Evidence of restorative therapies in the treatment of Peyronie disease: A narrative review.

OBJECTIVE: To describe the evidence of Platelet Rich Plasma (PRP), Stem cells therapy (SCT) and Extracorporeal shockwave therapy (ESWL) for the treatment of Peyronies disease (PD), including information from the main urological society guidelines. MATERIALS AND METHODS: A literature review of PubMed articles published between 2000 and 2023 was conducted, utilizing keywords such as "Peyronie's Disease", "Penile curvature", "Platelet Rich Plasma", "Stem cells", and "Extracorporeal shockwave therapy". Only full-text articles in English were included, excluding case reports and opinions. RESULTS: A considerable number of clinical trials were conducted using PRP penile injections for therapy of PD, showing reduction of curvature, plaque size and improvement in quality of life. Preclinical studies in rats have shown the potential benefit of adipose-derived stem cells, with improvements in erectile function and fibrosis. Human studies with mesenchymal stem cells demonstrated promising results, with reduction of curvature and plaque size. ESWL effects on PD were investigated in randomized clinical trials and demonstrated no significant impact in curvature or plaque size, but reasonable effect on pain control. CONCLUSION: Restorative therapies has emerged as an innovative treatment option for PD and the results from current studies appear to be promising and demonstrated good safety profile. Unfortunately, due to scarce evidence, PRP and SCT are still considered experimental by American Urological Association (AUA) and European Association of Urology (EAU) guidelines. ESWT is recommended, by the same guidelines, for pain control only. More high-quality studies with long-term follow-up outcomes are needed to evaluate efficacy and reproducibility of those therapies.

Low-intensity extracorporeal shockwave therapy in the treatment of erectile dysfunction - a narrative review.

OBJECTIVES: To provide an overview of low-intensity extracorporeal shockwave therapy (LIEST) for erectile dysfunction (ED), pointing out which concepts are already consolidated and which paths we still need to advance. MATERIALS AND METHODS: We performed a narrative review of the literature on the role of shockwave therapies in erectile dysfunction, selecting publications in PUBMED, including only relevant clinical trials, systematic reviews and meta-analyses. RESULTS: We found 11 studies (7 clinical trials, 3 systematic review and 1 meta-analysis) that evaluated the use of LIEST for the treatment of erectile dysfunction. One clinical trial evaluated the applicability in Peyronie's Disease and one other clinical trial evaluated the applicability after radical prostatectomy. CONCLUSIONS: The literature presents little scientific evidence but suggests good results with the use of LIEST for ED. Despite a real optimism since it is a treatment modality capable of acting on the pathophysiology of ED, we must remain cautious, until a larger volume of higher quality studies allows us to establish which patient profile, type of energy and application protocol will achieve clinically satisfactory results.

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.

Preliminary findings from a new animal model for Peyronie's disease involving extracorporeal shock waves.

OBJECTIVE: To develop an experimental model in rabbits to analyse the efficiency of extracorporeal shock wave therapy (ESWT) for Peyronie's disease. MATERIALS AND METHODS: We used 15 adult male rabbits divided into three equal groups. In group 1 (no penile ESWT) rabbits had three sessions of ESWT with 2000 shocks each (15 kV), but a rubber mat was placed between the shock head and rabbit to protect the penis; the rabbits were killed at 7 days after the last session of ESWT. In group 2 the rabbits had three sessions of ESWT using the same parameters, and were killed immediately after the last session to analyse the penis. In group 3 the rabbits had three sessions of ESWT as before but were killed at 7 days after the last session, and the penile tissue analysed macroscopically and histologically. RESULTS: The results showed clearly that the model was efficient, creating a similar situation to that when applying ESWT in the human penis. All of the rabbits in groups 2 and 3 had haematomas and diffuse petechiae after ESWT, and only four had urethral and penile bleeding. Almost all macroscopic changes disappeared after 48 h and only one rabbit in group 3 after 7 days had a haematoma on the dorsal penile surface. The histology (assessed using haematoxylin and eosin staining) of the cavernous body of the penis showed: unchanged histology in group 1; in group 2 there was a dilated and congested vascular space in the cavernous body, with interstitial extensive bleeding in the dermis; and in group 3 there was an increase in interstitial fibrous tissue in the cavernous septum, with deposition of collagen fibres and thickening of the tunica albuginea. CONCLUSION: The present model was efficient in producing tissue injury in the normal penis when treated with ESWT, suggesting that this promising model should be considered for use future studies of Peyronie's disease.

