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Review of Management Options for Patients With Atypical Peyronie's Disease

Published on Apr 1, 2017in Sexual medicine reviews
· DOI :10.1016/j.sxmr.2016.07.004
Faysal A. Yafi19
Estimated H-index: 19
(Tulane University),
Georgios Hatzichristodoulou14
Estimated H-index: 14
(TUM: Technische Universität München)
+ 1 AuthorsWayne J.G. Hellstrom63
Estimated H-index: 63
(Tulane University)
Abstract
Abstract Introduction Peyronie's disease (PD) is a wound-healing disorder of the tunica albuginea often associated with penile deformity. Less commonly, patients with PD might display atypical presentations such as ventral curvature, hourglass deformity, significantly shortened penis, and/or multiplanar curvature. Aim To review the available literature on the prevalence of and management options for atypical PD. Methods A literature review was performed through PubMed from 1982 through 2016 regarding atypical PD. Keywords used for the search were Peyronie's disease, atypical Peyronie's disease, ventral Peyronie's disease, ventral plaque, hourglass deformity, penile indentation, penile notching, short penis, shortened penis, shrunken penis, biplanar curvature, and multiplanar curvature. Main Outcome Measures To assess the various surgical and non-surgical techniques used for the management of atypical PD. Results Collagenase Clostridium histolyticum is contraindicated for patients with ventral plaques and/or hourglass deformities. Patients with maintained erectile function and ventral PD plaques are best treated with intralesional injections of interferon alpha-2b or tunica plication. Patients with maintained erectile function with PD associated with hourglass deformity and/or multiplanar curvature are best treated with plaque incision or partial excision and grafting. Patients with a shortened penis could attempt conservative measures such as penile traction therapy and medical management. When erectile function is compromised, insertion of an inflatable penile prosthesis with or without ancillary straightening procedures should be recommended. Lengthening procedures can be attempted in very special circumstances by expert surgeons. Conclusion There is a paucity of data regarding atypical PD. Ventral plaques can be treated with intralesional injections or surgery, hourglass deformity and multiplanar curvatures are best managed surgically, and a shortened penis should be treated with non-invasive approaches. When concomitant erectile dysfunction is present, insertion of an inflatable penile prosthesis is recommended. Caution should be advised before undergoing ancillary penile lengthening maneuvers owing to the potential for serious complications. Yafi FA, Hatzichristodoulou G, DeLay KJ, Hellstrom WJG. Review of Management Options for Patients With Atypical Peyronie's Disease. Sex Med Rev 2017;5:211–221.
  • References (66)
  • Citations (13)
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References66
Newest
#1Faysal A. Yafi (Tulane University)H-Index: 19
#2Georgios Hatzichristodoulou (TUM: Technische Universität München)H-Index: 14
Last. Wayne J.G. Hellstrom (Tulane University)H-Index: 63
view all 6 authors...
Abstract Introduction Approximately 10% of Peyronie's disease (PD) patients present with ventral curvatures and, as such, there is a paucity of data describing the optimal approach for treatment. Aim This study aims to compare the outcomes of surgery (tunical plication [TP]) and intralesional injection (ILI) therapy (interferon‐α2b) in men with ventral PD. Materials and Methods Retrospective data were collected from two centers: Tulane University (ILI) and Technical University of Munich (TP). Co...
10 CitationsSource
#1Eric Chung (Memorial Hospital of South Bend)H-Index: 20
#2David J. Ralph (UCLH: University College Hospital)H-Index: 46
Last. Gregory A. Broderick (Mayo Clinic)H-Index: 39
view all 10 authors...
Abstract Introduction Despite recent advances in our knowledge and treatment strategies in Peyronie's Disease (PD), much remained unknown about this disease. Aim To provide a clinical framework and key guideline statements to assist clinicians in an evidence-based management of PD. Methods A systematic literature search was conducted to identify published literature relevant to PD. The search included all relevant articles published up to June 2015, including preclinical studies and published gu...
50 CitationsSource
#1Luigi Rolle (UNITO: University of Turin)H-Index: 13
#2Marco Falcone (UCL: University College London)H-Index: 12
Last. Bruno Frea (UNITO: University of Turin)H-Index: 21
view all 14 authors...
Objectives To report the results from a prospective multicentric study of patients with Peyronie's disease (PD) treated with the ‘sliding’ technique (ST). Patients and Methods From June 2010 to January 2014, 28 consecutive patients affected by stable PD with severe penile shortening and end-stage erectile dysfunction (ED) were enrolled in three European PD tertiary referral centres. The validated International Index of Erectile Function (IIEF) questionnaire, the Sexual Encounter Profile (SEP) Qu...
19 CitationsSource
#1Faysal A. Yafi (Tulane University)H-Index: 19
#2Georgios Hatzichristodoulou (TUM: Technische Universität München)H-Index: 14
Last. Wayne J.G. Hellstrom (Tulane University)H-Index: 63
view all 6 authors...
