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Abstract Background Peyronie's disease (PD) is a fibrotic disorder of the penile tunica albuginea, characterised by the formation of a localised fibrous plaque that can lead to deformity and erectile dysfunction. Nonsurgical therapeutic options for PD are limited in efficacy and safety. Myofibroblasts are key cells in the pathogenesis of PD, and inhibition of myofibroblast transformation has been suggested as a therapeutic option. Objective To identify potential drugs using a novel phenotypic assay and then to test them using in vitro and in vivo models of PD. Design, setting, and participants We have developed and validated a phenotypic screening assay that measures myofibroblast transformation, by which we tested 21 compounds that were suggested to be efficacious in treating PD. The successful hits from this assay were further tested using in vitro and in vivo models of PD. Results and limitations The new assay was able to detect transforming growth factor-β1–induced myofibroblast transformation. Using this assay, phosphodiesterase type 5 inhibitors (PDE5i) and selective oestrogen receptor modulators (SERMs) were identified to significantly inhibit myofibroblast transformation. A PDE5i (vardenafil) and an SERM (tamoxifen) inhibited myofibroblast transformation, collagen gel contraction, and extracellular matrix production in a synergistic fashion. In a rat model of PD, the antifibrotic effect of the combination of vardenafil and tamoxifen was greater than that of each drug alone. This study is limited by not providing a molecular mechanism for the proposed synergy. Conclusions This is the first demonstration of a synergistic activity between a PDE5i and an SERM discovered through a phenotypic screening approach. Future clinical trials using a combination of these drugs should be considered during the active phase of PD, given the early evidence of benefit in both in vitro and in vivo models. Patient summary This report suggests that the combination of a phosphodiesterase type 5 inhibitor and a selective oestrogen receptor modulator may be efficacious in treating Peyronie's disease in its active phase. Take Home Message We have developed a novel phenotypic screening assay measuring myofibroblast transformation and tested 21 compounds. Only phosphodiesterase type 5 inhibitors and selective oestrogen receptor modulators showed significant effects. The drugs exerted a synergistic effect in vitro and in vivo, suggesting that their combination may be clinically efficacious. [ABSTRACT FROM AUTHOR]

Abstract Context Conservative therapies for Peyronie's disease (PD) aim to treat early-stage disease by improving clinical outcomes such as penile curvature, penile length erectile dysfunction, and pain. Objective To summarise the available evidence regarding injection and mechanical therapies for PD treatment. Evidence acquisition An extensive search of Medline, Embase, and Scopus databases retrieved English-language articles up to 15 May 2018. The systematic review protocol was registered on PROSPERO (CRD42017077050). Inclusion criteria were as follows: adults with early or chronic PD receiving treatment with injection therapy, penile traction, or a vacuum device. Evidence synthesis Fifty-two articles were selected according to the inclusion criteria—17 comparative studies and 35 cohort studies—analysing the effects of calcium channel blockers (verapamil, nicardipine), collagenase Clostridium histolyticum (CCH), interferon α-2b (IFNα-2b), hyaluronic acid (HA), onabotulinum toxin A, thiocolchicine, penile extender devices, and vacuum devices. Qualitative data from these studies suggest a clinically significant effect of CCH and IFNα-2b injection therapy to decrease penile curvature and conserve penile length. Verapamil and HA performed well in single-arm or case-control studies. Studies of penile traction and vacuum devices in patients with PD demonstrated some benefits in terms of curvature and penile length but only in small, underpowered, nonrandomised studies. Studies of onabotulinum toxin A injections or thiocolchicine showed significant improvements in penile curvature, but only in studies of single-arm or case-control design. Conclusions CCH and IFNα-2b injected into stable PD plaques can decrease penile curvature; CCH can also improve penile length. However, based on available data, strong conclusions cannot be drawn for other treatments, including calcium channel blockers, HA, or mechanical therapies. Patient summary Our systematic review of injection therapies provides evidence for improvements in penile curvature for patients with Peyronie's disease. No robust evidence is available to support the use of other local treatments including calcium channel blockers, hyaluronic acid, or mechanical therapies. Take Home Message Collagenase Clostridium histolyticum (CCH) and interferon α-2b injected into stable Peyronie's disease plaques can decrease penile curvature; moreover, CCH can also improve penile length. No strong conclusions can be drawn for other treatments including calcium channel blockers (verapamil and nicardipine), hyaluronic acid, or mechanical therapies. Injection therapy including collagenase or interferon α-2b can improve penile curvature in patients affected by Peyronie's disease. There is no robust evidence supporting the use of other local treatments including calcium channel blockers (verapamil and nicardipine), hyaluronic acid, or mechanical therapies in this setting. [ABSTRACT FROM AUTHOR]

