Real-world practice in Peyronie's disease management: Results from a national survey of urologists.

BACKGROUND: Despite many available treatments for Peyronie's disease (PD), practice patterns of available therapeutics are not well characterized. OBJECTIVE: We conducted a national survey of urologists to characterize real-world practice patterns of PD management and to characterize the use of therapies discouraged by the American Urological Association guidelines on PD management. MATERIALS AND METHODS: A 34-item survey was distributed via RedCap to urologists who treat patients with PD in all American Urological Association sections. Questions elicited demographic information as well as practices in the diagnosis and treatment of PD. Comparisons were made with Pearson's chi-squared test. The primary outcome was reported use of therapies discouraged by the American Urological Association guidelines on PD. RESULTS: A total of 145 respondents completed the survey, of whom 19% were fellowship trained in andrology/sexual medicine, 36% practiced in an academic setting, and 50% had at least 20 years in practice. Only 60% of respondents reporting performing in-office curvature assessment prior to commencing intralesional injection or surgical treatment, with higher prevalence in andrology/sexual medicine fellowship-trained versus non-fellowship-trained urologists (85% vs. 54%, p = 0.003). The most popular treatment modalities were collagenase clostridium histolyticum (61% of respondents), phosphodiesterase-5 inhibitors (54%), and penile traction (53%). Twenty-one percent of respondents reported currently using a treatment that is explicitly discouraged by the American Urological Association guidelines (extracorporeal shockwave therapy for curvature, L-carnitine, omega-3 fatty acids, or vitamin E). DISCUSSION: Patients seeking PD treatment may be offered different therapies, some of which are not evidence-based, depending on the treating urologist. This study is limited by self-selection and response bias. Its strength is that it represents a cross-sectional overview of real-world practice patterns in PD management, which has not been previously described. CONCLUSIONS: A significant proportion of urologists reported PD management practices that are not evidence-based and not guideline-supported.

A systematic review of non-surgical management in Peyronie's disease.

The efficacy of many non-surgical treatments for Peyronie's disease is unclear. This systematic review aims to critically assess the currently available options and provide a recommendation for treatment based on this. A systematic literature search utilising the Medline (Pubmed), Embase, global health and Cochrane library databases was conducted up to May 2021. All randomised controlled trials assessing non-surgical treatment modalities for Peyronie's Disease were included. Individual study risk of bias was evaluated using the Cochrane tool and GRADE was used to assess evidence strength. Outcome measures were the change in penile curvature (degrees), plaque size (volume or size), International Index of Erectile Function score, pain scores and change in penile length. Prospero registration number: CRD42017064618. Amongst the 5549 articles identified, 41 studies (42 reports) were included. Seven different oral treatment options including vitamin E supplementation showed evidence for improving outcomes such as penile curvature and plaque size. Of the intralesional treatments, Collagenase Clostridium Histolyticum showed evidence for improving penile curvature (Range: 16.3-17 degrees, moderate level certainty of evidence). Intralesional Interferon demonstrated some improvement in curvature (Range: 12-13.5 degrees), plaque size (Range: 1.67-2.2 cm2) and pain, whilst intralesional calcium channel blockers such as Verapamil showed variable evidence for changes in the plaque size and pain. Extracorporeal Shockwave Therapy consistently demonstrated evidence for improving penile pain in stable disease, and two mechanical traction devices improved curvature. Iontophoresis, topical medications, and combination therapies did not demonstrate any consistent improvements in outcome measures. Intralesional options demonstrate the best potential. Overall, results varied with few high-quality randomised trials present.

[Research progress on penis cavernosa fibrosis].

Penis cavernosa fibrosis is an important cause of refractory erectile dysfunction.Its exact pathogenesis remains incompletely elucidated, and conventional treatment is not effective, seriously affecting the quality of life, physical and mental health of men. With the deepening of research, the progress of two-dimensional shear wave elastography (2D-SWE) and molecular imaging provides the possibility for the early diagnosis, grading and staging of cavernous fibrosis. Studies on stem cell therapy, energy-based treatments, targeted therapy, and traditional Chinese medicine show promising applications in the anti-penile cavernous fibrosis. This article reviews the research progress in the diagnosis and treatment of penile cavernosis fibrosis.

Corporoplasty under local anesthesia: Cost-effective improvement of the surgical treatment of Peyronie's disease.

