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To investigate the clinical effect of low-intensity extracorporeal shockwave therapy (LI-ESWT) on Peyronie's disease.

From October 2016 to December 2017, we treated 32 cases of Peyronie's disease by LI-ESWT, with the therapeutic index of 0.

Surgical correction is advocated in patients with stable Peyronie's disease (PD) and severe curvature of the penis. Contemporary series demonstrate favorable outcomes based on relatively short follow-up periods.

Although many grafts have been used for plaque incision with grafting (PIG) and penile prosthesis (PP) implantation, there is no evidence that favors 1 specific graft over another.

To compare fibrin-coated collagen fleece (TachoSil; Baxter International, Deerfield, IL, USA) with porcine small intestinal submucosa (SIS; Cook Biotech, West Lafayette, IN, USA) as grafts.

OBJECTIVES - To report the results from a prospective multicentric study of patients with Peyronie's disease (PD) treated with the 'sliding' technique (ST).

PATIENTS AND METHODS - From June 2010 to January 2014, 28 consecutive patients affected by stable PD with severe penile shortening and end-stage erectile dysfunction (ED) were enrolled in three European PD tertiary referral centres.

OBJECTIVE - Urethral recurrence (UR) after radical cystectomy is rare but associated with high mortality. With the recently increased use of orthotopic bladder substitution and the questionable benefit of prophylactic urethrectomy, identification of patients at high risk of recurrence, management of the remnant urethra, and treatment of recurrence become critical questions.

Despite published guidelines on Peyronie's disease (PD), there are limited data on actual surgical practice among surgeons.

To evaluate the surgical practice patterns in PD among surgeons from different continents and members of various sexual medicine societies.

INTRODUCTION - The surgical treatment of comorbid erectile dysfunction and Peyronie's disease has long included the implantation of an inflatable penile prosthesis as well as a number of adjuvant maneuvers to address residual curvature after prosthesis placement.

Peyronie's disease (PD) is a fibrotic entity for which the pathogenetic mechanism remains unclear and if resulting in severe deformity, its treatment is only surgical. In this study we investigated the possible role of insulin-like growth factor 1 (IGF1) expression in the pathogenesis of PD.

To review recent trends in the treatment of PD, we assess surgical practice patterns of urologists in the United States with emphasis on specialty training, demographics, and temporal changes.

Six month case log data of American urologists between 2004 and 2013 was obtained from the American Board of Urology.

SAN DIEGO, CA USA (UroToday.com) - In this podcast, Dr. Wayne J. G. Hellstrom from Tulane University School of Medicine in New Orleans gives a summary of some of the key points and discusses results from the Investigation for Maximal Peyronie's Reduction Efficacy and Safety Studies (IMPRESS) I and II phase three trials.

SAN DIEGO, CA USA (UroToday.com) - Full title: AUA 2013 - Slide Presentation: Composite responders showed improvement in both penile curvature deformity and symptom bother in two large double-blind, randomized, placebo-controlled phase 3 studies of collagenase clostridium histolyticum in the treatment of Peyronie’s disease

Non-curvature penile deformities associated with loss of erect penile volume are often overlooked and have not been thoroughly investigated.

To describe the prevalence and functional impact of penile volume-loss deformities in our cohort of men with Peyronie's disease (PD).

Peyronie's disease is a disorder of the tunica albuginea and causes penile curvature, requiring surgical correction when the deformity impedes penetration.

Retrospective analysis of the short-term results (penile length, angle of curvature and erectile function) of treating Peyronie's disease in 10 patients through cavernoplasty with oral mucosa graft.

Collagenase Clostridium histolyticum (CCH) intralesional injection was efficacious for the management of Peyronie's disease (PD) in the double-blinded, randomized, placebo-controlled Investigation for Maximal Peyronie's Reduction Efficacy and Safety Studies I and II (IMPRESS I and II).

