Low-intensity extracorporeal shock wave therapy for Peyronie's disease: a single-center experience / 亚洲男科学杂志(英文版)

The aim of this article is to assess the outcomes of a low-intensity extracorporeal shock wave therapy (LiESWT) protocol for the treatment of Peyronie's disease (PD). Patients treated for PD were prospectively recorded, and data were retrospectively reviewed. Age, characteristics of fibrous plaques, concomitant treatments, International Index of Erectile Function (IIEF-5), Lue score, and pain score on Likert scale were collected. Patients in acute phase of PD and an angulation of <40° were included. The protocol consisted of 6 weekly sessions of 4000 pulses each, applied from different directions, with a maximal power of 20 W and 8 Hz frequency. We included 39 patients (median age: 56.8 years, interquartile range [IQR]: 35.8-62.2 years). The median number of sessions received per patient was 7.2. After treatment, the median Lue score decreased from 6.8 initially to 3.3 (P = 0.003), the median Likert pain score dropped from 1.8 to 0.7 (P = 0.004), the median plaque size was reduced from 2 cm to 1.2 cm (P = 0.08), and the median penile curvature diminished from 31° to 17° (P = 0.07). On univariate and multivariate analysis, the only predictors of success were younger age (odds ratio [OR] = 0.95, P = 0.03 and OR = 0.91, P = 0.04, respectively) and concomitant use of phosphodiesterase-5 inhibitors (PDE5i; OR = 0.92, P = 0.02 and OR = 0.93, P = 0.01, respectively). LiESWT had a favorable impact on Lue score and notably penile pain, curvature, plaque size, and erectile function in patients treated for PD during the early inflammatory phase, with no side effects. Younger age and concomitant use of PDE5i were the only success predictors.

Enfermedad de Peyroni / Disease Peyroni

La enfermedad de Peyroni es un desorden de la ténica albugínea del pene, caracterizado por la formación de placas fibrosas, provocando una curvatura patología del mismo. Este artículo hace una revisión de las opciones terapéuticas y la importancia de un diagnóstico temprano, y de esta manera realizar un adecuado manejo del paciente.

Inner preputial flap as tunica albuginea replacement in the management of previously untreated fracture of the penis

To assess the efficacy of an inner preputial skin flap as replacement for the tunica albuginea of the corpus cavernosum after excision of fibrous plaque. Patients and Methods In this retrospective study we evaluated 5 men who presented with impotence; chordee; painful erection and/or painful coitus after previously undiagnosed or untreated penile fracture. In two patients soft tissue X-rays suggested calcification of the plaque; while ultrasonography revealed extension of fibrosis in four cases. In all patients the plaque was excised and the defect in the tunica albuginea was closed with an inner preputial pedicle skin flap. Results The flaps had taken well in all cases at 3 months follow-up and all patients reported having normal sexual intercourse. Conclusion Surgical excision is the treatment of choice for management of symptomatic fibrous plaques occurring in undiagnosed; untreated or conservatively managed penile fracture. A defect of more than 1.5 cm after excision of the plaque requires tunica replacement; and an inner preputial flap is a good replacement

Vitamina E associada a terapia extracorpórea por onda de choque no tratamento da doença de Peyronie / The association of high dose vitamin E and extracorporeal shockwave therapy in the treatment of Peyronie's disease

Doença de Peyronie consiste em deformidades penianas adquiridas durante a ereção (curvatura, indentação, deformidade em ampulheta ou encurtamento). É caracterizada por placas fibróticas da túnica albugínea do pênis.(au)