Abstract: Background: Peyronie''s disease (PD) is a connective tissue disorder of the tunica albuginea (TA). Currently, no gold standard has been developed for the treatment of the disease in its active phase. Objective: To test the effects of a local injection of adipose tissue–derived stem cells (ADSCs) in the active phase of a rat model of PD on the subsequent development of fibrosis and elastosis of the TA and underlying erectile tissue. Design, setting, and participants: A total of 27 male 12-wk-old Sprague-Dawley rats were divided in three equal groups and underwent injection of vehicle (sham), 50-μg transforming growth factor (TGF)-β1 in a 50-μl vehicle in either a PD or a PD plus ADSC group in the dorsal aspect of the TA. Intervention: The sham and PD groups were treated 1 d after TGF-β1 injection with intralesional treatment of vehicle, and the PD plus ADSC group received 1 million human-labeled ADSCs in the 50-μl vehicle. Five weeks after treatment, six rats per group underwent erectile function measurement. Following euthanasia, penises were harvested for histology and Western blot. Outcome measurements and statistical analysis: The ratio of intracavernous pressure to mean arterial pressure (ICP/MAP) upon cavernous nerve stimulation, elastin, and collagen III protein expression and histomorphometric analysis of the penis. Statistical analysis was performed by analysis of variance followed by the Tukey-Kramer test for post hoc comparisons or the Mann-Whitney test when applicable. Results and limitations: Erectile function significantly improved after ADSC treatment (ICP/MAP 0.37 in PD vs 0.59 in PD plus ADSC at 5-V stimulation; p =0.03). PD animals developed areas of fibrosis and elastosis with a significant upregulation of collagen III and elastin protein expression. These fibrotic changes were prevented by ADSC treatment. Conclusions: This study is the first to test stem cell therapy in an animal model of PD. Injection of ADSCs into the TA during the active phase of PD prevents the formation of fibrosis and elastosis in the TA and corpus cavernosum. [Copyright &y& Elsevier]

Abstract: Background: Extracorporeal shock wave therapy (ESWT) is a conservative therapy for patients with Peyronie''s disease (PD). Objective: To investigate the effects of ESWT in patients with PD. Design, setting, and participants: One hundred patients with a history of PD not >12 mo who had not had previous PD-related treatments were enrolled in a prospective, randomized, double-blind, placebo-controlled study. Patients were randomly allocated to either ESWT (n =50) or placebo (n =50). Erectile function (EF), pain during erection, plaque size, penile curvature, and quality of life (QoL) were assessed at baseline, at 12 wk, and at 24 wk follow-up. Intervention: Four weekly treatment sessions were administered. Each ESWT session consisted of 2000 focused shock waves. For the placebo group, a nonfunctioning transducer was employed. Measurements: EF was evaluated with the shortened version of the International Index of Erectile Function (IIEF-5), pain was evaluated with a visual analog scale (VAS; 0–10), plaque size was measured in cm2, and penile curvature was measured in degrees. Results and limitations: After 12 wk, mean VAS score, mean IIEF-5 score, and mean QoL score ameliorated significantly in patients receiving ESWT. Mean plaque size and mean curvature degree were unchanged in the ESWT group, while a slight increase was reported in the placebo group (p-value not significant vs baseline). After 24 wk, mean IIEF-5 score and mean QoL score were stable in the ESWT group, while mean VAS score was significantly lower when compared with baseline in both groups. Interestingly, after 24 wk, mean plaque size and mean curvature degree were significantly higher in the placebo group when compared with both baseline and ESWT values. The main limitations were that the QoL questionnaire was not validated, ED was not etiologically characterized, and inclusion criteria were restricted. Conclusions: In patients with PD, ESWT leads to pain resolution and ameliorates both EF and QoL. [Copyright &y& Elsevier]

