Diagnosis Of Peyronie's Disease Research Articles

Ultrasound Elastography as a Diagnostic Tool for Peyronie's Disease: A State-of-the-Art Review.

Elastography is a noninvasive method that utilizes ultrasound imaging to assess the elasticity and stiffness of soft tissue. Peyronie's disease (PD) is a chronic inflammatory condition that affects the male penis, causing the formation of fibrous plaques. This alters the penis's elasticity and can lead to changes in its shape. Ultrasound elastography (UE) is an important advancement in the diagnosis of PD. It not only identifies plaques, but it also measures their rigidity, providing crucial information to monitor changes during and after treatment. We conducted a narrative review of the scientific literature to identify articles that discuss the use of elastography in the diagnostic study of PD. The purpose of this study was to describe the "state of the art" in the diagnostic use of ultrasound in combination with elastography to highlight any benefits in the diagnosis of PD. We found 12 relevant articles after searching PubMed, Embase, and Google Scholar using the keywords "ultrasound elastography" and "Peyronie's disease", including eight clinical studies, two case reports, and two review articles. The results of our review indicate that UE is a useful technique for identifying Peyronie-related plaques, particularly when they are not detectable using a standard ultrasound or physical examination. It is also helpful in monitoring improvements during and after conservative treatments. More research is required to confirm the effectiveness of ultrasound elastography in diagnosing Peyronie's disease and to determine whether it is better than traditional ultrasound.

Role of Shear Wave Elastography in the Diagnosis of Peyronie Disease.

The present study aims to explore the role of shear wave elastography (SWE) in the diagnosis of Peyronie disease (PD). A total of 59 PD patients and 59 age-matched healthy adult men were included in this study. The B-mode ultrasound (US) and SWE were performed for all subjects, and the Young modulus (YM) values of the corresponding regions of the penis in the PD and control groups were recorded and compared. The mean age of the included PD patients and age-matched controls was 53.81 years (SD 9.52, range 32-73). On B-mode US evaluation, 41 (69.5%) of 59 included PD patients were found to have penile plaques, and the remaining 18 (30.5%) patients had no evidence of penile plaque. After evaluation using SWE, the YM values in the penile plaque region of these 41 patients with penile dysplasia were found to be significantly higher (60.29 kPa ± 19.95) than those outside the plaque (in the same patient) (21.05 kPa ± 4.58) and in the same penile region of the control group (20.59 kPa ± 4.65) (P < .001). In the remaining 18 PD patients, the results showed that the YM value of the abnormal penile region in the PD patients (56.67 kPa ± 13.52) was significantly higher than the YM value outside the abnormal penile region in the same patients (22.79 kPa ± 4.31) and in the same penile region in the control group (19.87 kPa ± 3.48) (P < .001; P < .001). In conclusion, this study showed that SWE as a non-invasive technique is useful in identifying and differentiating penile plaques in PD patients and is a simple, rapid and complementary method to B-mode US.

Erectile dysfunction and Peyronie's disease diagnosis rates after penile fracture-a retrospective claims database cohort analysis.

Our objective was to analyze the rates of erectile dysfunction and Peyronie's disease following a penile fracture using a large, multi-institutional claims database. Inclusion criteria included men ages 15 or older with a diagnosis of penile fracture and any office visit within 5 years of the penile fracture. Exclusion criteria included prior erectile dysfunction, prescription of erectile aids, or penile prosthesis placement. Our primary outcome was the diagnosis of erectile dysfunction or prescription of phosphodiesterase-5 inhibitors within 5 years. A secondary analysis assessed rates of Peyronie's disease following penile fracture. 1242 men were identified with penile fracture and subsequently matched to men without penile fracture, resulting in equal cohorts of 1227 men. Men with a history of penile fracture were more likely to receive a diagnosis of erectile dysfunction or require phosphodiesterase-5 inhibitors (RR 3.18, 95% CI: 2.30-4.40). Men who did not undergo immediate repair had higher rates of erectile dysfunction or treatment (RR: 1.84, 95% CI: 1.22-2.78). Men over the age of 45 years who had a penile fracture were more likely to develop erectile dysfunction or treatment compared to men under 45 years (RR: 1.65, 95% CI: 1.14-2.39). Rates of Peyronie's disease were higher in men with a history of penile fracture (5.8% vs 0%, p < 0.0001). Rates of Peyronie's disease were lower if immediate repair of the fracture was performed (RR: 0.20, 95% CI: 0.10-0.41). Men over the age of 45 years with penile fracture were more likely to develop Peyronie's Disease within 5 years compared to men under the age of 45 years penile fracture (RR: 3.72, 95% CI: 1.94-7.16). Penile fracture increases the risk of both erectile dysfunction and Peyronie's disease, especially those treated with conservative measures or over the age of 45 years compared to patients under 45 years with a penile fracture.

