Abstract
The objective of this study is to evaluate the safety and feasibility of the combined simultaneous percutaneous needle tunneling coupled with injection of platelet-rich plasma in the outpatient department for the treatment of Peyronie’s disease. This prospective, non-randomized, cohort and preliminary study included patients who underwent this procedure from November 2020 to July 2022. The main outcome was an improvement in penile curvature. Fifty-four patients were enrolled and underwent 6 sessions under local anesthesia followed by vacuum therapy for the treatment of Peyronie’s disease in our outpatient unit. The amendment of the curvature angle was significant with a median correction percentage of −44.40% interquartile range (−66.70 to (−39.70)), [p-value = 0.001, 95% CI (−29.76 to (−18.02)), paired Student’s t-test]. The median pre-treatment curvature angle was 45° (40–75), and the median post-treatment was 30° (20–40). The median score for pain during the procedure was 3 (0–4.25) according to a 10-point visual analogic scale. After two hours, 20.37% of patients still had pain but none required any pain medication. 50% of patients had a minor hematoma and 75.93% patients reported penile ecchymosis. A single patient reported an injection site skin infection. In our experience percutaneous needle tunneling with platelet-rich plasma injections for Peyronie’s disease in the outpatient setting is a safe, effective, and feasible treatment of penile deformity for PD.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 8 print issues and online access
$259.00 per year
only $32.38 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
Data availability
The data that supports the findings of this study are not openly available due to reasons of sensitivity and are available from the corresponding author upon reasonable request.
References
Hellstrom WJ, Bivalacqua TJ. Peyronie’s disease: etiology, medical, and surgical therapy. J Androl. 2000;21:347–54.
Mulhall JP, Schiff J, Guhring P. An analysis of the natural history of Peyronie’s disease. J Urol. 2006;175:2115–8.
Gonzalez‐Cadavid NF. Mechanisms of penile fibrosis. J Sex Med. 2009;6:353–62.
Gelbard MK, Dorey F, James K. The natural History of Peyronie’s disease. J Urol. 1990;144:1376–9.
La Pera G, Pescatori ES, Calabrese M, Boffini A, Colombo F, Andriani E, et al. Peyronie’s disease: prevalence and association with cigarette smoking. A multicenter population-based study in men aged 50–69 years. Eur Urol. 2001;40:525–30.
Mulhall JP, Creech SD, Boorjian SA, Ghaly S, Kim ED, Moty A, et al. Subjective and objective analysis of the prevalence of Peyronie’s disease in a population of men presenting for prostate cancer screening. J Urol. 2004;171:2350–3.
Lindsay MB, Schain DM, Grambsch P, Benson RC, Beard CM, Kurland LT. The Incidence of Peyronie’s Disease in Rochester, Minnesota, 1950 through 1984. J Urol. 1991;146:1007–9.
Culha MG, Erkan E, Cay T, Yücetaş U. The effect of platelet-rich plasma on Peyronie’s disease in rat model. Urol Int. 2019;102:218–23.
Levine LA, Larsen SM. Surgery for Peyronie’s disease. Asian J Androl. 2013;15:27. ncbi.nlm.nih.gov/pmc/articles/PMC3739133/.
Rod X, Akakpo W, Roupret M. Efficacité et tolérance des traitements locaux en injections pour le traitement de la maladie de La Peyronie : revue de la littérature. Progs Urol. 2021;31:1072–9.
Burri A, Porst H. The relationship between penile deformity, age, psychological bother, and erectile dysfunction in a sample of men with Peyronie’s Disease (PD). Int J Impot Res. 2018;30:171–8.
Terrier JE, Nelson CJ. Psychological aspects of Peyronie’s disease. Transl Androl Urol. 2016;5:290–5.
Rosen R, Catania J, Lue T, Althof S, Henne J, Hellstrom W, et al. Impact of Peyronie’s disease on sexual and psychosocial functioning: qualitative findings in patients and controls. J Sex Med. 2008;5:1977–84.
