Acute phase Peyronie's disease management with traction device: a nonrandomized prospective controlled trial with ultrasound correlation. Clinical Efficacy of Injection and Mechanical Therapy for Peyronie's Disease: A Systematic Review of the Literature. Treatment of Peyronie's Disease With Collagenase Clostridium histolyticum and Vacuum Therapy: A Randomized, Open-Label Pilot Study. A pilot study demonstrating clinical benefit from intralesional interferon alpha 2B in the treatment of Peyronie's disease. Intralesional interferon-alpha-2B injections for the treatment of Peyronie's disease. Intralesional Injections for Early Peyronie Disease: Standardized Assessment and Analysis of Predictive Factors for Treatment Response. The impact of intralesional interferon alpha-2b injection therapy on penile hemodynamics in men with Peyronie's disease. Clinical safety and effectiveness of collagenase clostridium histolyticum injection in patients with Peyronie's disease: a phase 3 open-label study. Transdermal electromotive multi-drug administration for Peyronie's disease: preliminary results. Clinical Experience With Penile Traction Therapy Among Men Undergoing Collagenase Clostridium histolyticum for Peyronie Disease. Combination of penile traction, intralesional verapamil, and oral therapies for Peyronie's disease. Changes in the Effects of Peyronie's Disease After Treatment With Collagenase Clostridium histolyticum: Male Patients and Their Female Partners Minimally Invasive Therapy Using Intralesional OnabotulinumtoxinA in Peyronie's Disease. Intralesional Injection of Hyaluronic Acid in Patients Affected With Peyronie's Disease: Preliminary Results From a Prospective, Multicenter, Pilot Study Evaluation of intralesional injection of verapamil in treatment of Peyronie's disease. Intralesional verapamil prevents the progression of Peyronie's disease. Intralesional verapamil injection for the treatment of Peyronie's disease.
INTRODUCTION Outcome data of penile traction therapy ( PTT ) for the acute phase ( AP ) of Peyronie 's disease ( PD ) have not been specifically studied . AIM The aim of this study was to assess the effectiveness of a penile extender device for the treatment of patients with AP of PD . METHODS A total of 55 patients underwent PTT for 6 months and were compared with 41 patients with AP of PD who did not receive active treatment ( " no intervention group " [ NIG ] ) . MAIN OUTCOMES MEASURES Pre- and posttreatment variables included degree of curvature , penile length and girth , pain by 0 - 10 cm visual analog scale ( VAS ) , erectile function ( EF ) domain of the International Index of Erectile Function question naire , Erection Hardness Scale , Sexual Encounter Profile 2 question , and penile sonographic evaluation  ( only patients in the intervention group ) . RESULTS The mean curvature decreased from 33 ° at baseline to 15 ° at 6 months and 13 ° at 9 months with a mean decrease 20 ° ( P < 0.05 ) in the PTT  group . VAS score for pain decreased from 5.5 to 2.5 after 6 months ( P < 0.05 ) . EF and erection hardness also improved significantly . The percentage of patients who were not able to achieve penetration decreased from 62 % to 20 % ( P < 0.03 ) . In the NIG , deformity increased significantly , stretched flaccid penile length decreased , VAS score for pain increased , and EF and erection hardness worsened . PTT was associated with the disappearance of sonographic plaques in 48 % of patients . Furthermore , the need for surgery was reduced in 40 % of patients who would otherwise have been c and i date s for surgery and simplified the complexity of the surgical procedure ( from grafting to plication ) in one out of every three patients . CONCLUSIONS PTT seems an effective treatment for the AP of PD in terms of pain reduction , penile curvature decrease , and improvement in sexual function CONTEXT Conservative therapies for Peyronie 's disease ( PD ) aim to treat early-stage disease by improving clinical outcomes such as penile curvature , penile length erectile dysfunction , and pain . OBJECTIVE To summarise the available evidence regarding injection and mechanical therapies for PD treatment . EVIDENCE ACQUISITION An extensive search of Medline , Embase , and Scopus data bases retrieved English- language articles up to 15 May 2018 . The systematic review protocol was registered on PROSPERO ( CRD42017077050 ) . Inclusion criteria were as follows : adults with early or chronic PD receiving treatment with injection therapy , penile traction , or a vacuum device .  