Abstract: Background: Plaque incision and tunical grafting is widely used to correct penile curvatures secondary to Peyronie''s disease (PD), but there is no consensus on the ideal graft to be used. Objective: To evaluate the efficacy, safety, and reproducibility of plaque incision and buccal mucosa grafting (BMG) in the correction of severe penile curvatures secondary to PD. Design, setting, and participants: Fifteen patients reporting normal erections and stable curvature (>12-mo duration) entered this prospective study carried out at two university hospitals. Intervention: All patients underwent plaque incision and BMG. Measurements: Preoperative evaluation included the International Index of Erectile Function (IIEF-5) and penile duplex ultrasounds with measurement of curvature and length of affected side. Follow-up visits were scheduled at 1, 3, 6, and 12 mo postoperatively, then yearly. Three-mo postoperative evaluation included IIEF-5, patient and partner satisfaction, and intracavernous injection test with evaluation of penile rigidity, straightness, and length; patient and partner satisfaction was recorded at all subsequent visits. Results and limitations: Mean patient age was 56.3 yr and mean penile curvature 72°; five patients had a two-sided curvature with mean second curvature of 37°. There were no complications. All patients resumed unassisted intercourse 1 mo after surgery. Three-mo postoperative evaluation showed 100% penile straightening, 1.8-cm mean increase in length of affected side, no curvature recurrence or de novo erectile dysfunction, 1.6 mean increase in IIEF-5 score, and patient and partner satisfaction of 93.3% and 100%, respectively. Although results remained stable at subsequent follow-up (mean 13.1 mo), a greater number of patients and longer follow-up are needed before drawing any definite conclusions. Conclusions: BMG provided excellent short-term results, probably because its prompt revascularisation, suggested by the fast return of spontaneous erections, prevented shrinkage, which is the main cause of graft failure. It also proved to be safe and reproducible, thus representing a valuable treatment option for PD. [Copyright &y& Elsevier]

Abstract: Objectives: To define ultrasonographic patterns reflecting different states of Peyronie''s disease (PD) and to use them to evaluate the natural history of the disease. Material and methods: Diagnosis of PD was based on medical and sexual history, physical examination, intracavernosal injection test, and penile ultrasonography. Patients with penile fracture history were excluded from the study. Three groups were formed according to ultrasonographic patterns: solitary hyperechoic lesion without acoustic shadow (group A), moderately hyperechoic multiple scattered calcified lesions with acoustic shadows (group B), dense calcified hyperechoic plaque with acoustic shadow (group C). All patients entered a watchful waiting protocol for 1 yr followed by a new penile ultrasonography. Results: Ninety-five 95 patients with PD were included in the study (mean age, 57.2±9.1 yr; mean duration of disease, 12.9±8.9 mo). Risk factors associated with cardiovascular disease were present in 79 of 95 patients (83.16%). Eleven (11.6%), 35 (36.8%), and 49 (51.6%) patients were classified into groups A, B and C, respectively. At the end of the study, in group A, reduction of fibrotic lesions and curvature angle was noticed in 9 of 11 (81.8%) patients, whereas plaque formation was noticed in 2 of 11 (18.2%) patients. In group B, plaque and curvature reduction was noticed in 15 of 35 (42.9%) and 12 of 35 (34.3%) respectively, whereas in the rest a dense calcified plaque was noticed. In group C, no ultrasonographic evidence of improvement was noticed; curvature angle was reduced in 4 of 49 (8.2%), owing to the extension of the plaque circumferentially. Significant hemodynamic changes were noticed at the two time points tested (30.53% diagnosed with vascular disease at baseline vs. 46.32% at the end of the study, p =0.03). Conclusions: Corporal ultrasonography in patients with PD allows objective evaluation and classification of disease. The density of echogenic areas and presence of acoustic shadows are predictors of disease stability. [Copyright &y& Elsevier]

