Clinical Efficacy of Injection and Mechanical Therapy for Peyronie's Disease: A Systematic Review of the Literature. Combination of penile traction, intralesional verapamil, and oral therapies for Peyronie's disease. The impact of intralesional interferon alpha-2b injection therapy on penile hemodynamics in men with Peyronie's disease. Treatment of Peyronie's Disease With Collagenase Clostridium histolyticum and Vacuum Therapy: A Randomized, Open-Label Pilot Study. Effect of intralesional interferon-alpha 2b combined with oral vitamin E for treatment of early stage Peyronie's disease: a randomized and prospective study. Use of intralesional verapamil to dissolve Peyronie's disease plaque: a long-term single-blind study. Intralesional verapamil prevents the progression of Peyronie's disease. Verapamil versus saline in electromotive drug administration for Peyronie's disease: a double-blind, placebo controlled trial. Nicardipine vs. saline injection as treatment for Peyronie's disease: a prospective, randomized, single-blind trial. Intralesional interferon-alpha-2B injections for the treatment of Peyronie's disease. A pilot study demonstrating clinical benefit from intralesional interferon alpha 2B in the treatment of Peyronie's disease. Intralesional Injections for Early Peyronie Disease: Standardized Assessment and Analysis of Predictive Factors for Treatment Response. Clinical safety and effectiveness of collagenase clostridium histolyticum injection in patients with Peyronie's disease: a phase 3 open-label study. Clinical Experience With Penile Traction Therapy Among Men Undergoing Collagenase Clostridium histolyticum for Peyronie Disease. The use of intralesional clostridial collagenase injection therapy for Peyronie's disease: a prospective, single-center, non-placebo-controlled study. Single-blind, multicenter, placebo controlled, parallel study to assess the safety and efficacy of intralesional interferon alpha-2B for minimally invasive treatment for Peyronie's disease. Intralesional verapamil injection for the treatment of Peyronie's disease. Acute phase Peyronie's disease management with traction device: a nonrandomized prospective controlled trial with ultrasound correlation. Changes in the Effects of Peyronie's Disease After Treatment With Collagenase Clostridium histolyticum: Male Patients and Their Female Partners Restoration of Penile Function and Patient Satisfaction with Intralesional Collagenase Clostridium Histolyticum Injection for Peyronie's Disease. Minimally Invasive Therapy Using Intralesional OnabotulinumtoxinA in Peyronie's Disease. Evaluation of intralesional injection of verapamil in treatment of Peyronie's disease. EAU guidelines on prostate cancer. part 1: screening, diagnosis, and local treatment with curative intent-update 2013.
CONTEXT 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 . OBJECTIVE To summarise the available evidence regarding injection and mechanical therapies for PD treatment . EVIDENCE ACQUISITION An extensive search of Medline , Embase , and Scopus data bases retrieved English- language articles up to 15 May 2018 . The systematic review protocol was registered on PROSPERO ( CRD42017077050 ) . Inclusion criteria were as follows : adults with early or chronic PD receiving treatment with injection therapy , penile traction , or a vacuum device .  EVIDENCE SYNTHESIS Fifty-two articles were selected according to the inclusion criteria -17 comparative studies and 35 cohort studies -analysing the effects of calcium channel blockers ( verapamil , nicardipine ) , collagenase Clostridium histolyticum ( CCH ) , interferon α-2b ( IFNα-2b ) , hyaluronic acid ( HA ) , onabotulinum toxin A , thiocolchicine , penile extender devices , and vacuum devices . Qualitative data from these studies suggest a clinical ly significant effect of CCH and IFNα-2b injection therapy to decrease penile curvature and conserve penile length . Verapamil and HA performed well in single-arm or case-control studies . Studies of penile traction and vacuum devices in patients with PD demonstrated some benefits in terms of curvature and penile length but only in small , underpowered , nonr and omised studies . Studies of onabotulinum toxin A injections or thiocolchicine showed significant improvements in penile curvature , but only in studies of single-arm or case-control design . CONCLUSIONS CCH and IFNα-2b injected into stable PD plaques can decrease penile curvature ; CCH can also improve penile length . However , based on available data , strong conclusions can not be drawn for other treatments , including calcium channel blockers , HA , or mechanical therapies . PATIENT SUMMARY Our systematic review of injection therapies provides evidence for improvements in penile curvature for patients with Peyronie 's disease . No robust evidence is available to support the use of other local treatments including calcium channel blockers , hyaluronic acid , or mechanical therapies Introduction . There is no current consensus as to the most effective non-surgical therapy for Peyronie 's disease ( PD ) . Aim . To assess the benefit of penile traction therapy ( PTT ) when added to intralesional verapamil injections ( IVI ) combined with oral L-arginine 1 g bid and pentoxifylline 400 mg tid in men with PD . Methods . 74 men with PD completed 12 IVI . Patients electing to add PTT  were advised to wear the device for 2 - 8 hours daily , and no longer than 2 hours per session . Subjective responses were measured using patient question naires . Stretched penile length ( SPL ) and erect penile curvature ( EPC ) using penile duplex ultrasound ( DU ) were measured . Response to therapy was defined as at least a 10 degree reduction in EPC.Main Outcome Measures . Change in SPL ( cm ) , change in EPC ( degrees ) . Results . 39 patients in the PTT group ( I ) vs. 35 patients in group ( II ) completed the protocol . 