EVIDENCE SYNTHESIS Fifty-two articles were selected according to the inclusion criteria -17 comparative studies and 35 cohort studies -analysing the effects of calcium channel blockers ( verapamil , nicardipine ) , collagenase Clostridium histolyticum ( CCH ) , interferon α-2b ( IFNα-2b ) , hyaluronic acid ( HA ) , onabotulinum toxin A , thiocolchicine , penile extender devices , and vacuum devices . Qualitative data from these studies suggest a clinical ly significant effect of CCH and IFNα-2b injection therapy to decrease penile curvature and conserve penile length . Verapamil and HA performed well in single-arm or case-control studies . Studies of penile traction and vacuum devices in patients with PD demonstrated some benefits in terms of curvature and penile length but only in small , underpowered , nonr and omised studies . Studies of onabotulinum toxin A injections or thiocolchicine showed significant improvements in penile curvature , but only in studies of single-arm or case-control design . CONCLUSIONS CCH and IFNα-2b injected into stable PD plaques can decrease penile curvature ; CCH can also improve penile length . However , based on available data , strong conclusions can not be drawn for other treatments , including calcium channel blockers , HA , or mechanical therapies . PATIENT SUMMARY Our systematic review of injection therapies provides evidence for improvements in penile curvature for patients with Peyronie 's disease . No robust evidence is available to support the use of other local treatments including calcium channel blockers , hyaluronic acid , or mechanical therapies BACKGROUND Collagenase Clostridium histolyticum ( CCH ) is indicated for the treatment of penile curvature in adult men with Peyronie 's disease ( PD ) with palpable plaque and curvature deformity of at least 30 ° at the start of therapy . AIM To evaluate the efficacy and safety of CCH plus vacuum-pump therapy with and without penile modeling for the management of PD . METHODS Adult men with PD and penile curvature of at least 30 ° were r and omly assigned to receive  CCH  0.58 mg plus vacuum therapy alone ( n = 15 ) or with penile plaque modeling ( n = 15 ) . Patients received no more than four treatment cycles ( cycle = ∼6-week duration ) , each consisting of two intralesional injections of CCH administered 24 to 72 hours apart . Vacuum therapy was applied twice daily from 14 days after the second injection of each cycle until the following cycle . Modeling was performed 24 to 72 hours after the second injection of each cycle . OUTCOMES The primary end point was change in penile curvature from baseline to week 36 ; additional end points included changes in Peyronie 's Disease Question naire ( PDQ ) domain scores , composite response ( ≥20 % decrease in penile curvature and decrease in PDQ bother score ≥ 1 point ) , and global response ( small but important , moderate , or much improvement in the Global Assessment of PD ) . RESULTS At week 36 , improvement in penile curvature from baseline was similar in the two groups ( mean change from baseline = -23.7 ° [ SD = 10.9 ] for CCH + vacuum + modeling and -23.3 ° [ SD = 7.2 ] for CCH + vacuum ; between-group difference = -0.3 ° , 95 % CI = -7.3 to 6.6 ) . Improvements in most PDQ domains , including bother , were observed from baseline to week 36 in the two groups . Most patients were composite ( 66.7 % and 84.6 % with CCH + vacuum + modeling and CCH + vacuum , respectively ) and global ( 86.7 % and 92.3 % , respectively ) responders . The most common adverse events were penile contusion , penile swelling , and penile pain . CLINICAL IMPLICATION S Vacuum-pump therapy administered alone or in combination with modeling after CCH treatment could improve PD symptoms . STRENGTHS AND LIMITATIONS This was a pilot study with a small sample and limited follow-up duration . CONCLUSION CCH and vacuum-pump therapy ( alone or combined with modeling ) could be an appropriate consideration for men with PD and warrants further investigation . Ralph DJ , Abdel Raheem A , Liu G. Treatment of Peyronie 's Disease With Collagenase Clostridium histolyticum and Vacuum Therapy : A R and omized , Open-Label Pilot Study . J Sex Med 2017;14:1430 - 1437 Intralesional therapy is a less invasive method