Search Results (13)

Objectives: The preoperative hormonal treatment (PHT) in eligible patients has the potential to become an asset for the treatment of severe hypospadias. The aim of the paper is to report the preliminary results on tolerability and efficacy of tailored transdermal PHT with testosterone before primary hypospadias repair, resulting by the joint activity between pediatric surgeons and endocrinologists. Methods: A retrospective study collected all the patients affected by severe hypospadias, with a glans width (GW) < 14 mm and/or a penile ventral curvature > 30°, treated with preoperative transdermal testosterone gel 2% at a standard dose of 2 mg/day after pediatric endocrinologist evaluation, from December 2020 to February 2024. Increases in GWs and penile lengths (PLs), together with adverse events and the rate of surgical complications, were reported. Results: During the period, ten patients were included and received transdermal PHT for 43 (±15) days on average. The treatment with PHT stopped 52 (±23) days before surgery. PL increased 0.76 (±0.27) cm (+37%) on average, and GW increased 0.42 (±0.26) cm (+40%). No adverse events were described. Three surgical complications were reported with an overall rate of 30%. Conclusions: Transdermal PHT was well-tolerated and showed a positive impact on the treatment of severe hypospadias. Future investigations might confirm these findings. Full article

Background: The purpose of this study is to examine the combination of the mechanical effects of penile therapy with vacuum erection devices (VEDs) plus PDE5i, which improve clinical outcomes after extracorporeal shockwave therapy (ESWT) in men affected by erectile dysfunction (ED) associated with Peyronie’s disease (PD). Methods: A total of 153 medical records of patients affected by PD in stable stage with ED and treated with ESWT were divided into two groups. Group A (GA) included 72 men treated with ESWT, mechanical stretching with VEDs and PDE5ì (Tadalafil 5 mg), and Group B (GB) included 81 men who received only ESWT plus Tadalafil 5 mg with the same protocol of GA. The patients in both groups were assessed at baseline and follow-up for erectile function, painful erections, penile plaque size, and penile curvature. The results were evaluated at baseline and 3, 6, and 12 months after the treatments. Results: Three months after the treatment, GA patients had a reduction in penile curvature degree from a mean ± SD of 33.91 ± 8.34° at baseline to a mean ± SD of 19.46 ± 7.15° after 12 months, whereas pain in an erection or during intercourse was resolved completely in 88.9% of the patients. The mean ± SD IIEF-15 score of patients affected by severe/moderate ED further improved significantly in the GA group (p < 0.001) after 3, 6, and 12 months of treatment. There were no permanent adverse sequelae after treatments. Conclusions: The regular use of a VED plus Tadalafil in patients who had undergone ESWT significantly provided more benefit in patients with PD in terms of penile deformity, pain, and erectile function. Full article

Peyronie’s disease (PD) affects the penile albuginea, resulting in penile deformity, pain, erectile dysfunction (ED), and an anxious–depressive state. PD diagnosis involves a thorough medical history, penile palpation, documentation of the penile deformation, a dynamic penile echo color Doppler ultrasound (PCDU), and the completion of questionnaires for the evaluation of pain, ED, and psychometric tests. The aim of this study was to evaluate the symptoms of PD and their prevalence in PD patients in the active phase who had access to our andrology clinic. Inclusion criteria: availability of data on patients diagnosed with PD, including detailed medical history, blood tests, penile palpation, photographic documentation of penile deformity, and penile PCDU. Exclusion criteria: PD patients in the stable phase or those without the specified tests and data mentioned above. Our study found a higher prevalence of PD in younger patients (24.2%), a higher coexistence of PD with chronic prostatitis (35.6%), a higher percentage of cases of association between penile deformity and penile curvature (84.4%), a higher prevalence of “significant anxiety” (88.4%), a higher presence of plaque calcification (35.6%), and the detection of a longer duration of the first phase of PD (>18 months). The most frequently observed type of penile curvature was dorsal, followed by left lateral, right lateral, and, less commonly, ventral. We observed a significant statistical correlation between patient age and IIEF score, indicating that patients over the age of 40 years are at a higher risk of experiencing ED. We found a strong statistical relationship between VAS score and age. As age increases, the VAS score decreases, suggesting that younger patients reported more penile pain compared to those who were older than 40 years. Furthermore, we found that penile pain has a significant impact on the psychological state of PD patients. We also found that 38.8% of PD patients suffered from severe anxiety. In relation to this, psychotherapy should be integrated into PD treatment to improve the quality of life and treatment adherence. Full article

