Francesco Costantini Mesquita et al., 2024: Evidence of restorative therapies in the treatment of Peyronie disease: A narrative review

Tuesday, 03 December 2024

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Francesco Costantini Mesquita 1, Rodrigo Barros 2, Thiago Fernandes Negris Lima 3, David Velasquez 3, Luciano A Favorito 4, Edoardo Pozzi 1, James Dornbush 5, David Miller 1, Francis Petrella 1, Ranjith Ramasamy 1
1Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL, USA.
2Serviço de Urologia, Hospital Universitário Antônio Pedro - Universidade Federal Fluminense - UFF, Niterói, RJ, Brasil.
3Serviço de Urologia, Hospital Memorial Arthur Ramos, Maceió, AL, Brasil.
4Unidade de Pesquisa Urogenital, Universidade Estadual do Rio de Janeiro - UERJ, Rio de Janeiro, RJ, Brasil.
5AU/UGA Medical Partnership, Athens, GA, USA.

Abstract

Objective: To describe the evidence of Platelet Rich Plasma (PRP), Stem cells therapy (SCT) and Extracorporeal shockwave therapy (ESWL) for the treatment of Peyronies disease (PD), including information from the main urological society guidelines.

Materials and methods: A literature review of PubMed articles published between 2000 and 2023 was conducted, utilizing keywords such as "Peyronie's Disease", "Penile curvature", "Platelet Rich Plasma", "Stem cells", and "Extracorporeal shockwave therapy". Only full-text articles in English were included, excluding case reports and opinions.

Results: A considerable number of clinical trials were conducted using PRP penile injections for therapy of PD, showing reduction of curvature, plaque size and improvement in quality of life. Preclinical studies in rats have shown the potential benefit of adipose-derived stem cells, with improvements in erectile function and fibrosis. Human studies with mesenchymal stem cells demonstrated promising results, with reduction of curvature and plaque size. ESWL effects on PD were investigated in randomized clinical trials and demonstrated no significant impact in curvature or plaque size, but reasonable effect on pain control.

Conclusion: Restorative therapies has emerged as an innovative treatment option for PD and the results from current studies appear to be promising and demonstrated good safety profile. Unfortunately, due to scarce evidence, PRP and SCT are still considered experimental by American Urological Association (AUA) and European Association of Urology (EAU) guidelines. ESWT is recommended, by the same guidelines, for pain control only. More high-quality studies with long-term follow-up outcomes are needed to evaluate efficacy and reproducibility of those therapies.

Int Braz J Urol. 2024 Aug 12:50. doi: 10.1590/S1677-5538.IBJU.2024.9920. Online ahead of print.
PMID: 39133793 FREE ARTICLE

Comments 1

Jens Rassweiler on Tuesday, 03 December 2024 10:00

Comprehensive Overview: The article provides a detailed summary of three emerging restorative therapies (PRP, SCT, and ESWT) for Peyronie’s Disease (PD). It discusses the mechanisms of action, clinical applications, study outcomes, and guideline recommendations for each therapy.

Scientific Basis: The review presents underlying mechanisms (e.g., PRP’s growth factors, SCT’s regenerative capabilities, and ESWT’s potential for plaque restructuring) in a scientific and accessible manner. The reliance on a variety of preclinical and clinical studies ensures a well-rounded understanding of the therapies.

Key Messages:

• PRP: Promising for inflammation and curvature reduction, with a favorable safety profile but requiring standardized protocols and long-term studies.
• SCT: Potentially transformative due to its regenerative properties, though it remains in the experimental phase with high associated costs.
• ESWT: Demonstrates benefits for pain relief but limited effectiveness for curvature or plaque size reduction, reflecting heterogeneity in study results.

Acknowledgment of Limitations: The review does not overstate findings, highlighting the experimental status of PRP and SCT and the conditional recommendation of ESWT for pain management. It acknowledges gaps in standardization and long-term evidence, reinforcing the need for more high-quality research. For example, the results of studies like those by Achraf et al. (for PRP) and Di Mauro et al. (for ESWT) should be assessed more rigorously for statistical significance and reproducibility.

