Advertisement

Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

Intralesional hyaluronic acid: an innovative treatment for Peyronie’s disease

Abstract

Objective

The significantly different effects of several conservative treatments for Peyronie’s disease (PD) led us to conduct this study to evaluate the effectiveness of local treatment with injectable hyaluronic acid (HA) for patients with this disease.

Materials and methods

The study included 83 PD patients who underwent treatment and 81 PD patients who did not (control group). The inclusion criteria were: penile plaque volume <1 cm3; clinical characteristics and ultrasonographic appearance compatible with active inflammation; and penile curvature <45°. The medical history of all PD patients was collected. Patients undertook six tests: routine laboratory tests; penile auto-photography during erection; dynamic penile colour-duplex ultrasound study; penile X-ray (mammography technique); index of erectile function questionnaire (IIEF); and pain intensity questionnaire (visual analog scale). Treated patients received thirty penile infiltrations by injection of 20 mg HA in 6 months. Follow-up checks were conducted at the end of treatment and 12 and 24 months after treatment.

Results

At 12-month follow-up all treated PD patients had experienced three statistically significant outcomes: reduction in plaque size (−93.7 %, p < 0.0001); improvement in penile curvature (−9.01°, p < 0.0001); and improvement in penile rigidity (mean IIEF score +3.8) with an average increase of 21.1 % (p < 0.0001). Furthermore, the improvements remained substantially stable at 24-month follow-up.

Conclusion

Considering the minimally invasive approach in this study, the absence of major side effects, and the significant treatment outcomes achieved, we conclude that intralesional penile injections with HA are effective for treating Peyronie’s disease.

This is a preview of subscription content, log in to check access.

References

  1. 1.

    La Peyronie F (1743) Sur quelques obstacles qui sópposent à l’éjaculation naturelle de la semence. Mem Acad Royale Chir 1:425–439

  2. 2.

    Schwarzer U, Sommer F, Klotz T, Braun M, Reifenrath B, Engelmann U (2001) The prevalence of Peyronie’s disease: results of a large survey. BJU Int 88:727–730

  3. 3.

    Mulhall JP, Creech SD, Boorjian SA, Ghaly S, Kim ED, Moty A, Davis R et al (2004) Subjective and objective analysis of the prevalence of Peyronie’s disease in a population of men presenting for prostate cancer screening. J Urol 171:2350–2353

  4. 4.

    Dibenedetti DB, Nguyen D, Zografos L, Ziemiecki R, Zhou XA (2011) Population-based study of Peyronie’s Disease: prevalence and treatment patterns in the United States. Adv Urol. Article ID 282503. Published online 2011. doi:10.1155/2011/282503. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3202120/pdf/AU2011-282503.pdf

  5. 5.

    Dolmans GH, Werker PM, de Jong IJ, Nijman RJ, LifeLines Cohort Study, Wijmenga C et al (2012) WNT2 locus is involved in genetic susceptibility of Peyronie’s disease. J Sex Med 9(5):1430–1434

  6. 6.

    Hauck EW, Hauptmann A, Weidner W, Bein G, Hackstein H (2003) Prospective analysis of HLA classes I and II antigen frequency in patients with Peyronie’s disease. J Urol 170(4 Pt 1):1443–1446

  7. 7.

    Schiavino D, Sasso F, Nucera E, Alcini E, Gulino G, Milani A et al (1997) Immunologic findings in Peyronie’s disease: a controlled study. Urology 50(5):764–768

  8. 8.

    Stewart S, Malto M, Sandberg L, Colburn KK (1994) Increased serum levels of anti-elastin antibodies in patients with Peyronie’s disease. J Urol 152(1):105–106

  9. 9.

    Devine CJ Jr, Somers KD, Jordan GH, Schlossberg SM (1997) Proposal: trauma as the cause of the Peyronie’s lesion. J Urol 157:285–290

  10. 10.

    Paulis G, Cavallini G (2013) Clinical evaluation of natural history of Peyronie’s disease: our experience, old myths and new certainties. Inflamm Allergy Drug Targets 12(5):341–348

  11. 11.

    Mulhall JP, Schiff J, Guhring P (2006) An analysis of the natural history of Peyronie’s disease. J Urol 175:2115–2118

  12. 12.

    Gelbard MK, Dorey F, James K (1990) The natural history of Peyronie’s disease. J Urol 144:1376–1379

  13. 13.

    Hauck EW, Diemer T, Schmelz HU, Weidner W (2006) A critical analysis of nonsurgical treatment of Peyronie’s disease. Eur Urol 49:987–997

  14. 14.

    Levine LA, Cuzin B, Mark S, Gelbard MK, Jones NA, Liu G et al (2015) Clinical safety and effectiveness of collagenase clostridium histolyticum injection in patients with Peyronie’s disease: a phase 3 open-label study. J Sex Med 12(1):248–258

  15. 15.

    Safarinejad MR, Asgari MA, Hosseini SY, Dadkhah F (2010) A double-blind placebo-controlled study of the efficacy and safety of pentoxifylline in early chronic Peyronie’s disease. BJU Int 106:240–248

  16. 16.

    Safarinejad MR, Hosseini SY, Kolahi AA (2007) Comparison of vitamin E and propionyl-l-carnitine, separately or in combination, in patients with early chronic Peyronie’s disease: a double-blind, placebo controlled, randomized study. J Urol 178:1398–1403

  17. 17.

    Hatzimouratidis K, Eardley I, Giuliano F, Hatzichristou D, Moncada I, Salonia A et al (2012) EAU guidelines on penile curvature. Eur Urol 62(3):543–552

  18. 18.

    Gelbard M, Goldstein I, Hellstrom WJ, McMahon CG, Smith T, Tursi J et al (2013) 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 190(1):199–207

  19. 19.