54 % of men in group I responded to therapy vs. 46 % in group II ( p = 0.75 ) . Responders had a mean EPC improvement of 26.9 degrees in group I vs. 20.9 in group II ( p = 0.22 ) . Mean PTT use was 3.3 hours per day , and men with > 3 hours per day use gained 0.6 cm in SPL vs 0.07 cm using less than or equal to 3 hours per day ( p= 0.09 ) , while men in group I on lost 0.74 cm of SPL on average . Multivariate analysis revealed that duration of PTT use significantly predicts length gain ( 0.38 cm gain for every additional hour per day of PTT use , p = 0.007 ) . Conclusion . There was a trend toward measured curvature improvement , and a significant gain in SPL in men using the combination therapy protocol . Length improvement is related to duration of use of the traction device [ corrected ] INTRODUCTION Penile duplex Doppler ultrasound ( PDDU ) is currently the preferred method for the functional evaluation of penile hemodynamics . PDDU may be used to monitor objective ly changes in penile vascular parameters in men who undergo treatment for Peyronie 's disease ( PD ) , including intralesional interferon alpha-2b ( IFN alpha-2b ) . AIM To investigate the impact of intralesional IFN alpha-2b therapy for PD on penile hemodynamics by using PDDU and to assess the objective role of PDDU in monitoring treatment outcomes . MATERIAL S AND METHODS Thirty-nine patients ( 20 in the placebo and 19 in the IFN alpha-2b treatment arm ) were enrolled in this prospect i ve , placebo-controlled , parallel study . Patients received either 10 mL saline or 5 x 10(6 ) units of IFN alpha-2b intralesional injections every other week for a total of six injections . Patients in each group were evaluated at baseline and after completion of treatment regarding changes in penile hemodynamic parameters , penile curvature , plaque size and density , pain on erection , and erectile function . Specific published criteria were used for PDDU measurements . Outcomes were statistically compared between each group by using Mann-Whitney U and chi-square tests . RESULTS The mean age of the patients and the duration of PD were similar in both groups . The improvement in penile blood flow was significantly greater in IFN alpha-2b-treated patients than those in the placebo group . The number with the nonvascular classification increased significantly in the IFN alpha-2b arm from 31.5 % to 57.8 % . Additionally , improvements in penile curvature , plaque size and density , and pain on erection were better in the IFN alpha-2b group compared with the control . No significant improvement was observed in the erectile function domain in either group . CONCLUSION This study reveals that intralesional IFN alpha-2b injections have a significant benefit on penile hemodynamic parameters . Moreover , intralesional IFN alpha-2b is an effective , minimally invasive treatment for PD , and PDDU is a useful adjunct to monitor objective ly changes in penile vascular parameters . interferon alpha-2b injection therapy on penile hemodynamics in men with Peyronie 's disease BACKGROUND Collagenase Clostridium histolyticum ( CCH ) is indicated for the treatment of penile curvature in adult men with Peyronie 's disease ( PD ) with palpable plaque and curvature deformity of at least 30 ° at the start of therapy . AIM To evaluate the efficacy and safety of CCH plus vacuum-pump therapy with and without penile modeling for the management of PD . METHODS Adult men with PD and penile curvature of at least 30 ° were r and omly assigned to receive  CCH  0.58 mg plus vacuum therapy alone ( n = 15 ) or with penile plaque modeling ( n = 15 ) . Patients received no more than four treatment cycles ( cycle = ∼6-week duration ) , each consisting of two intralesional injections of CCH administered 24 to 72 hours apart . Vacuum therapy was applied twice daily from 14 days after the second injection of each cycle until the following cycle . Modeling was performed 24 to 72 hours after the second injection of each cycle . OUTCOMES The primary end point was change in penile curvature from baseline to week 36 ; additional end points included changes in Peyronie 's Disease Question naire ( PDQ ) domain scores , composite response ( ≥20 % decrease in penile curvature and decrease in PDQ bother score ≥ 1 point ) , and global response ( small but important , moderate , or much improvement in the Global Assessment of PD ) . RESULTS At week 36 , improvement in penile curvature from baseline was similar in the two groups ( mean change from baseline = -23.7 ° [ SD = 10.9 ] for CCH + vacuum + modeling and -23.3 ° [ SD = 7.2 ] for CCH + vacuum ; between-group difference = -0.3 ° , 95 % CI = -7.3 to 6.6 ) . Improvements in most PDQ domains , including bother , were observed from baseline to week 36 in the two groups . Most patients were composite ( 66.7 % and 84.6 % with CCH + vacuum + modeling and CCH + vacuum , respectively ) and global ( 86.7 % and 92.3 % , respectively ) responders . The most common adverse events were penile contusion , penile swelling , and penile pain . CLINICAL IMPLICATION S Vacuum-pump therapy administered alone or in combination with modeling after CCH treatment could improve PD symptoms . STRENGTHS AND LIMITATIONS This was a pilot study with a small sample and limited follow-up duration . CONCLUSION CCH and vacuum-pump therapy ( alone or combined with modeling ) could be an appropriate consideration for men with PD and warrants further investigation . Ralph DJ , Abdel Raheem A , Liu G. Treatment of Peyronie 's Disease With Collagenase Clostridium histolyticum and Vacuum Therapy : A R and omized , Open-Label Pilot Study . J Sex Med 2017;14:1430 - 1437 OBJECTIVES To compare the efficacy and safety of intralesional interferon-alpha 2b combined with oral vitamin E or intralesional interferon-alpha 2b alone or oral vitamin E alone for the treatment of Peyronie 's disease . METHODS From January 2000 to March 2002 , a total of 30 consecutive men with Peyronie 's disease were r and omized prospect ively into three different treatment groups . All the patients were assessed objective ly with  penile duplex Doppler ultrasonography  for plaque size , location , and presence of calcification before and after treatment . Subjective data were obtained by querying about the improvement in penile pain and by using the " global efficacy question " for the assessment of the quality of sexual intercourse at the end of the study . A total of 5.0 x 10(6 ) U of interferon-alpha 2b was given once per week directly into the plaque for a period of 12 weeks . Patients received 400 IU of vitamin E orally twice daily for 6 months . RESULTS At the 6-month follow-up visit , we did not find any statistically significant changes in the objective parameters when compared with the initial findings in each