Utility for Clinicians: By referencing the American Urological Association (AUA) and European Association of Urology (EAU) guidelines, the article provides practical insights for clinicians on current best practices and limitations.
________________________________________
Conclusion: The review effectively highlights the experimental yet promising nature of restorative therapies for PD. However, future research must address long-term efficacy, protocol standardization, and patient-centric outcomes to move these therapies from experimental to evidence-based practice. Including visual aids, critical appraisals of studies, and economic analyses would enhance the article’s utility for both clinicians and researchers.

Jens Rassweiler

Scientific Basis: The review presents underlying mechanisms (e.g., PRP’s growth factors, SCT’s regenerative capabilities, and ESWT’s potential for plaque restructuring) in a scientific and accessible manner. The reliance on a variety of preclinical and clinical studies ensures a well-rounded understanding of the therapies.

Key Messages:

•	PRP: Promising for inflammation and curvature reduction, with a favorable safety profile but requiring standardized protocols and long-term studies.
•	SCT: Potentially transformative due to its regenerative properties, though it remains in the experimental phase with high associated costs.
•	ESWT: Demonstrates benefits for pain relief but limited effectiveness for curvature or plaque size reduction, reflecting heterogeneity in study results.

Acknowledgment of Limitations: The review does not overstate findings, highlighting the experimental status of PRP and SCT and the conditional recommendation of ESWT for pain management. It acknowledges gaps in standardization and long-term evidence, reinforcing the need for more high-quality research. For example, the results of studies like those by Achraf et al. (for PRP) and Di Mauro et al. (for ESWT) should be assessed more rigorously for statistical significance and reproducibility.

Utility for Clinicians: By referencing the American Urological Association (AUA) and European Association of Urology (EAU) guidelines, the article provides practical insights for clinicians on current best practices and limitations.
________________________________________
Conclusion: The review effectively highlights the experimental yet promising nature of restorative therapies for PD. However, future research must address long-term efficacy, protocol standardization, and patient-centric outcomes to move these therapies from experimental to evidence-based practice. Including visual aids, critical appraisals of studies, and economic analyses would enhance the article’s utility for both clinicians and researchers.

Jens Rassweiler

Comprehensive Overview: The article provides a detailed summary of three emerging restorative therapies (PRP, SCT, and ESWT) for Peyronie’s Disease (PD). It discusses the mechanisms of action, clinical applications, study outcomes, and guideline recommendations for each therapy. Scientific Basis: The review presents underlying mechanisms (e.g., PRP’s growth factors, SCT’s regenerative capabilities, and ESWT’s potential for plaque restructuring) in a scientific and accessible manner. The reliance on a variety of preclinical and clinical studies ensures a well-rounded understanding of the therapies. Key Messages: • PRP: Promising for inflammation and curvature reduction, with a favorable safety profile but requiring standardized protocols and long-term studies. • SCT: Potentially transformative due to its regenerative properties, though it remains in the experimental phase with high associated costs. • ESWT: Demonstrates benefits for pain relief but limited effectiveness for curvature or plaque size reduction, reflecting heterogeneity in study results. Acknowledgment of Limitations: The review does not overstate findings, highlighting the experimental status of PRP and SCT and the conditional recommendation of ESWT for pain management. It acknowledges gaps in standardization and long-term evidence, reinforcing the need for more high-quality research. For example, the results of studies like those by Achraf et al. (for PRP) and Di Mauro et al. (for ESWT) should be assessed more rigorously for statistical significance and reproducibility. Utility for Clinicians: By referencing the American Urological Association (AUA) and European Association of Urology (EAU) guidelines, the article provides practical insights for clinicians on current best practices and limitations. ________________________________________ Conclusion: The review effectively highlights the experimental yet promising nature of restorative therapies for PD. However, future research must address long-term efficacy, protocol standardization, and patient-centric outcomes to move these therapies from experimental to evidence-based practice. Including visual aids, critical appraisals of studies, and economic analyses would enhance the article’s utility for both clinicians and researchers. Jens Rassweiler

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