for the treatment of Peyronie 's disease . The objective of this study was to evaluate intralesional injections of interferon alpha 2B ( IFN-alpha-2B ) as an effective alternative to the surgical treatment of Peyronie 's disease . Twenty-one patients with Peyronie 's disease were evaluated by use of penile duplex Doppler ultrasonography for cavernosal blood flows , degree of penile curvature , and plaque size . A question naire was given to all patients to assess sexual function . Each patient then received biweekly intralesional injections of 1 x 10(6 ) units of IFN-alpha-2B in 10 ml of normal saline over a period of 6 months . There was no placebo control group in this study . At the conclusion of the study , penile duplex Doppler imaging was repeated . A question naire was completed by all patients to assess changes in sexual function after treatment . Twenty patients completed the study , with all men reporting subjective softening of their plaques . Nine of 10 patients initially reporting penile pain with erection ( 90 % ) had resolution of their phallalgia while on study protocol . Thirteen patients ( 65 % ) had significant improvement in curvature , ranging from 20 to 90 % . Seventeen patients ( 85 % ) demonstrated an objective 10 to 80 % decrease in plaque size . Biweekly intralesional injections of Peyronie 's plaques with IFN-alpha-2B result ed in a significant improvement in penile curvature , diminished pain , and reduced plaque size , and result ed in a subjective improvement in sexual function BACKGROUND Intralesional therapies provide an alternative to surgical treatment of Peyronie 's disease ( PD ) . This study examines the efficacy of intraplaque injections of interferon-alpha-2B ( IFN-alpha-2B ) in the treatment of PD . METHODS Twenty-five patients were enrolled in the study with 21 completing the study . The average age of the study participants was 55.8 years , with 10 of the 21 having diabetes , hypertension , or both . Seven patients received placebo injections using 10 ml saline biweekly for 6 weeks before interferon therapy , and all 21 patients received biweekly injections of 2 x 10(6 ) U IFN-alpha-2B for 6 weeks before reevaluation . Patients were evaluated with  duplex Doppler ultrasonography  to assess penile curvature and blood flow . RESULTS The International Index of Erectile Function question naire was completed by 14 of 21 men to assess severity of erectile dysfunction ( ED ) before and after treatment . Improvements of 20 % or more in penile curvature occurred in 14 ( 67 % ) of 21 men . Penile pain decreased in eight ( 80 % ) of 10 , and plaque size decreased subjectively in 15 ( 71 % ) of 21 participants . The International Index of Erectile Function question naire showed significant improvement of ED in five ( 71 % ) of seven men with baseline moderate to severe ED . Peak systolic blood flow improved in three ( 43 % ) of seven men with baseline hemodynamic impairment , and veno-occlusive disease resolved in three ( 18 % ) of 17 individuals . IFN-alpha-2B injections led to significant improvements in penile pain and curvature caused by PD . CONCLUSION Results of intralesional IFN-alpha-2B injections in improving ED are encouraging . The study findings warrant further investigation of the effectiveness of IFN-alpha-2B injections for treatment of PD OBJECTIVE To assess the outcomes of a new protocol of intralesional injections of verapamil ( ILIV ) to treat Peyronie disease ( PD ) and to look for predictors of response . METHODS Patients followed up for PD in our center were prospect ively enrolled between 2007 and 2013 . The following data were collected : age , degree of curvature of the penis , Lue score  ( severity score of PD [ 0 - 15 ] ) , and pain  ( analogic Likert scale : 0 - 5 ) . The protocol consisted of 1 verapamil injection per session ( 15 mg in 6 mL ) in the main plaque using a single-puncture approach . Injections were repeated once every 3 weeks , at least 6 times . RESULTS Sixty men were included .  