Objective To investigate the outcomes of two surgical interventions for Peyronie's disease (PD) with hourglass deformity: partial excision and grafting (PEG) or inflatable penile prosthesis (IPP) implantation. Materials and Methods Retrospective data were collected from two centers: Technical University of Munich (PEG) and Tulane University Medical Center (IPP). Collected variables included patient demographics, sexual function, penile vascular measurements, and treatment outcomes. Results A tot...
2 CitationsSource
#1C WeinbergAaron (Columbia University)H-Index: 11
#2Matthew J. Pagano (Columbia University)H-Index: 2
Last. Robert J. Valenzuela (Columbia University)H-Index: 1
view all 4 authors...
Abstract Introduction The surgical treatment of disorders of male sexual function requires specific exposure to correct the underlying problem safely and efficiently. Currently, sub-coronal exposure is used for treatment of phimosis, Peyronie's disease plaque (PDP), and semirigid penile prosthesis insertion. Infra-pubic and scrotal incisions are used for inflatable penile prosthesis (IPP) placement. However, men who present with several disorders might require multiple procedures and surgical in...
19 CitationsSource
#2A. Parnham (Manchester Royal Infirmary)H-Index: 5
Last. Walter StacklH-Index: 4
view all 6 authors...
Abstract Introduction Surgical correction is advocated in patients with stable Peyronie's disease (PD) and severe curvature of the penis. Contemporary series demonstrate favorable outcomes based on relatively short follow-up periods. However, long-term follow-up is rarely reported and there is a paucity of evidence on the influence of patients' age, comorbidities, and natural history on surgical outcomes. Aims The present study aims to examine the influence of patient's age, comorbidities, sever...
14 CitationsSource
Objective To present the feasibility and safety of penile length and girth restoration based on a modified ‘sliding’ technique for patients with severe erectile dysfunction (ED) and significant penile shortening, with or without Peyronie's disease (PD). Patients and Methods Between January 2013 and January 2014, 143 patients underwent our modified ‘sliding’ technique for penile length and girth restoration and concomitant penile prosthesis implantation. It is based on three key elements: (i) the...
27 CitationsSource
#1Carrie A. Stewart (Tulane University)H-Index: 1
#2Faysal A. Yafi (Tulane University)H-Index: 1
Last. W. Hellstrom (Tulane University)H-Index: 2
view all 9 authors...
Purpose: Collagenase clostridium histolyticum is the only FDA (Food and Drug Administration) approved treatment for Peyronie's disease. However, to our knowledge collagenase clostridium histolyticum has not been studied in men with ventral plaques. Given this limitation and the paucity of literature on ventral plaque outcomes, we compared the results of Peyronie's disease treatment in men with different plaque locations treated with intralesional interferon-α2b.Materials and Methods: We retrospe...
19 CitationsSource
#1Faysal A. Yafi (Tulane University)H-Index: 19
#2Michael R. Pinsky (Tulane University)H-Index: 82
Last. Wayne J.G. Hellstrom (Tulane University)H-Index: 63
view all 8 authors...
Purpose: The concomitant use of penile traction therapy with interferon α-2b has been previously described. We present an update on our clinical experience to assess the benefit and duration of daily traction.Materials and Methods: A retrospective review of patients who underwent interferon α-2b therapy between 2001 and 2012 was performed. Charts were reviewed and data collected regarding various patient demographics, vascular parameters, objective length and curvature measurements, and use of p...
27 CitationsSource
#1Premsant Sangkum (Tulane University)H-Index: 10
#2Faysal A. Yafi (Tulane University)H-Index: 19
Last. Wayne J.G. Hellstrom (Tulane University)H-Index: 63
view all 11 authors...
Objective To evaluate the treatment effect of collagenase Clostridium histolyticum (CCH) in a rat model of urethral fibrosis. Materials and Methods Thirty male Sprague-Dawley rats (300-350 g) were divided into 5 groups. The rat urethra was injected with normal saline in the sham group and, in the other 4 groups, the rat urethra was injected with 10 μg of transforming growth factor beta 1 to create fibrosis of the urethra. Two weeks following transforming growth factor beta 1 injection, the rats ...
10 CitationsSource
Cited By13
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#1Matthew Ziegelmann (Mayo Clinic)H-Index: 11
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Last. Tobias S. Köhler (Mayo Clinic)H-Index: 15
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Objective To identify patient-specific factors associated with patient-reported improvements in functional outcomes after intralesional Collagenase Clostridium histolyticum for Peyronie's Disease (PD). Methods We retrospectively explored our prospectively-maintained CCH registry. We sought to identify patient-specific factors that prevented the need for surgical straightening and/or improved ability to engage in penetrative intercourse. Results 86 patients underwent CCH monotherapy and had objec...
