlikely. Thus, although many options exist for nonsurgical management of Peyronie’s disease, surgery remains the best option for men who desire the most reliable and rapid pathway to a functionally straight, erect penis. The goal of nonsurgical therapy should be a scientifically feasible, safe approach to prevent the progression of, or reduce, deformity and improve sexual function.
Article
Introduction: Evidence for noninvasive management of Peyronie's disease contains many options with varying levels of evidence for each. Many first-line treatments recommended by urologists lack strong evidence for their use. Aim: We summarize the noninvasive (oral medications, topical medications, traction, vacuum erection devices, extracorporeal shock wave therapy, intracavernosal injections and electromotive therapy) treatment options for Peyronie's disease and provide the levels of evidence for each. Methods: A literature search of PubMed, EMBASE, Cochrane Library, and ClinicalKey databases was conducted, current up to April 2019. Main outcome measure: For each treatment modality, we measured level of evidence, change in penile curvature, change in erectile function, the percentage of patients with improved angulation, and pain scores. Results: There is weak evidence to support the use of oral or topical medications. Higher levels of evidence exist for intracavernosal injections and extracorporeal shock wave therapy and may be helpful in certain patient populations. Conclusion: The mechanisms behind Peyronie's disease are not fully understood. Penile injections provide the highest quality of evidence for noninvasive treatment. Ory J, MacDonald L, Langille G. Noninvasive Treatment Options for Peyronie's Disease. Sex Med Rev 2020;XX:XXX-XXX.
Article
Objectives: To present our experience with multimodal therapy for Peyronie's disease. Methods: Retrospective data were collected since 2008 to 2017. The following features were evaluated at baseline and after treatment: age, duration of disease, erectile function, erected penile curvature, and stretched penile length. All patients were offered the same protocol including: 12 intralesional verapamil injections, oral therapy (OT) ?L-arginine 2g once and pentoxifylline 400mg 3 times a day for 6 months?, and penile traction therapy. The adherence to each of the 3 components of multimodal treatment was evaluated. Results: One hundred and seventy-seven individuals were considered. Depending on the grade of adherence our survey was divided into 3 groups. Group 1: patients who only completed OT; group 2: men who accomplished OT and intralesional verapamil injections; group 3: patients who completed the entire protocol. Seventy-six, 45 and 56 men were assigned to group 1, 2 and 3 respectively. The mean age at the diagnosis was 59±8.4, 59.1±5.9 and 54.2±4.8 years, while the mean duration of the disease was 6.3±3.4, 4.8±2.9 and 3.9±3.1 months in group 1, 2 and 3. The erected penile curvature before and after treatment was 24.2±9 and 23.7±8.9° in group 1 (P<.36); 25.4±16.8 and 24.1±13.6° in group 2 (P<.34), and 34.3±17.9 and 26.1±17.2° in group 3 (P<.001). Conclusions: OT alone was successful to block the progression of the disease. The add of intralesional verapamil injections to OT brought only mild improvements. The complete protocol significantly reduced erected penile curvature and improved erectile function.
Article
A common characteristic of Peyronie's Disease (PD) is plaque calcification, which is associated with decreased response to treatments and higher rates of surgical intervention. Despite its prevalence in the PD population, the literature on plaque calcification is limited. While the diagnosis of PD is mostly clinical, imaging modalities such as ultrasound can be used to identify plaque calcification. The proper identification of plaque calcification is crucial for guiding management and setting therapeutic expectations for patients with PD. Herein we discuss what is known about PD plaque calcification, including epidemiology, etiology, diagnosis, and management.