Abstract: Objectives: Only minimal literature exists on consequences of shock wave therapy (SWT) on erectile function in treatment of Peyronie''s disease (PD). This study was undertaken to define SWT impact at varied energy/dose levels at different time points on functional and structural changes in erectile tissue. Methods: In 45 rats 2000 shock waves (sw) at 2BAR were applied to the penis weekly sorted by one, two, and three sessions (high-dose/energy level, HD-1, HD-2, HD-3). Each group was followed for 1, 7, or 28 d before measuring intracavernosal pressure (ICP) and mean arterial pressure (MAP). Fifteen control animals (C1, C7, C28) underwent anesthesia alone. Another 15 animals were exposed to three SWT sessions applying 1000sw at 1BAR and analyzed identically (low-dose/energy level, LD-3-1, -7, -28). Terminal deoxynucleotidyl transferase biotin-dUTP nick-end labeling assay was used to define the apoptotic index (AI) and Masson''s trichrome (MT) staining was prepared to evaluate smooth muscle-to-collagen ratios. Results: ICP/MAP ratios for all C groups displayed a mean of 64%. All SWT groups demonstrated significantly reduced ICP/MAP ratios compared to their corresponding C groups (p <0.05). The LD-3 groups showed a trend toward improved ICP/MAP ratios. LD-3-28 demonstrated significant recovery compared to HD-3-28 (55±8% vs. 41±10%, p =0.004), but remained reduced compared to C28 (63±5%, p =0.03). No statistical differences were seen for MT staining in SWT groups compared to C (p >0.05). AIs for the LD-3 groups were significantly lower compared to the HD-3 groups (p <0.001), but all AIs were significantly increased compared to C groups (p <0.01). Conclusions: Overall, at both energy/dose levels, SWT resulted in a time- and treatment-dependent reduction of ICP/MAP ratios, which might be mediated partly through apoptosis and collagenization of corporal smooth muscle. [Copyright &y& Elsevier]

Abstract: Objectives: To assess the outcomes of the surgical techniques used in Peyronie''s disease (PD) surgery. Patients and methods: One hundred fifty patients received surgical treatment for PD. Fifteen and 75 patients underwent simple corporoplasties and incision of the plaque, and venous (IV) grafting, respectively, whereas 60 patients with erectile dysfunction underwent penile prosthesis implantation. At follow-up, the erectile function and penile deformity were assessed at 3 and 12 mo postoperatively, and every 6 mo thereafter. Results: Postoperative results were satisfactory in 14 of 15 patients with simple corporoplasties, with a mean angle of deformity and follow-up of 51.0°±14.9° and 21.0±9.7 mo, respectively. Among patients undergoing IV grafting with sapheneous vein (mean curvature angle: 61.6°±19.5°), 70 were regularly seen with a mean follow-up of 41.7±35.1 mo. Penile curvature was completely straightened in 53 (75.7%) patients, whereas 12.8% and 11.4% had residual curvature less than 20° and more than 20°, respectively. The mean degree of penile curvature of patients with penile prosthesis was 46.9°±20.1°. Straightening of the penis was accomplished with implantation of the prosthesis only, manual modeling, plaque incision and grafting (autologous rectus fascia in the majority), incision of the plaque, and penile plication in 35%, 30%, 33.3%, 1.6%, and 1.6%, respectively. In the prosthesis group, two patients had recurrent curvatures. Conclusions: IV grafting is a good option with satisfactory mid- and long-term outcome. Insertion of the prosthesis only and manual modeling correct the curvature in the majority of the patients. For the remaining patients, autologous rectus fascia is an appropriate graft material. [Copyright &y& Elsevier]

Abstract: Objective: A broad spectrum of options is available for treatment of Peyronie''s disease; however, the effects of minimally invasive therapy are generally inadequate. Although useful, oral drugs must be administered at onset of the disease. Only a few patients request penile surgery. Therefore, new medical treatments for Peyronie''s disease are needed. A better understanding of the pathogenesis of Peyronie''s disease is required to facilitate development of these new medical treatments. Several studies have described an increased level of TGF-β in the fibrotic plaques of patients with Peyronie''s disease, underscoring this important signalling pathway in the onset and/or development of Peyronie''s disease. Methods: Plaque biopsies were taken from 16 patients with Peyronie''s disease. Furthermore, 7 patients without Peyronie''s disease were biopsied to provide control material. Fibroblasts were cultured from biopsy tissue, and cultured fibroblasts were stimulated with TGF-β1, BMP-2, IFN-γ, and IFN-γ combined with one of the other stimuli. Protein was extracted from treated fibroblasts and prepared for immunoblots. The membranes were probed for phosphorylated Smad and total Smad to indicate activation of TGF-β signalling. Results: An agonistic effect of IFN-γ on TGF-β signalling was observed. Stimulation with TGF-β1 increased levels of phospho-Smad2 and phospho-Smad3. After stimulation with TGF-β1 and IFN-γ combined, the levels of phospho-Smads were higher than those observed with stimulation withTGF-β1 alone. Conclusions: The profibrotic effect of TGF-β1 is enhanced by IFN-γ in fibroblasts from patients with Peyronie''s disease. The inhibitory effects of IFN-γ on the TGF-β pathway do not appear in Peyronie''s disease. Therefore, IFN-γ cannot be taken as a useful tool in the therapy of Peyronie''s disease. [Copyright &y& Elsevier]

