Creation of a Novel Classification System (PTNM) for Peyronie's Disease and Penile Curvature Using Evidence-Based Criteria.

PURPOSE: Our goal was to identify new Peyronie's disease (PD) subtypes, non-PD penile curvature classifications, and define active (acute) vs stable (chronic) phases of disease using evidence-based analyses. MATERIALS AND METHODS: A retrospective review was performed of 1098 men who presented with penile deformity, including subjective standardized and nonstandardized questionnaires and objective measures. A second cohort of 719 men who were sent a mailed survey was also utilized for the relapsing/remitting subtype. Statistical analyses were performed to identify clusters of disease characteristics representative of distinct PD and non-PD categorizations, including sensitivity/specificity analyses and subtype comparisons. RESULTS: Comparative analyses identified 4 distinct subtypes of PD: (1) classical and nonclassical, (2) calcifying-moderate/severe calcification, (3) progressive-subjective worsening following disease onset, and (4) relapsing/remitting-reactivation following ≥ 6 months of stability. Additional, non-PD categorizations included congenital (lifelong), maturational (developed around puberty), and trauma induced. Statistical analyses demonstrated unique profiles among each category. Penile pain was not found to be a reliable predictor for disease progression or stability. Stable phase disease (historically "chronic") was variably defined by subtype: classical (≥3 months); progressive, calcifying, or trauma induced (≥12 months + ≥3 months stable OR ≥6 months stable). Similarly, PD subtypes may be assigned at ≥ 3 months following disease onset. A PTNM staging system is proposed to help communicate disease states, in which P = PD component (Ca-calcifying, Cl-classical, P-progressive, R-relapsing/remitting, U-undifferentiated), T = trauma component (0-absent, 1-present), N = non-PD component (C-congenital, M-maturational, U-undifferentiated), and M = mode (0-stable, 1-active); for example, PClT1N0M0 = stable classical PD with prior trauma. CONCLUSIONS: The current study provides an evidence-based proposal for the establishment of new PD subtypes and non-PD curvature categorizations as well as a standardized definition for active vs stable phases of disease.

A Consistent Lack of Consistency in Defining the Acute and Chronic Phases of Peyronie's Disease: A Review of the Contemporary Literature.

INTRODUCTION: Treatment recommendations for Peyronie's Disease (PD) differ based on whether a patient is in the acute/active versus chronic/stable phase of the disease, yet there are no agreed upon criteria for defining these clinical entities. OBJECTIVES: To review the criteria used to define acute and chronic phase PD in modern PD intervention studies METHODS: We performed a search engine review to identify indexed publications for PD intervention studies and review articles / meta-analyses from the year 2011-2020. Outcomes results were catalogued and summarized across articles. As a result of the substantial heterogeneity of outcome measures and follow-up intervals, meta-analytic techniques were not applied to the data analysis. RESULTS: We identified a total of 104 studies that met inclusion criteria and had available information for review (n = 79 primary intervention studies; n = 25 review articles/meta-analyses/guidelines). Among the queried studies, we were unable to identify a consensus with respect to the criteria used to define acute and chronic phases of PD. 33% of primary intervention studies did not specifically define their criteria for acute and chronic phase PD, despite referencing these populations as part of the inclusion criteria in many instances. Studies used heterogenous criteria including total symptom duration, duration of "stable" symptoms, and presence/absence of pain. CONCLUSION: Due to varying definitions across the literature, we were unable to create a standardized definition of acute and chronic phase Peyronie's in terms of time. Our findings emphasize the need for greater consensus in defining the treatment cohorts with future studies that assess treatment for men with PD. Piraino J, Chaudhray H, Ames K, et al. A Consistent Lack of Consistency in Defining the Acute and Chronic Phases of Peyronie's Disease: A Review of the Contemporary Literature. Sex Med Rev 2022;10:698-713.

Physical treatment of Peyronie disease.

OBJECTIVE: Peyronie disease is a localized and progressive fibrosis. It is characterized by a plaque in the tunica albuginea, which leads to penile deformity, making sexual intercourse difficult, if not impossible. DESIGN: During a 4-yr period, we treated 35 patients, aged 30-62 yr, in different stages of this disease. We applied ultrasound therapy (0.5 W/cm; 10 min), infrared radiation, and iontophoresis with 8% potassium iodide (0.2 mA; 30 min). The patients were taught to administer therapy by themselves. The patients' diseases were classified into three stages on the basis of subjective symptoms and clinical findings. At the beginning of treatment, 20 patients' diseases were classified as being in the first stage, 13 patients' diseases in the second stage, and 2 patients' diseases in the third stage. RESULTS: By the end of treatment, 10 patients were cured, 17 patients' diseases were classified as being in the first stage, 8 patients' diseases were in the second stage, and there were no patients in the third stage. CONCLUSIONS: The method is simple, safe, painless, and inexpensive. Patients were taught to administer the therapy by themselves. There were no side effects. Functional improvement and the cessation of pain were noted by all the patients. The level of improvement depended on the disease duration, the length of therapy, and the stage of the disease.

Induratio penis plastica: effectivity of low-dose radiotherapy at different clinical stages.

This study describes the treatment of Peyronie's disease by means of low-dose radiotherapy. We treated 265 men aged 24.5-79.4 years (median = 57.7 years). No previous therapy had been carried out in 214 patients, and 41 patients had been pretreated (systemic: potassium p-aminobenzoate, vitamins a, b, e; topical: corticosteroids, teleradiotherapy). The disease was classified using criteria proposed by Alth in 1984 location, number and size of foci, hardness of fibromatous foci and axis deviation, potentia coeundi and pain were evaluated). Radiotherapy was performed by local application of a special iridium-192 moulage developed at our institute. In 66.4% of the monitored patient group (n = 155) therapy was successful. We obtained complete regression of the fibromatous foci in 9% (n = 14), partial remission > 50% in 29.7% (n = 46) and partial remission < 50% in 27.7% (n = 43) of the patients. We found a significant correlation between hardness, size of the treated foci and therapeutic success. Eighty-three patients suffered from pain during penile erection before therapy, and in 61.4% (n = 51) of these patients the pain disappeared after treatment. Moreover, the patients confirmed that both loss of pain and regression of deviation related to foci regressions were correlated with improvement in erectile function. No serious side effects were observed in any of our patients.

[Classification of plastic penile induration (Peyronie's disease)]. / Zur Klassifikation der Induratio penis plastica (Peyronie's Disease).

In this work an attempt has been made to find a general nosological formula of induratio penis plastica in order to compare the typical and numerous possibilities of therapy. The author has developed a classification based on the T.N.M. system, whereby the typical parameters of this disease, such as the grade of induration and deviation, as well as the subjective symptoms of pain and the ability of penetration has been considered in this system. The size of the indurations and the number of solidifications are as important as the site. This nomenclature makes it possible pro futuro to obtain a comparative therapeutic assessment in induratio penis plastica and, hence, to obtain guidelines on the indication for the optimal therapy of Peyronie's disease.

Classification of congenital and acquired penile deviation.

In addition to sonography and the classical diagnostic tools, a new method for the accurate classification of congenital and acquired penile deviation is made possible by using autophotography, 'five-line system' to determine the angle of deviation, and the table for 'classification of Peyronie's disease'. it is suggested that the wide use of this new method of documentation would lead to a better comparison of the results and understanding of the disease.