An alternative non-invasive treatment for Peyronie's disease

OBJECTIVE: Surgical correction of the deformity and plaque caused by Peyronie's disease has some important disadvantages and extracorporeal shockwave therapy (ESWT) emerged as a new promising therapy. We evaluated prospectively the efficacy and safety of the association of high dose vitamin E and ESWT as a non-invasive treatment for the disease. MATERIALS AND METHODS: Twenty-five patients 42 to 68 years old (mean = 54) presenting penile deviation and sexual distress caused by Peyronie's disease were treated in a non-invasive manner. The time of penile deviation ranged from 16 to 52 months (mean = 30). All patients had previous unsuccessful treatment for Peyronie's disease. The angulation's deformity of the penis was assessed by photography at home. The patients received vitamin E (l.200 mg daily) during 3 months and underwent 3 to 6 sessions (mean = 3) of ESWT (3,000 to 4,000 shockwaves) at a power level of l to 2 at 1-week intervals. RESULTS: From 25 patients treated, 16 (64 percent) reported an improvement in penile angulation, with a mean reduction of 21 degrees (10 to 40). Eight patients reported improvement in their spontaneous erections. Overall, the patients presented only minimal bruising at the site of treatment and skin hematoma. Four patients presented urethral bleeding. The mean angulation after treatment in the control group was 48.67 degrees (30 - 70) and in the study group was 24.42 degrees (0 - 70), statistically significant. CONCLUSION: Considering the common complications and the unsatisfactory outcome of the surgical correction for Peyronie's disease, the association of high dose vitamin E and ESWT represents a good option for a non-invasive, effective and safe treatment of the penile deformity.

disfunção erétil / erectile dysfunction

A disfunção erétíl é a persistente incapacidade de se atingir ou manter uma ereção suficiente para uma relação sexual satisfatória. No Brasil, encontrou-se algumgrau de disfunção erátil em 39,8 por cento da população estudada. Até 1996, os tratamentos recomendados para disfunção erétil eram os dispositivos a vácuo, terapia com drogas vasoativas injetáveis e prótese peniana, quando foram publicados os primeiros resultados clínicos do uso de citrato de sildenafil. A introdução do sildenafil no diagnóstico e tratamento da disfunção erétil determinou uma revolução não apenas médica e científica, mas principalmente social e cultural O alto índice de sucesso, com obtenção de ereções fisiológicas, o que era impossível até então, efeitos colaterais discretos e fácil administração fazem do sildenafíi e dos novos ínibidores da fosfodiesterase não só a primeira opção terapêutica da disfunçáo erétil, como toma a sua investigação clinicamente desnecessária. Para a pequena parcela de pacientes que não responde ao sildenafil, à tadalafila ou ao vardenafil, os tratamentos de segunda e terceira linhas são indicados. A auto-injeçáo de drogas vasoativas e o implante de próteses penianas continuam representando terapias de grande sucesso, mas, devido a suas características mais invasivas, devem ser reservadas para pacientes mais graves. Como vimos, o tratamento da disfunção erétil passou a apresentar alto índice de sucesso, com grande conforto e segurança para o paciente, porém a sua cura ainda é bastante difícil. Contudo, num futuro não muito distante, a terapia gêníca será utilizada para vencermos de forma definitiva a disfunção erétil, anulando o seu impacto marcante na qualidade de vida dos nossos pacientes e daqueles com quem se relacionam.

Intralesional verapamil injection in treatment of Peyronie's disease. Preliminary results

Objective To evaluate the efficacy of intra-lesional verapamil injection in the treatment of Peyronie's disease. Patients and Methods Twenty-six patients with Peyronie's disease were divided into two groups: the verapamil treatment group (study group) including 13 patients and the saline group (control group) including another 13 patients. The patients' age ranged from 35 to 58 years with a mean age of 43.75 years. The patients in the study group were subjected to a weekly injection of 10 mg verapamil hydrochloride (5 mg / 2 ml) into the plaque for the duration of six weeks. At the same time; the patients in the control group received a weekly injection of normal saline into the plaque; also for the duration of six weeks. The patients' response to the injections was evaluated subjectively with respect to pain and sexual dysfunction and objectively with respect to the plaque volume and the degree of curvature. Results Following therapy; pain was improved in 8 of 9 patients (88.9) of the patients in the verapamil group; while in the control group it was stationary in 6 of 8 patients (75) and had progressed in 2 of 8 patients (25). Curvature was improved in 5 of 10 patients (50) and remained unchanged in 5 of 10 patients (50) of the study group; while no improvement could be recorded in any of the patients of the control group. Three of five patients (60) of

Tratamiento de la enfermedad de Peyronie con interferón beta natural / Treatment of la Peyronie's disease with natural interferon

Se trataron 10 pacientes con enfermedad de Peyronie mediante la aplicación intralesional de interferon beta natural humano (IFNbeta). La edad media de los pacientes fue de 49 años, con límites de 37 a 67 años, y el tiempo promedio de evolución de la enfermedad fue de 11.9 meses. Se efectuó una aplicación promedio de 36 millones de unidades internacionales (que equivale a 12 aplicaciones, ya que cada ampolleta contiene 3 millones de unidades internacionales). Se logró hacer desaparecer el dolor en 100 por ciento de los pacientes; en 80 por ciento la curvatura disminuyó y en 87 por ciento decreció la placa fibrosa. No se observaron efectos secundarios graves ni complicaciones mayores. El IFNbeta aplicado en forma intralesional es un medicamento sumamente eficaz para el tratamiento de la enfermedad de Peyronie.

