阴茎Peyronie病动物模型研究进展

Peyronie病以阴茎白膜局部纤维斑块形成为特征,在临床中相对少见。国内外与之相关的基础研究甚少,除疾病本身相对少见外,可能与疾病动物模型的不确定性有一定关系。目前较常用的Peyronie病动物模型各存利弊,其中转化生长因子β1(TGF-β1)与Fibrin白膜下注射缺乏阴茎弯曲、钙/骨化等特征;手术创伤可能建立Peyronie病急性期模型;自发模型则可能带来全身多组织器官纤维化与人Peyronie病表现不一等不足。模型的选择对基础研究至关重要,因此,本文通过回顾Peyronie病相关的动物研究模型,为该病基础研究提供参考。

白膜削除—折叠缝扎术治疗Peyronie’s病和先天性阴茎弯曲畸形

目的 探讨治疗Peyronie’s病和先天性阴茎弯曲新的手术方法。方法 手术取包皮环切口 ,分离暴露白膜 ,生理盐水灌注海绵体诱发勃起 ,明确弯曲部位、程度和方向 ,确定白膜削除的部位和范围 ,于弯曲的凸面分离背血管神经束或尿道海绵体 ,牵开并保护 ,用小园刀卵圆形削除双侧白膜浅层 ,丝线内翻折叠缝合创损的白膜 2～ 3针 ,其中 3例背深静脉漏者同时行背深静脉结扎术。结果 弯曲矫正率 10 0 %,术后无血肿、感染发生 ,勃起功能无影响 ,随访 1/ 2～ 4年 ,无弯曲复发 ,13例有满意性交 ,3例背深静脉结扎者 1例有自发性勃起 ,2例需依赖万艾可 (Viagra)性交。结论 白膜削除 折叠缝扎术可完全矫正阴茎弯曲畸形 ,且不损伤海绵体血窦 ,无出血和勃起功能影响 ,白膜粘连愈合牢固 ,无缝线断裂复发的可能。因而 ,白膜削除 折叠缝扎术是矫正阴茎弯曲畸形的简便、安全、有效的方法。

Peyronie’s病的外科治疗进展

Peyronie’s病常并发阴茎弯曲和勃起疼痛,内科治疗不理想,须外科治疗,主要治疗方式有三类:包括阴茎白膜缩短术、斑块切开或切除补片修复术和阴茎假体植入术,因阴茎组织结构的特殊性,治疗效果均不理想,脱细胞细胞外基质和阴茎假体植入技术兴起与发展可望为Peyronie’s病患者阴茎修复重建提供较为有前景的治疗模式。

牵引疗法在Peyronie病治疗中的应用现状及展望

阴茎硬结症又称Peyronie病，是一种以阴茎海绵体白膜纤维性结节、斑块形成为特征的良性慢性病变，发病年龄多见于45—60岁。Peyronie病的确切病因尚不清楚，其病理生理表现为纤维蛋白和胶原蛋白的局部沉积。临床表现为阴茎硬结、痛性勃起和（或）勃起时阴茎弯曲畸形，常伴有心理障碍和（或）勃起功能障碍（ED）。Peyronie病的治疗策略可分为保守治疗、手术治疗以及综合治疗。不同的治疗策略适应症各异，各有其优缺点，但现有Peyronie病治疗方法的总体疗效不佳，目前也无单一的标准治疗方法可供选择。近几年，国外有关将牵引疗法用于治疗Peyronie病的报道逐渐增多。在治疗Peyronie病时，牵引疗法可以单独或者与其他治疗方法联合使用，并且可以在手术治疗前后应用。现有的研究结果显示：牵引疗法在阻止Peyronie病的瘢痕进展，恢复阴茎长度及周径，减少阴茎弯曲，改善性功能等方面显示出优势。但是，由于现有的报道多缺乏统计学设计，因此，需要大样本、多中心、随机对照研究进一步证实牵引疗法的有效性。另外，应该加大对Peyronie病发病机制的研究力度，争取从根本上防治Peyronie病。