Abstract: Objective: 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. Methods: 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. Results: 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 α2-β 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. Conclusions: 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. [Copyright &y& Elsevier]

Abstract: Objectives: The development of fibrotic diseases is associated with alterations in the transforming growth factor β (TGF-β) pathway. We have investigated the expression and activity of Smad transcription factors of the TGF-β pathway in primary tunical fibroblasts derived from patients with Peyronie''s disease and from controls. Methods: Primary fibroblasts were established from biopsies obtained from plaques of 16 patients with Peyronie''s disease or the tunica albuginea of 8 control patients. The expression and activity of Smad transcription factors in control and TGF-β–stimulated primary fibroblasts were investigated at the RNA and protein level by reverse transcription-polymerase chain reaction, Western blotting, and immunofluorescence. Results: RNA expression levels of Smad3 and Smad4 were significantly increased in fibroblasts from patients with Peyronie''s disease. When stimulated with TGF-β1, fibroblasts showed rapid nuclear translocation of Smad2/3, as soon as 15min after stimulation. This effect was more pronounced and exhibited an earlier onset in fibroblasts from patients with Peyronie''s disease, compared with controls. In addition, an increased nuclear retention time of Smad4 was observed in fibroblasts from patients with Peyronie''s disease. Conclusions: The expression and activity of Smad transcription factors of the TGF-β pathway is increased in fibroblasts of patients with Peyronie''s disease. Alterations in the TGF-β pathway seem to be a pathogenetic factor in the development of Peyronie''s disease. [Copyright &y& Elsevier]

Abstract: Objective: The present paper reviews surgical treatment alternatives for patients with Peyronie''s disease using knowledge obtained from the contemporary literature. Methods: : All aspects of surgical treatment for Peyronie''s disease were examined on the basis of MEDLINE database researches. Results: Surgical treatment should be delayed until the acute inflammatory phase has resolved and should be considered in patients with deformity that impairs sexual function. Currently, surgical treatment alternatives are reconstructive surgery by either lengthening the concave side (incision and grafting) or shortening the convex side (Nesbit procedure or plication) of the penis, and implantation of penile prosthesis with or without incision of the plaque. PD patients with good erectile capacity are candidates for reconstructive surgery. Meanwhile, implantation of penile prosthesis with or without remodeling should be considered for patients without adequate erectile capacity. Conclusions: The aim of the surgical treatment in Peyronie''s disease is to correct the deformity while preserving or improving erectile capacity of the penis. Appropriate treatment options should be individualized according to the patients’ expectations and erectile capacity. [Copyright &y& Elsevier]

Abstract: Objective: Because the efficacy of nonsurgical therapy of Peyronie''s disease is controversial, this review analyses the current status of conservative therapy of Peyronie''s disease. Method: A systematic survey on results of studies published as original papers in peer-reviewed journals is provided. Results: Oral drug therapies include potassium para-aminobenzoate (Potaba), vitamin E, colchicine, tamoxifen, propoleum, acetyl-l-carnitine, and propionyl-l-carnitine. Verapamil, interferon-α2a and interferon-α2b, collagenase, cortisone, hyaluronidase, and superoxide dismutase are considered intralesional therapies that have had various degrees of success. Other treatments include local gels, iontophoresis, extracorporeal shock wave therapy, and radiation. Conclusion: This review analyses the current status of the conservative therapy of Peyronie''s disease, because the efficacy of the nonsurgical therapy is controversial. [Copyright &y& Elsevier]