Mean number of injections per patient was 12.6 ( ±8.9 ) . Average Lue scores before and after ILIV were 9.4 ( ±2 ) and 4.5 ( ±2 ; P = .05 ) , respectively . Average penile curvatures during erection before and after ILIV were 37.3 ° ( ±13.3 ) and 21 ° ( ±13 ) , respectively ( P = .02 ) . There were no serious side effects . At the end of follow-up , 47 patients ( 78 % ) considered themselves globally improved . Younger age was the only predictor of response to ILIV in univariate ( odds ratio = 0.91 ; P = .04 ) and multivariate analyses ( odds ratio = 0.87 ; P = .03 ) . CONCLUSION ILIV had a favorable impact reducing PD in 78 % of patients with minimal side effects . Most patients required at least 12 injections to obtain optimal improvement . A protocol consisting of repeated courses of 6 injections using a single-puncture approach appears a valid option . Younger age was the only predictor of success INTRODUCTION Penile duplex Doppler ultrasound ( PDDU ) is currently the preferred method for the functional evaluation of penile hemodynamics . PDDU may be used to monitor objective ly changes in penile vascular parameters in men who undergo treatment for Peyronie 's disease ( PD ) , including intralesional interferon alpha-2b ( IFN alpha-2b ) . AIM To investigate the impact of intralesional IFN alpha-2b therapy for PD on penile hemodynamics by using PDDU and to assess the objective role of PDDU in monitoring treatment outcomes . MATERIAL S AND METHODS Thirty-nine patients ( 20 in the placebo and 19 in the IFN alpha-2b treatment arm ) were enrolled in this prospect i ve , placebo-controlled , parallel study . Patients received either 10 mL saline or 5 x 10(6 ) units of IFN alpha-2b intralesional injections every other week for a total of six injections . Patients in each group were evaluated at baseline and after completion of treatment regarding changes in penile hemodynamic parameters , penile curvature , plaque size and density , pain on erection , and erectile function . Specific published criteria were used for PDDU measurements . Outcomes were statistically compared between each group by using Mann-Whitney U and chi-square tests . RESULTS The mean age of the patients and the duration of PD were similar in both groups . The improvement in penile blood flow was significantly greater in IFN alpha-2b-treated patients than those in the placebo group . The number with the nonvascular classification increased significantly in the IFN alpha-2b arm from 31.5 % to 57.8 % . Additionally , improvements in penile curvature , plaque size and density , and pain on erection were better in the IFN alpha-2b group compared with the control . No significant improvement was observed in the erectile function domain in either group . CONCLUSION This study reveals that intralesional IFN alpha-2b injections have a significant benefit on penile hemodynamic parameters . Moreover , intralesional IFN alpha-2b is an effective , minimally invasive treatment for PD , and PDDU is a useful adjunct to monitor objective ly changes in penile vascular parameters . interferon alpha-2b injection therapy on penile hemodynamics in men with Peyronie 's disease INTRODUCTION Collagenase clostridium histolyticum ( CCH ; Xiaflex , Auxilium Pharmaceuticals , Inc. , Chesterbrook , PA , USA ) is a Food and Drug Administration-approved , intralesional treatment for Peyronie 's disease ( PD ) . AIM The aim of this study was to assess the safety and effectiveness of CCH in the treatment of PD . METHODS This phase 3 , open-label study enrolled subjects who were CCH-naïve , were enrolled in a previous pharmacokinetic study , or had received placebo in an earlier phase 2 CCH study . Each treatment cycle included two intralesional injections of CCH 0.58 mg , approximately 24 - 72 hours apart , and plaque modeling 24 - 72 hours after the second injection of each cycle . The treatment cycle was repeated after 6 weeks for ≤4 treatment cycles . MAIN OUTCOME MEASURES The co- primary end points were the mean percent change in penile curvature deformity and the mean improvement in PD bother score ( range 0 - 16 ) from baseline to week 36 . RESULTS Of the 347 subjects treated with ≥1 injection , 238 had both a penile curvature measurement and a Peyronie 's Disease Question naire response at baseline and ≥1 subsequent time point . Mean baseline penile curvature deformity was 53.0 ° and mean PD symptom bother was 7.3 . Statistically significant mean improvements from baseline to week 36 were observed in both penile curvature deformity ( 34.4 % [ 95 % confidence interval { CI } , 31.2 % , 37.6 % ] ) and PD symptom bother score ( 3.3 [ 95 % CI , 2.8 , 3.7 ] ) . Most adverse events ( AEs ) were mild or moderate in severity and local to the penis . There were three serious treatment-related AEs , two penile hematomas and one corporal rupture ; all resolved with treatment . CONCLUSIONS Potentially clinical ly meaningful and statistically significant improvements in penile curvature deformity and PD symptom bother scores were observed with intralesional injection of CCH compared with baseline in men with PD . CCH was generally well tolerated , with AEs primarily transient and local to injection site . In conjunction with previous studies , the results of this open-label study support the use of CCH in the treatment of PD The purpose of this study was to clarify the actual therapeutic potential of a new transdermal drug delivery system ( electromotive drug administration ; EMDA ) for selected patients with Peyronie 's disease . Forty patients with Peyronie 's disease were treated by electromotive administration of the 3-drug association orgotein-dexamethasone-lidocaine in a double-blind , placebo-controlled , partial crossover study ( study 1 ) . Another 25 patients were treated by EMDA with a combination of verapamil-dexamethasone in an uncontrolled study ( study 2 ) . Treatment sessions lasted 20 minutes each and took place 3 times a week for 3 weeks with a current of 3 mA. Patients were assessed before treatment and at 1- and 3-month follow-up examinations . Assessment s were based on sexual history , physical examination , and dynamic color Doppler ultrasonographic results . Adverse effects of EMDA were not reported . In study 1 , the clinical results observed after treatment proved to be significantly better than those of the placebo .  Penile pain disappeared in all patients in both studies . Penile lesion ( nodule or plaque ) either disappeared or significantly improved in 79 % and 90 % of patients treated by the 3- and 2-drug association , respectively . The improvement of penile deformity also was notable although it did not match the effect observed on penile nodules or plaque ( 62 % and 88 % , in studies 1 and 2 , respectively ) . In both studies , more than 80 % of patients reported a definite amelioration of penile rigidity , which paralleled the improvement of penile dynamic color Doppler ultrasonographic parameters . Overall , the combination of verapamil-dexamethasone achieved better clinical results than the 3-drug combination . Electromotive drug administration is a novel technique capable of safely achieving satisfactory results in selected patients with Peyronie 's disease not only in terms of improvement of patient 's symptoms but also due to the reduced need for penile surgery OBJECTIVE To evaluate the outcomes in men undergoing collagenase Clostridium histolyticum ( CCH ) with concurrent penile traction therapy ( PTT )  for the treatment of Peyronie disease ( PD ) . MATERIAL S AND METHODS We identified patients treated with CCH between March 2014 and July 2016 . Patients were recommended to perform modeling and PTT between injection series . A final curve assessment was performed after patients completed CCH . A prospect i ve data base was maintained , including patient-reported frequency and duration of PTT . Statistical analysis was performed to evaluate outcomes based on use and duration of PTT . RESULTS A total of 51 patients completed CCH and had complete objective data available for analysis . Mean ( st and ard deviation [ SD ] ) baseline curvature was 66.7 ( 25.0 ) degrees , and mean ( SD ) improvement post CCH was 20.9 ( 17.3 ) degrees ( P < .0001 ) . Thirty-five ( 69 % ) men reported daily  PTT  for a mean ( SD ) of 9.8 ( 6.3 ) hours per week . No significant difference was identified in the degree of curve improvement based on frequency or duration of PTT ( P = .40 ) . Similarly , no associations between PTT and functional outcomes including intercourse restoration and surgery prevention were identified . Stretched penile length increased nonsignificantly by a mean ( SD ) of + 0.4 ( 1.5 ) cm in the PTT group , compared with -0.35 ( 1.5 ) in the non-PTT group ( P = .21 ) . CONCLUSION The current series represents a " true-to-life " experience , wherein utilization patterns , attrition , and compliance issues are relevant factors impacting efficacy . PTT use with the And ropenis declined in both frequency and duration with subsequent injection series , and there was no significant difference in curve improvement or stretched penile length with a mean 10 hours of weekly concurrent PTT Introduction . There is no current consensus as to the most effective non-surgical therapy for Peyronie 's disease ( PD ) . Aim . To assess the benefit of penile traction therapy ( PTT ) when added to intralesional verapamil injections ( IVI ) combined with oral L-arginine 1 g bid and pentoxifylline 400 mg tid in men with PD . Methods . 