INTRODUCTION AND OBJECTIVES: Peyronie's disease produces penile curvature that leads, in certain cases, to difficulties in having satisfactory sexual relations. The objective of this study is to evaluate the functional and cost-effectiveness results obtained in the surgical treatment of penile curvature due to Peyronie's disease under local anesthesia, comparing them with those performed under a general-spinal anesthesia regimen. MATERIAL AND METHODS: Two groups of patients undergoing corporoplasty are compared according to the type of anesthesia used. Group 1 consists of 32 patients who underwent major outpatient surgery and under local anesthesia from June 2016 to June 2019. Their data are collected prospectively. Group 2 consists of 30 patients who underwent surgery under general/spinal anesthesia with hospital admission, from January 2013 to December 2015, with their data collected retrospectively. Anesthetic and surgical procedure, postoperative functional results, degree of satisfaction and hospital costs between both groups are analyzed, considering p≤0.05 as statistical significance and analyzing the results with the SPSS 20.0 program. RESULTS: Of the 32 patients included in group 1, none required admission for intra or postoperative complications. In both groups, an improvement of the PDQ-test was observed without statistically significant differences, with the degree of global satisfaction above 95% in both groups. There were also no differences in the appearance of complications secondary to the anesthetic procedure or the hospital regime. We observed differences in hospital costs, being 44% lower for the group performed with local anesthesia. CONCLUSIONS: Surgical treatment of penile curvature under local anesthesia improves the cost-effectiveness ratio with the same quality of care, degree of satisfaction and postoperative functional results, maintaining a similar rate of intra/postoperative complications. For this reason, we consider that corporoplasty can be successfully performed under local anesthesia.

Specific urogenital disease information-revealing male genital votive offerings dedicated to gods in ancient age sanctuary medicine. / Información en los votivos de órganos genitales masculinos sobre enfermedades urogenitales, en las ofrendas a dioses en la antigua medicina para la sanación.

OBJECTIVES:  The people of ancient age appealed to sanctuaries of different gods and goddesses they believed to have healing powers and consecrated anatomical votive offerings representing their sick or healed organs. Male genital organ votives were also present among these votives. In this article, male genital organ votive offerings presented to gods and goddesses were examined and the votives giving information about the diseases they indicated were revealed in contemporary medicine. METHODS: Information available in written resources on ancient medicine and diseases was reviewed. Main sanctuary healing centers in Anatolia (Asia Minor), Greece and Italy which concurrently hosted similar civilizations were investigated. Male genital organ shap anatomical votive samples in national and foreign medical history and archaeology museums, galleries and special collections were investigated and examined. RESULTS:  It was observed that most male genital organ votives had a healthy and normal structure and didn't provide any specific information on a urogenital disease. But it was also observed that some votives among genital organ votives consecrated by sick individuals to gods demonstrated some urogenital diseases and conditions. Among this very limited number of genital votives providing disease information, votives indicating phimosis, hypospadias, varicocele, penile hemangioma or condylama, Peyronie's disease or penile curvature, genital hidradenitis suppurativa, condition of pubic hair and erectile condition of penis were detected. CONCLUSIONS: As proofs of seeking a remedy for diseases or recovering from diseases, anatomical organ votives are very important to understand ancient sanctuary medicine. Among male genital organ votives, very limited number of samples providing specific information on diseases provided us important information so that we can understand some ancient age diseases.