Peyronie病的诊治——附11例报告

目的:探讨提高Peyronie病的诊断和治疗水平。方法:对11例Peyronie病进行了临床分析。阴茎勃起弯曲8例,阴茎结节并触痛2例,尿痛、排尿不畅1例,有外伤史2例。11例均以局部注射曲安缩松并服用维生素E胶囊治疗。结果:自觉疼痛及局部压触痛消失者10例,其中斑块触摸不清者8例,有软条索2例,阴茎弯曲有好转1例。结论:Peyronie病的诊断对症状不典型者需仔细诊查。治疗以非手术疗法为主,局部结节内注射曲安缩松及同时口服维生素E胶囊是一种较为有效的治疗方法。

阴茎Peyronie病治疗进展

正常阴茎体检触诊质地柔软，恰似海绵状，具有弹性，解剖学称之为阴茎海绵体（ｃｏｒｐｕｓｃａｖｅｒ－ｎｏｓｏｕｍ）。倘若海绵体纤维变性，引起斑块和瘢痕化，可出现勃起不良，或出现阴茎弯曲畸形，影响性生活。纤维瘢痕主要发生于阴茎海绵体白膜（ｔｕｎｉｃａａｌｂ...

应用包皮内板修补阴茎白膜缺损治疗Peyronie病(附9例报告)

目的探讨阴茎硬结切除后应用包皮内板修补阴茎白膜缺损的可行性。方法观察9例Peyronie病患者采用手术切除硬结后应用包皮内板修补阴茎白膜缺损的效果。结果随访6～12个月,9例病人手术后恢复良好,局部硬结消失,无痛性勃起。8例勃起时阴茎可完全伸直;1例仅有<15°弯曲,性生活正常。结论利用包皮内板修补阴茎硬结切除后的阴茎白膜缺损是可行的。包皮内板材料丰富,取材方便,其主要组织结构与阴茎白膜近似,均为致密胶原纤维及弹力纤维,组织相容性好,不会发生渗漏,且有一定的韧性及弹力,可适应于阴茎勃起时的张力。

Peyronie病发病机制研究进展

Peyronie病(Peyronie′s disease,PD)又称阴茎海绵体硬结症,是一种局部结缔组织病,本病特点是在阴茎海绵体白膜内和勃起组织中形成纤维斑块。这些斑块含有较多的胶原和增生的弹性纤维组织,导致阴茎不同程度的弯曲和缩窄,造成阴茎疼痛及勃起功能障碍(erectile dysfunction,ED)。目前发病机制尚不明确,且关于该病的治疗仍存在一些争议。PD的发病机制已经在动物模型、细胞培养和临床试验中被探索,但这些又引起了更多的问题。本文就近年来PD病发病机制的研究进展做一综述。

Surgery for Peyronie＇s disease

Peymnie＇s disease （PD） is most simply referred to as a fibrotic wound-healing disorder of the tunica albuginea. It is both a physically and psychologically devastating disorder that causes penile deformity, curvature, hinging, narrowing and shortening, which may compromise sexual function. Although a variety of non-surgical treatments have been suggested, none to date offer a reliable and effective correction of the penile deformity. As a result, surgery remains the gold standard treatment option, offering the most rapid and reliable treatment which will be the focus of this article. We review the preoperative evaluation, surgical algorithm, graft materials and postoperative management of PD. Outcomes for tunical shortening, tunical lengthening and penile prosthesis placement for penile straightening are reviewed. Tunica albuginea plication is the preferred method of straightening for men with adequate rigidity and less severe disease defined as curvature less than 70° without narrowing/hinging. Men who have more severe, complex deformity, but maintain strong preoperative erectile function should be considered candidates for straightening with plaque incision or partial excision and grafting. Finally, for those men who have inadequate rigidity and PD, penile prosthesis placement with straightening is the best approach to address both problems.

