Comparative analysis of tunical plication vs. intralesional injection therapy for ventral Peyronie s disease

Transcription

1 Comparative analysis of tunical plication vs. intralesional injection therapy for ventral Peyronie s disease Faysal A. Yafi, Kenneth DeLay, Georgios Hatzichristodoulou, Christopher J. Knoedler, Landon W. Trost, Suresh C. Sikka, Wayne J.G. Hellstrom Department of Urology Section of Andrology Tulane University Medical Center New Orleans, Louisiana

2 Ventral PD

3 Introduction 9% of all PD plaques are on the ventral penis. Infrequent prevalence = paucity In patients with ventral PD and poor erectile function not responding to PDE5i, IPP insertion is recommended. Best management of Ventral PD with preserved EF Kadioglu A, et al. J Urol. 2002; 168(3):

4 Intralesional injection therapy (ILI) Collagenase Clostridium Histolyticum(CCH) is the only FDA-approved ILI for the treatment of PD. IMPRESS trial excluded ventral PD due to urethra Not FDA approved for ventral PD We have recently published our results using interferonα2b for ventral PD with equivalent results to dorsally located plaques without any major complications. Gelbard M, et al. J Urol. 2013; 190(1): Stewart CA, et al. J Urol. 2015; 194(6):

5 Surgery Ventral I&G is associated with a higher rate of complications due to the close proximity of the urethra such as recurrence of curvature and urethrocutaneous fistulae. Tunical plication is the preferred surgical intervention in men with ventral PD and preserved erectile function. Hatzichristodoulou G, et al. J Sex Med. 2013; 10(5):

6 Aim We sought to compare the performance of ILI therapy of IFN-α2b versus penile plication for the management of men with ventral PD and preserved erectile function

7 Patient population Retrospective data collected for PD patients with ventral curvature who underwent ILI therapy between 1/2001 and 7/2015 or TP between 1/2010 and 7/2015 from two academic centers: Tulane University (ILI, group 1) and Technical University of Munich (TP, group 2). Patients with a greater than 90 degree curvature, erectile dysfunction (ED) refractory to PDE5- inhibitors therapy, and complex or multiplanar curvature were not recommended for ILI therapy or TP. 21 ILI (Tulane) 35 patients 14 tunical plication (Munich)

8 Penile duplex Doppler ultrasound All patients underwent baseline PDDU after ICI of a vasodilator agent before and after intervention. PSV, EDV, and RI were documented. Studies were performed by a single experienced operator in each institution using a standardized technique. Sikka SC, et al. J Sex Med. 2013; 10(1): Yafi FA, et al. Andrology. 2015; 3(5):

9 Intralesional injection therapy(ifnα2b) 12 biweekly injections of 2,000,000 U IFN suspended in 10mL normal saline using a multiple puncture technique. PDDU after ICI 2 to 4 weeks before and 6 to 8 weeks after the final ILI. Response defined as 20% improvement in baseline penile curvature. Trost LW, et al. J Urol. 2013; 190(6):

10 Tunical plication PDDU after ICI before and 6 to 8 weeks after TP. Similarly, response to TP was defined as 20% improvement in baseline penile curvature as previously described. Courtesy of Hatzichristodoulou G.

11 Table 1. Clinical characteristics Interferon, N=21 (60%) Plication, N=14 (40%) P value Mean age (months, SD) 55.5 (7.5) 52.7 (4.7) Relationship status Single 5 (24%) 2 (14%) Partnered 16 (76%) 12 (86%) Mean duration of PD (months, SD) 32.2 (43.8) 24.9 (10.3) Previous treatment for PD No Yes 11 (52%) 10 (48%) 3 (21%) 11 (79%) History of trauma Absent 11 (52%) 12 (86%) Present 10 (48%) 2 (14%) Mean pre-op SHIM score (SD) 17.9 (7.3) 21.3 (2.5) Previous treatment for ED No Yes Mean pre-procedure curvature (degrees, SD) 0-30 degrees degrees >60 degrees Hourglass deformity Absent Present PDDU vascular findings Non-vascular Vascular 11 (52%) 10 (48%) 44.5 (21.5) 3 (14) 14 (67) 4 (19) 10 (48%) 11 (52%) 9 (43%) 12 (57%) 10 (71%) 4 (29%) 50.7 (14.1) 0 (0) 12 (86) 2 (14) 10 (71%) 4 (29%) 7 (50&) 7 (50%)

12 Table 2. Procedural and post-procedural characteristics Interferon, N=21 (60%) Plication, N=14 (40%) P value Mean follow-up period in months (SD) 90.2 (54.0) 19.4 (11.7) < Mean post-procedure curvature (degrees, SD) 35.2 (27.0) 4.3 (6.1) Mean change in curvature (degrees, SD) 9.3 (17.7) 46.4 (16.0) < % change in curvature Yes 14 (67%) 14 (100%) No 7 (33%) 0 (0%) Mean post-procedure SHIM (SD) 17.9 (5.3) 20.4 (2.5) Mean change in SHIM (SD) Improved Maintained Worsened Mean stretched penile length(cm) Baseline Post-treatment Change Mean erect penile length(cm) Baseline Post-treatment Change Major procedural complications 0.3 (3.7) 5 (36%) 6 (43%) 3 (21%) 14.6 (2.2) 14.1 (2.4) -0.4 (1.7) 14.6 (2.1) 14.3 (2.3) -0.3 (1.5) -0.9 (1.3) 0 (0%) 9 (64%) 5 (36%) 14.4 (1.5) 13.4 (1.5) -0.9 (0.9) 15.8 (1.1) 14.7 (0.8) -1.1 (0.6) No 21 (100%) 14 (100%) Use of penile traction device No 21 (100%) 14 (100%) Penile hypoesthesia No 0 (0%) 1 (7%) Need for secondary procedures No 20 (95%) 14 (100%) Yes 1 (5%) 0 (0%)

13 Ventral Peyronie's disease (stable phase) ED nonresponsive to medical therapy No ED or ED responsive to medical therapy Penile prosthesis +/- ancillary straightening procedures Poor surgical candidate Considerable penile length loss Concerned about erectile function Good surgical candidate Minimal or no penile length loss Intralesional injection of interferon α2b Penile Plication

14 Conclusions Tunical plication confers a better overall improvement in penile curvature as compared to ILI therapy in patients with ventral Peyronie s plaques. Preserved or improved erect penile length and SHIM scores may be observed in certain patients undergoing ILI therapy.