Abstract: Purpose: To assess the prevalence of Peyronie''s disease (PD) among patients with erectile dysfunction (ED). Materials and Methods: A total of 1,440 male patients with ED were enrolled in this study. Patients were interviewed for ED using the International Index of Erectile Function (IIEF). All patients were also screened for socio-demographic data and risk factors for ED that included age, smoking, diabetes, hypertension, dyslipidemia, Ischemic Heart Disease (IHD), and psychological disorders. The diagnosis of PD was based on a palpable penile plaque or acquired penile curvature. Patients underwent routine laboratory investigation in addition to testosterone and prolactin assessment. Results: Mean ages ±SD were 54.1±6.9 (range 42–71) and 52.5±11.9 (range 20–84) years for patients with and without PD respectively. Of the patients, 11.8% had mild, 38.3% had moderate and 49.9% had severe ED. 7.9% of the patients had PD. Significant associations between PD and both the longer duration and the increased severity of ED were detected. There were also significant associations between PD and the following socio-demographic risk factors of ED: age, obesity, smoking, duration and number of cigarettes smoked per day. Concomitant diseases and medical comorbidities such as diabetes, dyslipidemia, psychological disorders and the presence of at least one risk factor were significantly associated with PD in patients with ED. Conclusions: Peyronie''s disease was not rare among the study population. There were significant associations between ED risk factors and PD. Further studies are needed to investigate how much ED and PD influence each other. [Copyright &y& Elsevier]

Abstract: Objective:: To demonstrate the efficacy and safety of a topical gel containing liposomally encapsulated recombinant human Superoxide Dismutase (lrhSOD) in the treatment of painful Peyronie''s Disease. The theoretical background is that lrhSOD, by scavenging of free oxygen radicals, might interrupt inflammatory cascades and thereby limit further disease progression. Methods:: In a placebo-controlled randomized clinical trial, 39 patients with Peyronie''s Disease and significant pain symptoms were treated with lrhSOD or placebo for a 4 week period. At this time, statistical evaluation of pain resolution was performed as primary study endpoint. Patients then were continued in a cross-over study design to ensure a total of 8 weeks of lrhSOD therapy for all study participants. Pain, plaque and curvature assessment was performed at study entry and every 4 weeks until week 12. Results:: LrhSOD treatment resulted in a statistically significant reduction of pain (p =0.017) compared to placebo already after 4 weeks. At week 12 pain was significantly reduced in 89% of patients who all had received 8 weeks of lrhSOD therapy at that time. Response to other disease parameters was assessed at week 12: plaque size was reduced in 47% of patients, as was plaque consistence in 38%. Penile curvature was improved at 5–30 degrees in 23% of patients. The expected spontaneous disease progression rate of up to 40%, as reported by several investigators, was significantly reduced to &#60;10% under lrhSOD therapy, and patients satisfaction was high, also consequent to the lack of therapy-related side effects observed in the present study. Conclusion:: LrhSOD is an easily administrable, safe and effective local therapeutic for the painful phase of Peyronie''s Disease. [Copyright &y& Elsevier]

Abstract: Objectives:: The aim of this work was the evaluation of clinical results of the use of buccal mucosa for replacement of Peyronie''s disease plaque. Patients and methods:: Twenty-six patients with Peyronie''s disease were under observation. All the patients underwent the following investigations before and periodically within 3 years after the treatment: International Index of Erectile Function (IIEF-5), manual examination of plaque, autophotography of erect penis, conventional and power color Doppler sonography of penis, Peno-Brachial Index (PBI) before and its increase (IPBI) after the intracavernous injection of papaverin, Peak Systolic Velocity (PSV), end diastolic velocity (EDV), Resistance Index (RI), Sexual Encounter Profile questions (SEP-2 and SEP-3), measurements of penile length and curvature angle in the phase of rigidity. After stabilization in plaque''s development (mean time 2.0±0.1 years) the patients underwent a surgery by means of excision of plaque and its replacement by free autograft of buccal mucosa. Results:: After the surgical treatment (with mean follow up observation of 3.2±0.1 years) in 24 patients out of 26 (92.3%) the complete straightening of penis occurred, in two (7.7%) cases a residual curvature (&#60;10°) remained, in four patients (15.4%) the shortening of penis (by 1cm) and in two patients (7.7%) a partial reduction of erectile power were observed. Conclusion:: Buccal mucosa showed high properties of adaptation and revascularization, good anatomical and functional clinical results by replacement of indurative plaque, it kept a stable elasticity without shrinkage; the method is simple and can be recommended for wide use in clinics for surgical treatment of Peyronie''s disease. [Copyright &y& Elsevier]