Source
#1Georgios Hatzichristodoulou (University of Würzburg)H-Index: 14
Surgical therapy of Peyronie’s disease (PD) still remains the gold standard treatment to correct penile curvature in patients with stable disease. This is indicated when curvature inhibits satisfying sexual intercourse. In advanced cases when penile curvature is ≥60° grafting techniques are recommended as these procedures can maintain penile length as they lead to stretching of the penile shaft after plaque incision or partial plaque excision. The resulting tunical defect is then closed by means...
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#1Andrea Cocci (UniFI: University of Florence)H-Index: 9
#2Fabrizio Di Maida (UniFI: University of Florence)H-Index: 4
Last. Nicola MondainiH-Index: 30
view all 12 authors...
PURPOSE: The aim of this study was to evaluate the efficacy of collagenase Clostridium histolyticum (CCH) in patients with Peyronie's disease (PD) suffering from atypical deformities. MATERIALS AND METHODS: We retrospectively collected data of patients with atypical penile curvature (PC) secondary to PD. All patients underwent a modified treatment protocol, consisting of 3 intralesional injections of 0.9 mg of CCH performed at 4-week intervals at the point of maximum PC. Patients were instructed...
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#1P. KrishnappaH-Index: 2
#1Pramod KrishnappaH-Index: 3
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Abstract Introduction Surgical intervention in Peyronie’s disease (PD) should ideally be delayed until the resolution of acute inflammatory phase. Aim The objective of this review was to highlight the results of penile prosthesis to correct refractory erectile dysfunction (ED) in patients with PD, and the secondary procedures that may be required to correct the penile curvature. Methods A systematic search on PubMed online database using Preferred Reporting Items for Systematic Reviews and Meta-...
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#1Fabio Castiglione (UCL: University College London)H-Index: 16
#2Petter Hedlund (Linköping University)H-Index: 37
Last. Maarten Albersen (Katholieke Universiteit Leuven)H-Index: 21
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OBJECTIVE: To investigate whether local injection of autologous adipose stromal vascular fraction (SVF) can prevent the development of fibrosis and elastosis in the tunica albuginea (TA) using a rat model of the acute phase of Peyronie's disease (PD). METHODS: A total of 24 male 12-week-old Sprague-Dawley rats were divided into three equal groups: sham; PD without treatment (transforming growth factor-β [TGF -β]); and PD treated with SVF 1 day after disease induction. Sham rats received two inje...
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#1R. Avant (Mayo Clinic)H-Index: 3
#2Matthew Ziegelmann (Mayo Clinic)H-Index: 11
Last. Landon Trost (Mayo Clinic)H-Index: 23
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Abstract Introduction Peyronie's disease (PD) has historically been managed by at least 1 treatment, including oral supplements or medications, intralesional injections, or surgery. Adjunctive mechanical therapies also have been described, including penile traction therapy (PTT) and vacuum erection devices (VEDs), although relatively limited data are available on their use with PD. Aim To review and summarize the published literature on the role and efficacy of PTT and VED in men with PD. Method...
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#1Esaú Fernández-Pascual (UAM: Autonomous University of Madrid)H-Index: 2
Last. Juan I. Martínez-Salamanca (UAM: Autonomous University of Madrid)H-Index: 24
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Abstract Introduction Patients with Peyronie’s disease (PD) and erectile dysfunction (ED) concomitant with shortening or other malformations benefit from prosthesis implantation and penile lengthening procedures. Aim To evaluate the safety and efficacy of a multi-incisional technique with penile prosthesis implantation with multiple corporeal incisions and collagen grafting for the surgical management of complex cases of PD with ED and severe penile shortening. Methods From February 2015–May 201...
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Ventral penile curvature in Peyronie’s disease (PD) is not very common but may lead to inability for sexual intercourse, especially in severe cases > 60°. Ventral curvatures are most often addressed surgically with plication owing to fear of urethral complications, as it requires the mobilisation of the urethra. In this study, the ventral sealing technique is introduced for correction of ventral curvatures in patients with PD. The surgical approach includes the mobilisation of the neurovascular ...
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#1Alexander K. Chow (Rush University Medical Center)H-Index: 2
#2Steven A. Sidelsky (Rush University Medical Center)H-Index: 1
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Abstract Background There are limited data in the literature that describe the management of Peyronie's disease (PD) with severe compound curvature, which often requires additional straightening procedures after plaque excision and grafting (PEG) to achieve functional penile straightening ( Aim This study highlights the clinical distinction and our experience with men with PD and severe compound curvature treated with PEG and supplemental tunica albuginea plication (TAP). Methods We performed a ...
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#1Daniel J. Cwikla (UCI: University of California, Irvine)H-Index: 1
#2Faysal A. Yafi (UCI: University of California, Irvine)H-Index: 19
The use of Clostridium histolyticum collagenase (CCH) has become increasingly widespread for the treatment of Peyronie’s disease (PD) in recent years. Numerous trials have confirmed both its safety and efficacy in appropriately selected patients with this condition. The purpose of this review is to examine pivotal trials demonstrating the efficacy of CCH, revisit viable candidates for treatment with intralesional injection therapy, and provide a summary of injection technique and appropriate man...
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