Imaging can benefit clinicians in evaluating men with infertility or sexual dysfunction by giving an overview of a patient's overall clinical condition before undertaking an invasive procedure. An understanding of the limitations and advantages of image modalities used in clinical practice will ensure that clinicians can optimize patient care with imaging when necessary.

Conservative therapies for Peyronie's disease (PD) aim to treat early-stage disease by improving clinical outcomes such as penile curvature, penile length erectile dysfunction, and pain.

To summarise the available evidence regarding injection and mechanical therapies for PD treatment.

Peyronie's disease (PD) is defined as the abnormal accumulation of connective tissue in the tunica albuginea of the penis, and is an ongoing physical and psychological challenge for thousands of Americans.

Peyronie's disease (PD) is a common condition which results in penile curvature making sexual intercourse difficult or impossible. Collagenase clostridium histolyticum (CCH) is the first licensed drug for the treatment of PD and is indicated in patients with palpable plaque and curvature deformity of at least 30° of curvature.

Peyronie's disease (PD) is a common condition that results in penile deformity, which makes sexual intercourse difficult or impossible, and causes psychological, emotional, and relationship difficulties for the man affected and his partner.

Peyronie's disease (PD) is a connective tissue disorder resulting in the abnormal accumulation of type I to III collagen, fibrin, and disorganized elastic fibers in the tunica albuginea of the penis.

Approximately 10% of Peyronie's disease (PD) patients present with ventral curvatures and, as such, there is a paucity of data describing the optimal approach for treatment.

This study aims to compare the outcomes of surgery (tunical plication [TP]) and intralesional injection (ILI) therapy (interferon-α2b) in men with ventral PD.

Peyronie's disease (PD) is a benign fibrotic disorder of the tunica albuginea of the penis, which can cause penile pain, curvature, shortening, erectile dysfunction, and psychological distress. Surgery is indicated when penile curvature prevents satisfactory sexual intercourse.

To analyze the literature on the current treatment options for Peyronie's disease (PD).

Intracavernosal injection therapy using collagenase clostridium histolyticum (CCH) has been widely adopted since its FDA approval in 2013.

Peyronie's disease (PD) is a penile wound-healing disorder resulting in fibrotic plaque in the tunica albuginea, likely resulting from micro trauma. Due to variable disease presentations, a myriad of proposed treatment options, physician misconceptions about the disorder, and severe psychological distress in afflicted patients; PD can be a difficult to manage entity.

INTRODUCTION - Penile corporal fibrosis represents a challenging clinical scenario for surgeons placing penile prostheses (PP). Because of its rarity, a small number of series with limited follow-up have reported outcomes in this cohort.

Penile Traction Therapy (PTT) is increasingly being recognized as a viable non-surgical approach to Peyronie's Disease (PD). The goal of this article is to review the current literature on PTT with attention to traction protocols, devices, and outcomes.

Several intralesional therapeutic protocols have been proposed for the treatment of Peyronie's disease. Among all, hyaluronic acid (HA) and verapamil have been differently tested. We aimed to evaluate the efficacy of intralesional verapamil (ILVI) compared with intralesional HA in patients with early onset of Peyronie's disease (PD).

Despite recent advances in our knowledge and treatment strategies in Peyronie's Disease (PD), much remained unknown about this disease.

To provide a clinical framework and key guideline statements to assist clinicians in an evidence-based management of PD.

Penile duplex Doppler ultrasound (PDDU) assesses the etiology of erectile dysfunction. Peak systolic velocity (PSV), end-diastolic velocity (EDV), and resistive index (RI) are common PDDU parameters.

Peyronie's disease (PD) causes penile deformity and can result in sexual dysfunction and psychological distress. Currently, nothing is known about the psychosexual impact on the partners of men with PD.

The difficulty implicit in combining all the characteristics that an ideal patch to treat Peyronie's disease with a lengthening procedure should have, together with the challenges of comparing results from different series, means that the ideal patch has yet to be determined.

The subsequent health risks associated with Peyronie's disease (PD) are unknown.

This cohort study assesses the risk of developing auto-immune conditions and common chronic health conditions after a diagnosis of PD.