Abstract: Purpose:: The aim of this study was to investigate the effect of potassium paraaminobenzoate (Potaba™) in Peyronie''s disease in a prospective, randomized, double-blind, placebo-controlled, multicentre study during a 12-months period of treatment. Patients and methods:: 103 patients with Peyronie''s disease and a history &#60;12 months, non-calcified plaques and without pre-treatment were included. 51 were randomized to potassium paraaminobenzoate, 52 to placebo receiving 4×3g/day for 12 months. Follow-up was performed during the treatment period. Response has been defined as regression in plaque-size and/or reduction in penile curvature of at least 30%. Data analysis was focussed on 75 patients who completed the study [valid-cases (VC)]. Results:: No severe adverse events occurred. Response rates were 74.3% on potassium paraaminobenzoate and 50.0% on placebo (p =0.016). Mean plaque-size decreased from 259mm2 to 142mm2 in the treatment arm. In the placebo group, plaque-size aggravated from 259mm2 to 303mm2 after 6 months but improved slightly to 233mm2 after 12 months. Differences between the groups were significant (p =0.042). Pre-existing curvature did not improve under the drug (p =0.066) but comparing the development of new curvature or deterioration of pre-existing curvature under potassium paraaminobenzoate penile deviation remained stable. However, under placebo penile curvature deteriorated significantly in 32.5% of the cases (p &#60;0.001). No significant differences concerning decrease of pain could be observed between the two gropus (82.6% vs. 77.3%). Conclusions:: The results of this study indicate a significant plaque-related effect of potassium paraaminobenzoate. There was no relevant difference with regard to improvement of pre-existing penile deviation. However, under potassium paraaminobenzoate a significant protective effect on deterioration of penile curvature could be demonstrated. Potassium paraaminobenzoate appears to be useful to stabilize the disorder and prevent progression of penile curvature. [Copyright &y& Elsevier]

Abstract: Introduction:: Most surgical therapies used to date for Peyronie''s disease produce good results but cause penis retraction. The authors propose a personal surgical technique that makes use of an intracavernous cylinder, soft but axially rigid in consistency, in association with tunical relaxing incisions and saphenous vein grafting, in this exact sequence. Methods:: Between March 1997 and March 2003, 145 patients presenting with Peyronie''s disease underwent this 3-phase personal surgical procedure. Complete plaque excision was necessary only for 13 patients (8.9%); in the remaining 132, a single incision was placed in 113 cases (77.9%) and double incisions were used for 19 patients (13.1%). Penile length was measured intraoperatively, after drug-hydraulic erection, then at the later control visits. Distance follow-up ranged from a minimum of 6 months to a maximum period of 3 years (mean 13 months); the latter follow-up period was possible for 38 patients. All patients and partners with at least one year follow-up were asked to answer a questionnaire administered over the telephone at 12 months post-surgery. Results:: Average penile lengthening was approximately 1.5cm. 80 patients answered the questionnaire (70.75%): 76 expressed complete satisfaction, while 4 patients reported glans paresthesia. No major complications were noted; for 8 patients circumcision was repeated because of preputial edema. In 6 cases there was a local, postoperative infection, that was treated conservatively with a prolonged antibiotic therapy. Conclusions:: This technique allows to successfully solve penile retraction, caused by traditional surgery for Peyronie''s disease. The technique is easy to carry out, has low risks of complications and ensures very high rates of patient satisfaction. [Copyright &y& Elsevier]

Objective: To evaluate the outcome at long term follow-up after straightening corporoplasty of penile curvature due to Peyronie’s disease.Methods: Between 1986 and 2001 a total of 279 patients with Peyronie’s disease were operated on using the Nesbit procedure. We were able to obtain complete follow-up data in 218 patients. The follow-up data included evaluation of complete correction of the curvature, penile shortening, sexual function, complications and subjective patient satisfaction.Results: After a median follow-up of 89 months subjective patient determination of satisfaction indicated that 83.5% were completely satisfied with the results of surgery. Complete correction of the penis was obtained in 86.3% of the patients. One hundred and ninety patients (87.1%) had good erectile function (IIEF-5 >21). Shortening of the penis (from 1.5 to more than 3 cm) occurred in 38 patients (17.4%), but only in 5 (2.3%) was intercourse difficult because of excessive shortening. Major sensory changes, confined to the glans area, were reported by 24 patients (11%).Conclusion: The Nesbit operation is a simple and safe technique to correct the penile deformity due to Peyronie’s disease. This technique results in the greatest amount of patient satisfaction about erectile function. The procedure can be used to correct all degrees of penile curvature successfully except for the short penis. Informed consent should be amply discussed before operating in regard to the risk of penile shortening and major sensory changes of the glans area. [Copyright &y& Elsevier]