74 men with PD completed 12 IVI . Patients electing to add PTT  were advised to wear the device for 2 - 8 hours daily , and no longer than 2 hours per session . Subjective responses were measured using patient question naires . Stretched penile length ( SPL ) and erect penile curvature ( EPC ) using penile duplex ultrasound ( DU ) were measured . Response to therapy was defined as at least a 10 degree reduction in EPC.Main Outcome Measures . Change in SPL ( cm ) , change in EPC ( degrees ) . Results . 39 patients in the PTT group ( I ) vs. 35 patients in group ( II ) completed the protocol . 54 % of men in group I responded to therapy vs. 46 % in group II ( p = 0.75 ) . Responders had a mean EPC improvement of 26.9 degrees in group I vs. 20.9 in group II ( p = 0.22 ) . Mean PTT use was 3.3 hours per day , and men with > 3 hours per day use gained 0.6 cm in SPL vs 0.07 cm using less than or equal to 3 hours per day ( p= 0.09 ) , while men in group I on lost 0.74 cm of SPL on average . Multivariate analysis revealed that duration of PTT use significantly predicts length gain ( 0.38 cm gain for every additional hour per day of PTT use , p = 0.007 ) . Conclusion . There was a trend toward measured curvature improvement , and a significant gain in SPL in men using the combination therapy protocol . Length improvement is related to duration of use of the traction device [ corrected ] Introduction Collagenase Clostridium histolyticum ( CCH ) intralesional injection was efficacious for the management of Peyronie 's disease ( PD ) in the double-blinded , r and omized , placebo-controlled Investigation for Maximal Peyronie 's Reduction Efficacy and Safety Studies I and II ( IMPRESS I and II ) . Little is known about the consequences of PD or treatment on the sexual partners of affected men . Aim To assess the safety and efficacy of CCH treatment in men who received placebo in the IMPRESS I or II study and to evaluate the men 's PD symptoms and partner bother as reported by female sexual partners . Methods In this phase 3 , open-label study ( NCT01685437 ) , men ( n = 189 ) received up to eight injections of CCH ( 0.58 mg/injection ) . Female sexual partners who provided informed consent at screening ( n = 30 ) participated in the study . Main Outcome Measures Co- primary end points were change or percentage of change in penile curvature deformity and change in PD symptom bother domain score of the Peyronie 's Disease Question naire ( PDQ ) from baseline to week 36 . Participating women completed the PDQ for  female  sexual partners ( PDQ-FSP ) and the Female Sexual Function Index ( FSFI ) . Results Statistically significant mean improvements were observed in penile curvature deformity ( 36.3 % decrease ; 95 % CI = −41.6 to −30.9 ) and PDQ symptom bother score ( 2.4-point decrease ; 95 % CI = −3.0 to −1.8 ) from baseline to week 36 . Most treatment-emergent adverse events were mild or moderate . After CCH treatment of their male partners , female sexual partners reported improvement ( using the PDQ-FSP ) in their male partner 's PD symptoms and female bother regarding their partner 's PD . The percentage of female sexual partners with sexual dysfunction ( FSFI total score ≤ 26.55 ) also decreased after male partner treatment , from 75.0 % at baseline to 33.3 % . Conclusions These results support the safety and efficacy of CCH in the management of appropriate patients with PD and the potential benefits for patients ' partners . Goldstein I , Knoll LD , Lipshultz LI , et al. Changes in the Effects of Peyronie 's Disease After Treatment With Collagenase Clostridium histolyticum : Male Partners and Their Female Partners . Sex Med 2017;5:e124–e130 PURPOSE To determine the effectiveness of intralesional administration of onabotulinumtoxinA in patients with Peyronie ’s disease ( PD ) . MATERIAL S AND METHODS A prospect i ve therapeutic cohort study was undertaken in patients aged ≥ 18 years with stable PD . Intervention included one-time intralesional application of 100 U of onabotulinumtoxinA. We included 22 patients who attended the urology clinic