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.
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
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 .