Extracorporeal shockwave therapy for Peyronie＇s disease： an alternative treatment？

Aim： To determine retrospectively the safety and efficacy of extracorporeal shock wave therapy （ESWT） in patients with Peyronie＇s disease. Methods： Fifty-three patients with stable Peyronie＇s disease underwent ESWT （group 1）. Fifteen patients matched with the baseline characteristic of the patients in group 1, who received no treatment, were used as the control （group 2）. The patients＇ erectile function （International Index of Erectile Function [IIEF-5] score）, pain severity （visual analog scale）, plaque size and degree of penile angulation were assessed before and after the treatment in group 1 and during the follow-up in group 2. Results： The mean follow-up time was 32 months （range： 6-64 months） in group 1 and 35 months （range： 9-48 months） in group 2. All the patients were available for the follow-up. Considering erectile function and plaque size, no significant changes （P 〉 0.05） were observed in group 1 before or after the ESWT. A total of 39 patients （74%） reported a significant effect in pain relief in group 1 after ESWT. However, regarding improvement in pain, IIEF-5 score and plaque size, no significant differences were observed between the two groups. In 21 patients （40%） of group 1, the deviation angle was decreased more than 10° with a mean reduction in all patients of 11° （range： 6-20°）. No serious complications were noted considering ESWT procedure. Conclusion： ESWT is a minimally invasive and safe alternative procedure for the treatment of Peyronie＇s disease. However, the effect of ESWT on penile pain, sexual function and plaque size remains questionable.

Peyronie's disease:a silent consequence of diabetes mellitus

Aim： To investigate the clinical characteristics of patients with Peyronie＇s disease （PD） and diabetes mellitus （DM）. Methods： During an 8-year period, a total of 307 men seen at our outpatient clinic were diagnosed with PD. Clinical characteristics, penile deformities and the erectile status of patients with PD and DM together （n = 102） were retrospectively analyzed and compared to patients with PD alone with no risk factors for systemic vascular diseases （n = 97）. Results：The prevalence of PD among men with DM and sexual dysfunction was 10.7 %. The mean age of diabetic patients with PD was （55.9 ± 8.9） years; in the no risk factor group it was （48.5 ± 9.0） years （P 〈 0.05）. The median duration of DM was 5 years. The majority of diabetic patients with PD （56.0 %） presented in the chronic phase （P 〈 0.05）, and they were more likely to have a severe penile deformity （〉 60°） than the no risk factor group （P 〈 0.05）. In the diabetic group, the most common presenting symptom was penile curvature （81.4%）, followed by a palpable nodule on the shaft of the penis （22.5%） and penile pain with erection （14.7%）. A total of 19.6% of patients were not aware of their penile deformities in the diabetic group. Erectile function, provided by history and in response to intracavernosal injection and a stimulation test, was significantly diminished in patients with PD and DM （P 〈 0.05）. Conclusion： DM probably exaggerates the fibrotic process in PD. Diabetic patients with PD have a higher risk of severe deformity and erectile dysfunction （ED）. PD seems to be a silent consequence of DM and should be actively sought in diabetic men. （Asian JAndrol 2006 Jan; 8： 75-79）

Non-surgical therapy of Peyronie＇s disease

The present paper provides a review of the available non-surgical treatments for Peyronie＇s disease （PD）. A review of published literature on oral, intralesional, external energy and iontophoresis therapies for PD was performed, and the published results of available treatment options reviewed. The authors＇ recommendations for appropriate non-surgical management of PD are provided. Although there are many published reports that show the efficacy of non-surgical therapies for PD, there is a lack of large scale, multicenter controlled clinical trials, which makes treatment recommendations difficult. Careful review of the literature does suggest that there are treatment options that make scientific sense and appear to stabilize the disease process, reduce deformity, and improve function. Offering no treatment at all will encourage our patients to pursue alternative treatments, which might do harm, and misses the opportunity to do some good. Clearly further work is necessary to develop safe and effective non-surgical treatments for PD.