group or among the three groups ( P > 0.05 ) . We did not observe any clinical ly significant improvement in the subjective parameters among the three groups ( P > 0.05 ) . However , all patients who were treated with interferon-alpha 2b experienced brief flu-like side effects . CONCLUSIONS Our findings indicate that 5 million units of intralesional interferon-alpha 2b injection therapy either alone or in combination with vitamin E does not appear to be clinical ly effective in the management of early stage Peyronie 's disease compared with only oral vitamin OBJECTIVES Multiple conservative therapies for the treatment of Peyronie 's disease have been offered with variable and poor response rates . Calcium channel blockers have been shown in vitro and in vivo to inhibit secretion and synthesis of extracellular matrix , including collagen , glycosaminoglycans , and fibronectin , as well as causing increased collagenase and anti transforming growth factor-beta activity . Calcium antagonists , including verapamil , are effective in stimulating the remodeling and degradation of extracellular matrix in tissue by altering the metabolic pathways of fibroblasts . Recently , a pilot study ( 1994 ) showed preliminary promising results in treating plaque caused by Peyronie 's disease . This r and omized single-blind placebo-based study ( 1994 to 1996 ) was undertaken to confirm the hypothesis . METHODS In this r and omized single-blind study , 14 patients completed the study and were divided into two groups : the verapamil treatment group ( n = 7 ) or the control saline group ( n = 7 ) . Verapamil or saline was injected directly into the Peyronie 's plaque once a week for 6 months . Patients were evaluated before and after treatment with duplex ultrasound to confirm the extent of the lesion and to measure volume of the plaque , and by interview and mailed question naire 3 months after treatment . Patients being treated with oral calcium antagonists were excluded from the study . RESULTS A decreased plaque volume was measured in 57 % of the verapamil-treated men versus 28 % in the control group ( P < 0.04 ) . Penile curvature demonstrated an improvement trend of 37.71 + /- 9.3 degrees to 29.57 + /- 7.3 degrees in the verapamil-treated patients , but the difference was not significant ( P < 0.07 ) . Plaque softening was noted in all patients treated with verapamil . There was significant objective improvement in plaque-associated penile narrowing in all patients in the verapamil group . Subjective plaque-associated erectile dysfunction ( quality of erection ) showed improvement in 42.87 % of the verapamil group versus none in the control group ( P < 0.02 ) . There was no local or systemic toxicity except for an occasional ecchymosis/bruise at the injection site . After a positive clinical response , plaque size , penile angulation , and symptoms continued to improve . Decrease in plaque size was noted in each of the responders in the first 3 months . CONCLUSIONS This r and omized single-blind study suggests that intralesional injection of calcium channel blocker may be a reasonable approach in some selected patients for the treatment of Peyronie 's disease with noncalcified plaque and penile angulation of less than 30 degrees . Patients whose plaque failed to respond to intralesional verapamil therapy within 3 months or whose angulation was greater than 30 degrees at presentation were more likely to benefit from surgery OBJECTIVES To define the impact of intralesional verapamil injection therapy on  penile deformity in men with Peyronie 's disease . METHODS Patients underwent a total of 6 intralesional injections of verapamil .  Penile deformity was assessed at baseline and 3 months after the last intralesional injection of verapamil during penile erection after the administration of intracavernosal medication . Measurement was recorded using a goniometer at maximum penile rigidity . Endpoints included change in magnitude of curvature , stretched penile length , penetration ability , and resolution of pain . RESULTS Ninety-four consecutive patients met all inclusion criteria . Mean ( + /- st and ard deviation ) patient age and duration of Peyronie 's disease at time of baseline deformity assessment were 44 + /- 18 years and 5.2 + /- 2.7 months , respectively . At baseline 86 % had dorsal and 14 % lateral curvature . The mean curvature and stretched flaccid length were 50 degrees + /- 28 degrees and 12.6 + /- 3.1 cm , respectively . At the follow-up evaluation , patients were 5.2 + /- 1.8 months after their last ILV injection and were 11.7 + /- 4.2 months after the onset of Peyronie 's disease . Eighteen percent of patients had improvement of curvature , 60 % were unchanged , and 22 % worsened . Pain resolved in 100 % of patients . CONCLUSIONS In response to intralesional verapamil , a minority of men experienced improvement in penile deformity ; however , the majority of patients had stabilization of their deformity . This information may permit clinicians to give realistic expectations to patients considering intralesional verapamil therapy PURPOSE While surgery remains the gold st and ard of therapy to correct the acquired curvature of Peyronie 's disease , the search for a less invasive therapy continues . Transdermal drug delivery was proposed to be superior to oral or injection therapy because it bypasses hepatic metabolism and minimizes the pain of injection . After electromotive drug administration with verapamil tunica albuginea specimens were demonstrated to contain detectable levels of the drug . Due to varying success with verapamil as injectable therapy for Peyronie 's disease we performed a double-blind , placebo controlled trial to determine the effectiveness of verapamil delivered through electromotive drug administration . MATERIAL S AND METHODS A total of 42 men with Peyronie 's disease volunteered to participate in this study , which was approved by our institutional review board . A genitourinary examination was performed on all patients , including plaque location , stretched penile length , objective measurement of curvature after papaverine injection and duplex ultrasound . Each subject was r and omized to receive 10 mg verapamil in 4 cc saline or 4 cc saline via electromotive drug administration . A Mini-Physionizer ( Physion , Mir and ola , Italy ) device was used at a power of 2.4 mA for 20 minutes . Treatments were performed 2 times weekly for 3 months . After 3 months each patient was reevaluated with physical examination and duplex ultrasound  by a technician blinded to the treatment received . A modified erectile dysfunction index of treatment satisfaction question naire was also completed by each patient . RESULTS A total of 23 patients were r and omized to the verapamil treatment group ( group 1 ) and 19 were r and omized to the saline group ( group 2 ) . There were no significant differences between patient groups with respect to patient age , disease duration or pretreatment curvature . In group 1 , 15 patients ( 65 % ) had measured improvement ( mean 9.1 degrees , range 5 to 30 ) , 5 ( 22 % ) had no change and in 3 ( 13 % ) the condition worsened . In group 2 , 11 patients ( 58 % ) had measured improvement ( mean 7.6 degrees , range 5 to 30 ) , 7 ( 37 % ) showed no change and in 1 ( 5 % ) the condition worsened . To better evaluate effectiveness the total number of patients experiencing significant improvement ( 20 degrees or greater ) was calculated and compared . Seven patients ( 30 % ) in group 1 and 4 ( 21 % ) in group 2 achieved this criterion . Although a greater percent of patients treated with verapamil had improved curvature , the results were not statistically significant . CONCLUSIONS Although a greater percent of patients treated with verapamil in our electromotive drug administration protocol had a measured decrease in curvature , the results were not statistically significant . Further research is necessary to determine whether electric current may have a role in the treatment of Peyronie 's disease as well as if verapamil delivered via electromotive drug administration may have a role as effective treatment . Electromotive drug administration is a treatment option in the patient whose major complaint is pain or in the patient with mild curvature who does not wish to undergo intralesional therapy or surgical correction INTRODUCTION Various conservative treatments for Peyronie 's disease ( PD ) have been attempted over the years . Intralesional verapamil injection has been tested in prospect i ve r and omized studies , but the effect of this treatment seems insufficient . Nicardipine is a calcium antagonist alternative to verapamil and is reportedly more effective in vitro . AIM The objective of our study was to evaluate the usefulness of intralesional nicardipine injection as a conservative treatment for PD in the transition period of acute and chronic phase . METHODS Eighty-six patients ( age : 38 - 72 years , mean : 52 ) were enrolled in this study . A total of 74 patients were assigned r and omly to nicardipine group ( 10 mg diluted in 10 mL of distilled water daily , N=37 ) and control group ( 10 mL of saline water , N=37 ) . A total of six injections were administrated biweekly . MEAN OUTCOME MEASURE The subjects were assessed by International Index of Erectile Function (IIEF)-5 and international pain scale . The plaque size was measured by ultrasonography after 20 µg intracavernosal injection of alprostadil ( prostagl and in E1 ) . The penile curvature was also measured by taking a photograph at maximum rigidity . RESULTS A reduction of pain score was seen throughout the course of treatment in both groups with a significant difference between the nicardipine and control groups ( multiple analysis of variance test , P=0.019 ) . A significant improvement of IIEF-5 score occurred only in the nicardipine group at 48 weeks after the initiation of treatment ( P<0.01 ) . The plaque size was significantly reduced at 48 weeks only in the nicardipine group ( 12 points , P=0.0004 by paired t-test ) . The penile curvature was significantly improved in both groups ( P<0.01 ) without significant difference between them ( P=0.14 ) . There were no severe side effects , such as hypotension or other cardiovascular events . CONCLUSION Our findings indicate that intralesional nicardipine injection is clinical ly effective as a conservative treatment for PD in the transition period of acute and chronic phase BACKGROUND Intralesional therapies provide an alternative to surgical treatment of Peyronie 's disease ( PD ) . This study examines the efficacy of intraplaque injections of interferon-alpha-2B ( IFN-alpha-2B ) in the treatment of PD . METHODS Twenty-five patients were enrolled in the study with 21 completing the study . The average age of the study participants was 55.8 years , with 10 of the 21 having diabetes , hypertension , or both . Seven patients received placebo injections using 10 ml saline biweekly for 6 weeks before interferon therapy , and all 21 patients received biweekly injections of 2 x 10(6 ) U IFN-alpha-2B for 6 weeks before reevaluation . Patients were evaluated with  duplex Doppler ultrasonography  to assess penile curvature and blood flow . RESULTS The International Index of Erectile Function question naire was completed by 14 of 21 men to assess severity of erectile dysfunction ( ED ) before and after treatment . Improvements of 20 % or more in penile curvature occurred in 14 ( 67 % ) of 21 men . Penile pain decreased in eight ( 80 % ) of 10 , and plaque size decreased subjectively in 15 ( 71 % ) of 21 participants . The International Index of Erectile Function question naire showed significant improvement of ED in five ( 71 % ) of seven men with baseline moderate to severe ED . Peak systolic blood flow improved in three ( 43 % ) of seven men with baseline hemodynamic impairment , and veno-occlusive disease resolved in three ( 18 % ) of 17 individuals . IFN-alpha-2B injections led to significant improvements in penile pain and curvature caused by PD . CONCLUSION Results of intralesional IFN-alpha-2B injections in improving ED are encouraging . The study findings warrant further investigation of the effectiveness of IFN-alpha-2B injections for treatment of PD Intralesional therapy is a less invasive method for the treatment of Peyronie 's disease . The objective of this study was to evaluate intralesional injections of interferon alpha 2B ( IFN-alpha-2B ) as an effective alternative to the surgical treatment of Peyronie 's disease . Twenty-one patients with Peyronie 's disease were evaluated by use of penile duplex Doppler ultrasonography for cavernosal blood