Objectives: In Peyronie’s disease, any kind of plication technique for correcting penile deformities is associated with penile shortening in addition to the disease-related shrinkage. To minimize penile shortening we describe a new technique of penile corporoplasty using a free graft from the tunica albuginea.Patients and Methods: From October 2001 to February 2003 we treated 18 patients with the new technique. All patients had stable Peyronie’s disease with relevant curvature and sufficient erectile rigidity without any signs of inflammatory disease. Penile corporoplasty was performed by incision of the plaques to produce straightening. The resulting gap was covered with a free graft of tunica albuginea removed from the crural segment of the corpora cavernosa.Results: In a preliminary follow-up of 16 patients, 12 penises were straight and 4 had a residual curvature less than 20°. Two patients needed sildenafil for sufficient penile rigidity. Fourteen of 16 patients were satisfactory with the result of penile straightening. No severe perioperative complication was noted.Conclusion: The technique of penile straightening using a free tunica albuginea graft is effective and avoids additional shortening of the penis. As the results are preliminary, the study is continued to gain experience with a larger number of patients. [Copyright &y& Elsevier]

Objective: To compare the value of magnetic resonance imaging (MRI) with palpation and ultrasound in the evaluation of plaque formation in Peyronie’s disease.Methods: 57 patients underwent a standardized diagnostic procedure to evaluate plaque formation consisting of palpation and ultrasonography (7.5 MHz). MRI was performed during flaccidity and during erection induced by Prostaglandin E1 including intravenous application of Gadolinium-diethylenetriaminepentaacetic acid (Gd-DPTA).Results: With all methods, 93 plaques have been detected in 57 patients. 85 plaques (91.4%) have been evaluated by palpation alone. Using ultrasound, 52 of these 93 plaques (55.9%) were detectable. This is equivalent to 61.1% of the palpable plaques. MRI confirmed 58 of the palpated plaques (68.2%) and exposed 8 primarily not palpable plaques at the penile basis. MRI revealed more palpable plaques than ultrasound, but this finding was not significant (p=0.083). By means of sonography, calcification was evident in 14 plaques. MRI failed in revealing any calcification. After application of Gd-DPTA, 5 of 57 patients (9%) demonstrated contrast enhancement indicating local inflammation. None of these patients reported on penile pain.Conclusions: Penile palpation in combination with ultrasound represents the method of choice to diagnose plaque formation in Peyronie’s disease. MRI provides better information on plaque formation at the penile basis. Calcification can only be proven by ultrasound, not by MRI. There may be additional information by MRI about local inflammation. A prospective study comparing the histological and MRI findings should be performed to answer the question, if pain is really associated with inflammation. [Copyright &y& Elsevier]

Objective: Assessment of a long-term follow-up of a previously described technique to correct the curvature of the penis in Peyronie’s disease.Material and Methods: Forty patients (43–69 years old) were operated between 1989 and 1999. The eligibility criteria for surgery were: lesion stabilised during, at least, one year; angulation of 40° or more; and difficult or impossible sexual intercourse. Moreover, the patients had to have good libido, maintained erections and interested sexual partners. The operative technique consisted in making an I-shaped relaxing incision in the zone of higher angulation of the tunica albuginea and the defect created in the tunica was covered with a human duramater graft.Results: The follow-up varied from 1 to 6 years (70%, ≥2 years). Cosmetic results: 95% good, 5% satisfactory (not needing further correction). Functional results: 85% good, 15% erectile dysfunction (10% moderate and 5% severe). Complications: one recurrence, one partial necrosis of the foreskin, nine decreases in the sensibility of the glans (eight recovered after 4–12 months post-operatively).Conclusions: The I-shaped relaxing incision and duramater graft procedure had a satisfactory success rate in the correction of severe Peyronie’s disease. The utilisation of ready to use material (homo or hetero graft) avoids additional surgery, reduces the operative time and possible complications. Like in other procedures, the major problem of this surgery is the erectile dysfunction rate. [ABSTRACT FROM AUTHOR]