In many patients with Peyronie disease, medical therapy has proved curative.
The vast majority of patients will require prosthetic placement.
Most patients with Peyronie disease understand the effects of their disease and thus require little counseling.
The majority of patients with Peyronie disease will eventually require surgery.
Surgery, when required, can be viewed as palliation for the effects of the Peyronie disease process.
angiotensin-converting enzyme inhibitors.
Paget disease of the bone.
The vast majority of patients with signs of Peyronie disease will have spontaneous resolution of the effects of the disease.
The asymptomatic prevalence of Peyronie disease is established to be 0.4% to 1.0%.
The symptomatic incidence of Peyronie disease has risen and now is estimated to be approximately 16%.
Smith, using an autopsy study, found the asymptomatic incidence of Peyronie disease to be 22%.
The average age at onset of Peyronie disease is in the middle 50s.
Prolonged use of papaverine and phentolamine (Regitine) has been implicated as a cause of intracorporeal fibrosis.
The vacuum erection device (VED) is contraindicated for use in the Peyronie disease patient.
Constriction rings are directly proven to be associated with the development of Peyronie disease.
Phosphodiesterase-5 (PDE5) inhibitor medications and the approved intracavernosal injection agents are contraindicated for use in Peyronie patients.
PDE5 inhibitors may directly lead to the development of Peyronie disease.
longitudinal lamina of the tunica albuginea is thickest at the ventral midline.
linear longitudinal layer attenuates at the 12-o’clock position (dorsal midline).
midline septal fibers interweave with the thickened periurethral outer lamina.
septal fibers interweave with the circular fiber lamina of the tunica albuginea.
circular lamina of the tunica albuginea attenuates at the 6-o’clock position (ventral midline).
Transforming growth factor-β1 (TGF-β1) has been implicated as a cause of the abnormal disordered healing.
There is a downregulation of antifibrotic factors in Peyronie disease.
Accumulation of plaque has been associated with other disorders governed by increased cholesterol and lipid levels.
Recent investigations also implicate the downregulation of factors known to be antifibrotic.
The inciting event leading to Peyronie disease seems to be buckling trauma during erection.
those who have curvature have painful erections.
many patients requiring surgery to resolve their painful erections.
frequent total resolution of the Peyronie disease process.
the majority of patients presenting with sudden onset of stable deformity.
all patients eventually developing a stable deformity.
Often, with corrective surgery, disorders of erectile function seen preoperatively resolve with the surgical process.
In many of the older published series, the stratification of erectile problems, functional versus organic, is not clear. Currently with better validated instruments, stratification is included in most series.
The highly emotional aspects of Peyronie disease are expressed in many men via disordered erectile function.
Many men tend to abandon their sexual activities in response to the emotional trauma of Peyronie disease.
Surgery to address cavernous veno-occlusive dysfunction is often effective in men with Peyronie disease.
Foreshortening of the penis is a frequent complaint of patients with Peyronie disease.
Migratory penile deformity is usually due to the development of additional plaque.
Pain with intercourse rarely disappears without surgical therapy.
Distal flaccidity occurs because of vascular blockage due to involvement of the spongy erectile tissue of the corpora cavernosa by the plaque.
Indentation of the corpora cavernosa is usually of cosmetic concern only.
aminobenzoate potassium (Potaba) has not been proven definitively to be efficacious.
nonsteroidal anti-inflammatory agents have been proven to be efficacious.
colchicine is thought to be efficacious by virtue of effects on purine metabolism.
vitamin E has been proven to be highly efficacious.
tamoxifen, by virtue of its action on tubulin, has proved to be highly efficacious.
Verapamil injection protocols are logistically laborious, but the injections are well tolerated.
Interferon injections are proposed to work by mechanisms similar to those of verapamil but are associated with postinjection systemic symptoms.
Intralesional corticosteroids are not recommended.
Both verapamil and interferon are believed to have action based on their property of blocking cell division and thus purging the system of TGF-β.
Collagenase is believed to work by dissolving collagen, thus allowing for plaque expansion and reinitiation of remodeling.
Persistent pain with erection
Severe foreshortening of the penis
Indentation of the penis not related to issues of penetration
Erectile dysfunction or curvature that precludes intercourse
All of the above
Incision and grafting techniques, in emerging well- stratified studies, have been shown to effectively straighten the penis and preserve erectile function in Peyronie disease patients.
Corporoplasty techniques are technically straightforward and thus are the best for the surgeon who does not operate frequently on Peyronie disease patients.
Incision and grafting techniques using synthetic “graft” material (e.g., Gore-Tex, Silastic) have been proven, in large series, to be highly effective.
Algorithms are the best mechanisms to determine surgical candidacy.
Corporoplasty techniques, in most series, have better results for preservation of erectile function and thus are clearly superior for all Peyronie disease patients who are surgical candidates.
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