flows , degree of penile curvature , and plaque size . A question naire was given to all patients to assess sexual function . Each patient then received biweekly intralesional injections of 1 x 10(6 ) units of IFN-alpha-2B in 10 ml of normal saline over a period of 6 months . There was no placebo control group in this study . At the conclusion of the study , penile duplex Doppler imaging was repeated . A question naire was completed by all patients to assess changes in sexual function after treatment . Twenty patients completed the study , with all men reporting subjective softening of their plaques . Nine of 10 patients initially reporting penile pain with erection ( 90 % ) had resolution of their phallalgia while on study protocol . Thirteen patients ( 65 % ) had significant improvement in curvature , ranging from 20 to 90 % . Seventeen patients ( 85 % ) demonstrated an objective 10 to 80 % decrease in plaque size . Biweekly intralesional injections of Peyronie 's plaques with IFN-alpha-2B result ed in a significant improvement in penile curvature , diminished pain , and reduced plaque size , and result ed in a subjective improvement in sexual function OBJECTIVE To assess the outcomes of a new protocol of intralesional injections of verapamil ( ILIV ) to treat Peyronie disease ( PD ) and to look for predictors of response . METHODS Patients followed up for PD in our center were prospect ively enrolled between 2007 and 2013 . The following data were collected : age , degree of curvature of the penis , Lue score  ( severity score of PD [ 0 - 15 ] ) , and pain  ( analogic Likert scale : 0 - 5 ) . The protocol consisted of 1 verapamil injection per session ( 15 mg in 6 mL ) in the main plaque using a single-puncture approach . Injections were repeated once every 3 weeks , at least 6 times . RESULTS Sixty men were included .  Mean number of injections per patient was 12.6 ( ±8.9 ) . Average Lue scores before and after ILIV were 9.4 ( ±2 ) and 4.5 ( ±2 ; P = .05 ) , respectively . Average penile curvatures during erection before and after ILIV were 37.3 ° ( ±13.3 ) and 21 ° ( ±13 ) , respectively ( P = .02 ) . There were no serious side effects . At the end of follow-up , 47 patients ( 78 % ) considered themselves globally improved . Younger age was the only predictor of response to ILIV in univariate ( odds ratio = 0.91 ; P = .04 ) and multivariate analyses ( odds ratio = 0.87 ; P = .03 ) . CONCLUSION ILIV had a favorable impact reducing PD in 78 % of patients with minimal side effects . Most patients required at least 12 injections to obtain optimal improvement . A protocol consisting of repeated courses of 6 injections using a single-puncture approach appears a valid option . Younger age was the only predictor of success INTRODUCTION Collagenase clostridium histolyticum ( CCH ; Xiaflex , Auxilium Pharmaceuticals , Inc. , Chesterbrook , PA , USA ) is a Food and Drug Administration-approved , intralesional treatment for Peyronie 's disease ( PD ) . AIM The aim of this study was to assess the safety and effectiveness of CCH in the treatment of PD . METHODS This phase 3 , open-label study enrolled subjects who were CCH-naïve , were enrolled in a previous pharmacokinetic study , or had received placebo in an earlier phase 2 CCH study . Each treatment cycle included two intralesional injections of CCH 0.58 mg , approximately 24 - 72 hours apart , and plaque modeling 24 - 72 hours after the second injection of each cycle . The treatment cycle was repeated after 6 weeks for ≤4 treatment cycles . MAIN OUTCOME MEASURES The co- primary end points were the mean percent change in penile curvature deformity and the mean improvement in PD bother score ( range 0 - 16 ) from baseline to week 36 . RESULTS Of the 347 subjects treated with ≥1 injection , 238 had both a penile curvature measurement and a Peyronie 's Disease Question naire response at baseline and ≥1 subsequent time point . Mean baseline penile curvature deformity was 53.0 ° and mean PD symptom bother was 7.3 . Statistically significant mean improvements from baseline to week 36 were observed in both penile curvature deformity ( 34.4 % [ 95 % confidence interval { CI } , 31.2 % , 37.6 % ] ) and PD symptom bother score ( 3.3 [ 95 % CI , 2.8 , 3.7 ] ) . Most adverse events ( AEs ) were mild or moderate in severity and local to the penis . There were three serious treatment-related AEs , two penile hematomas and one corporal rupture ; all resolved with treatment . CONCLUSIONS Potentially clinical ly meaningful and statistically significant improvements in penile curvature deformity and PD symptom bother scores were observed with intralesional injection of CCH compared with baseline in men with PD . CCH was generally well tolerated , with AEs primarily transient and local to injection site . In conjunction with previous studies , the results of this open-label study support the use of CCH in the treatment of PD OBJECTIVE To evaluate the outcomes in men undergoing collagenase Clostridium histolyticum ( CCH ) with concurrent penile traction therapy ( PTT )  for the treatment of Peyronie disease ( PD ) . MATERIAL S AND METHODS We identified patients treated with CCH between March 2014 and July 2016 . Patients were recommended to perform modeling and PTT between injection series . A final curve assessment was performed after patients completed CCH . A prospect i ve data base was maintained , including patient-reported frequency and duration of PTT . Statistical analysis was performed to evaluate outcomes based on use and duration of PTT . RESULTS A total of 51 patients completed CCH and had complete objective data available for analysis . Mean ( st and ard deviation [ SD ] ) baseline curvature was 66.7 ( 25.0 ) degrees , and mean ( SD ) improvement post CCH was 20.9 ( 17.3 ) degrees ( P < .0001 ) . Thirty-five ( 69 % ) men reported daily  PTT  for a mean ( SD ) of 9.8 ( 6.3 ) hours per week . No significant difference was identified in the degree of curve improvement based on frequency or duration of PTT ( P = .40 ) . Similarly , no associations between PTT and functional outcomes including intercourse restoration and surgery prevention were identified . Stretched penile length increased nonsignificantly by a mean ( SD ) of + 0.4 ( 1.5 ) cm in the PTT group , compared with -0.35 ( 1.5 ) in the non-PTT group ( P = .21 ) . CONCLUSION The current series represents a " true-to-life " experience , wherein utilization patterns , attrition , and compliance issues are relevant factors impacting efficacy . PTT use with the And ropenis declined in both frequency and duration with subsequent injection series , and there was no significant difference in curve improvement or stretched penile length with a mean 10 hours of weekly concurrent PTT INTRODUCTION Peyronie 's disease afflicts at least 3 % of sexually active men over the age of 30 . Many pharmacologic therapies have been tried , but to date , no systemic or local therapy has been proven to provide predictable and lasting results . AIM This study was design ed to assess the efficacy and safety of intralesional clostridial collagenase injection therapy in a series of patients with Peyronie 's disease . METHODS Twenty-five patients aged 21 - 75 years who were referred to a single institution with a well-defined Peyronie 's disease plaque were treated with three intralesional injections of clostridial collagenase 10,000 units in a small volume ( 0.25 cm(3 ) per injection ) administered over 7 - 10 days , with a repeat treatment ( i.e. , three injections of collagenase 10,000 units/25 cm(3 ) injection over 7 - 10 days ) at 3 months . Primary efficacy measures were changes from baseline in the deviation angle and plaque size . Secondary efficacy end points were patient responses to a Peyronie 's disease question naire and improvement according to the investigators ' global evaluation of change . MAIN OUTCOME MEASURE The primary efficacy measures were change in deviation angle and change in plaque size . Secondary end points were patient question naire responses and improvement according to the investigators ' global evaluation of change . RESULTS Significant decreases from baseline were achieved in the mean deviation angle at months 3 ( P = 0.0001 ) and 6 ( P = 0.0012 ) , plaque width at months 3 ( P = 0.0052 ) , 6 ( P = 0.0239 ) , and 9 ( P = 0.0484 ) , and plaque length at months 3 ( P = 0.0018 ) and 6 ( P = 0.0483 ) . More than 50 % of patients in this series considered themselves " very much improved " or " much improved " at all time points in the study , and the drug was generally well tolerated . CONCLUSION The benefits of intralesional clostridial collagenase injections in this trial lend support to prior studies supporting its use in the management of Peyronie 's disease . A double-blind , placebo-controlled study is currently under development PURPOSE We investigated the efficacy and safety of intralesional interferon alpha-2b for the treatment of Peyronie 's disease . MATERIAL S AND METHODS A total of 117 consecutive patients with a mean age of 55.1 years who had Peyronie 's disease were enrolled in a single-blind , multicenter , placebo controlled , parallel study to determine the efficacy and safety of intralesional interferon alpha-2b therapy ( Schering , Kenilworth , New Jersey ) , including 62 who received placebo and 55 who received interferon alpha-2b . Saline ( 10 ml ) in controls and interferon alpha-2b ( 5 x 10(6 ) U ) were administered biweekly for 12 weeks . Each patient was evaluated for penile curvature , plaque size and density , penile pain , erectile function and penile hemodynamics before and after study completion . Improvement in these parameters was statistically compared between the groups . RESULTS A total of 53 patients in the control arm and 50 in the interferon alpha-2b arm completed the study . Improvement in penile curvature , plaque size and density , and pain resolution was significantly greater in patients treated with interferon alpha-2b vs placebo . The increase in mean International Index of Erectile Function scores was not significantly different between the groups . Penile blood flow improvement was observed in interferon alpha-2b treated patients but not in those who received placebo . The decrease in the number of penile vascular pathologies was significantly higher in interferon alpha-2b cases . Side effects , mostly flu-like symptoms , which were frequently noted in patients on interferon alpha-2b , were mild to moderate in degree and of short duration . CONCLUSIONS This single-blind , multicenter , placebo controlled , parallel study demonstrates that intralesional interferon alpha-2b at a dose of 5 x 10(6 ) units biweekly for 12 weeks is effective and safe as minimally invasive therapy for Peyronie 's disease Peyronie 's disease remains a therapeutic dilemma for the practicing urologist . Multiple nonoperative therapies have been offered with variable suboptimal response rates . Calcium channel blockers have been shown to alter the metabolism of fibroblasts , result ing in decreased extracellular matrix secretion of collagen as well as increased collagenase activity . In this nonr and omized dose-escalating format study 14 men received biweekly injections of verapamil into the Peyronie 's plaques for 6 months . Subjectively , there was significant improvement in plaque-associated penile narrowing ( 100 % ) and curvature ( 42 % ) . Objective ly , a decreased plaque volume of greater than 50 % was noted in 30 % of the subjects . Plaque softening was noted in all patients , while 83 % noticed that plaque-related changes in erectile function had arrested or improved . There was no toxicity nor did symptoms recur when improvement was noted . This preliminary study suggests that intralesional calcium antagonist ( verapamil ) therapy offers an economical and sensible nonoperative approach to the treatment of Peyronie 's disease INTRODUCTION Outcome data of penile traction therapy ( PTT ) for the acute phase ( AP ) of Peyronie 's disease ( PD ) have not been specifically studied . AIM The aim of this study was to assess the effectiveness of a penile extender device for the treatment of patients with AP of PD . METHODS A total of 55 patients underwent PTT for 6 months and were compared with 41 patients with AP of PD who did not receive active treatment ( " no intervention group " [ NIG ] ) . MAIN OUTCOMES MEASURES Pre- and posttreatment variables included degree of curvature , penile length and girth , pain by 0 - 10 cm visual analog scale ( VAS ) , erectile function ( EF ) domain of the International Index of Erectile Function question naire , Erection Hardness Scale , Sexual Encounter