Discussion in 'Men's Health Forum' started by Michael Scally MD, Jun 5, 2012.

  1. Michael Scally MD

    Michael Scally MD Doctor of Medicine

    Hatzimouratidis K, Eardley I, Giuliano F, et al. Guidelines on Penile Curvature. Eur Urol. - European Urology - Guidelines on Penile Curvature

    CONTEXT: Penile curvature can be congenital or acquired. Acquired curvature is secondary due to La Peyronie (Peyronie's) disease.

    OBJECTIVE: To provide clinical guidelines on the diagnosis and treatment of penile curvature.

    EVIDENCE ACQUISITION: A systematic literature search on the epidemiology, diagnosis, and treatment of penile curvature was performed. Articles with the highest evidence available were selected and formed the basis for assigning levels of evidence and grades of recommendations.

    EVIDENCE SYNTHESIS: The pathogenesis of congenital penile curvature is unknown. Peyronie's disease is a poorly understood connective tissue disorder most commonly attributed to repetitive microvascular injury or trauma during intercourse. Diagnosis is based on medical and sexual histories, which are sufficient to establish the diagnosis. Physical examination includes assessment of palpable nodules and penile length. Curvature is best documented by a self-photograph or pharmacologically induced erection. The only treatment option for congenital penile curvature is surgery based on plication techniques. Conservative treatment for Peyronie's disease is associated with poor outcomes. Pharmacotherapy includes oral potassium para-aminobenzoate, intralesional treatment with verapamil, clostridial collagenase or interferon, topical verapamil gel, and iontophoresis with verapamil and dexamethasone. They can be efficacious in some patients, but none of these options carry a grade A recommendation. Steroids, vitamin E, and tamoxifen cannot be recommended. Extracorporeal shock wave treatment and penile traction devices may only be used to treat penile pain and reduce penile deformity, respectively. Surgery is indicated when Peyronie's disease is stable for at least 3 mo. Tunical shortening procedures, especially plication techniques, are the first treatment options. Tunical lengthening procedures are preferred in more severe curvatures or in complex deformities. Penile prosthesis implantation is recommended in patients with erectile dysfunction not responding to pharmacotherapy.

    CONCLUSIONS: These European Association of Urology (EAU) guidelines summarise the present information on penile curvature. The extended version of the guidelines is available on the EAU Web site European Association of Urology (EAU) - Guidelines ; II.pdf
    Last edited: Dec 31, 2012
  2. Structure

    Structure Member

    Re: Guidelines on Penile Curvature

    Sure, it's from "intercourse." That's why there's a statistical correlation between being right or left handed and which direction the Peyronie's disease inflicted penis points.

    Here's a hint: if you're right handed, and you notice your cock is pointing more and more to the left as time goes by, you might want to get a hobby...

    (Gripping too hard flexes the penis against the thumb, which over time causes the penis to bend in the direction that is opposite from the hand used during masturbation, as well as upwards.)
    Last edited: Jun 5, 2012
  3. BBC3

    BBC3 Member

    Re: Guidelines on Penile Curvature

    Damn.. You must be European..... LOL

    The truth is that the bastard just grows whatever way you got it in your pants when its fuckin hard 24/7 in the 4rth grade... I really have a hard time believing its a mystery... Really, curviture should be associated/related to psychological factors like - What kind of a showman one is, or how much time a person spent with wood when developing. Possibly even demonstative even of social psychological paradigm as it relates to sexual excitement. But the DIFFERENCE between natty growth curviture and self induced borderline pyronese should be distinguished. There is a big difference in owning a "g-blaster" and a "sidewinder missle"... Either way, all along it turns out the girls love the fucking warped ones..... LOL:D;)

    But I have no idea how genetics could even come into the argument...

    Last edited: Jun 6, 2012
  4. Structure

    Structure Member

    Re: Guidelines on Penile Curvature

    LOL. A few things to consider:

    * The most common cause of penile fracture is not intercourse, but is self-inflicted acute bending (Ateyah, A., Mostafa, T., Nasser, T. A., Shaeer, O., Hadi, A. A. and Al-Gabbar, M. A. (2008), Penile Fracture: Surgical Repair and Late Effects on Erectile Function. Journal of Sexual Medicine, 5: 1496–1502., Penile Fracture: Surgical Repair and Late Effects on Erectile Function - Ateyah - 2008 - The Journal of Sexual Medicine - Wiley Online Library).