Peyronie's disease (PD) is a devastating condition resulting in penile deformity, erectile dysfunction (ED), pain and emotional distress. This prospective two institution study evaluates a multimodal surgical and mechanical combined approach in the definitive treatment of PD and concomitant ED.

The activation of tunica albuginea myofibroblasts (MFs) serves an essential role in Peyronie's disease (PD). Increasing evidence has reported that adipose tissue-derived stem cells (ADSCs) have been demonstrated to attenuate the symptoms of PD in animal models.

The use ofClostridium histolyticumcollagenase (CCH) has become increasingly widespread for the treatment of Peyronie's disease (PD) in recent years. Numerous trials have confirmed both its safety and efficacy in appropriately selected patients with this condition.

INTRODUCTION - Hyaluronic acid has been shown to be efficacious in decreasing scar formation, inflammation, and oxidative stress.

AIM - To assess the efficacy of intralesional injection of hyaluronic acid in patients affected by Peyronie's disease.

The etiology of the disease of Peyronie is not certainly known. However, penile micro traumas are thought to be important in the pathogenesis of Peyronie's disease (PD) in genetically predisposed individuals.

The inflatable penile prosthesis (IPP) is typically the preferred implant for Peyronie's disease (PD) and malleable penile prostheses (MPPs) have been discouraged.

To evaluate the effectiveness and patient satisfaction of the MPP vs IPP in patients with PD.

To compare in a prospective, non-randomized fashion the outcomes of Collagenase Clostridium Histolyticum (CCH) and surgical interventions (tunical plication [TP] and partial plaque excision and grafting [PEG]) in patients with PD.

Peyronie's disease (PD) is associated with penile length loss due to atrophy that occurs as a result of fibrous inelastic scarring. Studies have shown diminished penile length and girth, as well as the inability to participate in sexual activity, can lead to decreased quality of life, emotional challenges, and sexual dissatisfaction in a large percentage of men.

Penile deformity is the most obvious manifestation of Peyronie's disease (PD) and key to determining the optimal method of treatment. Other aspects of PD to consider include plaque size, location, and density; amount of calcification; erection quality; disease progression; and penile anatomy.

OBJECCTIVE - To investigate the outcomes of two surgical interventions for Peyronie's disease (PD) with hourglass deformity: partial excision and grafting (PEG) or inflatable penile prosthesis (IPP) implantation.

To evaluate long-term sexual function results following plication surgery for the correction of penile curvature using patient questionnaires.

We performed a single-center, retrospective study in a cohort of patients with Peyronie's disease or congenital penile curvature.

Peyronie's Disease (PD) is an acquired connective tissue disorder that often leads to penile curvature (PC) and sexual dysfunction. Penile lengthening procedures (PLP) with four-layered porcine small intestinal submucosa graft (Surgisis® ES; Cook) have been widely used in patients with severe PC when erectile function is preserved.

Penile plication techniques with or without degloving offer a minimally invasive option for the treatment of penile curvature.

To review the outcomes of penile plication surgery and patient satisfaction with and without degloving of the penis.

Although there is a strong correlation between erectile dysfunction and Peyronie's disease (PD), there are limited data on the efficacy and satisfaction of inflatable penile prosthesis (IPP) placement in this population.

To provide an overview of current approaches to penile reconstructive surgery in Peyronie disease (PD), and to discuss the challenges in restoring normal penile size and function.

A systematic literature search was conducted to identify the published literature relevant to PD and penile reconstructive surgery.

Plaque incision and grafting (PIG) for Peyronie's disease (PD) is not devoid of complications such as erectile dysfunction and penile sensory changes.

To define the rate and chronology of penile sensation loss after PIG surgery and to define predictors of such.

The sliding technique (ST), commonly done with a subcoronal circumcising incision with penile degloving, has been used to restore penile size in patients with severe Peyronie's disease (PD) and erectile dysfunction, but with a potential risk of ischemic injury to the glans penis.