Profile 2 question , and penile sonographic evaluation  ( only patients in the intervention group ) . RESULTS The mean curvature decreased from 33 ° at baseline to 15 ° at 6 months and 13 ° at 9 months with a mean decrease 20 ° ( P < 0.05 ) in the PTT  group . VAS score for pain decreased from 5.5 to 2.5 after 6 months ( P < 0.05 ) . EF and erection hardness also improved significantly . The percentage of patients who were not able to achieve penetration decreased from 62 % to 20 % ( P < 0.03 ) . In the NIG , deformity increased significantly , stretched flaccid penile length decreased , VAS score for pain increased , and EF and erection hardness worsened . PTT was associated with the disappearance of sonographic plaques in 48 % of patients . Furthermore , the need for surgery was reduced in 40 % of patients who would otherwise have been c and i date s for surgery and simplified the complexity of the surgical procedure ( from grafting to plication ) in one out of every three patients . CONCLUSIONS PTT seems an effective treatment for the AP of PD in terms of pain reduction , penile curvature decrease , and improvement in sexual function Introduction Collagenase Clostridium histolyticum ( CCH ) intralesional injection was efficacious for the management of Peyronie 's disease ( PD ) in the double-blinded , r and omized , placebo-controlled Investigation for Maximal Peyronie 's Reduction Efficacy and Safety Studies I and II ( IMPRESS I and II ) . Little is known about the consequences of PD or treatment on the sexual partners of affected men . Aim To assess the safety and efficacy of CCH treatment in men who received placebo in the IMPRESS I or II study and to evaluate the men 's PD symptoms and partner bother as reported by female sexual partners . Methods In this phase 3 , open-label study ( NCT01685437 ) , men ( n = 189 ) received up to eight injections of CCH ( 0.58 mg/injection ) . Female sexual partners who provided informed consent at screening ( n = 30 ) participated in the study . Main Outcome Measures Co- primary end points were change or percentage of change in penile curvature deformity and change in PD symptom bother domain score of the Peyronie 's Disease Question naire ( PDQ ) from baseline to week 36 . Participating women completed the PDQ for  female  sexual partners ( PDQ-FSP ) and the Female Sexual Function Index ( FSFI ) . Results Statistically significant mean improvements were observed in penile curvature deformity ( 36.3 % decrease ; 95 % CI = −41.6 to −30.9 ) and PDQ symptom bother score ( 2.4-point decrease ; 95 % CI = −3.0 to −1.8 ) from baseline to week 36 . Most treatment-emergent adverse events were mild or moderate . After CCH treatment of their male partners , female sexual partners reported improvement ( using the PDQ-FSP ) in their male partner 's PD symptoms and female bother regarding their partner 's PD . The percentage of female sexual partners with sexual dysfunction ( FSFI total score ≤ 26.55 ) also decreased after male partner treatment , from 75.0 % at baseline to 33.3 % . Conclusions These results support the safety and efficacy of CCH in the management of appropriate patients with PD and the potential benefits for patients ' partners . Goldstein I , Knoll LD , Lipshultz LI , et al. Changes in the Effects of Peyronie 's Disease After Treatment With Collagenase Clostridium histolyticum : Male Partners and Their Female Partners . Sex Med 2017;5:e124–e130 PURPOSE Collagenase clostridium histolyticum is approved for the treatment of Peyronie 's disease . To date , no post-release study to our knowledge has evaluated patient perceived outcomes and satisfaction . Therefore , we evaluated patient perceived experience with collagenase clostridium histolyticum injection for Peyronie 's disease in a clinical practice . MATERIAL S AND METHODS From March 2014 to July 2015 , 69 patients underwent 1 to 4 series of collagenase clostridium histolyticum injections for Peyronie 's disease at our institution . Objective changes in penile curvature as well as patient reported functional outcomes and patient perceived curvature improvements were evaluated . RESULTS By the time of analysis 31 patients ( 45 % ) had completed 4 trials , 47 ( 68 % ) completed 3 trials and 59 ( 86 % ) completed 2 trials . Patient reported improvements ( percentage ) in curvature increased with each series ( trial 1 - 14 % , trial 2 - 28 % , trial 3 - 30 % and trial 4 - 37 % , p < 0.05 ) . Among those completing therapy 57 % reported that collagenase clostridium histolyticum injections negated a need for surgery and 52 % reported restoration of penetration . Overall 81 % of men perceived collagenase clostridium histolyticum treatment as meaningful and 88 % reported subjective improvements after 4 series of injections . Objective measures demonstrated a mean 23-degree curvature improvement ( 38 % , p < 0.0001 ) . Seven patients ( 10 % ) experienced penile hematomas and no patients experienced tunical rupture . CONCLUSIONS Collagenase clostridium histolyticum reduced the need for surgery and restored penetration in the majority of patients completing 4 series of injections . It also significantly reduced the degree of objective ly measured penile curvature . Subjective improvements in curvature increased with each series of collagenase clostridium histolyticum injections as well and the majority of patients considered the therapy worthwhile PURPOSE To determine the effectiveness of intralesional administration of onabotulinumtoxinA in patients with Peyronie ’s disease ( PD ) . MATERIAL S AND METHODS A prospect i ve therapeutic cohort study was undertaken in patients aged ≥ 18 years with stable PD . Intervention included one-time intralesional application of 100 U of onabotulinumtoxinA. We included 22 patients who attended the urology clinic from October 1 , 2011 to June 30 , 2012 . Primary outcome measure was degree of curvature . Secondary outcome measures were thickness of the fibrous plaque , improvement in erectile function and pain . Erectile function was evaluated using the International Index of Erectile Function ( IIEF-5 ) question naire . The Visual Analog Scale ( VAS ) was used to measure pain during an erection . Statistical analyses were performed by Pearson ’s chi-squared test for categorical variables and student ’s t-test for quantitative