    * In the same published report, the authors describe that their right handed patients "manipulated the penis to the left side that may result in right-sided tears."

    * Lastly, in right handed populations, the erect penis is more likely to point to the left, unlike left handed populations.

    So while causality has not been rigorously proven, I don't think you need to look too hard to figure out why, as a right handed male, your dick points left.
  5. BBC3

    BBC3 Member

    Re: Guidelines on Penile Curvature

    Well that figures then cause I'm not only know as a "switch hitter" on the tobacco rehlm. Lol
  6. pinkman

    pinkman Junior Member

    Re: Guidelines on Penile Curvature

    Dayum, that explains a lot. But wanking with the left hand is so exhausting. I can't go real fast with the left hand. :(
  7. BBC3

    BBC3 Member

    Re: Guidelines on Penile Curvature

    Yur supposed to be able to switch hands and gain a stroke....!
    And for those wondering what "European" means - its Pam out and thum/ forefinger to body. Yea, I have hung with some sick fuckers...
  8. pinkman

    pinkman Junior Member

    Re: Guidelines on Penile Curvature

    Can't imagine what you mean. Can you draw a pic or upload a video?
  9. BBC3

    BBC3 Member

    Re: Guidelines on Penile Curvature

    I'm Sorry. You will have to refer to LOL

  10. Michael Scally MD

    Michael Scally MD Doctor of Medicine

    Shindel AW. Sexual dysfunction: The potential of stem cell therapy for Peyronie disease. Nat Rev Urol 2013;10(1):8-9.

    Stem-cell therapy has the potential to regenerate tissue and cure disease—an approach preferable to many current treatments that simply mitigate symptoms. Currently, there is no approved medical therapy for Peyronie disease; a recent study suggests stem cells could provide an intriguing treatment option for this difficult-to-treat tissue defect.
  11. Michael Scally MD

    Michael Scally MD Doctor of Medicine

    Lipshultz LI, Goldstein I, Seftel AD, Kaufman GJ, Smith TM, et al. Clinical Efficacy of Collagenase Clostridium Histolyticum in the Treatment of Peyronie's Disease by Subgroups: Results From Two Large, Double-Blind, Randomized, Placebo-Controlled, Phase 3 Studies. BJU International.

    Objectives To examine the efficacy of intralesional collagenase clostridium histolyticum (CCH) in defined subgroups of subjects with Peyronie's disease (PD).

    Subjects and Methods The efficacy of CCH compared with placebo from baseline to week 52 was examined in subgroups of subjects from the Investigation for Maximal Peyronie's Reduction Efficacy and Safety Studies (IMPRESS) I and II, defined by:
    · severity of penile curvature deformity at baseline (30°-60° [n=492] and 61°-90° [n=120]);
    · PD duration (1 to ≤2 [n=201], >2 to ≤4 [n=212], and >4 years [n=199]);
    · degree of plaque calcification (no calcification [n=447], noncontiguous stippling [n=103], and contiguous calcification that did not interfere with the injection [n=62]); and
    · baseline erectile function (International Index of Erectile Function [IIEF] 1-5 [n=22], 6-16 [n=106], and ≥17 [n=480]).

    Results Reductions in penile curvature deformity and PD symptom bother were observed in all subgroups. Penile curvature deformity reductions were significantly greater for CCH vs placebo for: baseline penile curvature 30°-60° and 61°-90°; disease duration >2 to ≤4 years and >4 years; no calcification; and IIEF ≥17 (high IIEF erectile function) (P < .05 for all).

    PD symptom bother reductions were significantly greater in the CCH group for: penile curvature 30°-60°; disease duration >4 years; no calcification; and IIEF 1-5 (no sexual activity) and ≥17 (P < .05 for all).

    Conclusions In this analysis, the clinical efficacy of CCH treatment for reducing penile curvature deformity and PD symptom bother was demonstrated across subgroups. In the IMPRESS I and II studies overall, AEs were typically mild or moderate, although treatment-related serious AEs, including corporal rupture or penile hematoma, occurred.

