[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.

A Review of Treatment-Related Outcomes in Female Partners of Men With Peyronie's Disease-An Opportunity for Improved Assessment.

INTRODUCTION: Peyronie's disease (PD) is a disorder of the penile tunica albuginea, causing penile deformity, shortening, pain, and sexual dysfunction. While studies have shown treatment efficacy for patients, research on treatment-related outcomes for sexual partners is lacking. OBJECTIVES: We sought to review the literature on clinical characteristics and treatment-related outcomes from the perspective of female sexual partners of PD patients. METHODS: We performed a comprehensive literature search of PubMed, Embase, and MEDLINE databases to identify all studies pertaining to PD and partner satisfaction through December 2019. 13 articles that discussed partner satisfaction with treatments of PD including oral, intralesional, and surgical therapy were found in the literature review. RESULTS: At baseline, female partners of men with PD report lower sexual satisfaction and dyspareunia. Results showed that intralesional injection of collagenase Clostridium histolyticum resulted in partner satisfaction in approximately 70% of patients based on differing definitions. Penile plication demonstrated variable partner satisfaction ranging from 34% to 88% whereas plaque incision or partial excision with grafting achieved rates ranging from 90% to 100%. Penile prosthesis implantation resulted in partner satisfaction rates ranging from 40% to 75%. CONCLUSION: PD has a negative impact on psychological and emotional well-being for both patients and their female partners. Surgical and non-surgical treatment for PD has the ability to improve sexual satisfaction of partners. Studies discussed focus on the various forms of treatment for men with PD; however, the available studies were notably limited by small sample sizes, inconsistent use of validated questionnaires, and lack of control groups. In addition, the topic of partner satisfaction discussed in the articles mainly examined the response of female partners and did not discuss effects of the disease on male partners. Clinicians should consider carefully screening PD partners for sexual dysfunction to optimize couple-focused therapy. Further studies are needed to evaluate effects on male sexual partners of PD patients. Parikh NN, Heslop DL, Bajic P, et al. A Review of Treatment-Related Outcomes in Female Partners of Men With Peyronie's Disease-An Opportunity for Improved Assessment. J Sex Med 2020;8:548-560.

At what cost is collagenase clostridium histolyticum viable for treating Peyronie's disease in a public healthcare system?

BACKGROUND: Collagenase clostridium histolyticum is a recognized non-surgical management for Peyronie's disease, licenced for use in the UK for patients with a palpable plaque and a curvature deformity of at least 30°. However, it is not currently funded for use within the National Health Service. Collagenase clostridium histolyticum has also recently been withdrawn from the European and other markets worldwide, but there is potential for this to be produced off-patent in the future. OBJECTIVES: To determine whether collagenase clostridium histolyticum is cost-neutral when compared to surgical management within a public health care system, using the National Health Service as an example. MATERIALS AND METHODS: Two published protocols for the administration of collagenase in Peyronie's disease were identified-the 'IMPRESS protocol' and the 'London protocol'. Costs were taken from published NHS literature. Surgical intervention rates after collagenase clostridium histolyticum administration and primary penile plication were taken from published literature. The costs of the two published protocols were calculated with costs of any repeat surgical intervention were included within each protocol per patient cost. RESULTS: At the current cost per vial of collagenase to the National Health Service, the IMPRESS protocol per patient costs £3,832.77 (143.7%) more than primary surgery, whilst the London protocol costs £70.77 (2.7%) more than primary surgery. DISCUSSION: At a cost of £548.41 per vial, collagenase administered under the London protocol would be a management option for Peyronie's disease cost neutral to primary corrective surgery. CONCLUSION: Central funding of collagenase in a public healthcare system would enable the management of Peyronie's disease to be moved to the outpatient setting. For this to be done at no additional cost to the NHS, it would require a cost reduction per vial of collagenase of £23.59 (4.1%), to a cost of £548.41.

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.

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.

Patient's choice of health information and treatment modality for Peyronie's disease: a long-term assessment.

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.

Should assessment of penetrative sexual activity be used as the treatment arbiter in the management of Peyronie's disease?