OBJETIVOS:  Los habitantes de la era antigua acudían a santuarios de distintos dioses con la creencia de que éstos tenían poderes curativos y les entregaban ofrendas votivas de partes anatómicas enfermas, bien para que fueran sanados o como ofrenda una vez sanados. Entre estas ofrendas votivas encontramos órganos reproductores masculinos. En este artículo se han revisado y examinado estas ofrendas votivas de órganos reproductores masculinos y de ello se ha podido obtener información sobre enfermedades que existen en la medicina contemporánea. MÉTODOS: La información presente en escritos de medicina ancestral y enfermedades se revisó. Los principales santuarios de sanación en Anatolia (Asia Menor), Grecia e Italia que de forma concurrente tuvieron diferentes civilizaciones, fueron investigadas. La forma del órgano genital masculino en muestras votivas de historia de la medicina nacional y extranjera, museos arqueológicos, galerías y colecciones especiales, fueron investigadas y examinadas. RESULTADOS: Se observa que la mayoría de votivos de órganos genitales masculinos tenían una forma natural y sana y no proporcionaban ninguna información especial respecto a enfermedades urogenitales. Aunque también se observó que algunos votivos de individuos enfermos a dioses si presentaban algunas enfermedades urogenitales y condiciones especiales. Entre los votivos enfermos, encontramos votivos con fimosis, hipospadias, varicocele, hemangioma peneanos y condilomas, enfermedad de Peyronie o curvatura peneana, hidradenitis genital supurativa, desarrollo de pelo púbico y condiciones eréctiles del pene. CONCLUSIONES: Como prueba del interés por encontrar un remedio a las enfermedades o recuperarse de enfermedades, los votivos de órganos anatómicos fueron muy importantes para entender la medicina antigua. Entre todas estas ofrendas votivas de órganos genitales, a pesar de que un número muy limitado de ellas nos ha proporcionado información concreta sobre enfermedades, la información obtenida en ellas ha sido crucial para entender algunas de las enfermedades de la edad antigua.

Treatments of Peyronie's disease with Scutellaria baicalensis and surgery according to the disease course: a single-center retrospective study of 261 patients.

BACKGROUND: Oral medication therapies are more conventional than other non-surgical therapies in the acute phase of Peyronie's disease (PD). Although the commonly used oral drugs for PD have shown poor or indeterminate outcomes, most patients prefer oral medications. The aim of this study was to evaluate the efficacy and safety of Scutellaria baicalensis extract for treating acute-phase PD patients and examine the practicality of treatment strategies for PD according to the disease course. METHODS: This retrospective study was performed at our institution from 2005 to 2015 and analyzed the data of 261 patients with PD. The acute-phase PD patients received Scutellaria baicalensis extract for 6 months. After oral treatment, the patients with persistent curvature underwent surgical correction during the stable phase. RESULTS: During this study period, 183 patients received oral treatment with Scutellaria baicalensis, and 78 patients did not. Compared to the untreated patients, treatment with Scutellaria baicalensis had a significant effect in improving the symptoms of acute-phase PD. The mean time required for stabilization also showed a significant statistical difference. Treatment with Scutellaria baicalensis was safe and well-tolerated. After the disease stabilized, 70 and 31 patients with significant penile curvature underwent surgical correction by 16- dot plication and great saphenous vein grafting procedures, respectively. At the one-year follow-up, complete penile straightening and penile length shortening were observed in 92.86% and 41.43% of the patients after 16-dot plication and in 87.10% and 25.81% of the patients after grafting procedures, respectively. The postoperative Erectile Function domain of the International Index of Erectile Function scales were maintained in all patients after the 16-dot plication procedure and decreased in 54.84% of the patients after the grafting procedure. Overall, 92.86% and 83.87% of the patients who received 16-dot plication and grafting procedures, respectively, were satisfied with the final surgical results. CONCLUSIONS: Treatment with extract of Scutellaria baicalensis seems to be beneficial for improvements in symptoms of acute phase PD and acceleration of the disease stabilization. The 16-dot plication and great saphenous vein grafting procedure seem effective options in the surgical management of the stable phase after Scutellaria baicalensis administration in the acute phase of PD.

Peyronie's disease: what do we know and how do we treat it?

INTRODUCTION: Peyronie's disease is a common, benign condition characterized by an acquired penile abnormality due to fibrosis of the tunica albuginea. This may lead to penile curvature, deformity, discomfort, pain, and erectile dysfunction, resulting in emotional and psychosocial effects on patients. Therefore, it is important for urologists to thoroughly evaluate the extent of the patient's bother and discuss treatment goals, therapeutic options, and expectations. MATERIALS AND METHODS: We provide a review of the current landscape for the diagnosis, management, and treatment of Peyronie's disease, including oral, topical, intralesional, external energy, and surgical therapies. RESULTS: The hallmark of managing Peyronie's disease is attentive patient counseling. Patients may be hesitant to discuss their symptoms unless inquired directly and may not be aware that treatments exist. It is not uncommon for Peyronie's disease to be diagnosed incidentally during a routine or unrelated healthcare visit, with reported rates of incidental diagnosis as high as 16%. Treatment options are stratified by disease phase which is defined by whether symptoms (e.g. penile deformity and discomfort) are actively changing or have stabilized. Conservative therapy is the most common recommendation during the active phase with more invasive treatments reserved for the passive phase. Conservative therapy may include oral or topical medication, intralesional injection, and external energy therapy. These treatments may also have a role in improving symptoms during the passive phase prior to undergoing more definitive surgical treatment. Surgical interventions include tunical plication, plaque incision or excision with or without grafting, and penile prosthesis implantation. Despite the variety of treatment options available to patients, each has a distinct efficacy and adverse effect profile, warranting thorough discussion to meet patients' goals and manage expectations. CONCLUSION: Peyronie's disease is a common condition that is underdiagnosed and undertreated. Patients with Peyronie's disease will benefit from a comprehensive evaluation and in-depth counseling so that they may become familiar with the natural disease course and have appropriate expectations of each treatment option.