Article
Objectives To present our experience with multimodal therapy for Peyronie's disease. Methods Retrospective data were collected since 2008–2017. The following features were evaluated at baseline and after treatment: age, duration of disease, erectile function, erected penile curvature, and stretched penile length. All patients were offered the same protocol including: 12 intralesional verapamil injections, oral therapy (OT) ‒ l-arginine 2 g once and pentoxifylline 400 mg 3 times a day for 6 months ‒ and penile traction therapy. The adherence to each of the 3 components of multimodal treatment was evaluated. Results One hundred and seventy-seven individuals were considered. Depending on the grade of adherence our survey was divided into 3 groups. Group 1: patients who only completed OT; group 2: men who accomplished OT and intralesional verapamil injections; group 3: patients who completed the entire protocol. Seventy-six, 45 and 56 men were assigned to group 1, 2 and 3 respectively. The mean age at the diagnosis was 59 ± 8.4, 59.1 ± 5.9 and 54.2 ± 4.8 years, while the mean duration of the disease was 6.3 ± 3.4, 4.8 ± 2.9 and 3.9 ± 3.1 months in group 1, 2 and 3. The erected penile curvature before and after treatment was 24.2 ± 9 and 23.7 ± 8.9° in group 1 (p < 0.36); 25.4 ± 16.8 and 24.1 ± 13.6° in group 2 (p < 0.34), and 34.3 ± 17.9 and 26.1 ± 17.2° in group 3 (p < 0.001). Conclusions OT alone was successful to block the progression of the disease. The add of intralesional verapamil injections to OT brought only mild improvements. The complete protocol significantly reduced erected penile curvature and improved erectile function.
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Background Traditionally, surgery has been considered the gold standard treatment for Peyronie’s disease (PD). Less-invasive alternatives, such as collagenase Clostridium histolyticum (CCH) and traction therapy, have been proposed and proven effective. Aim To compare cost-effectiveness of management options for PD. Methods A Markov analytic model was created to compare the cost-effectiveness of treatment with a novel traction device, RestoreX (RXPTT), vs CCH vs surgery. Outcomes were derived from single-institution, prospective data of 63 men treated with RXPTT, 115 with CCH, and 23 with plication or incision and grafting. Costs were based on 2017 Medicare reimbursement and utility values from the literature. Main Outcome Measures Model outcomes included complications for each treatment arm, as well as the probability of success, which was defined as ≥20% improvement in curvature. Univariable and multivariable sensitivity analyses were performed to test the robustness of the model. Results Overall success rates were 96% (surgery), 66% (CCH), and 48% (RXPTT). At 10 years after treatment, RXPTT was the most cost-effective, with mean costs per patient of $883 (RXPTT), $11,419 (surgery), and $33,628 (CCH). CCH and surgery both resulted in a gain of quality adjusted life years (QALYs) relative to RXPTT (9.44 and 9.36 vs 9.27, respectively). Sensitivity analysis demonstrated greater cost-effectiveness for surgery if lower (≤46%) rates of postoperative erectile dysfunction or length loss (≤3%). CCH became more cost-effective at lower costs (≤$16,726) or higher success rates (≥76%). On multivariable sensitivity analysis at a willingness to pay threshold of $100,000/QALY, the most cost-effective strategy was RXPTT in 49%, surgery in 48%, and CCH in 3% of simulations. At a willingness to treat threshold of $150,000/QALY, the most cost-effective treatment option was RXPTT in 33%, surgery in 55%, and CCH in 12% of simulations. Clinical Implications In an era of value-based care, this model can guide cost-effective treatment selection on the basis of provider, patient, and payer characteristics. Strengths & Limitations The current study represents the first cost-effectiveness comparison of treatment modalities for PD and is strengthened by prospective data collection, large CCH and traction sample sizes, and robust sensitivity analyses. Consistent with cost-effective models, the model is limited by assumptions and may not apply to all scenarios. Conclusions RXPTT represents a more cost-effective method for achieving ≥20% curvature improvement compared with surgery or CCH. Depending on treatment goals, rate of surgical complications, and willingness to pay threshold, surgery and CCH may become more cost-effective in select scenarios. Wymer K, Kohler T, Trost L. Comparative Cost-effectiveness of Surgery, Collagenase Clostridium Histolyticum, and Penile Traction Therapy in Men with Peyronie’s Disease in an Era of Effective Clinical Treatment. J Sex Med 2019;16:1421–1432.
Article
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Purpose of Review To summarize data on lengthening treatments from PubMed-indexed scientific publications. Recent Findings Several surgical techniques achieve penile lengthening when combined with penile prosthesis (PP) implantation, including the sliding, incision/excision and grafting, and multiple incision techniques. Other factors associated with greater length with PP include use of AMS 700 LGX devices, new length measurement technique, immediate activation, and regular device cycling. Among non-surgical therapies, penile traction achieves lengthening in most studies, while vacuum therapies demonstrate milder improvements. Other treatments either have failed to demonstrate consistent benefits or have mixed data, including isolated incision/excision and grafting, scrotoplasty, lipectomy/escutcheonectomy, suspensory ligament release, placement of cylindrical silicone (Penuma), or penile injections with silicone, hyaluronic acid, or other similar materials. Summary Although multiple surgical and non-surgical therapies exist for penile lengthening, most have limited data available. Additionally, injection and surgical treatments can result in severe complications in some cases.
