53 Low-intensity Extracorporeal Shockwave Therapy as an Adjunct to Xiaflex® in the Treatment of Peyronie's Disease
Ayman SoubraJ KimH KimJacob GreenbergNicholas OttaianoRohan MorenasBenjamin ChackoWilliam P. WisenN FatimaBrian DickShams HalatWael AlmajedO RaheemAsim B. Abdel‐MageedW Hellstrom
1
Citation
0
Reference
10
Related Paper
Citation Trend
Keywords:
Extracorporeal shockwave therapy
Extracorporeal
Tunica albuginea (penis)
Sham surgery
Tunica albuginea (penis)
Penile curvature
Cite
Citations (0)
Extracorporeal shockwave therapy (ESWT) has been on the rise for the treatment of Peyronie's disease. There have been 21 original papers, 1 meta-analysis, and 2 review articles published. Analyzing these studies systematically, ESWT seems to have an effect on penile pain during erection and on the improvement of sexual function. It seems that pain resolves faster after ESWT treatment than during the course of natural history. The effect on plaque size and penile curvature is less impressive. The most recent studies do not provide evidence that ESWT has an effect on curvature and plaque size. Despite the lack of severe side effects, the data concerning efficacy published to date do not justify recognizing ESWT as an evidence-based, standard procedure for the treatment of Peyronie's disease.
Extracorporeal shockwave therapy
Penile curvature
Extracorporeal
Cite
Citations (0)
Extracorporeal shock wave therapy (ESWT) for Peyronie's disease is still a topic of debate. We evaluated the effects of ESWT in a large series of patients with Peyronie's disease via a prospective approach.In a prospective study 114 patients with Peyronie's disease were treated with ESWT. Baseline and followup examinations included ultrasound, and measurement of plaque size and curvature. Symptomatology was evaluated based on a standardized interview. A Minilith SL1 (Storz Medical AG, Kreuzlingen, Switzerland) lithotriptor was used with 4,000 shock waves at a maximum energy level of 0.17 mJ/mm2 applied per session.A total of 96 patients were available for followup. Considering the total study group no significant changes in penile curvature, plaque size or sexual function were observed despite significant improvements in patients with a curvature of 31 to 60 degrees. Penile pain ceased in 76% of the affected patients.According to our data ESWT does not appear to be significantly effective for decreasing penile curvature and plaque size or improving sexual function in the total population of patients with Peyronie's disease despite improvements in individuals. Penile pain seems to resolve earlier than during the natural course. Regarding the results of this study and previous reports with exact documentation of the clinical findings it can be concluded that ESWT cannot be recommended as a standard procedure for Peyronie's disease. To evaluate the exact efficacy of ESWT a controlled, single-blind, multicenter study with exact documentation of symptoms is urgently required.
