Peyronie's disease can best be described as a localized connective tissue disorder that primarily affects the tunica albuginea of the penis. The disease may be attributed to repetitive vascular trauma that initiates an inflammatory process and ultimately leads to the formation of a fibrous penile plaque. The plaque consists mainly of collagen and can significantly alter penile anatomy and function. Patients with Peyronie's disease will most often present with penile curvature, pain on erection, a palpable nodule most commonly located on the dorsal shaft of the penis, and erectile dysfunction. There is no definitive treatment for Peyronie's disease and the treating physician has many options. They may wait for spontaneous resolution of the plaque, choose medical therapy (which includes both oral and intralesional regimens), or opt for surgical management. The main purpose of this article is to discuss the advances in medical therapy for Peyronie's disease, in particular intralesional injection of interferon-alpha-2b (IFN-a-2b). Several studies have concluded that IFN-a-2b can be an effective modality of treatment and that many patients placed on a regimen of IFN-a-2b experienced a significant reduction in penile curvature, diminished pain with erection, and decreased size of the plaque. Further clinical studies are currently being undertaken to determine the precise quantity and frequency of administration of IFN-a-2b that is most effective with the least amount of side effects.
12 months throughout the follow-up (FU). Kaplan Meier analysis investigated the risk of EF decrease over time. Cox-regression model tested predictors of post-operative EF worsening.RESULTS: Of 242 patients, 66 reported normal IIEF-EF before surgery. Baseline median (IQR) age was 65(60-70) years and prostate volume (PV) was 75(58-100) mL. Median pre-operative IIEF-orgasmic function (OF) was 10(7-10). Median follow-up was 6(1-12) months. At Kaplan-Meier analysis, estimated rates of EF impairment depicted an increase over time, with 12%(95%CI: 6,25) and 19%(95%CI: 11,33) of patients with normal pre-operative EF reporting a post-operative worsening at 3 and 6 months, respectively. Median IIEF-EF score decrease was 4 (2-11). At cox regression analysis, baseline factors (i.e., age, BMI, Charlson Comorbidiy Index, PV, IPSS) and intraoperative factors (i.e., total energy used, capsule perforation) were not associated with EF decrease over time (all p>0.6). Conversely, patients experiencing a post-operative decrease of IIEF-OF were at higher risk of reporting IIEF-EF worsening (IIEF-OF: HR 0.81; 95%CI: 0.59, 0.94; p[0.009) (Figure 1).CONCLUSIONS: Sexually active patients with normal preoperative sexual function may experience a non-negligible EF worsening after HoLEP, which appears associated with post-operative OF decrease, thus suggesting that the impairment of antegrade ejaculation could play a major influence in post-HoLEP sexual function.
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