(166) Characteristics of Veterans Suffering Corporeal Rupture after Collagenase Clostridium Histolyticum

Abstract Introduction Collagenase clostridium histolyticum is the only guideline and US FDA approved intralesional treatment for Peyronie's disease (PD). The most feared complication is corporeal rupture which occurs in less than 0.5% of treated patients. In the largest clinical trial, only 3 occurred, however this was enough to include a black box warning and recommend patients to abstain from sexual intercourse for 6 weeks. To date, there have been few studies evaluating the timing and causes of fracture after injection. Objective To determine the incidence and factors leading to penile fracture in men with PD treated with CCH. Methods We queried the VA Informatics and Computing Infrastructure, to identify veterans with a diagnosis of PD by ICD-9 (607.85) or ICD-10 (N48.6) code between 2015-2020. We searched medication codes for CCH and ICD-9 (959.13) and ICD-10 (S39.840) codes for penile fracture to determine which patients had fractures. All patients with penile fracture codes were manually reviewed. Only patients with penile fractures after administration of CCH were included in the study. Results In total, 17,647 veterans were diagnosed with PD with 1,541 (8.7%) treated with CCH. In total, 11 patients (0.7%) had penile fracture after treatment with CCH. Table 1 shows patient demographic and clinical information for 11 patients with penile fracture post CCH treatment. Within these 11 patients, the median number of CCH injections was 6 with a median initial curvature of 35°. Fracture occurred at a median of 8 days after CCH injection with all occurring secondary to spontaneous ejections or sexual intercourse. Finally, 6 patients had their fracture repaired with surgery while the remaining were managed conservatively. Conclusions The highest risk of penile fracture appears to be within two weeks of the second injection of a CCH cycle. Only one fracture occurred after three weeks, and one occurred after the first injection of a cycle. Our data supports the warning to avoid sexual activity for 4 weeks after CCH injection. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Endo pharmaceuticals.

Real-world practice in Peyronie's disease management: Results from a national survey of urologists.

Despite many available treatments for Peyronie's disease (PD), practice patterns of available therapeutics are not well characterized. We conducted a national survey of urologists to characterize real-world practice patterns of PD management and to characterize the use of therapies discouraged by the American Urological Association guidelines on PD management. A 34-item survey was distributed via RedCap to urologists who treat patients with PD in all American Urological Association sections. Questions elicited demographic information as well as practices in the diagnosis and treatment of PD. Comparisons were made with Pearson's chi-squared test. The primary outcome was reported use of therapies discouraged by the American Urological Association guidelines on PD. A total of 145 respondents completed the survey, of whom 19% were fellowship trained in andrology/sexual medicine, 36% practiced in an academic setting, and 50% had at least 20 years in practice. Only 60% of respondents reporting performing in-office curvature assessment prior to commencing intralesional injection or surgical treatment, with higher prevalence in andrology/sexual medicine fellowship-trained versus non-fellowship-trained urologists (85%vs. 54%, p=0.003). The most popular treatment modalities were collagenase clostridium histolyticum (61% of respondents), phosphodiesterase-5 inhibitors (54%), and penile traction (53%). Twenty-one percent of respondents reported currently using a treatment that is explicitly discouraged by the American Urological Association guidelines (extracorporeal shockwave therapy for curvature, L-carnitine, omega-3 fatty acids, or vitamin E). Patients seeking PD treatment may be offered different therapies, some of which are not evidence-based, depending on the treating urologist. This study is limited by self-selection and response bias. Its strength is that it represents a cross-sectional overview of real-world practice patterns in PD management, which has not been previously described. A significant proportion of urologists reported PD management practices that are not evidence-based and not guideline-supported.

Peyronie's disease development and management in diabetic men.

Peyronie's disease (PD) is a fibrosing disorder of the penis resulting in plaque formation and penile deformity that negatively affect sexual and psychosocial function of patients. A multifactorial etiology of PD is assumed with diabetes mellitus (DM) being a potential risk factor. The aim of this narrative review was to investigate diabetes role in PD pathophysiology, diagnosis, and treatment. A non-systematic narrative review of original articles, meta-analyses, and randomized trials was conducted, including articles in the pre-clinical setting to support relevant findings. Diabetes is one of the most common comorbidity observed in PD patients, with a prevalence of about 11% and a strong association with erectile dysfunction (ED). DM is associated with both a higher risk of developing PD and has also an impact on the outcomes of PD's treatments. Evidence from literature underlines that metabolic alterations typical of DM are pivotal factors in the development of PD and resistance to its medical treatment. The role of DM in development of PD is still debated, while its role in PD development is not completely clear, there is a clear impact of DM on PD treatment outcomes.