    Kendirci M, Hellstrom WJ (2004) Critical analysis of surgery for Peyronie’s disease. Curr Opin Urol 14:381–388

  20. 20.

    Irani D, Zeighami SH, Khezri AA (2004) Results of dermal patch graft in the treatment of Peyronie’s disease. Urol J 1(2):103–106

  21. 21.

    Nikoobakht MR, Mehrsai A, Pourmand GH, Jaladat H, Nasseh HR (2004) Management of Peyronie’s disease by dermal grafting. Urol J. 1(2):99–102

  22. 22.

    Karna E, Miltyk W, Pałka JA, Jarzabek K, Wołczyński S (2006) Hyaluronic acid counteracts interleukin-1-induced inhibition of collagen biosynthesis in cultured human chondrocytes. Pharmacol Res 54(4):275–281

  23. 23.

    Nawrat P, Surazyński A, Karna E, Pałka JA (2005) The effect of hyaluronic acid on interleukin-1-induced deregulation of collagen metabolism in cultured human skin fibroblasts. Pharmacol Res 51(5):473–477

  24. 24.

    Andresen R, Wegner HE, Miller K, Banzer D (1998) Imaging modalities in Peyronie’s disease. An intrapersonal comparison of ultrasound sonography, X-ray in mammography technique, computerized tomography, and nuclear magnetic resonance in 20 patients. Eur Urol 34(2):128–134 (discussion 135)

  25. 25.

    Kelâmi A (1983) Autophotography in evaluation of functional penile disorders. Urology 21:628–629

  26. 26.

    Prando D (2009) New sonographic aspects of peyronie disease. J Ultrasound Med 28:217–232

  27. 27.

    Rosen RC, Riley A, Wagner G, Osterloh IH, Kirkpatrick J, Mishrs A (1997) The international index of erectile function (IIEF): a multidimensional scale for assessment of erectile dysfunction. Urology 49:822–830

  28. 28.

    Farrar JT, Young JP Jr, LaMoreaux L, Werth JL, Poole RM (2001) Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale. Pain 94:149–158

  29. 29.

    Vincent HK, Percival SS, Conrad BP, Seay AN, Montero C, Vincent KR (2013) Hyaluronic Acid (HA) viscosupplementation on synovial fluid inflammation in knee osteoarthritis: a pilot study. Open Orthop J 20(7):378–384

  30. 30.

    Ke C, Sun L, Qiao D, Wang D, Zeng X (2011) Antioxidant acitivity of low molecular weight hyaluronic acid. Food Chem Toxicol 49(10):2670–2675

  31. 31.

    Paulis G, Brancato T (2012) Inflammatory mechanisms and oxidative stress in Peyronie’s disease. Therapeutic “rationale” and related emerging treatment strategies. Inflamm Allergy Drug Targets 11:48–57

  32. 32.

    Moon DG, Kwak TI, Cho HY, Bae JH, Park HS, Kim JJ (2003) Augmentation of glans penis using injectable hyaluronic acid gel. Int J Impot Res 15(6):456–460

  33. 33.

    Trost LW, Ates E, Powers M, Sikka S, Hellstrom WJ (2013) Outcomes of intralesional interferon-α2B for the treatment of Peyronie disease. J Urol 190(6):2194–2199

  34. 34.

    Soh J, Kawauchi A, Kanemitsu N, Naya Y, Ochiai A, Naitoh Y et al (2010) Nicardipine vs. saline injection as treatment for Peyronie disease: a prospective, randomized, single-blind trial. J Sex Med 7:3743–3749

  35. 35.

    Tuygun C, Ozok UH, Gucuk A, Bozkurt IH, Imamoglu MA (2009) The effectiveness of transdermal electromotive administration with verapamil and dexamethasone in the treatment of Peyronie’s disease. Int Urol Nephrol 41(1):113–118

  36. 36.

    Fitch WP 3rd, Easterling WJ, Talbert RL, Bordovsky MJ, Mosier M (2007) Topical verapamil HCl, topical trifluoperazine, and topical magnesium sulfate for the treatment of Peyronie’s disease—a placebo-controlled pilot study. J Sex Med 4(2):477–484

  37. 37.

    Bennett NE, Guhring P, Mulhall JP (2007) Intralesional verapamil prevents the progression of Peyronie’s disease. Urology 69(6):1181–1184

  38. 38.

    Jordan GH (2008) The use of intralesional clostridial collagenase injection therapy for Peyronie’s disease: a prospective, single-center, non-placebo-controlled study. J Sex Med 5(1):180–187

Download references

Specific contributions of the Authors

Gennaro Romano: recruitment and treatment of patients, paper writing, research design, and acquisition and analysis of the data. Davide Barletta: recruitment and treatment of patients, research design, and acquisition and analysis of the data. Gianni Paulis: paper revision, interpretation of data, and statistical analysis.

Author information

Correspondence to Gianni Paulis.

Ethics declarations

Disclosure of potential conflicts of interest

Author Gennaro Romano declares that he has no conflict of interest. Author Davide Barletta declares that he has no conflict of interest. Author Gianni Paulis declares that he has no conflict of interest.

Research involving human participants: Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments, or comparable ethical standards. Specifically, the approval of the Institutional (LILT) Ethics Committee was obtained.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Gennaro, R., Barletta, D. & Paulis, G. Intralesional hyaluronic acid: an innovative treatment for Peyronie’s disease. Int Urol Nephrol 47, 1595–1602 (2015). https://doi.org/10.1007/s11255-015-1074-1

Download citation

Keywords

  • Peyronie’s disease
  • Hyaluronic acid
  • Penile curvature