variables . Any P value < .05 was considered statistically significant . RESULTS The size of the fibrous plaque was reduced from 0.34 ± 0.20 to 0.27 ± 0.13 cm after treatment ( P = .014 ) . The curvature initially averaged 32.95 ± 9.21 ° , and improved to 25 ± 9.38 ° ( P = .025 ) . According to the Kelami classification , the curvature was < 30 ° in 14 cases ( 63.6 % ) and was 30 ° -60 ° in eight cases ( 36.4 % ) . At 16 weeks , the curvature was < 30 ° in 19 cases ( 86.4 % ) and 30 ° -60 ° in three cases ( 13.6 % ) . The IIEF-5 score was 16.18 ± 4.46 before treatment and 18.22 ± 4.55 after treatment ( P = .002 ) . Pain was reduced from 3.36 ± 3.48 before treatment to 1.14 ± 1.58 after treatment ( P = .001 ) . CONCLUSION The administration of onabotulinumtoxinA may improve the clinical manifestations of PD result ing from fibrosis , thus improving sexual function in patients OBJECTIVE To evaluate the effect of intralesional injection of verapamil in Peyronie 's plaque with confirmed lesion . METHODS This r and omized clinical trial was carried out between March 2005 and March 2006 on 16 patients with Peyronie 's disease who were referred to the Urology Clinic of Shohadaye Ashayer Hospital in Khorram Abad , Iran . Performing a comprehensive physical exam , the genitalia of the patients were checked to confirm the diagnosis and reject other sexual disorders . Besides , parameters such as penis curving , lesion size were measured . Then , based on the 10-point visual analogue scale , sexual satisfaction of patients and their wives were recorded in a question naire . Patients got intralesional verapamil every 14 days and were treated for 6 months . After that , the parameters were assessed and data collected was analyzed using paired t-test . P-value < 0.05 was considered statistically significant . RESULTS On average , lesion size and penis curving decreased 30 % . Almost 20 % of patients and their wives were satisfied with the outcome of the treatment . No significant side effect was seen during the treatment . CONCLUSION Injection of calcium channel blockers are effective for treatment of the Peyronie 's disease ; however , more studies with more patients are CONTEXT The most recent summary of the European Association of Urology ( EAU ) guidelines on prostate cancer ( PCa ) was published in 2011 . OBJECTIVE To present a summary of the 2013 version of the EAU guidelines on screening , diagnosis , and local treatment with curative intent of clinical ly organ-confined PCa . EVIDENCE ACQUISITION A literature review of the new data emerging from 2011 to 2013 has been performed by the EAU PCa guideline group . The guidelines have been up date d , and levels of evidence and grade s of recommendation have been added to the text based on a systematic review of the literature , which included a search of online data bases and bibliographic review s. EVIDENCE SYNTHESIS A full version of the guidelines is available at the EAU office or online ( www.uroweb.org ) . Current evidence is insufficient to warrant widespread population -based screening by prostate-specific antigen ( PSA ) for PCa . Systematic prostate biopsies under ultrasound guidance and local anesthesia are the preferred diagnostic method . Active surveillance represents a viable option in men with low-risk PCa and a long life expectancy . A biopsy progression indicates the need for active intervention , whereas the role of PSA doubling time is controversial . In men with locally advanced PCa for whom local therapy is not m and atory , watchful waiting ( WW ) is a treatment alternative to and rogen-deprivation therapy ( ADT ) , with equivalent oncologic efficacy . Active treatment is recommended mostly for patients with localized disease and a long life expectancy , with radical prostatectomy ( RP ) shown to be superior to WW in prospect i ve r and omized trials . Nerve-sparing RP is the approach of choice in organ-confined disease , while neoadjuvant ADT provides no improvement in outcome variables . Radiation therapy should be performed with ≥ 74 Gy in low-risk PCa and 78 Gy in intermediate- or high-risk PCa . For locally advanced disease , adjuvant ADT for 3 yr results in superior rates for disease-specific and overall survival and is the treatment of choice . Follow-up after local therapy is largely based on PSA and a disease-specific history , with imaging indicated only when symptoms occur . CONCLUSIONS Knowledge in the field of PCa is rapidly changing . These EAU guidelines on PCa summarize the most recent findings and put them into clinical practice . PATIENT SUMMARY A summary is presented of the 2013 EAU guidelines on screening , diagnosis , and local treatment with curative intent of clinical ly organ-confined prostate cancer ( PCa ) . Screening continues to be done on an individual basis , in consultation with a physician . Diagnosis is by prostate biopsy . Active surveillance is an option in low-risk PCa and watchful waiting is an alternative to and rogen-deprivation therapy in locally advanced PCa not requiring immediate local treatment . Radical prostatectomy is the only surgical option . Radiation therapy can be external or delivered by way of prostate implants . Treatment follow-up is based on the PSA level
This method ological choice confers to the results a strong clinical relevance as PC has been reported to be one of the major determinants of bother and psychological distress in PD patients [ 2 ] .
Initially , the results in terms of PC were disappointing , probably due to the inadequate dosage and regimen of the drug , or simply because of wrong
In this month 's issue of European Urology , Russo et al. [ 1 ] published the results of a systematic review of the literature about the efficacy of injection therapies , vacuum devices , and penile traction in patients with Peyronie 's disease ( PD ) .
Historically , oral and intralesional therapies have represented the initial conservative option with surgery being considered the definitive gold st and ard therapy in stable disease .
More recently , recommended treatment algorithms have significantly shifted due to the introduction of potential new first-line options .
In this scenario , oral treatments have become less commonly prescribed due to inconsistent or negative outcome data , and intralesional therapies have gained growing interest .