[Biotherapies for erectile dysfunction and Peyronie's disease: Where are we now?] / Biothérapies pour les troubles de l'érection et la maladie de la Peyronie : ou en est-on ?

INTRODUCTION: Clinical trials of cell therapy for erectile dysfunction (ED) and Peyronie's disease (PD) were recently conducted after preclinical studies. AIMS: The aims of this study are to give an update on biotherapy for ED and PD and to describe the regulatory framework for these therapies. MATERIALS AND METHODS: A literature review was performed through PubMed and Clinical.trials.gov addressing cell therapy for ED and PD and using following keywords "erectile dysfunction", "Peyronie's disease", "stem cell", and "platelet-rich plasma". RESULTS: Preclinical studies in rodent models have shown the potential benefit of cell therapy for ED after radical prostatectomy or caused by metabolic diseases, and PD. The tissues used to obtain the therapeutic product were bone marrow, adipose tissue and blood (PRP, platelet-rich plasma). Mechanism of action was shown to be temporary and mainly paracrine. Four clinical trials were published concerning ED after radical prostatectomy and in diabetic patients and one for PD. Eleven clinical trials including three randomized trials are currently going on. Preclinical and preliminary clinical results suggested the possibility to improve spontaneous erectile function and response to pharmaceutical treatment in initially non-responder patients. This effect is mediated by an improvement of penile vascularization. A reduction of penile curvature without side effect was noted after injections into the plaque of PD patients. Most of these therapeutic strategies using autologous cells were considered as "Advanced Therapy Medicinal Products" with strict regulatory frameworks imposing heavy constraints, in particular in case of "substantial" modification of the cells. The regulatory framework remains unclear and more permissive for PRP and cell therapy processes with extemporaneous preparation/injection and no "substantial" modifications. CONCLUSIONS: First results on cell therapy for ED and PD are promising. The regulatory framework can significantly change according to cell preparations and origins leading to various constraints. This regulatory framework is crucial to consider for the choice of the procedure.

Intratunical injection of autologous adipose stromal vascular fraction reduces collagen III expression in a rat model of chronic penile fibrosis.

Previous studies have shown that the injection of adipose stem cells and stromal vascular fraction(SVF) into the tunica albuginea (TA) during the inflammatory phase in a rat model of Peyronie's disease(PD) prevented the development of TA fibrosis. Our aim was to investigate whether local injection of SVF can reduce established fibrosis in a rat model of chronic phase of PD. Eighteen-male 12-wk-old Sprague-Dawley rats were divided in three equal groups: sham, PD without treatment (PD) and PD treated with SVF(PD-SVF). Sham rats underwent 2 injections of vehicle into the TA one month apart. PD rats underwent TGF-ß1 injection and injection of vehicle one month later. PD-SVF rats underwent TGF-ß1 injection followed by SVF (1-million cells) one month later. One month after the last treatment, the animals, n = 6 rats per group, underwent measurement of intracorporal and mean arterial pressure during electrostimulation of the cavernous nerve. Following euthanasia, penises were harvested for in-vitro study. Erectile function was not statistically significantly different between groups. PD animals developed subtunical areas of fibrosis and elastosis with upregulation of collagen III protein. These fibrotic changes were reversed after injection of SVF. We provide evidence that local injection of SVF reverses TA fibrosis in a rat model of chronic phase of PD.

Antioxidant Mechanism of Xiaojin Pill () for Treatment of Peyronie's Disease in Rats Based on Matrix Metalloproteinases.

