The annual meeting of the Sexual Medicine Society of North America concluded on 10/27/2019. This is the largest and most respected sexual medicine society in North America and includes the greatest authorities on sexual medicine. There were several abstract that were presented at the meeting that relate to Peyronie’s Disease, and our objective with this post was to highlight and summarize key findings below. Because of the rapid method of getting this information out and summarized, details are limited and high level only. However, the key takehome points are included. It is important to recognize that these findings have not been published at this point, and therefore, the information may change somewhat with time. But it does give you a sneak peak as to the most up to date Peyronie’s information available.
- A small study was presented on the genetics of
- Men with PD were found to have erectile dysfunction in 79% of cases. Approximately 20-30% of men with PD were also found to have other conditions such as metabolic syndrome, cardiac disease, and similar findings. PD men were at increased risk of Ledderhose Disease
- Trost’s comment – these numbers are consistent with other published series and are consistent with the condition occurring in men in the 50-70’s.
Impact of PD on Partner
- A small study evaluated the impact of PD on partners. It demonstrated that men were bothered by the
appearance of the penis and curvature, while partners were bothered by the pain
associated with intercourse and difficulty with penetration. It also resulted in a decrease in frequency
of intercourse, which also bothered the partner.
- Trost comment – this study is also consistent with other published studies, where the men tend to be very bothered with the condition, while partners tend to be more bothered by the fact that it bothers their partner.
- One study evaluated whether there is benefit in performing 8 additional Xiaflex injections after the first 8 have been administered. They demonstrated that there was indeed ongoing improvements, although the amount was only a 4 degree additional gain.
- Trost comment – We had looked at this concept years ago, and we ultimately decided that it wasn’t recommended in most cases to continue beyond 8 injections after we reviewed our data at Mayo. There are individualized scenarios where it makes sense to do additional injections, but for the most part, once you have completed 8 injections, there are minimal benefits to doing additional injections.
- Our team evaluated a dataset that looked at trends of collagenase (Xiaflex) use since 2014 and compared it to other treatment trends in PD (such as plication, incision and grafting, penile prosthesis placement, interferon, and verapamil).
- Results showed that collagenase was preferred by patients / providers nearly 3:1 over surgery
- We also found that men who did surgery were 2x more likely to require another surgery within the next year compared to Xiaflex
- Xiaflex also had lower rates of complications, hospitalization, and pain medication use compared to surgery
- Our team also evaluated whether men should continue with Xiaflex if they had poor responses after the first two series (first 4 injections). Overall, our results showed that those who had poor responses initially were much more likely to get benefits during cycle 3 and 4, while those who had good responses during the first two cycles had minimal benefits during the subsequent injections.
- A study showed that men who were on anti-platelet or anticoagulation did just fine with Xiaflex, with no higher rates of bruising / hematoma.
- Trost comment – this is consistent with what we have seen as well
- An additional study showed that men who have other PD related deformities such as hourglass, indentation, multiplanar deformities, or ventral curvatures all do equally well with curvature improvement compared to men who do not have those conditions.
- Trost comment – this is consistent with what we have seen and published on as well
- The efficacy of collagenase is not impacted by adverse events such as bruising or hematomas during administration.
- Trost comment – this is consistent with what we have seen as well and similar to a publication that we have submitted where men who had suspected fractures actually did better from a curve improvement standpoint
- Our group presented data on men who had suspected penile fractures during Xiaflex treatments and showed that they did not experience erectile dysfunction at a higher rate than men who did not have suspected fractures. These data suggest that men who have suspected fractures are likely best managed by non-operative, conservative treatments rather than by going to surgery.
- There was a summary lecture on platelet rich plasma and stem cell therapy with the main conclusions suggesting that, to date, there have been no studies to support that either therapy is effective. Because of this, the treatments SHOULD NOT be done outside of a clinical trial. They also concluded that there is no clear role for these therapies with PD.