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While surgery remains the gold standard for the treatment of penile deformity associated with Peyronie’s disease, various non-surgical options including oral and topical agents, penile traction, and intralesional injections are available with varying levels of evidence and treatment efficacy seen in the literature. Herein we review various non-surgical managements for Peyronie’s disease and describe our techniques for intralesional injections with verapamil and Collagenase Clostridium histolyticum.
Article
Peyronie’s disease (PD)-related penile deformity is managed with multiple treatment modalities including oral medications, intralesional injections, and surgery. Penile traction therapy (PTT) is one such modality with purported benefits, albeit with notable differences in the characteristics of available traction devices and published study protocols. We provide a comprehensive review of the available data supporting PTT for PD treatment. We performed a rigorous database search to identify all studies pertaining to PTT for the treatment of PD through November 2019. Seventeen trials explored use of PTT as monotherapy or in combination with surgical or nonsurgical treatment, using over five different commercially available devices. All devices were well tolerated, although compliance and daily duration of use were highly variable. PTT resulted in variable improvements in stretched penile length and penile curvature, depending on study protocol, patient population, and device. PTT appears to be a safe and well-tolerated treatment for PD as monotherapy or in combination with other nonsurgical and surgical treatments, and for men in both the acute and chronic phases. Further studies are needed to compare available devices, evaluate device characteristics associated with treatment success, differentiate outcomes in acute vs. chronic PD populations, and determine the optimal duration of use.
Article
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Penile lengthening can restore normal functioning length and improve a patient's quality of life. Determining the underlying pathology is central to guiding choice of treatment, which will vary depending on individual patient circumstances.
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Peyronie’s disease is an acquired disorder of penis resulting from inflammation. This largely results in physical changes which include penile curvature and plaque formation, functional changes including erectile dysfunction, as well as significant psychological symptoms. Careful physical and psychosexual examination is necessary to properly identify the stage and extent of the disease. The use of adjunct diagnostic tools including B-mode ultrasound imaging as well as color duplex imaging significantly aids in the ability to better offer prognostic information to the patient and direct different treatment options. Multiple medical therapies exist with variable response rates, and currently there is only one FDA-approved treatment.
Article
Living tissues and organs are dynamic and change their mechanical properties and structure in response to stress alteration as a phenomenon of functional adaptation and optimal operation. This phenomenon is called 'Tissue Remodeling', and Wolff's law on bone remodeling is widely known. Several recent studies have shown that fibrous connective tissues such as tendons and ligaments also have the ability of remodeling. However, relatively little is known about the stress and motion effects on tissue homeostasis in biological soft tissues. This article primarily deals with changes of the biomechanical properties of knee joint tendons and ligaments through a wide variety of treatment modalities, including stress deprivation, recovery after stress deprivation, and stress enhancement. The experimental results indicate that tendons and ligaments have an ability to adapt in response to the change of stress if the extent of stress alteration is within allowable ranges.
Article
Introduction and Objective: Loss of penile length is a common complaint of patients undergoing surgical correction of penile curvature for Peyronie's (PD) disease. Penile extenders have been developed to increase penile length by regular application on the penis based on their tissue expansion properties. We assessed the value, in terms of increasing penile length, of the application of a penile extender (Andropenis ®) in men who have undergone tunica albuginea plication or grafting for PD. We also studied the impact of this treatment on the health related quality of life (HRQoL) Methods: 40 men, aged between 54 - 64 (mean 58 y.o.), undergoing PD surgery constituted the study population; 12 patients were submitted to a grafting procedure while the rest (n=28) undergone a plication technique. 20 consecutive patients were treated with a penile extender device (Andropenis ® ) while the previous 20 served as a control group. The extender was applied when the circumcision had healed (2 to 3 weeks after surgery) with a traction force of 900 to 1200 gr 8 to 12 hours daily during at least 4 months. Parameters studied were penile length before, after surgery and after the continued use of the device. HEQoL using the SF-36 questionnaire was also assessed to compare both groups of patients. Results: Penile shortening after surgery ranged from 0.5 cm to 4 cm. Shortening was slightly less relevant in patients undergoing a grafting procedure but this difference was not statistically significant. Treatment with the device produced a length increase ranging from 1 to 3 cm, this increase was proportional to the number of hours per month the patient was using the extender. There were significant differences in several of the SF-36 parameters in the patients under the device when compared to those not using the extender (p
Article
Many approaches to nonoperative treatment of Dupuytren's disease have been tried since the disease was originally described in 1831, and most have been abandoned. Nonetheless, the appeal for nonoperative methods persists, in pursuit of lower morbidity and lesser complications than may be encountered with open surgical treatment. A number of nonoperative treatment modalities are in current use for Dupuytren's disease, despite lack of high-level clinical studies supporting these methods. Some of these can be utilized as an adjunct to surgical treatment rather than a replacement for it. The most commonly used nonoperative treatment methods are briefly reviewed.
