Objective measurements of the penile angulation are significantly different than self-estimated magnitude among patients with penile curvature

ABSTRACT Introduction: The study was aimed to assess the presence of actual differences between the objective and the perceived magnitude of a curvature between patients affected by Peyronie's disease (PD) and congenital penile curvature (CPC). Materials and Methods: Wee analysed a cohort of 88 consecutive patients seeking medi- cal help for either CPC or PD. All patients were invited to provide a self-made drawing of their penis in erection in order to obtain self-provided description of the deformity. An objective measurement of the deformity was also performed drawing two intersecting lines through the center of the distal and proximal straight section of the penile shaft. Results: Our findings showed significant differences between patient self-estimation and the objective measurements of the penile angulation performed by trained experts, with only 32% of patients correctly assessing their own curvature. Overall, patients tended to overestimate (56%) their degree of curvature, but the results are different in patients with PD than those with CPC. In the 60 men (68%) who did not accurately assess their curvature, PD patients generally overestimated their curvature versus CPC patients (67% vs 16%). On the contrary CPC patients underestimated their curvature compared to PD (42% vs. 4%). Conclusion: In order to improve patients' satisfaction rates, the surgeon needs to take into consideration the patient's perception of the deformity when planning the type of surgical correction.

Peyronie's disease and low intensity shock wave therapy: Clinical outcomes and patient satisfaction rate in an open-label single arm prospective study in Australian men

PURPOSE: To evaluate the efficacy, safety and patient satisfaction outcomes following low intensity extracorporeal shock wave therapy (LiESWT) in men with Peyronie's disease (PD) using a standardised protocol. MATERIALS AND METHODS: In this open-label single arm prospective study, patients with PD were enrolled following informed consent. Patient demographics, change in penile curvature and plaque hardness, International Index of Erectile Function (IIEF)-5 score, and overall satisfaction score (on a 5-point scale) were recorded. Treatment template consists of 3000 shock waves to the Peyronie's plaque over 20 minutes, twice weekly for 6 weeks. RESULTS: The majority of patients have PD history longer than 6 months (mean, 12.8 months; range, 6-28 months). Two thirds of patients have received and failed oral medical therapy. There were improvements in penile curvature (more than 15 degrees in 33% of men), plaque hardness (60% of men) and penile pain (4 out of 6 men) following LiESWT. There was a moderate improvement in IIEF-5 score (>5 points reported in 20% of men). No complication was reported and the majority of patients were satisfied (rated 4 out of 5; 70% of men) and would recommend this therapy to others. CONCLUSIONS: In a carefully selected group of men with PD, LiESWT appears to be safe, has moderate efficacy and is associated with high patient satisfaction rate in the short term.

Application of Human Amniotic Membrane in Canine Penile Tunica Albuginea Defect: First Step toward an Innovating New Method for Treatment of Peyronie?s Disease

Purposes To evaluate the efficacy of human amniotic membrane (AM) grafting in the canine penile tunica albuginea defect; we developed an animal model as the first step toward an innovating new method for the treatment of Peyronie’s disease, penile cancers, and congenital deformities of the penis. Material and Methods From August to September 2011, ten healthy male dogs were selected. A rhomboid incision about 3x2cm over the tunica albuginea and its overlying squamous epithelium was made and then excised. The amniotic membrane was folded twice on itself and grafted on the defect. After 8 weeks, artificial erection was made for 5 dogs and for the other 5 dogs after 12 weeks. After artificial erection, partial penectomy was done and histopathological evaluation was performed on the grafts. Results Artificial erection performed successfully in all of the dogs. No infection or any other complication was seen. Histopathological examination showed complete re-epithelialization with squamous epithelium and collagen fiber deposition. Also, no dysplasia was seen. Conclusions The amniotic membrane can be used as a suitable substitution for tunica albuginea. It is safe, inexpensive, biodegradable, and available and may be used for the treatment of Peyronie’s disease, penile cancers, congenital penile deformities, and penile reconstructive surgery. .

Human penile ossification: case report

CONTEXT: Ossification in the human penis is such a rare condition that only 34 histologically evident cases have previously been reported. Among several conditions that have been correlated with this problem the most frequent is Peyronie disease. In all these conditions, human penile ossification appears to be a metaplastic bone formation process. CASE REPORT: A 59-year-old white man presented with a one-year history of slight pain upon erection and during intercourse. He also complained of hard plaque near the base of the penis. One year earlier, he had sustained blunt trauma during intercourse. Examination of the penis revealed a fixed firm mass extending over the proximal third of the penile shaft, measuring 3.0 x 3.0 x 2.0 cm and involving the corporal sponge, without surface extension. There was no impotence or other relevant clinical finding. Radiography on the penis revealed irregular calcification in the same position as the palpable mass and in the septum of the proximal inner third of the penis. The importance of this report lies in the extent of the human penile ossification, as demonstrated by the radiological and histological confirmation.

CONTEXTO: Ossificação do pênis humano é uma condição rara e apenas 34 casos histologicamente evidentes foram relatados. Várias condições foram relacionadas com o problema e o mais freqüente foi a Doença de Peyronie. Em todas, as ossificações parecem ser resultado de um processo de metaplasia com formação óssea. RELATO DO CASO: Um homem de 59 anos branco apresentou-se com história de leve dor no pênis durante as ereções há um ano. Ele também referia a presença de uma placa dura na base do pênis, que começou a crescer após um trauma na relação sexual. O exame do pênis revelou tratar-se de uma massa fixa, firme, no terço proximal do pênis de aproximadamente 3.0 x 3.0 x 2.0 cm, sem extensão para a superfície. Não havia impotência ou outra alteração clínica relevante. A radiografia do pênis identificou extensa área calcificada no corpo esponjoso e região do septo, em correspondência à massa palpada. A importância deste relato é a extensão da ossificação de acordo com a radiologia e confirmação histológica.

Doença de Peyronie: etiopatogenia e diagnóstico / Peyronie's disease: clinical and pathological findings and diagnosis

Os autores apresentam os achados clínicos e patológicos e indicam as possibilidades diagnósticas para a doença de Peyronie. Frente às condutas terapêuticas definidas, o diagnóstico seguro e a extensäo do processo passam a ser mais importantes.