OBJECTIVE: To evaluate the effects of Xiaojin Pill () in the treatment of Peyronie's disease (PD) in a rat model. METHODS: Twenty-four male Sprague-Dawley rats were randomly divided into four groups with 6 in each: sham operation, PD model, vehicle control and Xiaojin Pill groups. The rats in the sham operation group received penile tunica albsginea (TA) injection with 50 µL vehicle, while the rats in the other 3 groups received 50 µL penile TA injection of 50 µg transforming growth factor (TGF)-ß1. Forty-two days after the injection, rats in the vehicle control and Xiaojin Pill groups received 0.5 mL water and Xiaojin Pill solution (107 mg/kg of body weight), respectively by gavage for 28 days, while those in the sham operation and PD model groups did not receive any intervention. After intervention, the expressions of matrix metalloproteinase 2/9 (MMP2/9), nitric oxidesynthase (NOS), superoxide dismutase (SOD) and malondialdehyde (MDA) were measured. RESULTS: Rats in the PD model and vehicle control groups presented obvious fibrosis in corpus cavernosum (CC) and demonstrated a significantly increased expressions of MMP2 and MMP9 in the CC compared with the sham operation group (all P<0.01). In contrast, the expressions of MMP2 and MMP9 in the Xiaojin Pill group were significantly down-regulated (both P<0.01). In addition, the levels of NOS and MDA in CC were significantly increased while the activity of SOD was decreased in the PD model and vehicle control groups compared with the sham operation group (all P<0.01). After Xiaojin Pill treatment, the levels of MDA, NOS and SOD appeared to be corrected (all P<0.01). CONCLUSIONS: Xiaojin Pill could reduce fibrosis in the CC by decreasing the expressions of MMPs, NOS and MDA, and by increasing the activity of SOD. Therefore, Xiaojin Pill might be a therapeutic option for PD.

Intratunical injection of stromal vascular fraction prevents fibrosis in a rat model of Peyronie's disease.

OBJECTIVE: To investigate whether local injection of autologous adipose stromal vascular fraction (SVF) can prevent the development of fibrosis and elastosis in the tunica albuginea (TA) using a rat model of the acute phase of Peyronie's disease (PD). METHODS: A total of 24 male 12-week-old Sprague-Dawley rats were divided into three equal groups: sham; PD without treatment (transforming growth factor-ß [TGF -ß]); and PD treated with SVF 1 day after disease induction. Sham rats received two injections of vehicle into the TA 1 day apart. TGF -ß rats received TGF- ß1 injection and injection of vehicle 1 day later. SVF rats received TGF-ß1 injection, followed by SVF 1 day later. One month after treatment, all rats underwent measurement of intracavernosal pressure and mean arterial pressure during electrostimulation of the cavernous nerve. The rats were then killed and penises were harvested for histology and Western blot analysis. RESULTS: Erectile function was moderately reduced in the TGF-ß group and was significantly improved after SVF treatment (P < 0.05). PD rats developed areas of fibrosis with a significant upregulation of collagen III, collagen I and elastin protein expression. These fibrotic changes were prevented when treated with SVF. CONCLUSIONS: Local injection of SVF may represent treatment for the acute phase of PD.

The two phases of the clinical validation of preclinical translational mechanistic research on PDE5 inhibitors since Viagra's advent. A personal perspective.

The FDA approval of Viagra (sildenafil) for the on demand treatment of erectile dysfunction (ED) through relaxation of the corporal and cavernosal vascular smooth muscle that results in an increase in blood flow to the corporal tissues stemmed from 2 decades of research, mainly at academic centers. This culminated in the finding of the nitric oxide/cGMP pathway as the mediator of penile erection, followed by some years of basic studies and clinical validation at Pfizer. Further on, new translational laboratory and animal research from our group initiated a second phase when we proposed an alternative therapeutic schedule and mechanism of action for PDE5 inhibitors (PDE5i) in both corporal veno-occlusive dysfunction (CVOD) and Peyronie's disease (PD), specifically, continuous long-term administration (CLTA) to achieve sustained levels of cGMP within the penis. Due to the extended half-life of the long-acting PDE5i, tadalafil, this new alternative encompasses preferentially daily administration, although shorter half-life PDE5i, like sildenafil and vardenafil work too, depending on the duration, dose, and frequency of their administration This novel use was initially supported by showing the antifibrotic/antioxidant effects of nitric oxide and cGMP, produced by the induction of iNOS, as a mechanism of defense against collagen deposition in the localized fibrotic plaque of PD in an avascular tissue, the tunica albuginea. Our studies on iNOS and the progressive diffuse fibrosis occurring in the smooth muscle in CVOD, led to proposing the CLTA of PDE5i for maintaining sustained cGMP levels both in PD and in CVOD in order to halt or regress the penile fibrosis. In CVOD, we showed that PDE5i protect the corporal smooth muscle and reduce myofibroblast activation and number, counteracting the underlying corporal tissue pathology that causes CVOD, and potentially ameliorating long-term CVOD or even curing it. This review is focused on this novel PDE5i anti-fibrotic therapeutic concept.