History and Background:

• The first description of Peyronie's disease is credited to Francois Gigot de la Peyronie in 1743.
• No consensus exists with regard to the etiology, prevalence and treatment of the condition.  
• Peyronie's disease is associated with Dupuytren disease. Dupuytren disease has a familial pattern known to be transmitted in an autosomal dominant pattern. 
• Thirty percent to 40% of men with Peyronie's disease will also have Dupuytren disease.

Eitiology and Natual History:

• Peyronie's disease presents as a variety of deformities of the penis. 
• The symptomatic incidence has been estimated at 1%, but data indicates that the incidence is increasing and now can be estimated conservatively at 5% and some recent estimates are  8.9% to 13%.
• Peyronie’s disease is defined by the presence of an inflammatory reaction and eventual fibrotic plaque development within the tunica albuginea or of the corpora cavernosa.
• This plaque, which is palpable on physical examination in established cases, is associated with the common presenting symptoms of Peyronie’s disease, including pain with erection, curvature or deformity of the erect penis and erectile dysfunction (ED).
• Plaque formation is thought to be the result of trauma, to the erect or semi-erect penis, which is propagated by aberrant would healing.
• Reports of an association between Peyronie’s disease and Dupuytren’s contracture, plantar fascial contracture, tympanosclerosis, diabetes, urethral instrumentation, autoimmune disorders and as an inherited form of the disorder suggest that a multifactorial etiology is likely.
• Disease development is described in two phases. 
  • The first phase is associated with painful erections and changing deformity of the penis. 
  • The second phase,is characterized by the disappearance of painful erections, if previously present, and a stability in the disease process.
• Most patients do not require surgery. 
• Patient's do require reassurance and education. 
• Surgery for Peyronie's disease is considered palliation for the mechanical effects of the disease.
• Peyronie's disease has been related to a number of conditions. The strongest relation is to Dupuytren disease.
• The development of Peyronie's disease does seem to be related to the unique anatomy of the tunica albuginea and its relationship to the septal fibers.
• Buckling trauma of the penis, usually occurring during intercourse, has been implicated in the development of Peyronie's disease. 
• TGF-β has been found to be related to the disordered healing process that leads to the scarring of the Peyronie's plaque. 
• Failure of downregulation of a number of “antifibrotic” factors has been implicated.

Symptoms:

• The presenting symptoms of Peyronie's disease include, in many patients, penile pain with erection; penile deformity, both flaccid and erect; shortening with and without an erection; plaque or indurated areas in the penis; and, in many patients, erectile dysfunction. 
• On physical examination, virtually all patients have either a well-defined plaque or an area of induration that is palpable. 
• The plaque is usually on the dorsal surface of the penis, intimately associated with the insertion of the septal fibers.
• Spontaneous improvement in pain virtually always occurs as the inflammation resolves.

Patient Evaluation:

• Patients with Peyronie's disease present with a variety of deformities of the penis. 
• Most have noted an indurated area in the penis that has been identified as the plaque. 
• Many patients have noticed erectile dysfunction. 
• All patients must be evaluated with a medical history, as well as a detailed psychosexual history. 
• Approximately one third of the patients will develop dystrophic calcification in the plaque that can be demonstrated by ultrasonography or plain radiography. 
• The place for MRI in the evaluation of Peyronie's plaque has not been defined, nor has the place for vascular testing been clearly defined. 
• However, most urologists would agree that in patients who are to be operated on, vascular testing to stratify the vascular parameters of erectile function is a necessity. 
• Once all of the data have been assembled, individualization with regard to the patient's requirements, findings, and assessment is imperative.

