Marco Capece

Collagenase clostridium histolyticum for the treatment of Peyronie's disease: a prospective Italian multicentric study

Peyronies disease (PD) is a common condition which results in penile curvature making sexual intercourse difficult or impossible. Collagenase clostridium histolyticum (CCH) is the first licensed drug for the treatment of PD and is indicated in patients with palpable plaque and curvature deformity of at least 30° of curvature. However, only few monocentric studies are available in the current literature and this is the first national multicentric study focusing on this new treatment. In five Italian centres, 135 patients have completed the treatment with three injections of CCH using Ralphs shortened modified protocol. The protocol consisted of three intralesional injections of CCH (0.9 mg) given at 4‐weekly intervals in addiction to a combination of home modelling, stretching and a vacuum device on a daily basis. An improvement in the angle of curvature was recorded in 128/135 patients (94.8%) by a mean (range) of 19.1 (0–40)° or 42.9 (0–67)% from baseline (p < 0.001). There was also a statistically significant improvement in all IIEF and PDQ questionnaires subdomains (p < 0.001 in all subdomains). This prospective multicentric study confirms that the three‐injection protocol is effective enough to achieve a good result and to minimize the cost of the treatment.

Effectiveness of highly purified urofollitropin treatment in patients with idiopathic azoospermia before testicular sperm extraction

Introduction: Recent evidences demonstrated that male factor alone is responsible for about 30% cases of infertility. Human follicle-stimulating hormone (hFSH) has been introduced to increase sperm concentration, spermatogonial population, or both natural or assisted pregnancy rates (PRs) in oligozoospermic subjects with normal concentrations of gonadotropins. Methods: Fifty infertile men affected by idiopathic azoospermia were enrolled in this study, after undergoing medical history, physical and clinical examination, baseline semen parameters and hormonal plasma concentrations. Inclusion criteria were infertility for at least 2 years, idiopathic azoospermia, FSH <12 mIU/ml. Twenty-five patients were allocated to treatment with hFSH three times/week per 3 months (Fostimon), and 25 patients underwent just testicular sperm extraction (TESE) without medical treatment. All patients underwent, after 3 months, assisted reproduction techniques (ARTs) with TESE. The primary outcome was represented by the differences in the sperm retrieval rate (SRR) between groups, while the secondary outcomes were the differences in PR and fertilization rate (FR). Results: We observed a PR of 15% (3/25) and 28% (7/25) in control and treated group, respectively. SRR after medical treatment and ART was 24% (6/25), while in the control group was 12.5% (2/25). The sperm in the ejaculate of five patients (20%) after medical treatment exhibited a mean concentration of 0.9 million/ml and a mean motility of 12%. The FR was significantly greater in the treatment group with respect to the control group, 30% and 20%, respectively. Conclusions: FSH treatment showed greater efficacy rather than control by increasing the rate of PR and FR in azoospermic patients who underwent TESE.

Intralesional and Mechanical Therapies for Peyronie's Disease: A Road Anything but Straight

In this months issue of European Urology, Russo et al. [1] published the results of a systematic review of the literature about the efficacy of injection therapies, vacuum devices, and penile traction in patients with Peyronies disease (PD). The authors summarized available evidence about the effects of these therapeutic options on relevant outcomes such as penile curvature (PC), plaque size, erectile function, penile pain, and penile length [1]. The study has two major methodological strengths. Most importantly, it is the first systematic review addressing the efficacy of intralesional and mechanical therapies in PD patients. A further strength of the study is the adoption of PC improvement as a primary outcome measure. This methodological choice confers to the results a strong clinical relevance as PC has been reported to be one of the major determinants of bother and psychological distress in PD patients [2]. It is important to depict the state of the art about intralesional and mechanical therapies for PD because the management of PD has strongly evolved over time. Historically, oral and intralesional therapies have represented the initial conservative option with surgery being considered the definitive gold standard therapy in stable disease. More recently, recommended treatment algorithms have significantly shifted due to the introduction of potential new first-line options. In this scenario, oral treatments have become less commonly prescribed due to inconsistent or negative outcome data, and intralesional therapies have gained growing interest. Interferon a-2b (IFNa-2b) was adopted for the first time in 1995 by Wegner et al. [3]. Initially, the results in terms of PC were disappointing, probably due to the inadequate dosage and regimen of the drug, or simply because of wrong patient

Predictors of treatment success after collagenase Clostridium histolyticum injection for Peyronie's disease: development of a nomogram from a multicentre single-arm, non-placebo controlled clinical study

To build a nomogram able to predict treatment success after collagenase Clostridium histolyticum (CCH) for Peyronies disease (PD).