from October 1 , 2011 to June 30 , 2012 . Primary outcome measure was degree of curvature . Secondary outcome measures were thickness of the fibrous plaque , improvement in erectile function and pain . Erectile function was evaluated using the International Index of Erectile Function ( IIEF-5 ) question naire . The Visual Analog Scale ( VAS ) was used to measure pain during an erection . Statistical analyses were performed by Pearson ’s chi-squared test for categorical variables and student ’s t-test for quantitative variables . Any P value < .05 was considered statistically significant . RESULTS The size of the fibrous plaque was reduced from 0.34 ± 0.20 to 0.27 ± 0.13 cm after treatment ( P = .014 ) . The curvature initially averaged 32.95 ± 9.21 ° , and improved to 25 ± 9.38 ° ( P = .025 ) . According to the Kelami classification , the curvature was < 30 ° in 14 cases ( 63.6 % ) and was 30 ° -60 ° in eight cases ( 36.4 % ) . At 16 weeks , the curvature was < 30 ° in 19 cases ( 86.4 % ) and 30 ° -60 ° in three cases ( 13.6 % ) . The IIEF-5 score was 16.18 ± 4.46 before treatment and 18.22 ± 4.55 after treatment ( P = .002 ) . Pain was reduced from 3.36 ± 3.48 before treatment to 1.14 ± 1.58 after treatment ( P = .001 ) . CONCLUSION The administration of onabotulinumtoxinA may improve the clinical manifestations of PD result ing from fibrosis , thus improving sexual function in patients Introduction Hyaluronic acid has been shown to be efficacious in decreasing scar formation , inflammation , and oxidative stress . Aim To assess the efficacy of intralesional injection of hyaluronic acid in patients affected by Peyronie 's disease . Methods In this prospect i ve , single-arm , self-controlled , interventional , multicenter pilot study , 65 patients underwent a 10-week cycle of weekly intraplaque injections with hyaluronic acid ( 0.8 % highly purified sodium salt hyaluronic acid 16 mg/2 mL ; Sinovial , IBSA , Lodi , Italy ) . Patients were re-evaluated 2 months after the end of therapy . Main Outcome Measures Plaque size ( millimeters ) , penile curvature ( degrees ) , International Index of Erectile Function ( IIEF-5 ) score , visual analog scale ( VAS ) score for sexual satisfaction , and Patient 's Global Impressions of Improvement ( PGI-I ) score . Results Median age was 57 years ( range = 23–70 ) . At baseline , mean plaque size was 10 mm ( range = 3–30 mm ) , mean penile curvature was 30 ° ( range = 0 ° –50 ° ) , and mean IIEF-5 score was 20 ( range = 0–25 ) , with slight to moderate erectile dysfunction ( IIEF score < 21 ) in 36 of 65 patients ( 55 % ) . A median VAS score of 6 ( range = 2–10 ) was found . Mean follow-up was 12 months ( range = 6–24 months ) . Statistically significant post-treatment improvements were detected for plaque size ( before treatment = 10 mm [ 3–30 mm ] , after treatment = 8 mm [ 1–30 mm ] , P < .0001 ) , penile curvature ( before treatment = 30 ° [ 0 ° –50 ° ] , after treatment = 20 ° [ 0 ° –40 ° ] , P < .0001 ) , IIEF-5 score ( before treatment = 20 [ 11–25 ] , after treatment = 21 [ 15–25 ] , P < .0001 ) , and VAS score ( before treatment = 6 [ 2–10 ] , after treatment 8 [ 2–10 ] , P < .0001 ) . After treatment , the rate of patients with an IIEF score lower than 21 decreased from 55 % ( 36 patients ) to 40 % ( 25 patients ) . Overall improvement on the PGI-I question naire was 69 % . Conclusion Intralesional treatment with hyaluronic acid can improve plaque size , penile curvature , and overall sexual satisfaction and seems preferably indicated in the early ( active ) phase of the disease . Furthermore , it is easy to perform and well tolerated OBJECTIVE To evaluate the effect of intralesional injection of verapamil in Peyronie 's plaque with confirmed lesion . METHODS This r and omized clinical trial was carried out between March 2005 and March 2006 on 16 patients with Peyronie 's disease who were referred to the Urology Clinic of Shohadaye Ashayer Hospital in Khorram Abad , Iran . Performing a comprehensive physical exam , the genitalia of the patients were checked to confirm the diagnosis and reject other sexual disorders . Besides , parameters such as penis curving , lesion size were measured . Then , based on the 10-point visual analogue scale , sexual satisfaction of patients and their wives were recorded in a question naire . Patients got intralesional verapamil every 14 days and were treated for 6 