Surgical treatment of Peyronie＇s disease： choosing the best approach to improve patient satisfaction

Aim： To discuss important points on medical history, preoperative evaluation, real expectations, and selection of the appropriate surgical procedure to improve patient satisfaction after surgical procedures for Peyronie＇s disease. Methods： Recent advances in approaches to Peyronie＇s disease are discussed based on the literature and personal experiences. Issues concerning surgical indication, patient selection, surgical techniques, and grafting are discussed. Lengthening procedures on the convex side of the penile curvature by means of grafting offer the best possible gain from a reconstruction standpoint. Penile rectification and rigidity are required to achieve a completely functional penis. Most patients experience associated erectile dysfunction （ED）, and penile straightening alone may not be enough to restore complete function. Twenty-five patients were submitted to total penile reconstruction on length and girth with concomitant penile prosthesis implant. The maximum length restoration was possible and limited by the length of the dissected neurovascular bundle. The mean age was 55.4 years （32-69 years） and the mean angle of curvature 74.2± 22.4° （0-100°）. Pericardial grafting was used to cover the defect. The mean follow-up time was 11.2 ± 5.9 months （3-22 months）. Results： Mean functional penile length gain was 3.40 ＋ 0.73 cm （2-5 cm）. Penile prosthesis maintained the penis straight. No infections occurred. Sexual intercourse was restored in all patients and all reported recovered self-esteem. Conclusion： Improving patient satisfaction with the surgical treatment includes proper preoperative evaluation on stable disease, penile shortening, vascular and erectile status, patient decision and selection as well as extensive discussion on surgical technique for restoring functional penis （length and rigidity）. Length and girth restoration is very important for self-esteem and patient satisfaction.

Tunica albuginea allograft： a new model of LaPeyronie＇s disease with penile curvature and subtunical ossification

The pathophysiology of LaPeyronie＇s disease （PD） is considered to be multifactorial, involving genetic predisposition, trauma, inflammation and altered wound healing. However, these factors have not yet been validated using animal models. In this study, we have presented a new model obtained by tunica albuginea allograft. A total of 40, 16-week-old male rats were used. Of these, 8 rats served as controls and underwent a 10 × 2-mm-wide tunical excisionwith subsequent autografting, whereas the remaining 32 underwent the same excision with grafting of the defect with another rat＇s tunica. Morphological and functional testing was performed at 1, 3, 7 and 12 weeks after grafting. Intracavernous pressure, the degree of penile curvature and elastic fiber length were evaluated for comparison between the allograft and control groups. The tissues were obtained for histological examination. The penile curvature was significantly greater in the allografted rats as compared with the control rats. The erectile function was maintained in all rats, except in those assessed at 12 weeks. The elastin fiber length was decreased in the allografted tunica as compared to control. SMAD2 expression was detected in the inner part of the allograff, and both collagen-Ⅱ- and osteocalcin-positive cells were also noted. Tunica albuginea （TA） allograft in rats is an excellent model of PD. The persistence of curvature beyond 12 weeks and the presence of ossification in the inner layer of the TA were similar to those observed in men with PD. Validation studies using this animal model would aid understanding of the PD pathophysiology for effective therapeutic interventions.

Inhibition of histone deacetylase 2 mitigates profibrotic TGF-β1 responses in fibroblasts derived from Peyronie＇s plaque