Does Transfer Capacitive Resistive Energy Has a Therapeutic Effect on Peyronie's Disease? Randomized, Single-Blind, Sham-Controlled Study on 96 Patients: Fast Pain Relief.

Background/Aims/Objectives: We have investigated the clinical and physiological effects of Transfer Capacitive Resistive Energy (TCARE) therapy on men with Peyronie's disease (PD). METHODS: Ninety-six men with PD have been randomized in a 2:1 ratio to receive 3 sessions of TCARE therapy or sham therapy. Pain, penile curvature and erectile function have been assessed before the first treatment and up to 9 months after the end of treatment, using the Visual Analogue Scale for the pain, a goniometer to measure the degree of curvature using at-home photography and an International Index of Erectile Function (IIEF-5) questionnaire. RESULTS: A significant pain reduction at the end of the treatment in 51 (79.6%) patients (p < 0.01) of the treated group was observed. No significant improvements in the sham group (p = 0.23) have been observed. No statistical differences in the degree of curvature have been observed in both groups. No statistical improvements have been observed in the IIEF-5 questionnaire. Adverse events have not been reported. CONCLUSION: This is, to our knowledge, the first randomized, single-blind, sham-controlled study that shows that TCARE has a positive short-term clinical effect on pain in patients with PD. The feasibility and tolerability of this treatment produce an attractive new therapeutic option for men with PD.

Adipose tissue-derived stem cell therapy for prevention and treatment of erectile dysfunction in a rat model of Peyronie's disease.

Peyronie's disease (PD) is a localized connective tissue disorder that involves the tunica albuginea (TA) of the penis. While surgical correction remains the gold standard, the search for an effective and less invasive therapy continues. The objective of this study was to evaluate the effects of intratunical injection of adipose tissue-derived stem cells (ADSCs) for the prevention and treatment of erectile dysfunction in a rat model of PD. Twenty-four male Sprague-Dawley rats (300-350 g) were randomly divided into four groups: sham, PD, PD + ADSC (prevention) and PD + ADSC (treatment). All rats underwent penile injections into the TA with 50 µL vehicle (sham) or 0.5 µg transforming growth factor (TGF)-ß1 (remaining groups). The ADSC groups received intratunical injections with 0.5 million rat-labelled ADSCs on day 0 (prevention) or day 30 (treatment). Forty-five days following TGF-ß1 injection, rats underwent cavernous nerve stimulation (CNS) with total intracavernous-to-mean arterial pressure ratio (ICP/MAP) and total ICP recorded to measure response to therapy. Tissues were evaluated histologically and for mRNA expression of tissue inhibitors of metalloproteinases (TIMPs), matrix metalloproteinases (MMPs) and zymographic activity of MMPs. Statistical analysis was performed by analysis of variance followed by the Tukey test for post hoc comparisons. In both prevention and treatment groups, intratunical injection of ADSCs resulted in significantly higher ICP/MAP and total ICP in response to CNS compared with the PD group. Local injection of ADSCs prevented and/or reduced Peyronie's-like changes by decreasing the expression of TIMPs, and stimulating expression and activity of MMPs. This study documents the preventive and therapeutic benefits of ADSC on penile fibrosis and erectile function in an animal model of PD.

Long-term multimodal therapy (verapamil associated with propolis, blueberry, vitamin E and local diclofenac) on patients with Peyronie's disease (chronic inflammation of the tunica albuginea). Results of a controlled study.

