Trauma as the cause of Peyronie's disease: penile fracture as a model of trauma

PURPOSE: This study was performed to determine whether patients with penile fracture or a long history of forcefully bending the erect penis (taqaandan), as models of acute and chronic penile trauma, had an increased rate of Peyronie's disease (PD). MATERIALS AND METHODS: The study included 193 surgical cases of penile fracture (average followup 85 months), 150 cases of long history of taqaandan, and 50 cases of PD. All 3 groups of patients were interviewed and physically examined. RESULTS: Signs of PD were found in only 1 case of long-term taqaandan and in no case of penile fracture. None of the 50 cases of PD had a history of penile fracture. CONCLUSIONS: Severe, acute trauma of penile fracture and moderate, chronic buckling injury of taqaandan are not associated with later development of PD. These findings question whether the hypothesis that trauma, trauma-induced smoldering inflammatory cascade and aberrant wound healing are the main causes of PD. Alternative, plausible, evidence based explanations should be sought for the etiology of PD. Any theory on the etiology of PD should provide an explanation for total lack of occurrence of PD following the trauma of penile fracture.     

Dystrophic penile calcification in Peyronie's disease

Plain film radiography was performed in 66 consecutive patients with Peyronie's disease. Dystrophic calcification was noted in 22 patients (33 per cent). Patients with dystrophic calcification were younger (p less than 0.025) and had a more severe deformity (p less than 0.05) than those without calcification.     

Shockwave therapy as first-line treatment for Peyronie's disease: a prospective study

BACKGROUND AND PURPOSE: To assess in a prospective study whether shockwave therapy (SWT) is effective as a first-line treatment for Peyronie's disease. PATIENTS AND METHODS: Forty patients with previously untreated Peyronie's disease underwent SWT with the Epos overhead-module device (Dornier). The pain severity (visual analog pain scale [VAS] 0-5), the degree of penile angulation after vasoactive drug injection, plaque size by ultrasound measurement, and erectile dysfunction (IIEF score) were assessed prior to and after treatment. Of the 40 patients, 7 underwent two sessions and the rest three sessions. The time interval between treatments was 2 weeks. At a power level of 2 to 5 (mean 4), a maximum of 3000 shockwaves per plaque per treatment were applied. The mean follow-up was 12 months. RESULTS: All patients completed the protocol. The tolerance and safety were excellent. Of the 25 patients with pain on erection, 12 (48%) noticed relief after the first session, while 9 more were pain free at the end of the treatment (VAS reduction 2.8; P<0.0001, and 2; P<0.001, respectively). For 25 patients (62.5%), an improvement in penile angulation>20 degrees was observed, with a mean reduction of 35 degrees (range 20 degrees-60 degrees ) (P<0.001). No significant change in plaque size was noted. Among 28 patients with erectile dysfunction, 18 (64.2%) had a marked increase in erection quality (IIEF score change: +4 for 10 patients, +6 for 4 patients, +8 for 2 patients, +9 for 2 patients). CONCLUSION: Our results support SWT as an effective and safe first-line treatment for Peyronie's disease.     

Primary penile lymphoma in a patient with Peyronie's disease

Malignant lymphoma involving the penis is rare, with only 5 cases reported in the literature. We report a case of primary lymphoma of the penis in a 60-year-old white man with Peyronie's disease who underwent ablation followed by brief chemotherapy. There was no evidence of systemic lymphoma involvement 6 years after therapy.     

Management of Peyronie's disease with penile prostheses

Peyronie's disease is a common malady affecting men mostly between the ages of 40 and 60. When penile curvature and erectile softening are present and the erectile dysfunction does not respond to Viagra a penile implant will strengthen and usually straighten the penis. If curvature persists after implant placement 'modeling' the erect penis will successfully achieve straightening in most patients. Plaque incision and grafting or a Nesbit procedure are rarely necessary to straighten the penis but will afford excellent results when employed. A thorough explanation of the pathogenesis of Peyronie's disease and effects of the disease and treatment on penile size will help avoid some of the disappointment seen when a shorter erection occurs.     