Introduction: Hypospadias is a syndrome of penile maldevelopment. The primary goal of hypospadias surgery is to create a penis with normal appearance and function. Historically, the outcome of hypospadias repair has been assessed based on the need for reoperation due to urethroplasty complications (UC), including fistula formation, dehiscence, meatal stenosis, or development of a urethral stricture. The Glans–Urethral Meatus–Shaft (GMS) score is a standardized tool to predict UC. Analysis of the cosmetic outcomes of hypospadias repair based on the appearance of the reconstructed penis has been validated, and standardized scores have been published. The Hypospadias Objective Penile Evaluation (HOPE) score is a validated questionnaire used to assess postoperative cosmetic outcomes. Although predictors of surgical outcomes and UC have been well documented, predictors of optimal cosmetic outcomes are lacking in the literature. Furthermore, reoperation due to cosmetic considerations has been poorly reported. Objective: To identify predictors of cosmetic outcomes after hypospadias repair and to assess the reoperation rate according to cosmetic considerations. Materials and Methods: This prospective cohort study included 126 boys who underwent primary hypospadias repair. The severity of hypospadias, degree of penile curvature, glans width, preoperative HOPE, and GMS scores were documented. The standard technique for single-stage repairs, the tubularized incised plate urethroplasty, was performed. The primary endpoint was cosmetic outcomes evaluated by the HOPE score questionnaire six months postoperatively. Optimal cosmetic results were defined by HOPE scores ≥ 57. Results: The study population consisted of the following cases: 87 (69%) subcoronal, 32 (25%) shaft, and 7 (6%) proximal hypospadias. Among the study participants, 102 boys (81%) had optimal cosmetic results (HOPE ≥ 57), and 24 boys (19%) had surgeries with suboptimal cosmetic outcomes (HOPE < 57). Ancillary procedures were performed in 21 boys (16%), of which 14 (11%) were solely for cosmetic considerations, and 7 were secondary to UC. Using the Receiver Operating Characteristic analysis of potential predictors of optimal cosmetic outcomes, the preoperative HOPE score had the highest area under the curve (AUC = 0.79; 95% CI 0.69–0.89, p < 0.001). After multivariable analysis, the degree of penile chordee (p = 0.013), glans width (p = 0.003), GMS score (p = 0.007), and preoperative HOPE score (p = 0.002) were significant predictors of cosmetic outcomes. Although meatal location predicted suboptimal cosmetic results in univariate analysis, it was not a factor in multivariable analysis. Conclusions: Over 80% of boys undergoing hypospadias repair achieved optimal cosmetic outcomes. More than 10% of cases underwent ancillary procedures, secondary solely to cosmetic considerations. Predictors of optimal cosmetic outcomes after hypospadias surgery included degree of chordee, glans width, and preoperative HOPE and GMS scores, which were the best predictors of satisfactory cosmetic results. Although meatal location is the main predictor of UC, it was not a predictor for cosmetic outcomes. Factors affecting cosmetic outcomes should be clearly explained to parents during the preoperative consultation. Full article

Background: Peyronie’s disease (PD) represents a challenging urological disease, due to not optimal post-operative surgical outcomes. We aim to retrospectively evaluate if vacuum erection device (VED) treatment before penile curvature surgery is able to improve post-operative surgical outcomes. Methods: All enrolled patients were assigned to the following groups: (a) the treatment group: VED treatment (three times per week) starting 3 months before surgery and (three times per week) one month after surgery; and (b) the control group: VED treatment (three times per week) one month after surgery. Follow-up urologic visits were scheduled for 3 and 6 months after surgery, and the two groups were compared. Results: A total of 38 patients were enrolled (median age 67 years, 57–74, IQR): 20 in the treatment group and 18 in the control group. At the follow-up visits, the two groups were different in terms of IIEF-5 (26 vs. 24; p = 0.02), “yes” to SEP2 and 3 (85% vs. 55%; p < 0.001, 85% vs. 50%; p < 0.001, respectively), and PDQ (−16 vs. −11; p = 0.03). Complete correction of penile curvature was achieved in 36 patients (94.7%). In the treatment group, no hourglass deformity was reported, whereas one patient reported a mild hourglass deformity in the control group. In the treatment group, we obtained a longer total penile length (median +1.5 cm). The overall satisfaction rate was 98% in the treatment group and 96% in the control group. Conclusions: The VED treatment before penile curvature surgery in patients affected by PD was able to improve surgical outcomes. Full article