Alkandari MH, Touma N, Carrier S. Platelet-rich plasma injections for erectile dysfunction and peyronie’s disease: a systematic review of evidence. Sex Med Rev. 2022;10:341–52.
Chung E, Ralph D, Kagioglu A, Garaffa G, Shamsodini A, Bivalacqua T, et al. Evidence-based management guidelines on Peyronie’s disease. J Sex Med. 2016;13:905–23. https://pubmed.ncbi.nlm.nih.gov/27215686/.
Chong W, Tan RBW. Injectable therapy for Peyronie’s disease. Transl Androl Urol. 2016;5:310–7.
Levine LA, Costabile RA. Is intralesional verapamil effective therapy for Peyronie’s disease? J Urol. 2012 ;188:704–6.
Milam DF. Intralesional interferon-α2b improves penile curvature in Peyronie’s disease. J Urol. 2015;194:1533.
Zucchi A, Costantini E, Cai T, Cavallini G, Liguori G, Favilla V, et al. Intralesional injection of hyaluronic acid in patients affected with Peyronie’s disease: preliminary results from a prospective, multicenter, pilot study. Sex Med. 2016;4:e85–90.
Levine LA, Cuzin B, Mark S, Gelbard MK, Jones NA, Liu G, et al. Clinical safety and effectiveness of collagenase Clostridium histolyticum injection in patients with Peyronie’s disease: a phase 3 open‐label study. J Sex Med. 2015;12:248–58.
Mohit K. H-22411: BOTOX® for Peyronie’s disease. 2020. https://clinicaltrials.gov/ct2/show/NCT00812838.
Carson CC, Sadeghi-Nejad H, Tursi JP, Smith TM, Kaufman GJ, Gilbert K, et al. Analysis of the clinical safety of intralesional injection of collagenase Clostridium histolyticum (CCH) for adults with Peyronie’s disease (PD). BJU Int. 2015;116:815–22. https://pubmed.ncbi.nlm.nih.gov/25818264/.
Hellstrom WJG, Kendirci M, Matern R, Cockerham Y, Myers L, Sikka SC, et al. Single-blind, multicenter, placebo controlled, parallel study to assess the safety and efficacy of intralesional interferon alpha-2B for minimally invasive treatment for Peyronie’s disease. J Urol. 2006;176:394–8. https://pubmed.ncbi.nlm.nih.gov/16753449/.
Alizadeh M, Karimi F, Fallah MR. Evaluation of verapamil efficacy in Peyronie’s disease comparing with pentoxifylline. Glob J Health Sci. 2014;6:23–30. https://pubmed.ncbi.nlm.nih.gov/25363175/.
Hatzimouratidis K, Eardley I, Giuliano F, Hatzichristou D, Moncada I, Salonia A, et al. EAU guidelines on penile curvature. Eur Urol. 2012;62:543–52. https://pubmed.ncbi.nlm.nih.gov/22658761/.
Nehra A, Alterowitz R, Culkin DJ, Faraday MM, Hakim LS, Heidelbaugh JJ, et al. Peyronie’s Disease: AUA Guideline. J Urol. 2015;194:745–53. https://pubmed.ncbi.nlm.nih.gov/26066402/.
Bella AJ, Lee JC, Grober ED, Carrier S, Benard F, Brock GB. 2018 Canadian Urological Association guideline for Peyronie’s disease and congenital penile curvature. Can Urol Assoc J. 2018;12:E197–209. https://pubmed.ncbi.nlm.nih.gov/29792593/.
Larsen SM, Levine LA. Review of non-surgical treatment options for Peyronie’s disease. Int J Impot Res. 2012;24:1–10. https://www.nature.com/articles/ijir201145.
Virag R, Sussman H, Lambion S, de Fourmestraux V. Evaluation of the benefit of using a combination of autologous platelet rich-plasma and hyaluronic acid for the treatment of Peyronie’s disease. Sex Health Issues. 2017;1:1–8.
Werner S, Grose R. Regulation of wound healing by growth factors and cytokines. Physiol Rev. 2003;83:835–70.