The Effect of Collagenase Clostridium Histolyticum Injection on the Treatment Patterns of Peyronie's Disease: An Analysis of Large Health Care System Over 15-year Period

ABSTRACT Introduction Penile plication or excision with grafting has traditionally been the only effective treatment for stable Peyronie's disease (PD) without concurrent erectile dysfunction. Intralesional collagenase clostridium histolyticum (CCH) was approved by the U.S. Food and Drug Administration(FDA) in 2013 for patients with stable disease with curvature between 30 and 90°. The effect of CCH injection therapy on the diagnosis and treatment patterns of PD is unknown. Objective We studied the effect of FDA approval of CCH on the management of PD in a population-based analysis. We analyzed the effect of the advent of CCH on rates of prescribing of oral treatments, including vitamin E, colchicine, and pentoxifylline along with surgical intervention. We also studied the effect of injection therapy on the rate of new diagnosis of PD in a population-based analysis. Methods The Kaiser Permanente Southern California database, which provides comprehensive data on all Kaiser Permanente patients in 15 medical centers in the Southern California region was reviewed. Patients undergoing a penile prosthetic surgery for concurrent erectile dysfunction were excluded. PD patients were identified using ICD-9 code and ICD-10 code. Injection therapy was determined using CPT codes, as well as the use of CCH based on the pharmacy database. Surgical therapy (either penile plication or excision with grafting) was identified using CPT codes. The use of oral medication treatment (e.g., vitamin E, colchicine, and pentoxifylline) was ascertained using both the outpatient and inpatient pharmacy database. Main Outcome Measure This study first presented the annual incident rates of PD from 2004 to 2020 among Kaiser members ages 18 or older, and, among eligible PD patients, the annual rates of receiving CCH injection therapy, surgical therapy, and oral medication treatment. Descriptive statistics and multivariable logistic regression modeling were used to assess factors influencing the choice of intralesional injection vs surgical therapy. Results From 2004 to 2020, 11,706 patients presented for PD management (average incident rate, 52.8 per 100,000 eligible members). Median age was 58 years and 54.5% were Caucasian. Over the study period, the incident rate (per 1,000 eligible patients) of surgical management declined on average by 0.37 each year (p &amp;lt; 0.001) while there was an increase of 0.43 for injection therapy (p &amp;lt; 0.001). Following the FDA's approval of CCH in 2013, the average incident rate (per 1,000 eligible patients) for surgical therapy in 2014-2020 declined by 2.8 (p &amp;lt; 0.001) compared to that in 2004-2013, whereas it significantly increased by 5.1 (p &amp;lt; 0.001) for injection therapy. Average rates of prescribing of oral colchicine and vitamin E significantly decreased from 2016-2020 compared to 2004-2015 (p&amp;lt;0.001), while average rates of prescribing pentoxifylline significantly increased (p&amp;lt;0.001). Patients presenting in the post-CCH era were approximately two times significantly more likely to receive injection therapy (OR: 2.08; P &amp;lt; 0.001 CI: 1.47 to 2.94). On multivariable modeling, patients more likely to receive injection therapy as primary treatment for PD were ages 45-54 (OR: 2.77; P = 0.002; CI: 1.34 to 5.73). Conclusions Since the Introduction: of CCH, there has been a significant change in the management pattern for PD (decrease in surgical therapy, and increase in intralesional injections). Since the recent publication of AUA Guidelines on PD in 2015, there has been a significant decrease in non-evidence supported oral medication prescriptions. Disclosure No

Time to presentation of Peyronie's Disease in the era of injections and information

ABSTRACT Introduction Characterized by acquired fibrosis of the tunica albuginea, Peyronie's disease (PD) can cause penile curvature, pain, and plaque, as well as erectile dysfunction and difficulty with penetration. Using online surveys in 2007-2008, Dibenedetti et al found that the prevalence of PD in adult men in the US was 0.5% based on PD diagnosis; 0.8% based on PD diagnosis or treatment of PD; and 13.1% based on diagnosis, treatment, or any symptom of PD. They found that 68% of patients saw a doctor when they first noticed symptoms, at a mean time to see a doctor of 16.8 (SD = 5.5) months. The other third, or 32%, of patients who sought treatment later in the disease course, had a mean time of 46.2 (SD = 8.4) months. Only 5% of patients presented with current pain, thus in the active phase. Objective Our study investigated how patient presentation for PD changed after two sentinel events: 1) the FDA approval of intralesional injections of collagenase clostridium histolyticum (CCH) in 2013, and 2) the national publicity surge for PD in 2016-2017. We then aimed to compare this data to a prior study by Dibenedetti et al conducted for patients in 2007-2008. Methods Our retrospective, single institution study was conducted as a chart review of patients presenting from 2014 to 2020 with penile curvature, pain, or plaque. Descriptive statistics were used to compile data at the time of initial evaluation by the reconstructive urologist, including patient demographics, pre-treatment assessments, and time to evaluation. Results Our study included 152 adult men, and mean age was 57.9 years old (SD = 8.1) (Table 1). Initial symptoms included penile curvature (87%), pain (30%), and plaque (8%). 38% of patients were in the active phase of PD at time of evaluation. The mean time from onset of symptoms to evaluation by the specialized urologist was 27.5 months (SD = 53.2, range 1 to 360 months) (Figure 1). For the 2/3 of patients, or 68%, who had the shortest time to evaluation, the mean duration of PD symptoms prior to evaluation by a specialized urologist was 10.0 months (SD = 4.6) (Figure 2). For the 1/3 of patients, or 32%, who had the longest time to evaluation, the mean duration of PD symptoms prior to evaluation was 69.7 months (SD = 80.6). Conclusions Over the years, the majority of PD patients are presenting sooner in their PD course. The outlier patients, or those who have suffered from PD for a relatively long time, are also presenting for evaluation and treatment. These trends are likely influenced by the FDA approval of intralesional injections of CCH and by the national media efforts to raise awareness of the underdiagnosed and undertreated disease. Disclosure No