Peyronie’s disease (PD) is a benign condition caused by plaque formation on the tunica albuginea of the penis. It is associated with penile pain, curvature, and shortening, and contributes to erectile dysfunction, which worsens patient quality of life. In recent years, research into understanding of the detailed mechanisms and risk factors involved in the development of PD has been increasing. In this review, the pathological mechanisms and several closely related signaling pathways, including TGF-β, WNT/β-catenin, Hedgehog, YAP/TAZ, MAPK, ROCK, and PI3K/AKT, are described. Findings regarding cross-talk among these pathways are then discussed to elucidate the complicated cascade behind tunica albuginea fibrosis. Finally, various risk factors including the genes involved in the development of PD are presented and their association with the disease summarized. The purpose of this review is to provide a better understanding regarding the involvement of risk factors in the molecular mechanisms associated with PD pathogenesis, as well as to provide insight into disease prevention and novel therapeutic interventions. Full article

Peyronie’s disease is a condition characterized by the formation of fibrous plaques in the tunica albuginea, which can cause pain, curvature, and erectile dysfunction. Preclinical studies have demonstrated the potential benefits of hyaluronic acid in treating Peyronie’s disease, including antifibrotic, anti-inflammatory, and proangiogenic effects, although more research is needed to fully understand its mechanisms of action. Clinical studies have shown promising results, with hyaluronic acid injections leading to improvements in plaque size, penile curvature, and erectile function, and being well tolerated by patients. The findings suggest that HA injections could be a viable and safe treatment option for Peyronie’s disease, particularly in the early stages of the disease. However, more research is needed to determine the optimal dosage and treatment duration for HA injections, and to confirm its efficacy in the stable phase of Peyronie’s disease. Overall, hyaluronic acid is a potentially effective therapy for Peyronie’s disease, with the ability to inhibit fibrosis and promote angiogenesis, and low risk of adverse effects, making it an attractive option for patients who are unable or unwilling to undergo surgery. Full article

Current literature has indicated that Peyronie’s disease (PD) could be initiated by microtrauma and the subsequent inflammation episodes that follow. PD could be sorted into acute or chronic status, and it can differ when selecting the clinical therapeutics. PD would cause pain and penile deformity to diseased men and impair their erectile function. Occasionally, surgical revision of the penis might be needed to correct the penile curvature. We find that there are limited effective options of intra-lesion injections for the PD plaques. By searching the databases and screening the literature with the PRISMA 2020 guideline, we observed that several preclinical studies that applied stem cell therapy in treating PD were fruitful in the acute phase. Although in the chronic phase of PD, erectile parameters were not significantly improved, and therefore, future studies might be better elevated in certain aspects, such as the sites selected for harvesting stem cells or changing the centrifugation forces. In this review, we concluded the contemporary understanding of inflammatory microenvironments in PD, the stem cell therapy in PD, and our perspectives on future studies. We concluded that there may be great potential in stem cell therapy for treating both acute and chronic phases PD. Full article

Peyronie’s disease (PD) is a fibrotic disorder of the tunica albuginea of the penis. Conservative medical therapy includes oral and/or injective active substances. Until now, only two PD patients who recovered after medical treatment are described in the literature. This article describes three new cases of PD patients who achieved complete resorption of plaque following antioxidant treatment. Case Presentations: Case 1. The patient was a 34-year-old man, a smoker, with lateral-left penile curvature (40 degrees), penile pain, and good penile rigidity. The patient was treated with combined therapy (oral antioxidants + Propolis creme). At follow-up, after about 29 months of treatment, we observed the disappearance of the acquired penile deformity. The ultrasound examination no longer showed any plaque. Case 2. The patient was a 32-year-old man with chronic prostatitis, penile lichen sclerosus, lateral-left penile curvature (10 degrees), a palpable lump, and good penile rigidity. The patient was treated with combined therapy (oral antioxidants + Propolis creme + penile injections of pentoxifylline). After 33 months of treatment, at follow-up, we observed the disappearance of the penile deformity. Ultrasound examinations no longer showed any plaque. Case 3. The patient was a 33-year-old man with penile pain, dorsal penile curvature (30 degrees), and good penile rigidity. The patient was treated with combined therapy (oral antioxidants + Propolis creme + penile injections of pentoxifylline). At follow-up, after 41 months of treatment, the penile pain was no longer present, and the ultrasound study no longer showed any plaque. Conclusions: Although our study presents a limited number of cases, it is a matter of fact that these patients obtained full regression in the affected area. We believe our experience may be very useful for urological clinical practice. Full article