Galliera E, Corsi MM, Banfi G. Platelet rich plasma therapy: inflammatory molecules involved in tissue healing. J Biol Regul Homeost Agents. 2012;26:35S–42S.
von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The strengthening the reporting of observational studies in epidemiology (STROBE) statement. Epidemiology. 2007;18:800–4.
DeLong JM, Russell RP, Mazzocca AD. Platelet-rich plasma: the PAW classification system. Arthrosc: J Arthrosc Relat Surg. 2012;28:998–1009.
Fernández-Pascual E, González-García FJ, Angulo J, Cerezo E, Quintana LM, Turo J, et al. Optimizing collagenase Clostridium histolyticum therapy for Peyronie’s disease using a novel approach with percutaneous needle tunnelling. BJU Int. 2019;124:1055–62.
Fernández-Pascual E, González-García FJ, García-Criado E, Souto AD, Marcos D, Angulo J, et al. V04-07 How to improve your xiapex results in Peyronie’s disease: the percutaneous needle tunnelling (PNT) technique. step-by-step surgical video. J Urol. 2019;201.
Ferretti L, Madec FX, Akakpo W, Methorst C, Carnicelli D, Terrier JE, et al. Recommandations pour l’évaluation et la prise en charge de la maladie de Lapeyronie : rapport du comité d’andrologie et de médecine sexuelle de l’AFU. Prog Urol. 2021;31:477–94.
Gelbard M, Goldstein I, Hellstrom WJG, McMahon CG, Smith T, Tursi J, et al. Clinical efficacy, safety and tolerability of collagenase Clostridium histolyticum for the treatment of peyronie disease in 2 large double-blind, randomized, placebo controlled phase 3 studies. J Urol. 2013;190:199–207.
Egui Rojo MA, Moncada Iribarren I, Carballido Rodriguez J, Martinez-Salamanca JI. Experience in the use of collagenase clostridium histolyticum in the management of Peyronie’s disease: current data and future prospects. Ther Adv Urol. 2014;6:192–7.
Abdel Raheem A, Capece M, Kalejaiye O, Abdel-Raheem T, Falcone M, Johnson M, et al. Safety and effectiveness of collagenase Clostridium histolyticum in the treatment of Peyronie’s disease using a new modified shortened protocol. BJU Int. 2017;120:717–23.
Fernández Pascual E, Carballo N, Cerezo E, Fraile A, Martínez Ballesteros C, Peinado F, et al. HP-09-003 Clinical outcomes of the use of Collagenase Clostridium Histolyticum (CCH) for peyronie’s disease (PD). J Sex Med. 2017;14:e160–1.
Ziegelmann M, Savage J, Toussi A, Alom M, Yang D, Kohler T, et al. Outcomes of a novel penile traction device in men with Peyronie’s disease: a randomized, single-blind, controlled trial. J Urol. 2019;202:599–610.
Moncada I, Krishnappa P, Romero J, Torremade J, Fraile A, Martinez-Salamanca JI, et al. Penile traction therapy with the new device ‘Penimaster PRO’ is effective and safe in the stable phase of Peyronie’s disease: a controlled multicentre study. BJU Int. 2019;123:694–702.
Martínez‐Salamanca JI, Egui A, Moncada I, Minaya J, Ballesteros CM, del Portillo L, et al. Acute phase Peyronie’s disease management with traction device: a nonrandomized prospective controlled trial with ultrasound correlation. J Sex Med. 2014;11:506–15.
Ibrahim A, Gazzard L, Alharbi M, Rompré-Brodeur A, Aube M, Carrier S. Evaluation of oral pentoxifylline, colchicine, and penile traction for the management of Peyronie’s Disease. Sex Med. 2019;7:459–63.
Raheem AA, Garaffa G, Raheem TA, Dixon M, Kayes A, Christopher N, et al. The role of vacuum pump therapy to mechanically straighten the penis in Peyronie’s disease. BJU Int. 2010;106:1178–80.