Epigenetic modifications, such as histone acetylation/deacetylation, have been shown to play a role in the pathogenesis of fibrotic disease. Peyronie＇s disease （PD） is a localized fibrotic process of the tunica albuginea, which leads to penile deformity. This study was undertaken to determine the anti-fibrotic effect of small interfering RNA （siRNA）-mediated silencing of histone deacetylase 2 （HDAC2） in primary fibroblasts derived from human PD plaque. PD fibroblasts were pre-treated with HDAC2 siRNA and then stimulated with transforming growth factor-p1 （TGF-β1）. Protein was extracted from treated fibroblasts for Western blotting and the membranes were probed with antibody to phospho-Smad2/Smad2, phospho-Smad3/Smad3, smooth muscle α-actin and extracellular matrix proteins, including plasminogen activator inhibitor-β 1, fibronectin, collagen I and collagen IV. We also performed immunocytochemistry to detect the expression of extracellular matrix proteins and to examine the effect of HDAC2 siRNA on the TGF-β1-induced nuclear translocation of Smad2/3 in fibroblasts. Knockdown of HDAC2 in PD fibroblasts abrogated TGF-β1-induced extracellular matrix production by blocking TGF-β1-induced phosphorylation and nuclear translocation of Smad2 and Smad3, and by inhibiting TGF-β1-induced transdifferentiation of fibroblasts into myofibroblasts. Decoding the individual function of the HDAC isoforms by use of siRNA technology, preferably siRNA for HDAC2, may lead to the development of specific and safe epigenetic therapies for PD.

Penile prosthesis implantation and tunica albuginea incision without grafting in the treatment of Peyronie＇s disease with erectile dysfunction

We evaluated penile prosthesis implantation with tunica albuginea-relaxing incisions without grafting in the treatment of Peyronie＇s disease associated with erectile dysfunction. Between April 2005 and June 2011, 62 patients underwent surgery due to severe Peyronie＇s disease associated with erectile dysfunction. Malleable and inflatable penile prostheses were inserted in 49 and 13 cases, respectively. Penile prostheses were inserted into the corpora cavernosa using the standard ventral approach. After lifting the neurovascular bundle, the tunica albuginea was incised and opened at the plaque region to correct the deformities and to lengthen the penis. Subsequently, the wide neurovascular bundle was replaced, and all incisions of the tunica albuginea were covered to prevent corporal grafting. In the median follow-up of 35 months （range 14-82 months）, the penis was completely straightened in 59 （95%） patients. Numbness of the glans, which the patients found initially upsetting, decreased or disappeared spontaneously 3-6 months later. Penile prosthesis implantation with tunica albuginea incisions is a viable alternative in the treatment of Peyronie＇s disease because the extensive dissection of the neurovascular bundle allows a good approach to the plaque and provides excellent covering of the incised tunica albuginea without additional grafting.

Pentoxifylline treatment and penile calcifications in men Nith Peyronie＇s disease

This retrospective cohort study from a single clinical practice enrolled patients with evidence of calcified Peyronie＇s disease （PD） plaques detected on penile ultrasound at the time of initial presentation. The primary objective was to describe the effect of pentoxifylline （PTX） treatment on subtunical calcifications in men with PD. A PD-specific questionnaire was administered and sonographic evaluations were performed at baseline and follow-up visits. Descriptive statistics and X2 analysis were used to characterize the effect of PTX on calcified tunical plaques. In all, 71 men （mean age： 51.9 years） with PD and sonographic evidence of calcification were identified. Of them, 62 of these men were treated with PTX for a mean duration of I year, and nine with vitamin E or no treatment. Improvement or stabilization in calcium burden at follow-up was noted in 57 （91.9%） of men treated with PTX versus four （44,4%） of those not treated with PTX （P〈0.001）. PTX users were much less likely to have a subjective worsening of their clinical condition （25.0% versus 78.3%, P=0.002）. Treatment with PTX appeared to stabilize or reduce calcium content in PD plaques. A randomized controlled trial is warranted to further explore this effect.

局部药物注射治疗Peyronie病的研究进展

Peyronie病是一种发生在阴茎白膜的纤维性疾病,其发病机理尚不清楚,由于该疾病会导致阴茎畸形、疼痛和改变阴茎曲率,甚至引起勃起功能障碍,给患者和性伴侣带来重大困扰。局部药物注射可在疾病急性期发挥作用,减缓疾病进程,改善畸形情况达到治疗目的。目前注射治疗药物种类繁多,各有利弊,如何合理选择注射治疗药物仍值得商榷。