Erection measurements are the most important indicator of male urological disease diagnosis, treatment, and results. Rigiscan has been used widely in studies and diagnoses for nocturnal penile tumescence for evaluating erectile dysfunction by measuring the number and timing of erectile dysfunctions during sleep. However, this device has limitations such as the weight and bulk of the device and has been questioned for its role as a standard for ED Erectile Dysfunction (ED) diagnosis. In this study, we propose a real-time wearable monitoring system that can quantitatively measure the length and circumference of the penis using electronic textiles (E-textile) and carbon nanotube (CNT) sensors. The E-textile sensor is used to measure the length, circumference, and gradient with portability, convenience, and comfort. Sensors were created by coating CNTs on latex for flexibility. The CNT-based latex condom-type sensor in our proposed system shows the length, circumference, and curvature measurements with changes in resistance, and the E-textile performance shows a 1.44% error rate and a cavity radius of 110 to 300. The results of this conceptual study are for supplementary sensor development with a combination of new technologies with alternatives or existing methods for measuring erection function. Full article

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. Full article

Background: Peyronie’s disease (PD) is a little-known disease characterized by pain during erections, the presence of penile curvature, and consequent psychological disorders. In addition, concomitant erectile dysfunction may be present. The treatment of PD is adapted to the patient, especially when the penile curvature is >60°; with stabilized pathology, it is preferable to perform penile straightening approaches, such as penile plication and plaque incision, or partial excision and grafting. The most frequent side effect of straightening approaches is the onset of erectile dysfunction due to the formation of venous leakage appearing after the excision of calcific plaque. Materials and methods: All enrolled patients had PD, a curvature >60°, had an IIEF subdomain erectile function score >16, and refused penile prosthesis implantation concurrent with tunica albuginea grafting surgery. Subsequently, 4 weeks after surgery, all patients underwent a rehabilitation protocol that consisted of low-intensity extracorporeal shock wave therapy (Li-ESWT), the administration of 5 mg/daily of tadalafil, and the use of a vacuum device. Results: From January 2014 to March 2016, 15 subjects affected by PD with severe penile curvatures were enrolled in the study. At 6 months after surgery, the IIEF scores for erectile function were not statistically significantly different before and after surgery (p > 0.05); the other items, especially orgasmic function (p = 0.01), sexual desire (p < 0.01), intercourse satisfaction (p = 0.01), and overall satisfaction (p = 0.04), were all statistically significant. The modified EDITS questionnaire reported that 80% of patients were satisfied, that 13.3% were dissatisfied, and that 1 patient (6.6%) was dissatisfied with the surgery. Moreover, there was no statistically significant decrease in the patients’ penile lengths. The aim of this study was to use a rehabilitation protocol consisting of Li-ESWT, the administration of 5 mg/daily, and the use of a vacuum device in order to preserve the erectile function of patients undergoing straightening approaches using surgical grafting. In addition, patient satisfaction following surgery was analyzed. Full article

Peyronie’s disease is a condition that causes abnormal healing of the tunica albuginea, causing penile curvature. It is difficult to treat and its management is continuing to evolve. Proposed non-surgical treatments have included oral, topical, intralesional, extracorporeal shockwave, and traction therapy. The study of Peyronie’s disease is made difficult by heterogeneity in the timing of presentation, severity and characteristics of deformity, and associated complaints. Moreover, meta-analyses of studies are difficult due to inconsistencies across study endpoints and the duration of treatments. This article reviews the current clinical evidence and guideline recommendations, with a focus on an improvement in penile curvature. Full article