Racial Trends in Peyronie's Disease Treatments: Analysis of the Veterans Health Administration

ABSTRACT Introduction Racial disparities are known to affect urologic care. Settings such as the Veterans Affairs (VA) health system, where access to care is more equitable, have noted reductions in racial disparities for certain diseases. Previous studies of Peyronie's Disease (PD) have investigated responses to treatment by race, but not treatment rates themselves. Frequently, racial disparities in healthcare are attributed to differences in income or decreased insurance rates among people of color. For this reason, we aimed to investigate racial disparities in PD treatments by evaluating the VA Informatics and Computing Infrastructure (VINCI), which contains data from the VA. As veterans are insured and able to obtain treatment for PD through the VHA, this population allows us to study the effects of race on treatment rates when insurance does not serve as a barrier. Objective To evaluate the treatment rates for Peyronie's Disease within the VA by race in order to determine whether racial disparities exist when insurance access is equitable. Methods We queried VINCI to obtain data for a cohort of men that have a recorded diagnosis of PD by ICD-9 or ICD-10 code between 2015-2020. We then used the following CPT codes to identify which patients had procedures known to be therapeutic for PD: plaque injection (CPT 54200), penile prosthesis (54400, 54405), penile reconstruction to correct penis angle (54360), or plaque excision (54110, 54111, 54112). We evaluated treatment rates among patients with race/ethnicity information recorded. We reported results as frequencies and used the chi-square test to evaluate significant differences in treatment rates when comparing racial groups to Whites, with statistical significance reported at p&amp;lt;.05. Results We obtained data for 17,022 patients with diagnoses of PD. Within the total population of patients diagnosed with PD, 71.4% were White (Non-Hispanic), 25.4% were Black, 5.8% were Hispanic or Latino, 0.3% were Asian or Pacific Islander (API), and 1.6% were Native American (NA), and 5.4% were unknown. Among this cohort, 13.6% of all patients, 13.6% of Whites, 14.3% of Blacks (p=0.2985), 13.5% of Hispanics (p=0.9205), 9.1% of API (p=0.3319), 16.7% of NA (p=0.1406), and 9.6% of unknown (p=0.0041) were treated. Conclusions Within the VHA population, which is not limited by access to health insurance, all patients with recorded race information were treated at similar rates for PD to Whites. Only those without racial information recorded were treated at a significantly lower rate. This study demonstrates the potential for equitable insurance and access to healthcare to reduce racial disparities. Further investigation is required to evaluate whether these treatment patterns are similar within the general population. Disclosure No

Incidence of Secondary Intervention for Peyronie's Disease after Collagenase Clostridium Histolyticum

ABSTRACT Introduction Collagenase clostridium histolyticum (CCH) is the only FDA-approved medical therapy for Peyronie's Disease (PD). It is unknown how many men will elect for surgical correction after CCH treatment. Other surgical options exist, including penile plication, incision and grafting and penile prosthesis. By studying patients within the Veterans Health Administration (VHA), who are all insured and therefore not limited by cost, we aimed to determine the percentage of patients electing additional surgical correction after treatment with CCH. Objective To determine the need for secondary surgical correction after CCH Methods We queried the VA Informatics and Computing Infrastructure (VINCI), the VHA's national database, to identify veterans with a diagnosis of PD by ICD-9 or ICD-10 code between 2015-2020. We searched medication codes for CCH and surgical CPT codes to determine which patients had the following procedures PD: plaque injection (CPT 54200), penile prosthesis (54400, 54405), penile reconstruction to correct penis angle (54360), or plaque excision (54110, 54111, 54112). Patients with medication codes for CCH and another procedure were assumed to have had surgery after CCH. Results In total, 17,647 veterans were diagnosed with PD. Of those, 1295 (7.3%) were treated with CCH. Of those who were treated with CCH, 100 (7.7%) elected for intervention after CCH. Within the group 61 had penile prosthesis, 23 had penile plication, and 32 had plaque excision and grafting (16 combined with IPP). Conclusions Approximately 7% veterans who are treated with CCH injection elect secondary surgical correction. This indicates that CCH is an efficacious option for men suffering from PD, and a particularly beneficial choice for those who do not want surgery. Disclosure No