    Future studies could be considered to directly assess the efficacy and safety of CCH treatment in defined subgroups of PD patients, with the goal of identifying predictors of optimal treatment success. This article is protected by copyright. All rights reserved.
  12. MR10X

    MR10X Member

    Xiaflex injections are the newest treatment approved for Peyronie's, but it is very expensive and cost about $40,000.00 for the treatments.My insurance would not cover it......
    Michael Scally MD likes this.
  13. Michael Scally MD

    Michael Scally MD Doctor of Medicine

    Gelbard MK, Chagan L, Tursi JP. Collagenase Clostridium histolyticum for the Treatment of Peyronie's Disease: The Development of This Novel Pharmacologic Approach. The Journal of Sexual Medicine.

    Introduction The conception of collagenase Clostridium histolyticum (CCH) as treatment for Peyronie's disease (PD) was a vital first step in providing a nonsurgical, minimally invasive FDA-approved treatment for men with PD.

    Aim To review the origins, clinical research history, and ultimately FDA approval of collagenase as PD treatment.

    Methods A PubMed search using (Peyronie's or Peyronie) AND collagenase, and limited to clinical research studies, returned nine papers that were examined in the current review.

    Results Collagenase as a PD treatment arose in response to a lack of effective nonsurgical treatments and the incomplete understanding of underlying PD etiology. Awareness of dense collagen in PD scarring and parallel initial exploration of collagenase to treat herniated lumbar discs coincided with and inspired laboratory-based investigation of collagenase effects on excised PD plaque tissue. The foundational conceptual work and the critical development of purified injectable collagenase allowed the pursuit of clinical studies. Progression of clinical studies into large-scale robust trials culminated in two important outcomes: development of the first validated, PD-specific measure of psychosexual function, the Peyronie's Disease Questionnaire, and the first FDA-approved treatment for PD.

    Conclusions Collagenase therapy began as an attempt to modify the structure of PD-related tunica albuginea scarring, despite the lack of a fundamental understanding of the scar's origin. If we wish to advance PD treatment beyond this first effective step, the future needs to bring us full circle to the starting point: We need a greater understanding of the control of collagen deposition and wound healing in men with PD.
  14. Michael Scally MD

    Michael Scally MD Doctor of Medicine

    Capece M, Cocci A, Russo G, et al. Collagenase clostridium histolyticum for the treatment of Peyronie's disease: a prospective Italian multicentric study. Andrology 2018;0.

    Peyronie's disease (PD) is a common condition which results in penile curvature making sexual intercourse difficult or impossible. Collagenase clostridium histolyticum (CCH) is the first licensed drug for the treatment of PD and is indicated in patients with palpable plaque and curvature deformity of at least 30° of curvature.

    However, only few monocentric studies are available in the current literature and this is the first national multicentric study focusing on this new treatment. In five Italian centres, 135 patients have completed the treatment with three injections of CCH using Ralph's shortened modified protocol.

    The protocol consisted of three intralesional injections of CCH (0.9 mg) given at 4‐weekly intervals in addiction to a combination of home modelling, stretching and a vacuum device on a daily basis. An improvement in the angle of curvature was recorded in 128/135 patients (94.8%) by a mean (range) of 19.1 (0–40)° or 42.9 (0–67)% from baseline (p < 0.001). There was also a statistically significant improvement in all IIEF and PDQ questionnaires subdomains (p < 0.001 in all subdomains).

    This prospective multicentric study confirms that the three‐injection protocol is effective enough to achieve a good result and to minimize the cost of the treatment.
  15. MR10X

    MR10X Member

    medicare paid for a vacuum pump.......after use of pump and cialis it is 98% straight.......not sure how it got bent..just woke up one morning and it was pointing to the left....not just curved but sharp bend. i read where Dennis Rodman broke his 3 times....once by diving on a woman........
  16. Michael Scally MD

    Michael Scally MD Doctor of Medicine

    Predictors of Treatment Success After Collagenase Clostridium Histolyticum Injection for Peyronie's Disease

    Objective - To build‐up a nomogram able to predict treatment success after Collagenase clostridium histolyticum (CCH) for Peyronie's disease (PD).

    Material and methods - From November 2016 to November 2017, we enrolled 135 patients with PD in a multicentre single‐arm prospective study. All patients enrolled had a treatment with CCH. Success of therapy was defined as a penile curvature decrease of at least 20 degrees from baseline curvature.

    Treatment satisfaction was assessed using a scale from 1 to 10 and high satisfaction was arbitral defined as a score ≥8. The calcification level was classified as: absence of calcifications, low spots perilesional calcifications and high calcification.