Combination of intralesional verapamil and oral antioxidants for Peyronie's disease: a prospective,randomised controlled study

The aim of this study was to evaluate the efficacy of the association of intralesional verapamil (ILV) injection with oral antioxidants compared with ILV monotherapy in patients with early onset of Peyronie's disease (PD) at 12‐week follow‐up. Group A (n = 52) received ILV 10 mg weekly for 12 weeks, while group B (n = 53) received ILV 10 mg weekly for 12 weeks + antioxidants orally one tablet once a day for 3 months. The main efficacy outcomes were the change in plaque size (PS), penile curvature (PC), visual analogue score (VAS), IIEF‐15 and IIEF‐15 subdomains. Both groups showed significant improvement from baseline to week 12 relative to PS and PC, while group B also in IIEF‐15 score (mean difference: 5.51, P < 0.01) and VAS (mean difference: ?2.71, P < 0.01). No significant differences were observed between both groups in PS and PC. Finally, both groups showed significant increase in orgasmic function (IIEF‐OF) and overall satisfaction (IIEF‐OS), while group B showed significant improvement also in intercourse satisfaction (IIEF‐IS). Significant differences were found relative to IIEF‐OF, IIEF‐IS, IIEF‐OS and VAS scores in the group B compared with group A. Patients affected by PD may benefit from combination treatment with ILV and oral antioxidants thanks to the improvement in IIEF‐OF, IIEF‐IS and IIEF‐OS at 12 weeks.     

Relationship between haemorrhoids and prostatism: results of a prospective study

Haemorrhoids are less prevalent in Africans than their European counterparts due to consumption of high-residue diet and bulky stools resulting in less straining at stooling. Bowesman felt that most cases of haemorrhoids in the African were due to lower urinary obstruction. This study was carried out to find any cause and effect relationship between benign prostatic hypertrophy and haemorrhoids. Sixty-two elderly patients with benign prostatic hypertrophy were screened for haemorrhoids before and after prostatectomy. Twenty-five patients had haemorrhoids before operation. In 20 patients (80%) the haemorrhoids had regressed spontaneously 3 months after surgery. It is therefore important to recognise that the presence of haemorrhoids in elderly males may be due to prostatism.     

Relationship between bone quantitative ultrasound and mortality: a prospective study

Summary

In a cohort of 5,201 women [72.3?±?5.3 years] from 58 primary care centers in Spain, followed for three years, no relationship between heel QUS parameters and overall mortality was found. However, a significant relationship between a low speed of sound (SOS) and vascular mortality was observed.

Introduction

An inverse relationship between mortality and bone mineral density measured by dual-energy absorption densitometry or quantitative bone ultrasound (QUS) has been described. The aim of the present study was to test this relationship in the ECOSAP cohort, a 3-year prospective study designed to assess the ability of heel QUS and clinical risk factors to predict non-vertebral fracture risk in women over 64.

Methods

A cohort of 5,201 women [72.3?±?5.3 years] was studied. QUS was assessed with the Sahara® bone sonometer. Women attended follow-up visits every 6 months. Physicians recorded if the patient died and cause of death. Hazard rates (HR) of all-cause and vascular mortality per one standard deviation reduction in QUS parameters were determined.

Results

One hundred (1.9%) women died during a median of 36.1 months follow-up, for a total of 14,999 patient-years, 42 because of vascular events (both cardiovascular and cerebrovascular). After adjusting for age, none of the QUS variables showed statistically significant differences between the patients who died and the survivors. In the final multivariate model, adjusted for age, current thyroxine and hypoglycaemic drug use, chronic obstructive pulmonary disease and decreased visual acuity, SOS was marginally non-significant: (HR: 1.19; 0.97–1.45). However, each 1 SD reduction in SOS was associated with a 39% increase in vascular mortality (HR: 1.39; 1.15–1.66).