Racial Disparities in Sexual Health Care Received by Kidney Transplant Recipients in a Metropolitan Area

ABSTRACT Introduction Issues regarding disparities in urologic health care delivery and access among different racial and ethnic groups in the United States is well described in oncologic care. Such issues also exist in male sexual health care and kidney transplantation, but are less studied when these areas overlap. As a result of improved outcomes with kidney transplants (KT), quality of life (QOL) metrics become increasingly important to address. Sexual function is one such QOL domain in which KT recipients are particularly affected. Objective This study aims to elucidate the racial composition of male KT recipients with and without a sexual health issue, how that compares to the racial breakdown of the metropolitan area, and whether a particular racial group is more likely to be diagnosed with sexual dysfunction before versus after their transplant surgery. Methods After obtaining IRB approval we retrospectively reviewed the charts of men age 18 and older who received a KT at a single institution in a metropolitan city between January 2016 and February 2020. We sought to identify those with a diagnosis of ED, low or decreased libido, hypogonadism, ejaculatory dysfunction, Peyronie's disease (PD), or male factor subfertility. Demographic information, time of initial diagnosis of ED, and treatment profile were documented. The causes of end stage renal disease (ESRD) were obtained, but not controlled for. Results A total of 833 men received KT's during this time, 43% of which identified as Hispanic or Latino, 26% white (non-Hispanic or Latino), 13% Asian, and 12% Black. Of the men with a sexual dysfunction diagnosis, 26% identified as Hispanic or Latino, 31% white (non-Hispanic or Latino), 14% Asian, and 23% Black (Figure 1). No men were found to have a diagnosis of ejaculatory dysfunction, PD, or male factor subfertility. Latino men were more likely to have a diagnosis of sexual dysfunction after receiving a KT when compared to their non-Latino counterparts (OR: 2.91, 95% CI: [0.41 to 20.90]). Finally, there was no statistically significant difference in treatment patterns for ED between racial groups. Conclusions In this study we show that the overall racial composition of men age 18 and over who received a KT is representative of the demographics in its corresponding metropolitan city. However, we do note that Latino men are underdiagnosed for sexual dysfunction issues when compared to their non-Latino counterparts. Latino men are also more likely to have a diagnosis of sexual dysfunction after their transplant, likely implying they suffer from these conditions longer than men of other races. These findings highlight the need for continued research to reduce and eliminate health care disparities in the sexual health arena, specifically for patients with ESRD. Disclosure No

Critical Underdiagnosis and Undertreatment of Sexual Health Issues in Male Kidney Transplant Recipients

ABSTRACT Introduction Patients with end stage renal disease (ESRD) often endure a worse quality of life (QOL) than the general population. As a result of improved outcomes with kidney transplants, it has become increasingly important to address QOL. Sexual function is one such QOL domain in which kidney transplant (KT) patients are particularly affected by. Objective This study aims to elucidate the underdiagnosis and undertreatment of sexual health issues in male KT recipients, as well as the treatment profile for erectile dysfunction (ED) in these patients. Methods With IRB approval we retrospectively reviewed the charts of men age 18 and older who received a KT between January 2016 and February 2020 at an academic institute. We sought to identify those with a diagnosis of ED, low or decreased libido, hypogonadism, ejaculatory dysfunction, Peyronie's disease (PD), or male factor subfertility. Next, for those with a diagnosis of ED, information regarding time of initial diagnosis of ED, time when treatment was started, treatment profile and adverse events were documented. Causes of ESRD were obtained, but not controlled for. Results A total of 35 men were diagnosed with some form of sexual dysfunction, which represents 4.2% of the 833 men aged 18+ years who received a KT during this time. Seventy-one percent of men had a diagnosis of ED, 17.1% had ED and hypogonadism, 2.9% had ED and low libido, 8.6% had hypogonadism alone, and there were no diagnosis of ejaculatory dysfunction, PD, or infertility. Seventy-five percent of men with a diagnosis of ED were treated with phosphodiesterase-5 inhibitors (PDE5i), 25% with intracavernosal injections (ICI), 3.1% with intraurethral (IU) suppositories, and 9.4% with a penile prosthesis (PP). No severe medical or surgical adverse events were noted. Of those with ED, 87.5% were diagnosed prior to their transplant surgery and only 62.5% received any treatment prior to it. Conclusions In this study we show that a small fraction of men who received a KT had a diagnosis of a sexual health issue. This is in spite of the known high prevalence of ED in ESRD patients that can be as high as 75%, with up to a 10-20% improvement of ED with transplant alone. Furthermore, we note that KT recipients with ED are treated similarly to the general population and have a similar side effect profile, however, a significant number of patients do not receive treatment until after their transplant. Disclosure No

Male genital lichen sclerosus associated with urological interventions and microincontinence: a case series of 21 patients.