Article
The natural history of Peyronie's disease was evaluated in 97 men by means of a questionnaire. Disease duration ranged from 3 months to 8 years. Questions addressed pain, bending, ability for intercourse, over-all effect of the disease, psychological effects, treatments received and degree of disease progression. Approximately 40% of the patients found pain, bending, ability for intercourse and over-all effects to be unchanged during the course of the disease. Bending and ability for relations worsened in 40% of the patients during the same interval, while only 6% had worsening of pain. Of the patients 77% reported psychological effects due to Peyronie's disease, which improved in 28%, did not change in 36% and worsened in 36%. Over-all, 13% of the patients believed the disease to be one of gradual resolution, 47% believed there had been little or no change and 40% believed that the disease pattern was one of gradual progression. We found no statistically significant association between disease duration and spontaneous improvement in penile bending. A similar lack of statistical significance was found when improvement in a variety of categories was compared in patients who received no therapy versus those who received a variety of conventional medical therapies.
Article
The continuous elongation technique is a preparatory step for excision of the pathologic palmar fascia for severe Dupuytren's contracture of the hands. It consists of a physiologic, painless, and atraumatic elongation that is obtained by means of a device fixed on the fourth and fifth metacarpal bones by two self-drilling pins. This paper presents our experience since 1986 with the TEC device, which we designed and built for severe hand contracture; the device has been applied on 56 hands and 85 fingers seriously flexed by Dupuytren's contracture. This advanced methodology also represents a real alternative to the surgical indication of finger amputation in progressive cases of the fascia retraction, and it avoids the necrosis, loss of vascularity, and bad functional results frequently seen after classical operations. The TEC device also avoids the plastic surgical correction of digital or palmar skin loss, particularly when there is a need for a flap or a skin graft. Dupuytren's contracture was for 160 years thought to be degenerative, progressive, and irreversible, but the TEC device, by bringing the contracture back to the initial stage of the disease, opens up new basic research into morphologic and biochemical processes of the collagen in the retracted palmar fascia.
Article
We define the cause of the occurrence of Peyronie's disease. Clinical evaluation of a large number of patients with Peyronie's disease, while taking into account the pathological and biochemical findings of the penis in patients who have been treated by surgery, has led to an understanding of the relationship of the anatomical structure of the penis to its rigidity during erection, and how the effect of the stress imposed upon those structures during intercourse is modified by the loss of compliance resulting from aging of the collagen composing those structures. Peyronie's disease occurs most frequently in middle-aged men, less frequently in older men and infrequently in younger men who have more elastic tissues. During erection, when full tumescence has occurred and the elastic tissues of the penis have reached the limit of their compliance, the strands of the septum give vertical rigidity to the penis. Bending the erect penis out of column stresses the attachment of the septal strands to the tunica albuginea. Plaques of Peyronie's disease are found where the strands of the septum are attached in the dorsal or ventral aspect of the penis. The pathological scar in the tunica albuginea of the corpora cavernosa in Peyronie's disease is characterized by excessive collagen accumulation, fibrin deposition and disordered elastic fibers in the plaque. We suggest that Peyronie's disease results from repetitive microvascular injury, with fibrin deposition and trapping in the tissue space that is not adequately cleared during the normal remodeling and repair of the tear in the tunica. Fibroblast activation and proliferation, enhanced vessel permeability and generation of chemotactic factors for leukocytes are stimulated by fibrin deposited in the normal process of wound healing. However, in Peyronie's disease the lesion fails to resolve either due to an inability to clear the original stimulus or due to further deposition of fibrin subsequent to repeated trauma. Collagen is also trapped and pathological fibrosis ensues.