Conclusions

In our cohort, SOS was related with vascular mortality, but not overall mortality.     

Risk factors for Peyronie's disease: a case-control study

OBJECTIVE: To test some hypotheses about risk factors for Peyronie's disease (PD). PATIENTS AND METHODS: In a case-control study, 82 patients with PD, consecutively diagnosed at the first author's institution, were compared with 246 men visiting the same institution for dermatological diseases. Univariate and multivariate logistic regression analyses were used to assess the data. RESULTS: From the multivariate logistic regression analysis the risk factors for PD were: a history of genital and/or perineal injuries, transurethral prostatectomy, cystoscopy, diabetes mellitus, hypertension, lipoma, propranolol in therapy, Dupuytren's contracture in the medical history, ever having smoked, alcohol consumption, fibromatous lesions of the genital tract of the partner, and surgical intervention on the genital tract of the partner. CONCLUSION: The results of the present study are in line with the hypothesis that, in addition to genetic predisposition, trauma of the penis and systemic vascular diseases are risk factors for PD. Smoking and alcohol consumption also seem to have some role in the development of the disease.     

Peyronie's disease: a review

PURPOSE: We provide a current review of Peyronie's disease. MATERIALS AND METHODS: We reviewed the world peer reviewed literature on the pathology, pathogenesis, diagnosis and treatment of Peyronie's disease. RESULTS: The incidence of Peyronie's disease has continuously increased during the last 30 years. However, fewer patients need prosthesis surgery as the sole treatment option because of earlier diagnosis, improved medical therapy, refinement in surgical technique and better understanding of the basic sciences of the disease. CONCLUSIONS: Currently patients with Peyronie's disease have had improvements in prognosis and experienced an expansion of the available therapeutic options.     

Corporal plication for penile curvature caused by Peyronie's disease: the patients' perspective

OBJECTIVE: To determine the acceptability by patients of corporal plication for Peyronie's disease. PATIENTS AND METHODS: A postal questionnaire was sent to 69 patients who had undergone corporal plication for Peyronie's disease between 1992 and 1999, to ascertain the subjective outcome and acceptance by the patients and their sexual partners of the results of the procedure. Of the 65 patients who were still alive, 44 (68%) returned the questionnaire. RESULTS: The mean (range) follow-up was 4.1 (0.5-7.25) years and the mean age of the patients 54.6 (32-80) years. Of the 44 patients responding, 24 (55%) were sexually active; after surgery, 16 (36%) had significant impairment of erections, seven (16%) continued to have significant penile discomfort and 15 (34%) could feel nodules at the suture site. Twenty-five (57%) patients reported a mild and six (14%) a severe persistent penile deformity; 40 (90%) reported having a shorter penis, of whom 22 (55%) thought it significant. Overall, 14 (32%) reported 'numbness' of the glans penis. Only 23 (52%) of the patients would recommend the surgery, with 25 (57%) reporting a deterioration in their overall quality of life. Of the partners of the evaluable patients, 38 (86%) responded, and a significant deterioration in sexual performance was reported by 19 (35%). CONCLUSIONS: Overall, the long-term results of corporal plication appear to be disappointing. These poor results could be related to a current lack of understanding of the natural history and progression of the disease, to case selection, or to the surgery. We intend to use these results to counsel our patients before such surgery and inform them of the possible outcome in the long term.     

Venous grafting for the correction of penile curvature in Peyronie's disease

A number of procedures have been developed to correct penile deformity secondary to Peyronie's disease. In many cases, tunica-shortening procedures have had reasonable success. The most popular of these are tunical plication and Nesbit's wedge resection. However, these procedures shorten the penis and do not correct the hourglass deformity. Tunica-lengthening by using autologous or synthetic materials has been reported with varying success. However, notable shortcomings including graft contracture, recurrence, and impotence have been reported. This review describes our experience with tunica incision and venous grafting.