months . After that , the parameters were assessed and data collected was analyzed using paired t-test . P-value < 0.05 was considered statistically significant . RESULTS On average , lesion size and penis curving decreased 30 % . Almost 20 % of patients and their wives were satisfied with the outcome of the treatment . No significant side effect was seen during the treatment . CONCLUSION Injection of calcium channel blockers are effective for treatment of the Peyronie 's disease ; however , more studies with more patients are OBJECTIVES To define the impact of intralesional verapamil injection therapy on  penile deformity in men with Peyronie 's disease . METHODS Patients underwent a total of 6 intralesional injections of verapamil .  Penile deformity was assessed at baseline and 3 months after the last intralesional injection of verapamil during penile erection after the administration of intracavernosal medication . Measurement was recorded using a goniometer at maximum penile rigidity . Endpoints included change in magnitude of curvature , stretched penile length , penetration ability , and resolution of pain . RESULTS Ninety-four consecutive patients met all inclusion criteria . Mean ( + /- st and ard deviation ) patient age and duration of Peyronie 's disease at time of baseline deformity assessment were 44 + /- 18 years and 5.2 + /- 2.7 months , respectively . At baseline 86 % had dorsal and 14 % lateral curvature . The mean curvature and stretched flaccid length were 50 degrees + /- 28 degrees and 12.6 + /- 3.1 cm , respectively . At the follow-up evaluation , patients were 5.2 + /- 1.8 months after their last ILV injection and were 11.7 + /- 4.2 months after the onset of Peyronie 's disease . Eighteen percent of patients had improvement of curvature , 60 % were unchanged , and 22 % worsened . Pain resolved in 100 % of patients . CONCLUSIONS In response to intralesional verapamil , a minority of men experienced improvement in penile deformity ; however , the majority of patients had stabilization of their deformity . This information may permit clinicians to give realistic expectations to patients considering intralesional verapamil therapy Peyronie 's disease remains a therapeutic dilemma for the practicing urologist . Multiple nonoperative therapies have been offered with variable suboptimal response rates . Calcium channel blockers have been shown to alter the metabolism of fibroblasts , result ing in decreased extracellular matrix secretion of collagen as well as increased collagenase activity . In this nonr and omized dose-escalating format study 14 men received biweekly injections of verapamil into the Peyronie 's plaques for 6 months . Subjectively , there was significant improvement in plaque-associated penile narrowing ( 100 % ) and curvature ( 42 % ) . Objective ly , a decreased plaque volume of greater than 50 % was noted in 30 % of the subjects . Plaque softening was noted in all patients , while 83 % noticed that plaque-related changes in erectile function had arrested or improved . There was no toxicity nor did symptoms recur when improvement was noted . This preliminary study suggests that intralesional calcium antagonist ( verapamil ) therapy offers an economical and sensible nonoperative approach to the treatment of Peyronie 's disease
This method ological choice confers to the results a strong clinical relevance as PC has been reported to be one of the major determinants of bother and psychological distress in PD patients [ 2 ] .
Initially , the results in terms of PC were disappointing , probably due to the inadequate dosage and regimen of the drug , or simply because of wrong
In this month 's issue of European Urology , Russo et al. [ 1 ] published the results of a systematic review of the literature about the efficacy of injection therapies , vacuum devices , and penile traction in patients with Peyronie 's disease ( PD ) .
Historically , oral and intralesional therapies have represented the initial conservative option with surgery being considered the definitive gold st and ard therapy in stable disease .
More recently , recommended treatment algorithms have significantly shifted due to the introduction of potential new first-line options .
In this scenario , oral treatments have become less commonly prescribed due to inconsistent or negative outcome data , and intralesional therapies have gained growing interest .