Enfermedad de la Peyronie: tratamiento con interferon y láser / Peyronie's disease: treatment with interferon and laser

Objetivo: Evaluar comparativamente los resultados del tratamiento con interferón, láser y su asociación en un grupo de sujetos con la enfermedad de la Peyronie. Método: Se realizó un estudio experimental para evaluar los principales resultados del tratamiento de la enfermedad de La Peyronie con Interferón y Láser, en el Hospital Provincial Universitario Saturnino Lora Torres y en el Hospital General Universitario Dr Juan Bruno Zayas Alfonso de la ciudad de Santiago de Cuba desde Enero del 2003 hasta Julio del 2005. Quedaron incluidos 96 pacientes, divididos en 3 grupos de tratamiento: Interferón, Láser e Interferón más Láser. Luego de la evaluación inicial se inició el tratamiento que duró 28 semanas, con reevaluaciones a los 6 y 12 meses de terminado el mismo. Resultados: Los resultados finales del tratamiento con Interferón y láser combinado fueron: mejoría de los síntomas (84,7 por ciento), disminución del tamaño de la placa fibrosa (90,6 por ciento) y, de la curvatura del pene (87,5 por ciento). Conclusiones: La combinación de ambas terapias resultó ser más efectiva que su empleo por separado, por lo que se recomienda, la incorporación de la misma como otra terapéutica en la enfermedad de La Peyronie(AU)

Objectives: To evaluate comparatively the results of treatment with interferon, laser and their association in a group of patients with Peyronies disease. Methods: We performed an experimental study to evaluate the main results of the treatment of Peyronies disease with interferon and laser, at Hospital Provincial Universitario Saturnino Lora Torres and Hospital General Universitario Dr Juan Bruno Zayas Alfonso in the city of Santiago de Cuba from January 2003 to July 2005. Ninety-six patients were included, divided into three treatment groups: interferon, laser and interferon plus laser. After initial evaluation, treatment was started and continued for 28 weeks, with reevaluation six and 12 months after the end of treatment. Results: Final results with combined interferon and laser were: symptoms improvement 84.7 percent, decrease of the size of the fibrous plaque 90.6 percent and decrease of penile curvature 87.5 percent. Conclusions: The combination of both therapies resulted to be more effective than each of them separately, so the recommendation is to incorporate it as another therapeutic alternative in Peyronies disease(AU)

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)

Enfermedad de PEYRONI: evaluación de tres modalidades terapéuticas, propóleo, Láser y propóleo + Láser

El objetivo es evaluar comparativamentelos resultados del tratamiento con propóleo, Láser y propóleo más Láser simultáneo. Se estudiaron 28 pacientes con Enfermedad de Peyronie entremayo 2002 y agosto 2003, procedentes de los Hospital Freyre de Andrade,Fajardo, Clínico Quirúrgico y Provincia Habana. Fueron divididos en tres grupos 1) Tratamiento con Propóleo (10 pacientes) 2) Tratamiento con Láser. (8pacientes) y 3) Tratamiento con Propòleo + Láser. (10 pacientes)

To compare the results oftreatment of peyroni`s disease with propoleum, laser, and simultaneous propoleum-laser. Prospective research. Twenty-eight patientswith Peyronies disease from the hospitals Freyre de Andrade,Fajardo, Clínico Quirúrgico y HabanaCampo were studied between May 2002 and August 2003. They were divided into three groups:1) treatmentwith propoleum: 10 patients; 2) treatment with laser: 8patients; and 3) treatment with propoleum + laser: 10

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.

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%) 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.

[Clinical evaluation of the use of propoleum in Peyronie's disease]. / Evaluación clínica del uso del propóleo en la enfermedad de Peyronie.

OBJECTIVE: To analyze the clinical efficacy of propoleum in Peyronie's disease. METHODS: A controlled, double-blind clinical trial based on a previous pilot study was conducted in 34 patients with Peyronie's disease treated with propoleum (Cuban Academy of Sciences patent no. 21875). The study was performed at the Freyre de Andrade Hospital in Habana. The clinical course and ultrasound features of the fibrous plaque were evaluated during a period of 6 months. RESULTS: A marked improvement was observed for penile curvature and pain in the treated group. Furthermore, plaque consistency and size was reduced five-fold after treatment and two-fold at ultrasound evaluation. No clinical or ultrasound changes were observed in the control group. CONCLUSIONS: Our results demonstrate the efficacy of propoleum in Peyronie's disease.

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.