Extracorporeal shockwave therapy
Penile curvature
Extracorporeal
Cite
Citations (54)
You have accessJournal of UrologySexual Function/Dysfunction/Andrology: Peyronie's Disease/Surgical Therapy I1 Apr 20101072 TUNICA ALBUGINEA CRURAL GRAFT FOR SEVERE PENILE CURVATURE DUE TO PEYRONIE'S DISEASE: 07 YEARS FOLLOW-UP Claudio Teloken, Patrick E. Teloken, Tulio Graziottin, Caio Schmit, and Rodrigo Blaya Claudio TelokenClaudio Teloken More articles by this author , Patrick E. TelokenPatrick E. Teloken More articles by this author , Tulio GraziottinTulio Graziottin More articles by this author , Caio SchmitCaio Schmit More articles by this author , and Rodrigo BlayaRodrigo Blaya More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.2231AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Surgery management of severe penile deformity due to Peyronie's disease is surgically challenging. Various surgical techniques and graft materials have been used; however most of them exhibited suboptimal long-term results, especially with regard to curvature recurrence and erectile dysfunction, infection and abnormal scars. We first described the use of tunica albuginea crural graft (TACRUG) and present herein the long-term follow-up results, based upon the principle that the graft comes from human in addittion from the same organ. METHODS We conducted a chart review of patients with preserved erectile function or erectile dysfunction (ED) responding to PDE-5 inhibitors who had undergone plaque incision and graft with TACRUG for stable penile deformity precluding vaginal intercourse. The TACRUG is obtained through a 3-cm longitudinal perineal incision. A longitudinal segment of proximal corpus cavernosum 2mm larger than the defect is delimited with methylene blue, preserving the cavernous artery entry point, and carefully removed. A segment of tunica from the contralateral corpus cavernosum may also be retrieved if necessary. The corpus caversonum then is closed with running 4-0 polyglactin suture. Graft is tailored accordin to the gap to be occluded. RESULTS One hundred and two patients with a mean follow up of 78 months (range 12 to 95) were included in this analysis. Mean age was 54 years (range 42 to 75). Intraoperative penile straightening was obtained in 95 % of all cases. Curvature recurrence requiring new procedure 8% OF patients. Penile shortening was observed in 7 patients and 10 reported glans numbness. Out of 74 patients who reported preoperative spontaneous erections 10 developed postoperative ED, 6 responded to PDE-5 inhibitors. Of 16 patients who preoperatively responded to PDE-5 inhibitors, 6 became unresponsive. Overall, 14 patients subsequently underwent penile prosthesis implantation. 81.7% classified the postoperative result as excellent or satisfactory CONCLUSIONS The TACRUG is easily obtained, does not carry the risk of rejection or transmission of infectious diseases, does not add costs and affords satisfactory long-term results. Despite the lack of a control group, based on our experience and published data, the TACRUG seems to be associated with less curvature recurrence and does not appear to increase the risk of ED when compared to other graft materials. Porto Alegre, Brazil© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e418 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.Metrics Author Information Claudio Teloken More articles by this author Patrick E. Teloken More articles by this author Tulio Graziottin More articles by this author Caio Schmit More articles by this author Rodrigo Blaya More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...
Tunica albuginea (penis)
Penile curvature
Tunica
Cite
Citations (0)
You have accessJournal of UrologyScience & Technology Posters1 Apr 2016S&T-51 EXTRACELLULAR MATRIX CHARACTERISTICS OF TUNICA ALBUGINEA IN MEN WITH AND WITHOUT PEYRONIE'S DISEASE Andre V. Oliveira, Marcelo S. Watanabe, Maria Aparecida Pinhal, Monica Luzia Leonel, Thérèse R. Theodoro, and Sidney Glina Andre V. OliveiraAndre V. Oliveira More articles by this author , Marcelo S. WatanabeMarcelo S. Watanabe More articles by this author , Maria Aparecida PinhalMaria Aparecida Pinhal More articles by this author , Monica Luzia LeonelMonica Luzia Leonel More articles by this author , Thérèse R. TheodoroThérèse R. Theodoro More articles by this author , and Sidney GlinaSidney Glina More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2880AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Peyronie's disease (PD) is characterized by the formation of fibrous plaques in the tunica albuginea (TA) of the penis, causing pain and penile curvature during erection, with great impact on quality of life of patients. There is a lack of highly effective medical treatments for PD, mainly because it’s pathophysiology is not completely understood. The aim of