(377) Optimization of the Medical Protocol for the Treatment of Peyronie's Disease

Abstract

Introduction Peyronie's disease is a widespread and potentially disabling condition affecting patients’ quality of life. Practitioners and researchers should explore the different approaches proposed to optimize management and tailor it to the patient. Objective To evaluate the efficacy and reproducibility of a semi-invasive protocol for Peyronie's disease made of "optimized" platelet-rich plasma (PRP) injections + penile traction + Phosphodiesterase type 5 (PDE5) inhibitors. Methods The study selected 12 patients who presented with the typical symptomatology of Peyronie's disease for less than 18 months with a curvature of less than 60° and had not received any other medical therapy. The average age was 49 years. 8 patients had a single plaque while 4 had multiple locations. The protocol consisted of 6 sessions of PRP injection, associated with a stretching of the penis and a daily intake of 5mg of Tadalafil. The parameters collected before and after the protocol were: Angulation of the penis, pain Visual Analogue Scale (VAS) on intercourse, International Index of the erectile function-5items (IIEF5), plaque size on ultrasound as well as the Peyronie Disease's Questionnaire scale (PDQ). Protocol description: - PRP injections: 6 injection sessions at one-week intervals. Each session is performed as follows: 1) Autologous collection of 10ml of blood which will be centrifuged at a force of 1500g RCF for 10min, only the supernatant plasma will be taken, avoiding the buffy coat which will only maintain an inflammatory reaction and will considerably reduce the activity of the PRP. 2) Performing a penile block with pure lidocaine 7ml on each side, avoiding peri-platelet injections which will lead to a significant decrease in platelet functionality. 3) Mechanical fragmentation of the plaques with an 18G or 25G needle depending on the sensitivity of the subject, after manual or ultrasound identification, is an essential time of the protocol conditioning the result. 4) Plasma injection around and inside fibrous plaque of the albuginea - Penile traction therapy (PTT): Throughout the protocol, the patient will stretch his penis for one hour, three times a day minimum. - Daily intake of 5mg of Tadalafil. Results The patients were well informed and followed the same protocol during the 6 weeks. The evaluation was done 3 months after the first injection: - Improvement in mean angulation: from 34° to 16°. - Significant decrease in pain during intercourse: from 57% to 22%. - Improvement of the average IIEF5 score: from 14 to 18.75 - Decrease in average plaque size: from 15mm to 6.7mm (55% reduction) - Improvement of PDQ scale in 91% of subjects. No infectious complications were noted. Only one subject reported a minimal hematoma at the injection site during a single session. Conclusions This study requires confirmation in a longer series of cases, but the preliminary results of this safe, reproducible, and very inexpensive protocol are promising and should encourage practitioners to adopt it, especially in low and middle-income countries. Disclosure No