Peyronie's disease is an inflammatory disorder, which causes thickening of the tunica albuginea of the penis. Peyronie's disease has a variable natural history and the assessment and management of the disease has yet to be standardised. The case notes of 97 patients with a diagnosis of Peyronie's disease were retrospectively reviewed at a single tertiary referral centre. Patients who were able to achieve sexual penetrative activity to the satisfaction of both partners were managed conservatively. Patients who were unable to achieve penetrative sexual activity were given intra-cavernosal prostaglandin, with those achieving a satisfactory erection being offered appropriate surgical intervention. The mean age at presentation was 50 years (range 18-82). A total of 59 (61%) men were able to have penetrative sex at the time of presentation. Following initial conservative management, only five (8%) of this group had disease progression, which stopped them from being able to penetrate. In all 38 (39%) men who were not able to penetrate at presentation were offered surgical intervention. In all 24 (63%) of these men chose to have surgical intervention. Tunical plication resulted in the ability to penetrate in 77% of men choosing this option whereas only 46% of men undergoing autologous saphenous vein grafting were able to have penetrative sex. Assessment of penetrative sexual function is an essential component of the management of patients with Peyronie's disease. This enables appropriate counselling with respect to possible conservative management or the most appropriate surgical intervention. The majority of patients with Peyronie's disease can achieve sexual penetrative activity, many without surgical intervention.

FastSize Medical Extender for the treatment of Peyronie's disease.

This paper reports on the scientific principles, treatment protocol and initial trial results of the FastSize Medical Extender, a new medical device developed for the treatment of Peyronie's disease and phalloplasty utilizing controlled periodic stretching of the penis; other uses of the device are also mentioned. Initial Institutional Review Boards monitored clinical trials of the device indicate that significant (10-45 degrees ) improvement in curvatures are achievable and that larger scale trials are therefore justified. The device appears to meet a previously unmet need within the population of Peyronie's disease sufferers for a noninvasive, nonsurgical first-option treatment modality. The device works by holding the penis in a cradle and subjecting it to gentle stretching, the tension being provided by small metal extensions that are added to the cradle frame to provide traction against internal springs. Patient education is minimal for the device, but patient compliance with the extended daily treatment procedure is critical for significant curvature change. While a review of appropriate reimbursement codes has not been conducted, the pricing of the device makes it easily affordable. Although it has not yet been formally studied, the device also appears to have applications beyond Peyronie's disease; such as offering potential for offsetting penile shortening prior to implant surgery, preventing shortening following PD penile reconstruction and after radical prostatectomy where loss of penile length is commonly reported. The recent trial noted that, over a 6-month period, patients reported increases in penile length of 1-2.0 cm, with an accompanying increase in girth. There are no alternative devices available that have proven efficacy as a result of a clinical trial and, given reproducible results, the device will begin to play an important role in treatments that require penile tissue remodeling. Future developments should include larger scale, multicenter trials aimed at reproducing the results of the initial study on Peyronie's disease, also trials in conjunction with pharmacological treatment involving plaque remodeling agents such as verapamil and interferon, and trials that will investigate the possible benefits of the device for penile enlargement that may help pre- and postsurgical candidates for penile implants and penile reconstruction following prostatectomy.

[Assessment among German urologists of various conservative treatment modalities for Peyronie's disease. Results of a survey]. / Einschätzung der verschiedenen konservativen Therapieverfahren der Induratio penis plastica unter deutschen Urologen. Ergebnisse einer Umfrage.

BACKGROUND: The aim of this study was to evaluate the frequency and the assessment of the different conservative modalities of treatment in Peyronie's disease. A representative survey among 3187 German urologists was performed using a standardized questionnaire comprising currently used concepts of therapy, their efficacy, and their tolerability. MATERIAL AND METHODS: A total of 636 urologists participated in the study. Altogether they had treated 6019 patients with Peyronie's disease in 2003. The majority of urologists treated between 3 and 15 patients per year. The most frequent treatment modality was the administration of potassium paraaminobenzoate, followed by vitamin E and extracorporeal shock wave therapy. Other oral drugs and intralesional drug administrations were used considerably less frequently. RESULTS: The most commonly used treatment modalities were assessed for the best results in terms of efficacy and tolerability. However, this outcome is contradictory to the few controlled studies regarding the efficacy of the different drugs. CONCLUSIONS: The large number of patients treated demonstrates the importance of conservative therapy for Peyronie's disease. Therefore, it is unfortunate that no conservative treatment modality is currently available that cures the symptoms of this disorder in all patients affected.

Peyronie's disease: assessment and treatment.

PURPOSE: To describe the assessment, diagnosis, appropriate testing, and available treatment options for Peyronie's disease. DATA SOURCES: Selected articles from the medical literature, standard textbooks and online resources. CONCLUSIONS: Clinical hallmarks of the disease include palpable, fibrotic plaques, temporary painful, penile curvature during erection and decreased rigidity of the penis. IMPLICATIONS FOR PRACTICE: Treatment options range from watchful waiting to surgery. Several promising medications, including vitamin E, are being investigated.