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A review of inflammation and fibrosis: implications for the pathogenesis of Peyronie's disease.

ABSTRACT: Peyronie's disease (PD) is a superficial fibrosing disorder that causes penile deformity and can interfere with sexual intercourse and reproduction, as well as diminish quality of life. While the exact mechanism of PD is still being investigated, there is likely a genetic component to the predisposition to penile plaque formation. Ultimately, however, perturbations in normal wound healing and aberrant deposition of extracellular matrix components lead to fibrotic tissue deposition. Fibrosis in PD is regulated by a complex pathway of inflammatory and fibrotic mediators. Currently there are no treatments for PD that address an underlying cause or disease progression. In this review, we provide an overview of the known inflammatory and fibrotic mediators of PD and explore the pathophysiology of other human superficial fibrosing disorders to develop further insights into PD.

SUBMITTER: Patel DP

PROVIDER: S-EPMC7333524 | biostudies-literature | 2020 Feb

REPOSITORIES: biostudies-literature

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A review of inflammation and fibrosis: implications for the pathogenesis of Peyronie's disease.

Patel Darshan P DP Christensen Michael B MB Hotaling James M JM Pastuszak Alexander W AW

World journal of urology 20190612 2

Peyronie's disease (PD) is a superficial fibrosing disorder that causes penile deformity and can interfere with sexual intercourse and reproduction, as well as diminish quality of life. While the exact mechanism of PD is still being investigated, there is likely a genetic component to the predisposition to penile plaque formation. Ultimately, however, perturbations in normal wound healing and aberrant deposition of extracellular matrix components lead to fibrotic tissue deposition. Fibrosis in P ...[more]

PMID: 31190155

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Project description:INTRODUCTION:Plaque incision and grafting (PIG) is indicated for men with complex or severe penile curvature and, despite a multitude of incision types and grafting materials having been used, no individual technique has proven superiority. AIM:To assess outcomes following PIG and to understand the operative technique. METHODS:A systematic review was performed to find all relevant studies reporting on use of the PIG technique to correct curvature resulting from Peyronie's disease. Studies were included if they had >40 participants, were written in the English language, and no penile prosthesis was implanted. MAIN OUTCOME MEASURES:Primary outcome measures included deformity correction, erectile dysfunction, and degree of penile lengthening/shortening. Secondary outcome measures included satisfaction, reoperation rate, and complications. RESULTS:Twelve studies were included in the quantitative synthesis, which overall report on the results of 1,025 patients. Careful patient selection was critical, with erectile function requiring assessment with the International Index of Erectile Function (IIEF), subjective patient reports, and consideration of whether erections are pharmacologically aided. There was no evidence of superiority in favor of any particular incision type or grafting material, and absorbable sutures were clearly favored. Postoperatively, 4.6%-67.4% required pharmacologically aided erections and 0-11.8% were completely unable to achieve erections. Successful straightening occurred in 80.0%-96.4%, although there was no consistent definition of success. Penile length was unchanged in 44.2%-95.0%; 88.0%-92.0% of the patients were satisfied, and .7%-4.7% required reoperation. Altered sensation occurred in 2.0%-22.5% of patients, of which 80.0%-100.0% was only a transient loss. All outcomes were heterogeneously reported. There are no clear predictive factors for erectile dysfunction following PIG surgery. No single incision type or grafting material has proven superiority. CONCLUSION:PIG is an effective and safe technique for correction of complex or severe penile curvature in terms of satisfaction, length change, straightening, and complications. Rice PG, Somani BK, Rees RW. Twenty Years of Plaque Incision and Grafting for Peyronie's Disease: A Review of Literature. Sex Med 2019;7:115-128.

Project description:IntroductionProviders may use several treatment options for patients with Peyronie's disease; however, it is unclear whether practice patterns have evolved over recent years and if this has impacted cost.AimsTo investigate trends in the treatment of Peyronie's disease over time and the associated costs using a national, commercial insurance claims database.MethodsA retrospective cohort study was conducted using claims from the Truven MarketScan database from 2007 to 2018 for men with Peyronie's disease. Cost was estimated as either the sum of prescription oral or injectable treatment costs or as the single net cost associated with the operative procedure.Main outcome measuresFrequency of use of various treatments for Peyronie's disease and associated costs were assessed as trends over the timeline by year.ResultsThe estimated annual incidence of Peyronie's disease in this population rose from 61 to 77 per 100,000 patients over the included years, and the percent annual treatment rate rose from 17.8% to 26.2%. Colchicine was the most commonly prescribed oral agent in 2007 used in 22% of treated individuals; by 2018, pentoxifylline was the most common prescribed oral agent used in 33%. In 2007, 11% of treated patients received intralesional verapamil; however, by 2018, 24% received injectable collagenase, whereas <1% received intralesional verapamil. The mean annual, per-individual cost of Peyronie's disease treatment increased from $1,531 in 2007 to $10,339 in 2018. The cost increase was greatest for injectable therapies, which rose from $811 per individual in 2007 to $16,184 in 2018, a 19-fold increase.ConclusionsDiagnosis and treatment of Peyronie's disease is increasing over time. Pentoxifylline has become the most common oral prescription, whereas injectable collagenase has become most common injection. The mean cost associated with Peyronie's disease treatment increased more than 5 times from 2007 to 2018 corresponding with Federal Drug Administration's approval of injectable collagenase. Loftus CJ, Rajanahally S, Holt SK, et al. Treatment Trends and Cost Associated With Peyronie's Disease. Sex Med 2020;8:673-678.

Dataset Information

A review of inflammation and fibrosis: implications for the pathogenesis of Peyronie's disease.

Publications

A review of inflammation and fibrosis: implications for the pathogenesis of Peyronie's disease.

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