Article
We discuss the clinical appearance and natural outcome of Peyronie's disease. During an 8-year period 307 men with Peyronie's disease were evaluated, and clinical characteristics, risk (factors), penile deformities, erectile status and outcome were analyzed. Mean patient age plus or minus standard deviation was 52.8 +/- 9.3 years (range 23 to 76). Penile deformity, pain on erection and palpable nodule were the most common (85%) presenting symptoms, usually in different combinations. The remaining 15% of men (mean age 59.4 +/- 6.5 years) were not aware of the penile deformity and were diagnosed during standard evaluation for erectile dysfunction. Dorsal (45.6%) and lateral (29.3%) were the most common curvatures. The degree of deformity was less than 30 degrees in 42.7% of patients, 31 to 60 degrees in 38.8% and greater than 60 degrees in 18.6%. At least 1 risk factor for systemic vascular disease was identified in 67.5% of patients, and hypercholesterolemia and diabetes were the most common. Patients with at least 1 risk factor had a significantly higher risk for severe penile deformity. Of the men 54.4% complained of erectile dysfunction and the probability of diminished erectile capacity was 86.7% in patients older than 60 years, with Peyronie's disease for more than 12 months and at least 1 risk factor. Of 63 patients presenting with the acute phase of disease penile deformity deteriorated in 30.2%, did not change in 66.7% and resolved spontaneously in 3.2% without any treatment after a mean followup of 8.4 months. Our data show that penile deformities are disabling (greater than 30 degrees) in 62.5% of cases. Risk factors, such as serum lipid abnormalities, diabetes and hypertension, seem to have significant impact on the severity of symptoms and outcome. Patients must be informed that Peyronie's disease is progressive in 30.2% without treatment and spontaneous resolution is rare.
Article
Multiple treatment options have been used for Peyronie's disease (PD) including intralesional injection of the calcium antagonist verapamil. The use of verapamil is based on its capacity to alter fibroblast function at several levels, including cell proliferation, extracellular matrix protein synthesis and secretion, as well as collagen degradation. Consequently, calcium antagonists may have the capacity to slow, prevent, or even reverse plaque formation and the progression of PD. The multicenter international experience with intralesional verapamil injection suggests that the majority of men with PD that receive treatment demonstrate durable reduction in pain, decrease in curvature, and improved sexual function. We review the scientific rationale, published literature, clinical experience, and technique of intralesional injection of verapamil.
Article
We provide a current review of Peyronie's disease. We reviewed the world peer reviewed literature on the pathology, pathogenesis, diagnosis and treatment of Peyronie's disease. The incidence of Peyronie's disease has continuously increased during the last 30 years. However, fewer patients need prosthesis surgery as the sole treatment option because of earlier diagnosis, improved medical therapy, refinement in surgical technique and better understanding of the basic sciences of the disease. Currently patients with Peyronie's disease have had improvements in prognosis and experienced an expansion of the available therapeutic options.
Article
The success of urogenital reconstruction in bladder exstrophy is dependent on how successfully the pelvic ring can be closed. In patients with this disorder, the pubic bones are short and separated. A two-component plate-rod combination was designed to widen the pelvic ring using distraction osteogenesis (callotasis). After a middiagonal iliac osteotomy, two components of the implant are connected with two bolts passing through the iliac bone. After 10 days, the rods outside the skin are approximated gradually. When the pubic bones get close, they are fixed by heavy nonabsorbable sutures. The current study included 14 patients who were operated on between 1990 and 1996. The mean followup was 6 years. No neurologic or vascular complications developed. Successful tension-free closure of the abdominal wall was achieved in all but one patient. Urogenital reconstruction was done in the second stage. In all but one patient, the bladder was closed in one stage of urogenital reconstruction. In one patient (7%), a deep infection developed for which the patient needed early implant removal resulting in failure of the urogenital reconstruction. The described method addresses the pathoanatomy of the pelvic ring. The diameter of the pelvic ring can be widened and the pubic bones can be approximated without a significant increase in tension.