Male genital lichen sclerosus (MGLSc) is an acquired, chronic, inflammatory cutaneous disease associated with significant morbidity and squamous cell carcinoma of the penis. Consideration of all of the evidence suggests that chronic exposure of susceptible epithelium to urinary occlusion by the foreskin is the most likely pathomechanism. MGLSc never occurs in men who were circumcised at birth, and has been associated with trauma, instrumentation and anatomical abnormalities, e.g. frank hypospadia that results in microincontinence. To describe 21 patients who developed MGLSc following urological diagnoses and procedures. We conducted a retrospective review of patients with a diagnosis of MGLSc whose symptoms related to urological procedures who attended or saw one of the authors (CBB) privately during the period June-October 2018. In total, 21 patients (mean age 59 years) were identified. The referrals came from the local urology departments, primary care or extramural dermatology services. Most of the patients were uncircumcised men. All had developed symptoms and signs of MGLSc within 5 years following their urological procedure; on examination, 30% of the patients were found to have damp penile skin due to microincontinence. Of the 21 patients, 10 had undergone radical prostatectomy for prostate cancer, 4 had a diagnosis of Peyronie disease, 4 had undergone multiple cystoscopies and urethroscopies, 2 had undergone surgery on the bladder neck and 1 had undergone implantation of a penile prosthesis to treat erectile dysfunction. This case series further strengthens the urinary occlusion hypothesis for the causation of MGLSc. It is important to recognize that urological interventions can create incompetence of the naviculomeatal valve post voiding. In uncircumcised men, this creates a risk factor for MGLSc that was not previously present. Occlusion, the phenomenon of koebnerization and currently unelucidated epithelial susceptibility factors lead to inflammation, sclerosis and cancer. Patients and urologists should be aware of these possibilities and preventative measures instituted, e.g. adaptive voiding habits and barrier protection.

Oral Administration and Intralesional Injection of Hyaluronic Acid Versus Intralesional Injection Alone in Peyronie's Disease: Results from a Phase III Study.

PurposeThe aim of this study was to compare the effect of combined oral administration and intralesional injection of hyaluronic acid (HA) with intralesional injections alone, in patients with early onset of Peyronie's disease (PD).Materials and MethodsFor this prospective, randomized phase III clinical trial we included patients with recent diagnosis of PD. Eighty-one patients were randomized into two groups. Group A consisted of 41 patients receiving oral administration of HA in combination with weekly intralesional injection of HA for 6 weeks. Group B consisted of 40 patients group B who received weekly intralesional injections of HA for 6 weeks, only. The main outcome measures were the changes from baseline to the end of therapy after three months in penile curvature (°) and changes in the international index of erectile function (IIEF-5) score and patient's global impressions of improvement (PGI-I) score.ResultsGroup A had a significantly larger reduction in penile curvature as compared with group B (Group A: −7.8°, Group B: −4.1° [p<0.001]). Group A also showed a higher improvement in IIEF-5 and PGI-I scores in comparison with Group B (Group A: +4 IIEF-5, Group B: +2 IIEF-5 [p<0.001]; Group A: 3 PGI-I, Group B: 1 PGI-I, [p<0.001]). At three months both groups had a significant reduction of penile curvature from baseline (p<0.001).ConclusionsOral administration combined with intralesional treatment with HA shows greater efficacy to improve penile curvature and overall sexual satisfaction in comparison with intralesional HA treatment alone.

Long-term patient-reported outcomes in men with Peyronie's disease undergoing nonsurgical and nonintralesional injection management.

Peyronie's disease (PD) has a negative impact on overall quality of life for many patients and their partners. There is a significant portion of patients who elect noninvasive therapy and in this scenario we have little data with which to counsel patients. We aim to evaluate long-term patient-reported outcomes in a cohort of men with PD who elected conservative treatment. We identified all males with a diagnosis of PD evaluated at our institution by a single provider between May 2012 and January 2018. We excluded men who were <18 years old or had undergone surgical or intralesional injection (ILI) treatments. A PD-specific questionnaire was sent to those who met our inclusion criteria. 88/514 patients completed the survey and met the inclusion criteria. Penile curvature subjectively improved in 49%, remained stable in 34%, and worsened in 17%. Penile shortening was reported in 89% of patients. Penile shortening subjectively improved in 27%, remained stable in 59%, and worsened in 14%. Roughly 60% reported worsened intercourse satisfaction and erectile function. 60% reported that PD had negatively impacted their self-esteem and 69% felt that PD negatively impacted their sexual partner. Patients who utilized penile traction therapy (PTT) were significantly more likely to report improvements in penile curvature, shortening, and ability to engage in penetrative intercourse. Our survey provides important data on patient-reported outcomes in men with PD electing nonsurgical and non-ILI interventions. Although 49% of men noted at least a mild subjective improvement in their curvature over time, a majority had declining erectile function, decreased intercourse satisfaction, and psychosocial distress. These data can be used when counseling patients with a new diagnosis of PD who are considering treatment options.

Peyronie's disease and testosterone deficiency: Is there a link?