this study was to compare possible markers related to alterations and remodeling of extracellular matrix which can be involved on the development of the disease in men with and without PD METHODS Samples of TA of 10 patients with PD were obtained at the moment of surgical correction of penile curvature. Samples of TA of 10 corpses with normal penis at the physical exam were obtained (control group). Tissues were processed and stained with Hematoxilin, submitted to immunohistochemistry (IHQ) with the following primary antibodies: heparanase (HPSE), heparanase2 (HPSE2), metalloproteinases 2 and 9 (MMP2 and MMP9) and TGF-ß. IHQ reaction used peroxidase kit LSAB®-peroxidase (DakoCytomation®, Copenhagen, Dinamarca). Genic expression of heparanase-1 (HPSE), heparanase2 (HPSE2), metalloprotease 9 (MMP9), syndecan 1 (SYN1), interleukin 6 (IL-6), hyaluronic acid sintetase 1 e 2 (HAS1 e HAS2), hyaluronidases 1 e 2 (HYL1 e HYL2), was done by quantitative RT- PCR (qRT-PCR). Statystical analyses were done using software Graph PRISM 5®. Project was reviewed and approved by the Research Ethical Committee of Faculdade de Medicina do ABC, (# 242/2010). RESULTS Histopathological evaluation showed higher number of cells, reduction of apoptosis events, alteration of the distribution of collagen fibers and diminished number of vessels on TA of patients with PD compared to the controls TA. qRT-PCR analysis showed increased concentration of TGF-ß and interleucine-1 reduction on HSPE-1 expression and decreased concentration of dermatan sulfate and chondroitin sulfate in patients with PD (p<0.05). However, there were no alterations on HPSE2, MMP2 e MMP9 expressions. Those findings suggest a higher remodeling of extracellular matrix in patients with PD. CONCLUSIONS In comparison with the controls the TA of patients with PD showed lesser number of vessels and apoptosis events; increased concentration of TGF-ß and interleukin-1, reduction of heparanase-1 expression and decreased concentration of dermatan sulfate and chondroitin sulfate. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e329 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Andre V. Oliveira More articles by this author Marcelo S. Watanabe More articles by this author Maria Aparecida Pinhal More articles by this author Monica Luzia Leonel More articles by this author Thérèse R. Theodoro More articles by this author Sidney Glina More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...
Tunica albuginea (penis)
Penile curvature
Tunica
Cite
Citations (0)
Peyronie's disease, the etiology of which remains unknown, is characterized by a focal or multifocal disorder of penile tunica albuginea. An excessive collagen deposition gives rise to the formation of the plaque, which is fibrotic first and then becomes calcific. Typical symptoms of the disease are painful erection, pathological bending of the erect penis and impotence at the more advanced stages (43% of the cases). There is evidence that the tunica albuginea has a fundamental role in the erection mechanism. We evaluated the tunica albuginea of patients suffering from Peyronie's disease, with or without impotence, and found progressive disorders of the microstructure in areas that were not affected by fibrocalcific formations. There was a significant decrease (p < 0.0001) of elastic fiber concentration (55.05 +/- 23.83 per high power field) in patients with Peyronie's disease compared to the concentration in the tunica albuginea of a control group (128.50 +/- 11.79 per high power field). Moreover, when the elastic fiber concentration in the tunica albuginea of patients Peyronie's disease and normal erection (71.36 +/- 12.00 per high power field) was compared to the concentration in the tunica albuginea of those with Peyronie's disease and impotence (33.14 +/- 4.84 per high power field) a significant difference was noted (p < 0.0001).
Tunica albuginea (penis)
Elastic fiber
High-power field
Cite
Citations (55)
Tunica albuginea (penis)
Penile curvature
Cite
Citations (0)
Extracorporeal
Extracorporeal shockwave therapy
Cite
Citations (0)
Peyronie’s disease (PD) is a connective tissue disorder characterized by inelastic fibrous plaques on the tunica albuginea of penis. Inelasticity induce penile deformity such as curvature, shortening, narrowing, hinging and also associated with penile pain and erectile dysfunction. The pathogenic mechanisms of the disorder are still poorly understood although physicians believed that the trauma to the tunica albuginea leads to excess inflammation in some men resulting in inflammatory mass formation in the early stage, then disruption of the normal cell architecture through deposition of collagen fibers and breaking down the elastic fibers create the “plaque”.
Tunica albuginea (penis)
Connective Tissue Disorder
Penile curvature
Cite
Citations (1)