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Aim: The purpose of this study is to identify the clinical outcomes of patients during acute phase of Peyronie's disease (PD) treated with daily Tadalafil 5 mg associated with non-surgical treatments such as intra-plaque verapamil injections (IVI), vacuum erection devices (VED) or extra corporeal shockwave therapy (ESWT)., Methods: 445 patients with PD in acute stage were treated as it follows: Group 1(G1) 117 men with only Tadalafil 5 mg once a day for 3 months; Group 2(G2) 106 men with IVI plus Tadalafil 5 mg for a period of 12 weeks; Group 3(G3) 124 men that received ESWT for 6 weeks plus Tadalafil with the same protocol of G1; Group 4(G4) 98 men with VED plus Tadalafil 5 mg for 3 months. There were assessed at baseline and follow-up: Erectile dysfunction (ED), presence and severity of painful erections, penile plaque size and penile curvature degree. The results were evaluated at baseline and 3,6,12 months., Results: Not statistically significant differences emerged between the two groups at baseline, except for higher presence of patients with ED in in G3(7.4%) vs other groups(p < 0.001). Three months after the treatment in G3 men had a significant reduction of penile curvature degrees after 1 year by treatments, whereas pain in an erection or during intercourse was resolved completely in 75% of the patients., Conclusions: Our study highlights that multimodal therapy has beneficial long-term effects not only in the decrease of ED symptoms, but also in the relief of the penile curvature and the quality of life., (© 2024. The Author(s), under exclusive licence to Royal Academy of Medicine in Ireland.)

Objective: To assess the relationship between baseline total serum testosterone (T) and clinical outcomes in men affected by Peyronie's disease (PD) stable stage and treated by extra corporeal shockwave therapy (ESWT)., Methods: In this study, 168 patients affected by PD in stable stage (≥12 months) and treated with ESWT, were divided into 2 groups. Group 1 (G1) counted 71 patients with low T levels (≤ 300 ng/dL); group 2 (G2) consisted of 97 patients with normal T that received ESWT with the same protocol of G1 for 6 weeks. There were assessed at baseline and follow-up: Erectile dysfunction (ED), presence and severity of painful erections, penile plaque size, and penile curvature degree. The results were evaluated at baseline and 3, 6, 12, months after the treatment., Results: Not statistically significant differences emerged between the 2 groups at baseline, except for higher presence of patients with ED in G1 (90%) vs G2 (52%). Three months after the treatment in G2 pain was resolved completely in 80.4% of the patients, compared with G1 (54.9%). G2 had a reduction of curvature degree after the 3-month treatment (P <.001). Mean plaque size decreased in both groups without statistically differences with baseline values. Mean ± SD International Index of Erectile Function-5 score progressively improved significantly in the eugonadal men., Conclusion: This study demonstrated greater efficacy for the treatment of PD in men with normal T concentrations compared with men with low T concentrations. The results obtained from this study suggest that may be valuable in considering T therapy in men with PD prior to ESWT., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Purpose: To assess the clinical effectiveness of extra corporeal shockwave therapy (ESWT) administration compared with ESWT plus a low-intensity laser diode therapy (LILDT) in the management of Peyronie's disease (PD) stable stage., Methods: In this study, 214 patients affected by PD in stable stage (≥ 12 months), were divided into two groups. Group 1 (G1) counted 111 patients treated only with ESWT; Group 2 (G2) consisted of 103 patients that received ESWT with the same protocol of G1 plus LILDT for six weeks. The patients of 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, 12 months after the treatment., Results: Three months after the treatment in G2 pain in an erection or during intercourse was resolved completely in 78.6% of the patients, whereas in 55.8% cases of G1 (p < 0.003). G2 patients had a reduction of curvature degree after the 3 months treatment (p < 0.002). However, mean plaque size decreased in both groups without statistically differences with baseline values. Mean ± SD IIEF-5 score further improved significantly in the group treated with ESWT plus LILDT (p < 0.001). There were no permanent adverse sequelae after treatments., Conclusion: This study demonstrates an interesting therapeutic strategy when combined to the synergistic action of a shock wave therapy with low-intensity laser therapy on the stable plaques with significant benefits in terms of pain perception, penile curvature and sexual activity., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objective: To assess functional outcomes after surgical correction of congenital and acquired penile curvatures using Yachia's technique (YT) with degloving (DG) and without degloving (WDG) of the penis., Materials and Methods: A penile deformity with angle ≥30°, difficulty in vaginal penetration, and severity of erectile dysfunction secondary to penile curvatures were the indications for a surgical treatment with YT. The preoperative characteristics of the patients, postoperative outcomes (change in angulation, palpation of sutures, penile shortening, and patient satisfaction), operative time, and hospital stay were recorded. A total of 64 patients were included in this review and divided into 2 groups: 34 in group I (YT with DG) and 30 in group II (YT-WDG)., Results: The mean operative time was 65.87 ± 21.32 minutes for group I and 48.17 ± 23.82 minutes for group II (P < .02). The mean hospital stay was 3.09 ± 0.96 and 2.87 ± 0.93 days in DG and WDG, respectively (P = .324). There were no significant differences in recurrence rates and complications (palpation of sutures: group I: 14.7% vs. group II: 13.3%; penile shortening: group I: 8.9% vs. group II: 10%). At follow-up of 20.8 months, all treated patients were able to insert the penis in the partner's vagina, were satisfied overall with sexual intercourse., Conclusion: The outcomes of the DG and WDG techniques were similar, even if the YT-WDG presents better results in terms of less healing and operative time., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Purpose: Non-palpable isolated septal plaques of the penis are likely present in a significant number of patients affected by erectile dysfunction (ED) and penile pain without deformity or curvature. The aim of this study was to evaluate the ultrasound (US) patterns observed in patients investigated for ED or penile pain without curvature., Materials and Methods: We reviewed the medical records of 386 patients who underwent an initial colour-Doppler ultrasonography (CDU) of the penis for DE and/or penile pain without curvature. After satisfying inclusion criteria, 41 patients were individualized. All patients had a non-palpable plaque with involvement of the penile septum. Three US patterns were identified: focal hyperecoic thickening of the intercavernosum septum (IS) with acoustic shadow (pattern 1), non-calcified thickening (isoechoic or slightly hyperechoic (pattern 2), and microcalcifications in the IS without associated acoustic shadow (pattern 3)., Results: Patients' mean age was 51.3±16.7. ED was the predominant disorder in 73.2% of patients, followed by penile pain and length loss in 19.5% and 7.3% of patients, respectively. 32(78.1%) patients showed the pattern 1, 6 (14.6%) pattern 2, and 3 (7.3%) pattern 3. Plaques size varied from 3 to 13 mm. The penile hemodynamic response to CDU reported abnormal findings distally to the septal plaques in 20 patients (<25cm/sec). Median left and right cavernosum artery flows measured a peak systolic velocity of 31cm/sec and 33 cm/sec, respectively., Conclusions: We believe that an US study with CDU provides a way to characterize, localize, and deliver treatment choice in patients with Peyronie's Disease., Competing Interests: Conflict of interest: None declared., (Copyright® by the International Brazilian Journal of Urology.)