Peyronie's disease (PD) and testosterone deficiency (TD) impact men at the same stage of life and can ultimately contribute to erectile dysfunction. There is speculation that low levels of testosterone (T) may predispose men to penile fibrosis; however, there is no published, up-to-date review summarizing the current evidence. Therefore, we conducted a narrative review of the literature exploring the relationship between PD and TD. A comprehensive systematic search of existing literature of five online databases from June 1990 to June 2018 examining the relationship between PD and TD was conducted. The Cochrane risk-of-bias tool for randomized trials and the risk-of-bias assessment tool for cohort studies were used to evaluate the quality of studies. Six studies were identified (n = 675). Overall, five studies supported the link between PD and TD by demonstrating relationships in PD patients with low total T, free T, bioavailable T, greater penile curvature, and plaque development. However, one study demonstrated no connection between the conditions. The literature is restricted by small studies with methodological flaws. There are a number of mechanisms to support the link between TD and PD. The literature on the topic is limited by small studies which are overall conflicting. The findings of this work suggest the need for larger, prospective studies to clarify the role of TD in the development, evaluation, and treatment of PD. Establishing such a relationship could change management of PD as a diagnosis of PD may encourage clinicians to evaluate a patient's testosterone levels.

The Impact of Clostridium Histolyticum Collagenase on the Prevalence and Management of Peyronie's Disease in the United States.

PurposeWe evaluated the impact of collagenase clostridium histolyticum (CCH) on rates of diagnosis, treatment, and corporal rupture in Peyronie's disease (PD). We examined the impact of CCH on cost of PD treatment.Materials and MethodsWe extracted data on PD diagnosis (ICD-9 607.95 and ICD-10 N48.6), corporal rupture (ICD-9 959.13 and ICD-10 S39.840A), CCH use (J0775), penile injections (CPT 54200), and corporal rupture repair from 2008 to 2016 in men over 40 years old using the Clinformatics® Data Mart Database (3.7 to 4.9 million males). We analyzed for prevalence of PD, rates of PD treatments, cost associated with treatment, and rates of corporal rupture and repair by year.ResultsThe prevalence of PD was 0.29% in 2013 and did not increase after CCH entered the market in 2014. An average of 2.52% of men with PD received treatment before CCH, compared with 3.75% after (p<0.0001). Penile injection rates increased (1.34% vs. 2.61%, p<0.0001), while rates of surgical treatments decreased between these periods. There was no change in rate of corporal rupture in men with PD before (0.024%) and after (0.024%) CCH. Overall, only 20.0% of corporal ruptures were repaired. After CCH entered practice, a significant increase in cost occurred (p=0.013).ConclusionsThe prevalence of men with PD did not change after CCH. However, more men with PD received treatment due to an increase in penile injections. The cost of treating PD increased after CCH became available. The overall prevalence of corporal rupture did not change after CCH entered the market.

PD44-07 PEYRONIE'S DISEASE: THE IMPACT OF COLLAGENASE CLOSTRIDIUM HISTOLYTICUM ON DIAGNOSIS, TREATMENT, AND COST

You have accessJournal of UrologySexual Function/Dysfunction: Peyronie's Disease I1 Apr 2018PD44-07 PEYRONIE'S DISEASE: THE IMPACT OF COLLAGENASE CLOSTRIDIUM HISTOLYTICUM ON DIAGNOSIS, TREATMENT, AND COST Andrew Sun, Shufeng Li, and Michael Eisenberg Andrew SunAndrew Sun More articles by this author , Shufeng LiShufeng Li More articles by this author , and Michael EisenbergMichael Eisenberg More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2131AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Peyronie's disease (PD) is characterized by fibrous penile plaque formation that interferes with sexual function and quality of life. Many treatments have been proposed, the most recent being collagenase clostridium histolyticum (CCH) injections (FDA approved in 2014). Currently only verapamil, CCH, and surgical approaches are recommended by AUA guidelines. Given mixed evidence for efficacy of verapamil, invasive nature of surgery, and novel mechanism of CCH, there is significant interest in CCH use. We sought to evaluate the impact of CCH on the prevalence, treatment, and cost of PD. METHODS Optum is a national database with information from adjudicated and paid insurance claims of privately-insured individuals, covering between 6 and 7 million males from 2004 to 2016. We extracted data on PD diagnosis (ICD-9 607.95 and ICD-10 N48.6) and treatments. Both individual years and eras before and after CCH use (2004-2013 vs 2015-2016) were analyzed for prevalence of PD, overall rate of PD treatment, rate of penile injections, rate of CCH use, rate of surgical PD procedures, and cost associated with treatment. Analyses were conducted using SAS (version 9.3). RESULTS The annual prevalence of PD rose from 0.03% in 2004 to 0.08% in 2011 and remained stable thereafter. Among men >50, the prevalence remained between 13-14% after 2011. However, annual rates of PD treatment increased from an average of 11.1% for 2004-2013 to a high of 14.8% in 2015. Corresponding to this, annual penile injection rates increased from an average of 5.5% from 2004-2013 to 9.5% for 2015-2016. By 2016, CCH was 74.9% of all penile injections. Average annual rates of penile plication (3.3% vs 3.4%), penile grafting (1.0% vs 0.51%), and penile prosthesis (12.1% vs 12.1%) among men with a PD diagnosis remained stable for the same eras. The average annual cost of PD treatment per man increased from $1824.16 in 2004 to $4010.92 in 2016 (inflation adjusted). This was most pronounced from 2013 to 2016 where an average increase of $361.41 per year was observed, versus $122.50 for the years prior. CONCLUSIONS The prevalence of PD stabilized in 2011 and did not increase after CCH became available in 2014. Over the same period, the proportion of men receiving treatment for PD increased, associated with more injections and CCH use. In addition, the cost of treating PD increased more rapidly after CCH became available. Further research into CCH use is needed to assess if the increase in treatment has improved outcomes of men with PD. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e883 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Andrew Sun More articles by this author Shufeng Li More articles by this author Michael Eisenberg More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Defining a glycated haemoglobin (HbA1c) level that predicts increased risk of penile implant infection.

