V12-05: What Treatment Options Are There For Peyronie's Disease?

Consuelo Conde Redondo*, Alejandro García Viña, María Núñez, Ana Ruano Mayo, Álvaro Zamora Horcajada, FERNANDO NATAL RODRIGUEZ, Luis Cuellar Martín, Valladolid, Spain

Introduction: Peyronie’s disease (PD) is a relatively common progressive fibrotic disorder that affects the tunica albuginea. Traditionally, men will present with a new penile curvature, which may be associated with pain in the acute phase. Prevalence is 0.4–20%, increasing in cases of diabetes mellitus. The treatment must be carried out when the plate is stabilized

Methods: In this video we present a review of the different therapeutic approaches to Peyronie's disease

Results: Non-surgical treatment
Non-surgical therapies include the penile extender, The reduction in curvature was enhanced when increasing the usage time. Greater than 6 hours ’use daily resulted in a 36.2 ° reduction compared to baseline (51.4%), whilst less than 4 hours produced a 19.7 ° improvement (28.8%).
Intraplaque therapy with clostridium histoliticum collagenase which is used to dissolve the plaques. The therapy is based on four cycles with two injections per cycle. Under local anesthesia we perform an erection and a controlled fracture of the plaque .Treatment with xiapex has a cost of eight times the treatment of simple plication, the use of 6 to 7 months of treatment of 8 vials and 14 consultations, the success rate is 34 to 40%.

Treatment of Peyronie's disease with bovine pericardium
Corporoplasty with a bovine pericardium graft with a total or partial incision of the plaque is a technique that shortens the surgical time by avoiding obtaining autologous tissue. The published success rate is 41-93% with a satisfaction rate close to 100% if a residual curvature rate of less than 10% is obtained.
Treatment of Peyronie's disease with tachosil patch
The advancement of the surgery leads us to look for alternatives that are easy to perform and that shorten surgical times, the total or partial incision of the peyronie plate plus tachosil graft leads us to obtain surgical results with a success rate of 83.8%. Tachosil is a sealing fibrin patch that is placed over the wound made, then covered with a compress moistened with warm saline for three minutes.
Treatment of Peyronie's disease with Vivostat
Activated autologous fibrin is also being used as a sealant. During anesthetic induction, 120 ml of blood from the patient is obtained to which citrate is added, subsequently it is put for 25 minutes in the processor unit and a solution of 5 to 6 ml of autologous fibrin is obtained ready for use. We make some transverse incisions in the plate without having to resect it, later with the help of the vivostat applicator we fill the incisions made with the autologous fibrin solution we have obtained. Regardless of the surgical technique used, all patients should undergo penile rehabilitation with the help of vacuum device or an extender, to avoid shrinkage and shortening.

Conclusions: There is no single approach to peyronie disease, it depends on the surgical skills of the surgeon and the involvement of the patient to achieve success

Source of Funding: anyone