OBJECTIVE: to demonstrate the possible effectiveness of a long-term multimodal medical therapy in patients with Peyronie's disease (PD) we carried out a controlled study on 82 patients diagnosed with PD, whereas in the scientific literature the conservative treatment of this disease is much discussed. METHODS: 82 patients (mean age=53.6±10.1 years-range 23-68) diagnosed with PD were selected for this study. Of these 41 patients (group A) were treated for 18 months as follows: Verapamil penile injections (12 total injections for six months and subsequently every month for twelve months: total 24 injections) + Iontophoresis with Verapamil/daily + blueberries 160mg/daily + propolis 600mg/daily + Vitamin E 600mg/daily + topical Diclofenac/daily. The other 41 patients spontaneously decided not to receive treatment for several motives and then were introduced as a control group B. All patients were controlled at 6- and 18-month follow up with the same diagnostic tests completed before the therapy (penile ultrasound, photograph documentation, pain scale etc.). RESULTS: In group A, after treatment of 6 and 18 months, the change in plaque volume consisted in volume reduction= - 47.6% and -73.6% respectively, while in group B, the change consisted of an increase in plaque volume= +55.7% and +118.7% respectively (p=0.000). In group A, after treatment of 6 and 18 months, improvement of curvature occurred in 76.3% and 81.5% of the cases respectively, while in group B it occurred in 2.7% and 8.1%, respectively (p<0.0001). CONCLUSION: Our results showed that a long-term multimodal medical therapy (Verapamil associated with Antioxidants and local Diclofenac) is statistically effective to treat PD patients, if we consider that lower therapeutic outcomes were achieved after 6 months treatment (medium-term treatment). Furthermore, this study confirms that the best treatment modality for PD is a combination therapy.

[TECAR therapy for Peyronie's disease: a phase-one prospective study. Great evidence in patients with erectile dysfunction]. / Il Trasferimento Energetico Capacitivo Resistivo (TECAR) nella terapia dell'Induratio Penis Plastica: studio pilota di fase uno sulla tollerabilità, sulla sicurezza e sull'applicabilità della tecnica. Quali altri risvolti sorprendenti.

Our phase-one prospective study wants to evaluate the safety and tolerability of TECAR therapy in the treatment of Peyronie's disease. From June 2011 to September 2012 we enrolled 70 patients. Each patient had been previously subjected to andrological examination, to a questionnaire for the evaluation of IPP and ED, and the SF-36 (V1) for the evaluation of the general state of health. The evaluation of pain was made using the VAS scale of pain. Every patient was subjected to TECAR treatment of the fibrotic plaque (both in resistive mode and in capacitive mode) for a total of three sessions carried out on consecutive days. We recorded a good compliance by patients; none of them reported side effects. Pain was decreased by the technique in 80% of the cases.The whole sample completed the study. Surprisingly enough those patients who complained also of erectile dysfunction, reported an improvement in sexual potency.

Peironimev-Plus® in the treatment of chronic inflammation of tunica albuginea (Peyronie's disease). results of a controlled study.

Peyronie's Disease (PD) is a connective tissue disorder involving the growth of fibrous plaques in penile corpora cavernosa (tunica albuginea). The conservative treatment is indicated in the development stage of PD for at least one year after diagnosis and in case of penile pain. This study was conducted to demonstrate the possible effectiveness of the new substances of Peironimev-plus®. Sixty four patients (age: 29-65 years, mean: 52.57 ± 9.06) diagnosed with PD were enrolled in a medical treatment. All patients underwent the following diagnostic tests: penile ultrasound, photographic documentation of penile curvature, IIEF questionnaire (erectile function score), pain evaluation with Visual Analogue pain Scale (VAS). The patients were divided into two treatment groups with different combinations of drugs: A = Peironimev-plus/oral/one tablet-daily + Verapamil injection (peri-lesional) 10 mg/every two weeks + Verapamil iontophoresis/5 mg/three times a week - for 6 months; B = Verapamil injection (peri-lesional) 10 mg/every two weeks + Verapamil iontophoresis/5 mg/three times a week - for 6 months. Intergroup analysis revealed statistically significant differences: in group A the effective plaque size reduction was -30.8% while in the group B the reduction was -18.0% (p=0.000). In group A the improvement of curvature occurred in 85.1% of the cases while in group B this occurred only in 53.5% (p=0.024), moreover the mean curvature decrease was respectively - 8.7° and - 4.6° (p=0.002). IIEF score was significantly improved in group A patients with erectile dysfunction (p=0.02). Our results suggest that Peironimev-plus is an effective drug in treating PD and it may help to prevent the progression of PD.