MP89-09 SALVAGE MTESE AFTER PREVIOUS FAILED MTESE: RESULTS AND PREDICTORS FOR SUCCESS.

INTRODUCTION AND OBJECTIVES: Ultrasonographically guided puncture (UGUP) of the rete testis (RT) has been proven to be an efficient method for sperm recovery in obstructed azoospermic men (Andrologia 35:85, 2003). In the current study we evaluated the role of UGUP of the RT in sperm recovery from non-obstructed azoospermic (NOA) men. METHODS: Bilateral UGUP of the RT was performed in 83 NOA-men. Under local anesthesia and ultrasonographical control (mode B, frequency of 7.50 MHz), the hyperdense tip of a 30-gauge needle approached and reached the RT of each NOA-man. When ultrasonographical control demonstrated that the tip of the needle had reached the hyperdense line of the RT negative pressure was applied and cells from the RT were aspirated. All the aspirated samples from the RT were observed via confocal scanning laser microscope and some of them after fluorescent in situ hybridization (FISH) techniques. Men who were negative for spermatozoa after UGUP of the RT underwent microsurgical therapeutic testicular biopsy (MTTB). Recovered spermatozoa subpopulations either from UGUP-RT samples or from MTTBsamples were frozen. RESULTS: UGUP of the RT resulted in sperm recovery in 19 men (22.89%). The remaining 64 NOA-men underwent MTTB. Twenty nine men out of the 64 men (45.31%) who underwent MTTB demonstrated testicular spermatozoa. Thus in total, 48 men (57.83%) were positive for spermatozoa either in the UGUP-RT-samples or in the MTTB-samples. There was not a significant difference between the mean value of peripheral serum testosterone three months after UGUPRT and the respective mean value prior to UGUP-RT. FISH techniques in UGUP-RT samples demonstrated in each of the 19 men at least 81% haploid spermatozoa. Hematomas were not demonstrated by ultrasonography one, three, and nine weeks post-UGUP-RT. Nine couples from the above mentioned 19 NOA-couples participated in assisted reproductive technology programs. Three clinical pregnancies were achieved. Four offspring were delivered. CONCLUSIONS: Considering that UGUP-RT puncture a) does not reduce the volume of testicular parenchyma, b) is less invasive than MTTB, and c) apparently causes less detrimental effect on testicular vasculature than MTTB, UGUP-RT is recommended as first line approach for the treatment of NOA-men. If UGUP-RT is negative for spermatozoa in non-obstructed men, biopsy is indicated.

Management of refractory ischemic priapism: current perspectives

Objectives The aim of the present manuscript is to review the current literature on priapism, focusing on the state-of-the-art knowledge of both the diagnosis and the treatment of the refractory ischemic priapism (IP). Methods Pubmed and EMBASE search engines were used to search for words “priapism”, “refractory priapism”, “penile prosthesis”, “diagnosis priapism”, “priapism treatment”, “penile fibrosis”, “priapism therapy”. All the studies were carefully examined by the authors and then included in the review. Results First-line treatment involves ejaculation, physical exercise and cold shower followed by corporal blood aspiration and injection of α-adrenoceptor agonists. Subsequently, a distal or proximal shunt may be considered. If none of the treatment is effective or the priapism episode lasts >48 hours penile prosthesis implantation could be the only option to solve the priapism and treat the ongoing erectile dysfunction. Conclusion The management of IP is to achieve detumescence of persistent penile erection and to preserve erectile function after resolution of the priapic episode. On the other hand, penile fibrosis and following shortening should be prevented. Early penile prosthesis implantation in patients with refractory IP is able to solve both the priapic episode and prevent the otherwise certain penile shortening. Penile prosthesis implantation is the actual gold standard of care in cases of refractory IP.