Ralph DJ, Abdel Raheem A, Liu G. Treatment of Peyronie’s disease with collagenase Clostridium histolyticum and vacuum therapy: a randomized, open-label pilot study. J Sex Med. 2017;14:1430–7.
Khouaja K, Delmas V, Boccon-Gibod L. [Leriche technique for the treatment of La Peyronie’s disease]. Prog Urol. 2004;14:586–9.
Matz EL, Pearlman AM, Terlecki RP. Safety and feasibility of platelet rich fibrin matrix injections for treatment of common urologic conditions. Investig Clin Urol. 2018;59:61.
Anitua E, Andia I, Ardanza B, Nurden P, Nurden A. Autologous platelets as a source of proteins for healing and tissue regeneration. Thromb Haemost. 2004;91:4–15.
Einhorn TA. The cell and molecular biology of fracture healing. Clin Orthop Relat Res. 1998;355S:S7–21.
Eppley BL, Woodell JE, Higgins J. Platelet Quantification and growth factor analysis from platelet-rich plasma: implications for wound healing. Plast Reconstr Surg. 2004;114:1502–8.
Pietrzak WS, Eppley BL. Platelet rich plasma: biology and new technology. J Craniofac Surg. 2005;16:1043–54.
Woodall J, Tucci M, Mishra A, Asfour A, Benghuzzi H. Cellular effects of platelet rich plasmainterleukin1 release from prp treated macrophages. Biomed Sci Instrum. 2008;44:489–94.
Andia I, Maffulli N. Platelet-rich plasma for managing pain and inflammation in osteoarthritis. Nat Rev Rheumatol. 2013;9:721–30.
Randelli P, Randelli F, Ragone V, Menon A, D’Ambrosi R, Cucchi D, et al. Regenerative medicine in rotator cuff injuries. Biomed Res Int. 2014;2014:1–9.
Xie X, Zhang C, Tuan RS. Biology of platelet-rich plasma and its clinical application in cartilage repair. Arthritis Res Ther. 2014;16:204.
Weiss RA. Autologous cell therapy. Facial Plast Surg Clin N Am. 2013;21:299–304.
Author information
Authors and Affiliations
Contributions
Research conception and design: AZ, MA, SL and SB. Data acquisition: AZ, MA, and SB. Statistical analysis: AZ, MA, SL and SB. Data analysis and interpretation: AZ, MA, SL and SB. Drafting of the manuscript: AZ, MA, SL and SB. Critical revision of the manuscript: MA and SB. Supervision: SB. Approval of the final manuscript: AZ, MA, SL and SB.
Corresponding author
Ethics declarations
Competing interests
The authors declare no competing interests.
Ethical approval
They study was conducted after obtaining approval from the Ethics Committee of Turin Hospital (Approval number: CT2022-74). The study adhered to the Helsinki protocols, and patients provided written, informed consent.
Additional information
Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary information
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Zugail, A.S., Alshuaibi, M., Lombion, S. et al. Safety and feasibility of percutaneous needle tunneling with platelet-rich plasma injections for Peyronie’s disease in the outpatient setting: a pilot study. Int J Impot Res 36, 140–145 (2024). https://doi.org/10.1038/s41443-023-00744-y
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/s41443-023-00744-y
This article is cited by
-
A phase 2 randomized, placebo-controlled crossover trial to evaluate safety and efficacy of platelet-rich plasma injections for Peyronie’s disease: clinical trial update
International Journal of Impotence Research (2024)
-
Commentary on: Safety and feasibility of percutaneous needle tunneling with platelet-rich plasma injections for Peyronie’s disease in the outpatient setting: a pilot study
International Journal of Impotence Research (2024)
-
Response to the Commentary on: Safety and feasibility of percutaneous needle tunneling with platelet-rich plasma injections for Peyronie’s disease in the outpatient setting: a pilot study
International Journal of Impotence Research (2024)
-
Unveiling treatment horizons and contemporary perspectives in Peyronie’s disease – take home messages from Laurance A. Levine special issue
International Journal of Impotence Research (2024)