Article
In this study we defined the prevalence of Peyronie's disease in a cohort of men being screened for prostate cancer in the United States. The association between Peyronie's disease, and medical comorbidities and patient self-reported erectile dysfunction was also defined. A total of 534 men presenting to 1 of 3 prostate cancer screening centers provided a complete medical history, underwent physical examination performed in all by a urologist and completed the Sexual Health Inventory for Men (SHIM) questionnaire. This population was chosen because of the access to a large number of subjects combined with the fact that subjects were not presenting with a specific urological complaint. The diagnosis of Peyronie's disease was based on a palpable penile plaque. Data were assessed using univariate analysis, multivariate logistic regression and Pearson chi-square analysis. A total of 48 patients were found to have a palpable penile plaque on physical examination for a prevalence rate of 8.9%. The mean age of men with Peyronie's disease was 68.2 years compared to a mean of 61.8 years in men without Peyronie's disease (p <0.0001). On univariate analysis hypertension (p = 0.02) and diabetes (p = 0.007) were present with significantly increased frequency in patients with Peyronie's disease. Patients diagnosed with Peyronie's disease had significantly lower values for responses to each of the 5 questions on the SHIM survey. An increase in age and decrease in total SHIM score remained significantly associated with a greater probability of Peyronie's disease on multivariate analysis. We found the prevalence of Peyronie's disease to be greater than in most previously reported series. We also noted a significant association between Peyronie's disease aging, hypertension, diabetes and self-reported erectile dysfunction.
Article
The investigation of medical options for the treatment of Peyronie's disease is lacking controlled clinical trials with uniform standardized assessments and objective measures of deformity, including curvature and circumference. A key to defining the beneficial effects of various medical therapies lies in standardizing the evaluation of the Peyronie's patient across various studies so that the proposed benefits can be confirmed and applied to all populations. Furthermore, basic science research into the pathophysiology of this disorder is likely to yield new insights into potential treatment options and direct future therapies.
Article
Understanding the effects of the mechanical environment on wound healing is critical for developing more effective treatments to reduce scar formation and contracture. The aim of this study was to investigate the effects of dynamic mechanical stretch on cell-mediated early wound remodeling independent of matrix alignment which obscures more subtle remodeling mechanisms. Cyclic equibiaxial stretch (16% stretch at 0.2 Hz) was applied to fibroblast-populated fibrin gel in vitro wound models for eight days. Compaction, density, tensile strength, and collagen content were quantified as functional measures of remodeling. Stretched samples were approximately ten times stronger, eight-fold more dense, and eight times thinner than statically cultured samples. These changes were accompanied by a 15% increase in net collagen but no significant differences in cell number or viability. When collagen crosslinking was inhibited in stretched samples, the extensibility increased and the strength decreased. The apparent weakening was due to a reduction in compaction rather than a decrease in ability of the tissue to withstand tensile forces. Interestingly, inhibiting collagen crosslinking had no measurable effects on the statically cultured samples. These results indicate that amplified cell-mediated compaction and even a slight addition in collagen content play substantial roles in mechanically induced wound strengthening. These findings increase our understanding of how mechanical forces guide the healing response in skin, and the methods employed in this study may also prove valuable tools for investigating stretch-induced remodeling of other planar connective tissues and for creating mechanically robust engineered tissues.
Article
Little information exists on the natural history of PD. We defined the course of PD in a group of men with this condition who received no treatment. The study population comprised patients with PD who presented within 6 months of disease onset, had no medical treatment and were followed until at least 12 months after disease onset. At baseline and followup penile abnormality was determined following intracavernous injection and by measurement at maximum penile rigidity. A total of 246 patients met inclusion criteria. At presentation mean age +/- SD was 52 +/- 22 years and the duration of PD was 3.5 +/- 1.5 months. At baseline in men with documented curvature 72% had dorsal, 17% had ventral and 11% had lateral curvature. Mean curvature at baseline was 42 +/- 22 degrees. Mean stretched flaccid penile length was 12.2 cm. The mean duration of PD at the followup assessment was 18 +/- 7 months. At followup stretched flaccid length had decreased to 11.4 cm (p = 0.035). Of the patients 32% complained of some degree of erectile dysfunction at baseline. All patients who reported penile pain had improvement and 89% reported complete resolution at followup. Of men with curvature 12% had improved, 40% remained stable and 48% had worsened at followup. In those in whom curvature improved the mean change was 15 degrees, while in those in whom curvature worsened the mean change was 22 degrees. To our knowledge this is the largest study to explore the natural history of PD. A minority of men experienced improvement in penile abnormality, while penile length decreased during the 1-year followup. This information will permit clinicians to provide patients with realistic expectations at presentation for the evaluation of PD.
