Tolerance and efficacy of platelet-rich plasma injections in Peyronie's disease: Pilot study.

INTRODUCTION: Platelet-rich plasma (PRP) injections are increasingly proposed for the treatment of Peyronie's disease since the discontinuation of Xiapex® despite poorly understood results. OBJECTIVES: Evaluation of the tolerance and efficacy of intra-plate PRP injections in patients with Peyronie's disease. METHODS: Three intra-plate injections of PRP were performed 15 days apart in 17 patients with Peyronie's disease. The Peyronie's Disease Questionnaire (PDQ) and the measurement of the angle of curvature of the erect penis were assessed before treatment and then 1, 3 and 6 months after treatment. Erectile function was assessed by different questionnaires (IIEF-EF, EHS, SEP, sexual discomfort score). RESULTS: No side effects were noted during the study period. Three months after treatment, all three PDQ domains were significantly improved (P=0.002; P=0.015; P=0.017 respectively). The angle of curvature of the penis was significantly decreased by 11.8° with a mean angle of 40.4° before treatment and 28.6° after (P=0.007). The IIEF-EF score was significantly improved after treatment (mean preoperative value: 10.67) with a gain of 5 points at months 1 and 6 (P=0.01 and P=0.036 respectively) and 7 points at month 3 (P=0.04). CONCLUSION: Our initial experience suggests that PRP injections for Peyronie's disease are safe. Although the limited data is suggestive of efficacy, a placebo control will be required for confirmation.

[Recommendations of the Committee of Andrology and Sexual Medicine of the AFU concerning the management of andrological and sexual medicine pathologies during the COVID-19 crisis]. / Recommandations du Comité d'andrologie et de médecine sexuelle de l'AFU concernant la prise en charge andrologique et en médecine sexuelle en contexte et en sortie de crise sanitaire liée au COVID-19.

OBJECTIVE: To assist urologists in the management of andrological and sexual medicine pathologies during the COVID-19 crisis. MATERIAL AND METHOD: Use of the formalized consensus method. RESULTS: The medical and surgical management of patients in andrology and sexual medicine must be adapted. Consultations should, as far as possible, be carried out by tele-consultation. For operative procedures, the delay between the operative decision and the date of (re)scheduling of the procedure will depend on: (1) the level of criticality of the clinical situation; (2) the type of intervention; (3) the functional and psychological repercussions, including quality of life while waiting for the procedure; (4) the notion of losing the chance of having an optimal outcome; (5) the risk of potential complications from delaying a procedure for too long; and (6) taking into account the patient's risk factors for severe forms of COVID-19. The protection of urologists from COVID-19 should be considered. Each urologist must make the best decision for the patient, taking into account the acceptable time frame and quality of life impact before surgical management, the COVID risk parameters, the technical and anesthetic feasibility and the structural possibility of the health care institution to ensure a specific dedicated pathway during the COVID-19 health crisis. CONCLUSION: The management of andrological and sexual medicine pathologies must be adapted to the COVID-19 crisis context. Some patients may require surgery, including in emergency. These recommendations are transitional and will end with the COVID-19 crisis.

[French Urological Association (AFU) guidelines for Peyronie's disease assessment and treatment]. / Recommandations pour l'évaluation et la prise en charge de la maladie de Lapeyronie : rapport du comité d'andrologie et de médecine sexuelle de l'AFU.

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.

[Extracorporeal shock wave therapy for Peyronie's disease]. / Traitement de la maladie de Lapeyronie par ondes de choc extracorporelles.

INTRODUCTION: The efficiency of extracorporeal shock waves (SW) for Peyronie's disease (PD) is controversial. METHODS: A systematic review of the literature published between 2000 and 2019 was conducted using the PRISMA methodology. We used Medline data with the following. KEYWORDS: "extracorporeal shock wave therapy" ; "Peyronie's disease"; "Sexuality"; Penile erection. RESULTS: Thirteen articles were selected. Our review showed that SW were beneficial in terms of pain. Regarding plaques size and penile curvature, the results remain divergent. CONCLUSION: SW may be useful in the management of pain in selected patients with PD. Its effectiveness on plaques size and penile curvature needs to be demonstrated through controlled and randomized trials. The population has to be targeted, and the treatment protocol must also be standardized.

[Plaque incision and Tachosil graft in Peyronie's Disease]. / Incision de plaque et greffe de Tachosil chez les patients atteints d'une maladie de Lapeyronie.

INTRODUCTION: Surgery is a treatment for correction of penile curvature in Peyronie's disease. Partial plaque excision and grafting is recommended for severe and complex curvature. METHODS: Patients with stable penile curvature who underwent a partial plaque excision and grafting between January 2017 and April 2018 were retrospectively included. The graft was realized using a self-adhesive collagen fleece (Tachosil®). Penile curvature, penile length and erection score were measured before and after surgery. RESULTS: Twenty-one patients, aged 52,13 (18-70 years) were included. The average follow-up after surgery was 8,36 months (1-14 months). Early complications included two hematomas and one dysuria (Clavien 1). One patient had a penile prosthesis hernia 3 months after surgery, and needed a new surgery (Clavien 3B). Patients stayed at the hospital 1.38 night (1-5) and operating time was 158min (102-249min). Average penile curvature after surgery was 5.88° (0-30°), while it was 82.75° (50-100°) before. Erection score increased from 7.62 (3-10) to 7.86 (4-10). There was no modification of the penile length 11.92cm (11-14.5) after surgery and 12.09cm (10-15cm) before. CONCLUSION: The use of TachoSil® reduces the operative time, is easy to use and has hemostatic properties at a low cost. However, prospective randomized trial and long terms results are required to confirm our encouraging results. LEVEL OF EVIDENCE: 3.