We present here a rare case of rupture of tunica albuginea and corpus cavernosum, in the site of a Peyronie's plaque, which happened in a 61- year-old man during a vacuum cleaner masturbation. Ultrasound study showed an irregular hyperechoic defect at the cavernosal rupture site in correspondence of the Peyronie's plaque. The hematoma was evacuated, partially plaque excised, and the tear repaired. Ultrasonography is an ideal technique for evaluating patients with penile trauma and can be routinely used in an emergency. It is a non-invasive method that gives faster results than cavernosography and Magnetic Resonance Imaging.

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. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this study was to evaluate the combination of intralesional verapamil injection (IVI) therapy with and tadalafil in men affected by Peyronie's disease (PD). Materials and Methods: In this study, 59 patients diagnosed with PD, were divided into three groups. Group A (GA) counted 23 patients treated with IVI; Group B (GB) treated 19 patients with tadalafil 5 mg once a day, and Group C (GC) treated 17 patients with IVI and tadalafil for 3 months. There were assessed at baseline and follow-up: Erectile function, presence and severity of painful erections, penile plaque size and penile curvature degree. Results: After 3 months pain resolved completely in 57% cases of GA, 61% of GB and 76% of GC; the final mean curvature degree further decreased in all groups without statistically significant differences; mean plaque size remained stable in GA: 1.57 versus 1.59 at baseline (P = 0.364) and GB: 1.51 versus 1.52 at baseline (P = 0,265), while a further decrease was evident in GC: 1.46 versus 1.58 at baseline (P = 0.03). Mean International Index of Erectile Function-5 score further improved significantly in the group treated with verapamil plus tadalafil: 23.1 versus 14.4 of GA and 18.2 of GB (P ≤ 0.01). Conclusions: The association of IVI and tadalafil showed better pain control while reducing penile curvature and erectile function, improving the quality of life. [ABSTRACT FROM AUTHOR]

Peyronie's disease (PD) is a localized connective tissue disorder of the tunica albuginea of the penis and its surrounding tissue which results in a painful erection, penile curvature and erectile dysfunction. The great number and variety of purposed treatments for PD is in proportion to the difficulty of its management.In fact no medical treatment is currently available to cure patients with PD. Pentoxifylline (PTX) is a non specific phosphodiesterase inhibitor with anti-inflammatory properties that has been used to treat claudication. PTX has also been used to decrease inflammation and fibrosis in kidney transplants, open heart surgery, dermatological conditions and after radiation injury. With respect to penile diseases, clinical studies have suggested that PTX decreases calcification in new-onset PD. These traits make PTX an interesting potential option for PD therapy. [ABSTRACT FROM AUTHOR]