5
ESSM
Today
Highlights from the “ESSM Meeting Istanbul”
La Peyronie’s disease (PD):
Still only failures (or so?)
Chairs:
Carlo Bettochi (Italy),
Ian Eardly (United Kingdom)
Speakers:
Fabio Castiglione (Italy), Wayne Hell-
strom (USA), Önder Kayigil (Turkey), Mustafa Faruk
Usta (Turkey), David Ralph (United Kingdom).
In this field there have been significant devel-
opments during the past year: The approval
of collagenase Clostridium hystolyticum (CCh)
intralesional in the treatment of PD and the
publication of Spanish study on the treatment of
the acute phase of Peyronie’s disease through
the use of penile extender devices and its cor-
relation with ultrasound.
Xiaflex
®
is an injectable collagenase prepara-
tion consisting in a predetermined mixture of
2 distinct collagenases that cleave collagen
strands at different sites. AUX I (a class I C
histolyticum collagenase) cleaves the terminal
ends of collagen, and AUX II (a class II C histo-
lyticum collagenase) cleaves internal sections
of collagen. Recently the FDA approved Xiaf-
lex
®
for non surgical treatment of men with PD
that have a curvature of 30 degrees or more
and tangible scar tissue plaque in their penis.
The results of a multicenter IIb study and two
phase III, prospective, randomized, double-blind,
placebo-controlled studies, conducted by Gel-
bard et al, were presented. The clinical efficacy
and safety of the intralesional therapy with CCh
was evaluated; that allowed drug approval.
Throughout these studies, were evaluated over
1000 patients who were administered up to
4 cycles of 0.58 mg of CCh, with 2 injections
per cycle, followed by penile modeling. The re-
sults showed, an average increase and improve-
ment of penile curvature as 34% (p < 0.0001)
and on the scale of “discomfort” (p < 0.0037)
using the PDQ (first validated questionnaire
that determines the psychosexual impact on
PD patients). Adverse effects are common: Pain,
swelling and bruising at the site of injection,
and resolved spontaneously in most patients,
although 3 cases of rupture of the corpora
cavernosa which required surgical treatment.
Similarly, they commented the results of a pro-
spective, randomized controlled trial conducted
in Spain by Martinez-Salamanca et al, whose
objective was to determine the effectiveness
and safety of penile traction therapy (PTT), in
the conservative treatment of acute phase of
PD. A total of 55 patients underwent PTT for
6 months and compared with 41 patients with
acute phase of PD who did not receive active
treatment (“No Intervention group”(NIG)). After
6 months of treatment, with a mean follow up of
9 months, the mean curvature decreased from
33º at baseline to 15º at 6 months and 13º at
9 months with a mean decrease 20º (p<0.05).
It also showed an increase in penile length and
girth. (p = 0.03).
Likewise, predictors associated with treatment
success were identified: Penile curvature < 45°
at baseline, visual analog scale (VAS ) pain > 5,
time to diagnosis < 3 months, absence of vis-
ible plaque on ultrasound and age < 45 years.
Pre-Clinical Research: Novel Insights and
Treatment Targets in the Pathophysiology
of Erectile Dysfunction
Chairs:
Stefan Ückert (Germany),
Javier Angulo (Spain)
Speakers:
Selim Cellek (UK), Carla Costa
(Portugal), Maarten Albersen (Belgium) and Trin-
ity J. Bivalaqua (USA).
Mainly emphasizes the large amount of re-
search being carried out at present on erectile
dysfunction, focused on the pathophysiology of
the disease and its relationship to other condi-
tions such as diabetes mellitus, hypercholes-
terolemia and the metabolic syndrome, and the
impact of cardiovascular risk factors and age
on this disease.
Treatment with stem cells derived from adi-
pose tissue, appears to be the new target of
research in the treatment of Peyronie’s disease,
performed by several work groups (Sakaya
University of Turkey; University Vita-Salute San
Raffaele of Milan, Italy; University of Leuven,
Belgium and the John Hopkins Medical, Bal-
timore, USA); showing encouraging results,
although a long way ahead will be necessary
to translate these results into clinical practice.
Another interesting field is the penile rehabili-
tation by administration of PDE5 inhibitors in
prostatectomy rat models.
A field with renewed interest, is the treatment
with testosterone and its theoretical benefits, as
a combined treatment in patients with metabolic
syndrome, accelerating weight loss and improv-
ing glycemic control.
Video-Courses
In this section, several videos were presented,
most of them focused in penile surgery for the
treatment of PD and prosthetic surgery. The
highlighted videos include:
Total phallic reconstruction and rehabilita-
tion after penile amputation
presented by Dr Javier Romero from Spain;
where the multidisciplinary approach is es-
sential and the urologist should be the leader
of the surgical team.
Simultaneous implantation of penile
prosthesis and artificial urinary sphincter
through a single incision
presented by Dr Juan Ignacio Martinez-Sala-
manca from Spain as the ideal approach in
those patients in whom both conditions coexist,
usually after radical pelvic surgery.
Incision and venous patch in Peyronie’s
patients with hourglass deformity
by Dr Ates Kadioglu from Turkey, and the
transposition of the corpora cavernosa for
the treatment of PD
presented by Dr Natalio Cruz from Spain as
nearly ideal grafts, with a low complication rate
and acceptable functional results.