Patient-reported long-term sexual outcomes following plication surgery for penile curvature: A retrospective 58-patient study.

OBJECTIVE: To evaluate long-term sexual function results following plication surgery for the correction of penile curvature using patient questionnaires. METHODS: We performed a single-center, retrospective study in a cohort of patients with Peyronie's disease or congenital penile curvature. All patients who underwent plication surgery on the convex aspect using the Nesbit, Yachia or diamond-shaped techniques were included. At a mean 34 months after the interventions, the patients were asked to respond to the IIEF5 questionnaire and a 19-item questionnaire. RESULTS: Forty-six patients operated for Peyronie's disease and 12 for congenital curvature (total: 58) were included in the study. The questionnaire response rate was 69% (40/58). The shortened penis bothered 47.5% of patients in their sexuality at least regularly. Involuntary exit from the vagina occurred for 35% of the patients in at least one out of two sexual intercourse sessions. Postoperative sexual life was as good as or better than preoperative sexual life for 35% of the patients and 95% stated that they could achieve erection at least sometimes, in coherence with the mean IIEF5 result of 19.3/25. CONCLUSION: Our study suggests that even when successful, a relatively high rate of patients may be unsatisfied with the results of plication surgery, and there may be a relatively low rate of maintenance or improvement of postoperative sexual life. Furthermore, our in-house questionnaire, although not validated, shed light on how bothersome the loss of penis length is in postoperative sexuality, an aspect the IIEF5 and its sole evaluation of erectile quality cannot detect. LEVEL OF EVIDENCE: 4.

[Medical and surgical treatments of congenital and acquired penile curvatures: a review]. / Traitements médicaux et chirurgicaux des courbures de verge congénitales et acquises: revue de la littérature.

INTRODUCTION: The aim of the current study was to provide an overview about the surgical and medical management of acquired and congenital penile's curvature. MATERIALS AND METHODS: [corrected] A systematic review of the literature was done from the PubMed database by searching the following keywords alone or in combination: Congenital penile curvature; Congenital penile deviation; Acquired penile curvature; Acquired penile deviation; Peyronie's disease. RESULTS: The treatment of congenital curvature is only surgical. The most common technique is the Nesbit's technique which consists in making elliptical excisions of the tunica albuginea. There are also incison or plication procedures which are efficient as well. Acquired curvature is most of the time represented by the Peyronie's disease or is post-traumatic. Among oral treatments available, the Potaba is the only drug which has proved a significant reduction in penile plaque size. Injections of interferon and nicardipine have also shown their efficacy. Ionotophoresis and extracorporeal shock-wave therapy may be beneficial for penile pain. Other therapies (vacuum, traction devices, topical Verapamil) can be interesting but other studies are necessary to recommend them. Surgical treatment is recommended during the fibrotic phase. The most common technique is also the Nesbit's technique. In case of severe curvature (curve superior to 60°), small penis, major deformations, graft techniques can be used. Moreover, if there is a sexual dysfunction, penile prosthesis is recommended. CONCLUSION: Other studies are necessary to prove the efficacy of most of the drugs already available in the treatment of the penile curvature. It seems to be interesting to combine the different treatments to improve the results of those therapies.

The impact of Peyronie's disease on couples.

PURPOSE: Peyronie's disease is an acquired fibrosis of penile albuginea which modifies the penile morphology. Few studies described the consequences of Peyronie's disease on the intimate environment. We studied consequences on the patient and on the partner(s). METHODS: We questioned last patients followed in our center and more specifically the partners in a direct way, through an online questionnaire, integrating a validated score (HAD score). RESULTS: Fifty-five patients and 41 partners gave their agreement by answering the questionnaire. Median age was 51.8 years, with a median duration of symptoms of 15 months. Patients described penile deformation (96%), erectile pain (80%) and erectile dysfunction (40%). Patients had penile pain at rest (26%) or sleep disorders (60%). The level of sexual desire was lower in 86%, Penetrative sex was possible in 87%, couple relationship was deteriorated in 40%. Penile deformation bothers 61% of partners. During the stable phase, 60% of patients underwent surgery. HAD score in the general population was 20.24. The 0-60° subgroup was statistically less anxious (10.06 vs. 13.25) and depressed (7.68 vs. 10.05) than the > 60° subgroup (P<0.05). Partners made research on the disease in 51% of cases; the feeling of having been involved in disease management was found in 66% of cases. Most of partners felt powerless or frustrated. CONCLUSION: Peyronie's disease has a certain psychological impact on the couple. It combines depressive and social disorders, a devaluation of patients and an alteration of their intimacy. The role of partners in the management of this pathology is undervalued. This must be a subject of further studies to guarantee optimal overal.

[Lapeyronie's disease]. / La maladie de Lapeyronie.

INTRODUCTION: Lapeyronie's disease is a common condition affecting 3.4 to 9% of the male population. Knowledge of pathophysiology, natural history, and treatment outcomes can guide the care of patients. MATERIALS AND METHODS: A literature review was carried out between 1940 and 2012 in Pubmed using the keywords: Lapeyronie's disease, Peyronie's disease (PD), pathophysiology of PD, surgical treatment for PD, medical treatment for PD. RESULTS: Seventy-five articles were selected, including original articles, reviews, and recommendations in English or French. Few studies available are of level 1 and most of them are of 2b and 3 level of evidence. CONCLUSION: The pathophysiology of Lapeyronie's disease is controversial. Medical treatments are ineffective. Surgery should be proposed when the curvature is stabilized, and the treatment of the concavity or convexity depends on the size of the erect penis, its curvature angle and erectile function. Penile implant must be proposed to patients when erectile dysfunction is combined with severe curvature.