Article
We evaluated the peer-reviewed urology literature for intraplaque injection of medication for Peyronie's disease and assessed the quality of studies via rigorous evidence-based medicine criteria. We performed a search of peer-reviewed literature looking at all agents used to treat Peyronie's disease by intraplaque injections. These were then evaluated using the Oxford Centre for Evidence-Based Medicine criteria, which ranks studies from strongest (level 1) to weakest (level 5) strength of evidence. Of the 19 studies found involving injection therapy for Peyronie's disease, 17 showed positive results. Six studies using injectable corticosteroids were identified and though all showed positive results, they were of level 4 quality. Two collagenase injection studies (one level 4 and one level 2 study) were identified, both of which showed positive results. All four verapamil injection studies found (three level 4 and one level 2 study) showed positive results. Seven papers involving interferon alpha2-beta injections were evaluated (six level 4 and one level 1 study), five of which showed positive outcomes and two of which showed no significant benefit. Ninety percent of the studies regarding Peyronie's disease showed positive outcomes. Unfortunately, most of these have not offered convincing evidence-based data, with only one positive study meeting level 1 Oxford criteria for clinical efficacy. Standardised outcome measures were not used, making comparisons difficult. These results reveal the need for the development of validated outcome measures and well-designed controlled trials to determine optimal therapeutic intervention for this disorder.
Article
Peyronie's disease (PD) may be treated in a medical or surgical fashion. Factors involved in the decision of which treatment to choose include duration of disease and magnitude of penile deformity. Curvature can be measured using at-home photography (AHP), vacuum erection device (VED), or intracavernosal injection (ICI). This study was undertaken to determine the concordance between the three methods of deformity assessment. Patients were also questioned regarding the presence of erectile dysfunction (ED) based on self-report and the International Index of Erectile Function. A total of 68 men presented to their urologist after taking penile photographs from three angles during maximal erectile rigidity. In the office, a VED was used to induce erection, and a goniometer was utilized to measure degree of curvature. ICI with trimix was then used to induce artificial erection, which was measured with a goniometer as well. There was a statistically significant difference in self-report curvature magnitude compared with measured ICI-assisted curvature. Curvature profiles included dorsal plaques in 50 patients (73.5%), ventral plaques in 10 (15%), and lateral in eight (11%). Using ICI, the mean curvature measured was 42 degrees. Mean degree of curvature using VED was 33 degrees, while that of photography was 34 degrees. Photographic measurements differed most from ICI in men with concurrent ED (P < 0.01), while vacuum device measurements were most inaccurate in men with curvatures of >60 degrees. Our results show that the degree of curvature measured using vacuum-assisted device and AHP is underestimated as compared with the gold standard ICI. We therefore recommend that ICI be used to most accurately determine degree of deformity. If ICI is not available, it is imperative that the same manner of measurement be used between all patients in a study group, as well as during serial evaluation in a trial.
Article
Peyronie's disease (PD) is a connective tissue disorder with an uncertain etiology that causes penile deformity. The interest in PD and our understanding of the disorder has grown significantly in recent years. Data have shown that several previous beliefs regarding the prevalence, natural history, and treatment of PD were incorrect. The prevalence is significantly higher than the previously reported 1%, and most cases of PD do not spontaneously resolve. To determine the extent to which newer information about PD has reached physicians who are likely to encounter men with PD and to determine practice patterns regarding this disorder. We created a survey of 20 questions and mailed it to primary-care physicians (PCPs) and urologists (UROs) in Illinois and Wisconsin. Responses to individual survey items were totaled. We received 152 responses from PCPs and 98 from UROs for response rates of 43% and 44%, respectively. Survey results revealed the following: 63% of PCPs and 41% of UROs thought the prevalence is less than 1%; 17% of PCPs and 38% of UROs believed PD spontaneously resolves in greater than 50% of cases; 17% of PCPs and 9% of UROs did not think PD occurs in men younger than 40 years of age; 48% of PCPs and 37% of UROs did not believe that PD is frequently associated with ED; 51% of PCPs and 1% of UROs were unsure if any effective medical or surgical treatment for PD existed. These data suggest that many physicians who are very likely to encounter men with PD have incorrect assumptions about the disease, and this can negatively affect diagnosis and treatment of men with PD.
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