To re-evaluate the role of diabetes mellitus (DM) as a risk factor for penile implant infection by exploring the association between glycated haemoglobin (HbA1c) levels and penile implant infection rates and to define a threshold value that predicts implant infection. We conducted a multicentre prospective study including all patients undergoing penile implant surgery between 2009 and 2015. Preoperative, perioperative and postoperative management were identical for the entire cohort. Univariate analysis was performed to define predictors of implant infection. The HbA1c levels were analysed as continuous variables and sequential analysis was conducted using 0.5% increments to define a threshold level predicting implant infection. Multivariable analysis was performed with the following factors entered in the model: DM, HbA1C level, patient age, implant type, number of vascular risk factors (VRFs), presence of Peyronie's disease (PD), body mass index (BMI), and surgeon volume. A receiver operating characteristic (ROC) curve was generated to define the optimal HbA1C threshold for infection prediction. In all, 902 implant procedures were performed over the study period. The mean patient age was 56.6 years. The mean HbA1c level was 8.0%, with 81% of men having a HbA1c level of >6%. In all, 685 (76%) implants were malleable and 217 (24%) were inflatable devices; 302 (33.5%) patients also had a diagnosis of PD. The overall infection rate was 8.9% (80/902). Patients who had implant infection had significantly higher mean HbA1c levels, 9.5% vs 7.8% (P < 0.001). Grouping the cases by HbA1c level, we found infection rates were: 1.3% with HbA1c level of <6.5%, 1.5% for 6.5-7.5%, 6.5% for 7.6-8.5%, 14.7% for 8.6-9.5%, 22.4% for >9.5% (P < 0.001). Patient age, implant type, and number of VRFs were not predictive. Predictors defined on multivariable analysis were: PD, high BMI, and high HbA1c level, whilst a high-volume surgeon had a protective effect and was associated with a reduced infection risk. Using ROC analysis, we determined that a HbA1c threshold level of 8.5% predicted infection with a sensitivity of 80% and a specificity of 65%. Uncontrolled DM is associated with increased risk of infection after penile implant surgery. The risk is directly related to the HbA1c level. A threshold HbA1c level of 8.5% is suggested for clinical use to identify patients at increased infection risk.

The Prevalence of Peyronie's Disease in the United States: A Population-Based Study.

Peyronie’s disease (PD) is a connective tissue disorder which can result in penile deformity. The prevalence of diagnosed PD in the United States (US) has been estimated to be 0.5% in adult males, but there is limited additional information comparing definitive and probable PD cases. We conducted a population-based survey to assess PD prevalence using a convenience-sample of adult men participating in the ResearchNow general population panel. Respondents were categorized according to PD status (definitive, probable, no PD) and segmented by US geographic region, education, and income levels. Of the 7,711 respondents, 57 (0.7%) had definitive PD while 850 (11.0%) had probable PD. Using univariate logistic regression modeling, older age (18–24 vs 24+) (OR = 0.721; 95% CI = 0.570,0.913), Midwest/Northeast/West geographic region (South vs Midwest/Northeast/West) (OR = 0.747; 95% CI = 0.646,0.864), and higher income level (<25K vs 25K+) (OR = 0.820; 95% CI = 0.673,0.997) were each significantly associated with reduced odds of having a definitive/probable PD diagnosis compared with no PD diagnosis. When all three variables were entered in a stepwise multivariable logistic regression, only age (OR = 0.642; 95% CI = 0.497, 0.828) and region (OR = 0.752; 95% CI = 0.647, 0.872) remained significant. This study is the first to report PD prevalence by geographic region and income, and it advocates that the prevalence of PD in the US may be higher than previously cited. Further, given the large discrepancy between definitive PD cases diagnosed by a physician and probable cases not diagnosed by a physician, much more needs to be done to raise awareness of this disease.