Penile surgery for patients with Peyronie’s disease initially treated with collagenase clostridium histolyticum or surgery: a claims database analysis

Collagenase clostridium histolyticum (CCH) is an injectable therapy targeting collagen present in penile plaques in Peyronie’s disease (PD). Data comparing CCH to penile surgery are limited, and long-term therapeutic outcomes are unknown. This retrospective analysis used a US claims database (January 2014–June 2017) to determine the percentage of men with subsequent penile surgery among those who initially received CCH (n = 1227) or surgery (index treatment; n = 620) for PD. Eligible patients were aged ≥18 years with continuous enrollment ≥6 months before and ≥12 months after index treatment date. During 12 months of post-index treatment follow-up, fewer patients with PD initially treated with CCH (4.6% [56/1227]) had subsequent penile surgery versus those initially treated with penile surgery (10.3% [64/620]; p < 0.0001). Mean ± SD time to first subsequent surgery after initial PD treatment was longer in the CCH versus surgery cohort (7.7 ± 3.0 vs 1.7 ± 3.2 months). The likelihood of subsequent surgery varied by initial surgery type: 18.2% after plaque incision or excision with grafting; 11.6% after penile implant; and 8.2% after tunical plication. Patients with PD who received CCH first were less likely to undergo subsequent surgery compared with those who received surgery first within a 12-month post-treatment follow-up.

Extensive penile skin necrosis after surgery for Peyronie's disease

The clinical case represents the surgical correction of postoperative complications in a patient with Peyronie's disease. The patient underwent flap corporoplasty using an autovein. The late postoperative period in the patient was complicated by extensive necrosis of the penile skin, which required repeated surgery as follows. The first stage of surgical treatment was performed by excision of necrotic tissues of the penile skin. Within 10 days of the postoperative period, chymotrypsin with an ointment containing dioxomethyltetrahydropyrimidine with chloramphenicol was applied to the penile wound surface to prepare the wound for subsequent skin autotransplantation. Further, within 5 days, the polymeric drainage sorbent «Aseptisorb DT» was applied to the wound surface until the wound was cleansed and granulation tissue was formed. The second stage of the surgical treatment performed penile skin replacement plasty with a free perforated skin graft taken from the patient's femoral surface.

IMPROVING THE EFFECTIVENESS OF CONSERVATIVE TREATMENT OF ERECTILE DYSFUNCTION IN PATIENTS WITH PEYRONIE'S DISEASE USING THE "BTL 6000" SHOCK WAVE THERAPY APPARATUS AND THE "TIVORTIN" DRUG

Исследовалось эффективность комплексной терапии эректильной дисфункции у пациентов с болезнью Пейрони, с применением препарата "Тивортин", который является субстратом для NO-синтазы - фермента, который катализирует синтез оксида азота в эндотелиоцитах, тем самым вызывая стабилизацию скорости кровотока в артериях полового члена, а также способствует восстановлению морфологической структуры, измененной белочной оболочки; и аппарата ударно-волновой терапий "БТЛ 6000", предназначенный для дезинтеграции бляшек в стадии кальцификации, которая купирует болевые ощущения в 91% случаев и уменьшает деформацию полового члена в 31% случаев, путем ударно-волновой терапии, и улучшения микроциркуляции в кавернозных телах полового члена, тем самым повышает эффективность лечения эректильной дисфункции у больных с болезнью Пейрони. The effectiveness of complex therapy of erectile dysfunction in patients with Peyronie's disease was studied with the use of the drug "Tivortin", which is a substrate for NO-synthase, an enzyme that catalyzes the synthesis of nitric oxide in endotheliocytes, thereby causing stabilization of the blood flow rate in the arteries of the penis, and also contributes to the restoration of the morphological structure, the altered protein envelope; and the shock wave therapy apparatus "BTL 6000", designed for the disintegration of plaques in the calcification stage, which relieves pain in 91% of cases and reduces the deformation of the penis in 31% of cases, by shock wave therapy, and improves microcirculation in the cavernous bodies of the penis, thereby increasing the effectiveness of treatment of erectile dysfunction in patients with Peyronie's disease.

Pathological Significance of Macrophages in Erectile Dysfunction Including Peyronie’s Disease

Erectile function is regulated by complex mechanisms centered on vascular- and nerve-related systems. Hence, dysregulation of these systems leads to erectile dysfunction (ED), which causes mental distress and decreases the quality of life of patients and their partners. At the molecular level, many factors, such as fibrosis, lipid metabolism abnormalities, the immune system, and stem cells, play crucial roles in the etiology and development of ED. Although phosphodiesterase type 5 (PDE5) inhibitors are currently the standard treatment agents for patients with ED, they are effective only in a subgroup of patients. Therefore, further insight into the pathological mechanism underlying ED is needed to discuss ED treatment strategies. In this review, we focused on the biological and pathological significance of macrophages in ED because the interaction of macrophages with ED-related mechanisms have not been well explored, despite their important roles in vasculogenic and neurogenic diseases. Furthermore, we examined the pathological significance of macrophages in Peyronie’s disease (PD), a cause of ED characterized by penile deformation (visible curvature) during erection and pain. Although microinjury and the subsequent abnormal healing process of the tunica albuginea are known to be important processes in this disease, the detailed etiology and pathophysiology of PD are not fully understood. This is the first review on the pathological role of macrophages in PD.

3D-printed phantoms to quantify accuracy and variability of goniometric and volumetric assessment of Peyronie’s disease deformities

Characterization of Peyronie’s disease (PD) involves manual goniometry and penile length measurement. These techniques neglect volume loss or hourglass deformities. Inter-provider variability complicates accuracy. Using 3D-printed models, we aimed to evaluate measurement accuracy and variability and establish computational assessment workflows. Five digital phantoms were created: 13.0 cm cylinder, 13.0 cm hourglass cylinder, 15.0 cm cylinder with 40° angulation, 12.0 cm straight penis, and 12.9 cm PD penis with 68° angulation and hourglass. Lengths, volumes, and angles were determined computationally. Each phantom was 3D-printed. Ten urology providers determined lengths, angles, and volumes with measuring tape, goniometer, and volume calculator. Provider versus computational measurements were compared to determine accuracy using t-tests or Wilcoxon rank-sum tests. No significant differences were observed between manual assessment of length of penile models and designed length in penile models. Average curvature angles from providers for bent cylinder and PD phantoms were 38.3° ± 3.9° (p = 0.25) and 57.5° ± 7.2° (p = 0.006), respectively. When assessing for volume, hourglass cylinder and bent cylinder showed significant differences between designed volume and provider averages. All assessments of length, angle, and volume showed significant provider variability. Our results suggest manual measurements suffer from inaccuracy and variability. Computational workflows are useful for improved accuracy and volume assessment.