Doença de Peyronie: tratamento clínico e fisioterapêutico local das placas fibrosas em um paciente / Peyrone's disease: local clinical and physiotherapeutic treatment of the fibrous plaque in a patient

A doença de Peyronie é caracterizada por placas fibrosas na túnica albugínea e tecidos envoltórios do corpo cavernoso, levando a dor e tortuosidade penianas, sendo sua etiopatogenia ainda desconhecida. O autor apresenta os resultados dos tratamentos medicamentosos e fisioterápico das placas fibrosas de um paciente com funçao erétil normal, em que as placas desapareceram enquanto o mesmo evoluía para uma disfunçao erétil de causa venoclusiva. Conclui-se que esse tratamento é uma alternativa aos tratamentos cirúrgicos em pacientes com doença de Peyronie em fase inicial, sendo feitas consideraçoes sobre a etiopatogenia dessa doença.

Enfermedad de Peyronie: informe de cinco casos tratados con interferón alfa dos B y colchicina / Peyronie's disease: report of five cases treated with alpha 2 B interferon and colchicine

La enfermedad de Peyronie es una induración en superficie dorsal o lateral del cuerpo cavernoso que desvía al pene hacia el lado afectado. Los interferones (alfa 2 B y beta) ejercen actividad antifibrótica mediante inhibición del fibroblasto y bloqueo de la producción de colágena. La colchicina produce colapso del retículo endoplásmico rugoso, y reducción de los miofilamentos y la colágena. Se realizó un estudio prospectivo, comparativo y no al azar, con la finalidad de comparar el tratamiento de pacientes con enfermedad de Peyronie con la inyección intralesional de interferón alfa 2 B en dos casos, la utilización de interferón por la misma vía, más colchicina por vía oral en otros dos casos y colchicina solo en uno. La mejoría (subjetiva y objetiva) con el tratamiento de interferón es satisfactoria, pero más lenta que en los pacientes tratados con interferón y colchicina. En el enfermo tratado con colchicina sola, hubo mejoría de los síntomas, sin disminución de la placa. Se concluye que el interferón alfa 2 B es útil para disolver las placas de fibrosis y aumenta su efecto con la utilización simultanea de colchicina por vía oral, lo que se logra más rápidamente y con menores dosis de interferón

Laserterapia para el tratamiento de la enfermedad de Peyronie (induración plástica del pene) / Lasertherapy for the treatment of Peronie's disease

Este estudio consistió en la aplicación de laserterapia a pacientes con enfermedad de Peyronie. Se llevó a cabo de marzo de 1992 a septiembre de 1993 en los servicios de Urología y Medicina Física y Rehabilitación del Hospital de Especialidades de C.M.O., Guadalajara, Jal., México, e incluyó en total a 17 pacientes con este trastorno patológico. El tratamiento consistió en dar 20 sesiones con un aparato emisor de láser del tipo de Helio-Neón de mediana potencia a cada paciente. Los resultados se valoraron al término del tratamiento. Los aspectos a evaluar fueron dolor, curvatura, patrón de relación sexual e involución o desaparición de la lesión (placa). En 63.6 por ciento de los pacientes ocurrió paliación del dolor, en 76.5 por ciento estabilidad de la enfermedad y en 52.9 por ciento disminución en el tamaño de la lesión (placa)

Tratamento cirurgico da doença de Peyronie / Surgical treatment of Peyronie's disease

Os autores avaliam o tratamento cirurgico de 8 pacientes com doença de Peyronie na fase estabilizada sintomatica. Em 4 dos pacientes foi realizada a corporoplastia tipo Nesbit; tres pacientes passaram a apresentar relaçao normal, sem nenhum metodo auxiliar. Um paciente necessitou de complementaçao com utilizaçao de droga vasoativa. Nos outros 4 pacientes devido a extensao da placa, foi realizada a exerese da placa e enxerto livre da fascia lata em 3 pacientes e com derme em um, com resultados inferiores ao da corporoplastia tipo Nesbit