Medical Management:

• The efficacy of medical management of Peyronie's disease is difficult to determine because there are few RCT. 
• Vitamin E has been used historically, and while supplementation has been studied for decades, and some success has been reported in older trials, those results have not been reproducible in RCT.
• A combination of Vitamin E and colchicine has shown some promise in delaying progression of the condition.
• Potassium aminobenzoate, in a small study, was found to reduce plaque size, not curvature, and thus in that study was found “efficacious.” However, the side effects make it difficult to tolerate.
• A number of intralesional protocols have been proposed. 
• The use of verapamil as an intralesional agent has been studied. A prospective study did show decrease in curvature in about 80% of the patients. 
• Injections to plaques (scar tissue formed by the inflammation) with Verapamil may be effective in some patients, but a recent placebo controlled trial failed to show a significant improvement. 
• So there are conflicting outcomes reported.
• Interferon-alpha-2b has been proposed in recent publications.
• Radiation therapy should be avoided. 
• The vacuum erection device has not been adequately studied.
• Penile traction has not been adequately studied.
• The place of extracorporeal shockwave therapy has likewise not been adequately determined.

The use of collagenase as an intralesional agent has been subjected to a number of double-blind placebo-controlled protocols, and, in all, efficacy was suggested. Collagenase is currently not available as an approved treatment and remains in development.  

Surgery:

• The consensus committee on Peyronie's disease at the World Health Organization Second International Consultation on Sexual Dysfunctions stated that the penile prosthesis is a reliable option for the older man with vascular impairment, erectile dysfunction, and acquired deformity of the penis.
• It is not the only treatment of Peyronie's disease but rather a prudent treatment for the patient with significant erectile dysfunction in association with Peyronie's disease. 
• Hydraulic prostheses are preferred, and those prostheses that have true controlled expansion cylinders have been shown to provide better results.

References:

• Brock G, Lue TF: Peyronie's disease, a modified treatment. Urology 1993; 42:300-304.
• Brock G, Hsu GL, Nunes L, et al: The anatomy of the tunica albuginea in the normal penis and Peyronie's disease. J Urol 1997; 157:276-281.
• Carson CC, Jordan GH, Gelbard MK: Peyronie's disease: new concepts in etiology, diagnosis and treatment. Contemp Urol 1999; 11:44-64.
• Dibenedetti DB, Nguyen D, Zografos L, Ziemiecki R, Zhou X. Adva Urol 2011;282503.
• Hellstrom WJ: History, epidemiology and clinical presentation of Peyronie's disease [review]. Int J Impot Res 2003; 15(Suppl.):S91-S92. S121-4.
• Levine LA, Greenfield JM: Establishing a standardized evaluation of the man with Peyronie's disease [review]. Int J Impot Res 2003; 15(Suppl.):S103-S112.
• Levine LA. Peyronie's disease and erectile dysfunction: Current understanding and future direction. Indian J Urol 2006;22:246-50.
• Mulhull JP, Creech SD, Boorjian SA, et al: Subjective and objective analysis of the prevalence of peyronie's disease in a population of men presenting for prostate cancer screening. J Urol 2004; 171:2350 - 53.
• Mynderse LA, Monga M (October 2002). "Oral therapy for Peyronie's disease". International Journal of Impotence Research 14 (5): 340–4.
• Nyberg Jr LM, Bias WB, Hochbert MC, Walsh PC: Identification of an inherited form of Peyronie's disease with autosomal dominant inheritance and association with Dupuytren's contracture and histocompatibility B7 cross-reacting antigens. J Urol 1982; 128:48-51.
• O’Brien K, Parker M, Guhring P, et al: Analysis of the natural history of Peyronie's disease [abstract 69]. J Sex Med 2004; 1(Suppl. 1):50.
• Prieto Castro RM, Leva Vallejo ME, Regueiro Lopez JC, et al: Combined treatment with vitamin E and colchicine in the early stages of Peyronie's disease. BJU Int 2003; 91:522-524.
• Riedl CR, Sternig P, Gallé G, et al. (October 2005). "Liposomal recombinant human superoxide dismutase for the treatment of Peyronie's disease: a randomized placebo-controlled double-blind prospective clinical study". European Urology 48 (4): 656–61.
• Trost LW, Gur S, Hellstrom WJ (2007). "Pharmacological Management of Peyronie's Disease". Drugs 67 (4): 527–45.