    Results - Median age was 56.0 (IQR [interquartile range]: 45.0,65.0) and median penile curvature (PC) was 30 degrees (IQR: 30.0,60.0). After the treatment protocol, we observed a significant median change for PC of ‐20.0 (p<0.01). The median percentage of penile curvature improvement was 44 (IQR: 28.0‐67.0). Overall median satisfaction was 8.0 (IQR: 7.0‐9.0).

    In total, treatment efficacy was reported in 77 patients (57.04%). When analysing factors associated with PC improvement after treatment, we found that baseline PC (OR= 1.14; p<0.01), basal plaque (OR= 64.27; p<0.01), low calcification (OR= 0.06; p<0.01) and high‐calcification (OR= 0.03; p<0.01) were significant predictors of penile curvature improvement. The c‐index for the model was 0.93.

    Conclusions - Patients with longer duration of the disease, greater baseline curvature and basal plaque localization were at greater chance of treatment success. These results could be applied into clinical practice before external validation of our nomogram.

    Cocci A, Russo Giorgio I, Briganti A, et al. Predictors of treatment success after Collagenase clostridium histolyticum injection for Peyronie's disease. Development of a nomogram from a multicentre single‐arm, non‐placebo controlled clinical study. BJU international 2018;0.
  17. Michael Scally MD

    Michael Scally MD Doctor of Medicine

    Peyronie’s Disease and testosterone Deficiency: Is There A Link?

    Introduction - 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.

    Methods - 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.

    Results - 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.

    Conclusion - 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.

    Aditya I, Grober ED, Krakowsky Y. Peyronie’s disease and testosterone deficiency: Is there a link? World Journal of Urology 2019. Peyronie’s disease and testosterone deficiency: Is there a link?
  18. Michael Scally MD

    Michael Scally MD Doctor of Medicine

    Current Strategies in the Management of Peyronie's Disease (PD)

    INTRODUCTION: Peyronie's disease (PD) is a progressive and devastating penile disorder that often results in severe penile curvature with penile shrinking, making vaginal insertion difficult or even impossible. Until now, in contrast to other penile disorders such as erectile dysfunction, PD is characterized by a paucity of conservative treatment options.

    AIM: To investigate the current status quo in the management of PD across European experts in sexual medicine.

    METHODS: Members of the European Society of Sexual Medicine and of various andrology and urology societies across Europe, with the majority (78%) being urologists, were contacted via e-mail and newsletters and asked to fill in an online questionnaire. The survey comprised 56 items developed by an expert consensus of the educational committee of the European Society of Sexual Medicine. In the end, 401 participants responded to the entire survey, with 277 reporting treating PD patients themselves and knowing this penile entity very well.

    MAIN OUTCOME MEASURES: Main outcome measures include description of current strategies regarding diagnosis and treatment of PD as reported by specialists in this field.

    RESULTS: Of the physicians treating PD patients, 94% performed penile palpation, and 74% perform ultrasonography. 45% assessed the degree of penile curvature by means of intravenous drug testing, but only 17% measured it accurately with a goniometer. Penile length, flaccid or in erect state, was measured by only 39% or 25%, respectively. Only 45% assessed testosterone.

    Primary treatment options were oral (65%), counseling (57%), and topical/local therapy (30%). Among oral drug users, tadalafil 5 mg was the most commonly used (57%), followed by vitamin E (40%). Regarding intralesional therapy, collagenase clostridium histolyticum was the leading drug (34%), followed by calcium channel blockers (17%).

    Considering surgical procedures, the original Nesbit technique was the preferred procedure (33%). 36% of the specialists expressed their dissatisfaction with the currently available treatment options, and 64% reported the impression that their patients were mostly dissatisfied with the treatment outcomes.

    CLINICAL IMPLICATIONS: Innovative and presumably multi-modal treatment protocols for PD are urgently needed.

    STRENGTHS & LIMITATIONS: The survey represents 1 of the largest studies on the management of PD. The results are representative for the standard management of PD mostly among European Urologists with specialization in sexual medicine and may therefore not be generalizable to regions outside Europe or to other physicians treating PD.

    CONCLUSION: Around one-third of experts and, from their perspective, around two-thirds of patients are dissatisfied with the currently available PD treatment options.

    Porst H, Burri A. Current Strategies in the Management of Peyronie's Disease (PD)-Results of a Survey of 401 Sexual Medicine Experts Across Europe. The journal of sexual medicine 2019.