Peyronie’s disease (PD) is a benign, progressive fibrotic disorder characterized by scar or plaques within the tunica albuginea (TA) of the penis. This study provides new insights into the pathogenesis of PD based on data from different studies regarding the roles of cytokines, cell signaling pathways, biochemical mechanisms, genetic factors responsible for fibrogenesis. A growing body of literature has shown that PD is a chronically impaired, localized, wound healing process within the TA and the Smith space. It is caused by the influence of different pathological stimuli, most often the effects of mechanical stress during sexual intercourse in genetically sensitive individuals with unusual anatomical TA features, imbalanced matrix metalloproteinase/tissue inhibitor of metalloproteinase (MMP/TIMP), and suppressed antioxidant systems during chronic inflammation. Other intracellular signal cascades are activated during fibrosis along with low expression levels of their negative regulators and transforming growth factor-β1 signaling. The development of multikinase agents with minimal side effects that can block several signal cell pathways would significantly improve fibrosis in PD tissues by acting on common downstream mediators.

Background: The aim of this work was to evaluate the influence of UPOINT-guided (Urinary, Psychosocial, Organ-specific, Infection, Neurologic/systemic, Tenderness of skeletal muscles) multimodal therapy in patients with chronic prostatitis (CP)/chronic pelvic pain syndrome (CPPS) on the dynamic values of the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) score. Patients and methods: In our study we investigated 110 patients aged 26–68 years with CP/CPPS. We performed digital rectal examination (DRE), pre- and post-massage test (PPMT) urine culture, urine analysis, transrectal ultrasound investigation of prostate, antibiotic susceptibility testing. We divided the patients into the intervention group and the control group which was followed up without any therapy. For the intervention group we offered multimodal therapy based on each predominated positive phenotype. For the urinary phenotype, patients in intervention group received 10 mg alfuzosin. For organ-specific and tenderness domains, the patients of the intervention group received 63 mg Cernilton and 1 g Quercetin. For infection control, the patients of the intervention group received antimicrobial agents according to the results of the post-massage urine culture, antibiotic susceptibility testing and a high level of contamination >105 colony-forming units (CFU)/ml. Microbiological assessment of PPMT urine culture was conducted with aerobic and anaerobic methods of cultivation Results: The 110 patients had an average age of 43.9 ± 11.1 years and a median duration of symptoms of 6.21 ± 1.8 months. Of these, 11 patients did not complete the trial and therefore in quantitative terms, the distribution of patients was as follows: 54 in the intervention group and 45 in the control group. The average total NIH-CPSI score before treatment was 29.8 ± 6.1 in both groups. The mean NIH-CPSI of the pain, urinary, and quality of life (QOL) subscores before treatment was 15.1 ± 3.0, 7.4 ± 1.4 and 8.1 ± 2.1, respectively in both groups. After 6 weeks the PPMT urine culture of patients of the intervention group showed the absence or low-level contamination of microorganisms. After conducting the treatment, the mean total NIH-CPSI score in the intervention and control groups was 13.9 ± 2.8 ( p = 0.025) and 29.8 ± 5.8 ( p = 0.18), respectively. The average NIH-CPSI pain subscore in the intervention and control group after treatment was 6.7 ± 1.4 ( p = 0.018) and 15.1 ± 2.8 ( p = 0.21), respectively. The mean NIH-CPSI urinary subscore after treatment in the intervention and control group was 3.22 ± 1.07 ( p = 0.045) and 7.4 ± 1.2 ( p = 0.15), respectively. The average NIH-CPSI QOL subscore after treatment in the intervention and control group was 3.87 ± 1.28 ( p = 0.015) and 8.1 ± 1.9 ( p = 0.35). After multimodal therapy, the prevalence of different UPOINT-positive domains in the patients of both intervention groups did not exceed 14%. Conclusions: The UPOINT clinical phenotypes significantly changed after multimodal treatment, including antibiotics, phytotherapy and α-blockers in patients with CP/CPPS. This combination of treatment showed a decreasing total NIH-CPSI score and an elevation of QOL in patients.

This review article focuses on conservative treatment options, topical, intralesional therapy, traction and vacuum therapy. A PubMed database search was performed for studies that were published between 1948 and 2019. Search keywords included “Peyronie’s disease,” “conservative therapy,” “traction treatment,” “extracorporeal shock wave therapy,” “topical and oral therapies,” and “vaccum therapy.” Clinical trials in men with Peyronie’s disease and scientific articles relating to pharmacologic data were included in the review. When possible, large, randomized, and well-designed trials were selected. Non-English-language articles were excluded.

No abstract

No abstract

No abstract

No abstract

No abstract