ESSM Newsletter # 37

12 / 20

12 ESSMToday
Have you read ? Best of the Best: Clinical
by Nicola Mondaini
dr. nicola Mondaini
Associate Editor
Department of Urology
Ospedale Santa Maria Annunziata
(Ponte a Niccheri)
Via dell’Antella, 58 – Bagno a Ripoli
Florence, Italy
INDURATIO PENIS PLASTICA
Abdel Raheem A et alt: Safety and effective-
ness of collagenase clostridium histolyticum
(CCH) (Xiapex®) in the treatment of Peyronie’s
Disease using a new modified shortened pro-
tocol. BJU Int. 2017 Jun 14.
To evaluate the efficacy and safety of collagenase
clostridium histolyticum (CCH) (Xiapex®, Xiaflex® )
in the treatment of Peyronie’s disease (PD) using
a new modified treatment protocol which aims at
reducing the number of injections needed and
reducing patient visits, thus reducing the cost
and duration of treatment. A prospective study of
53 patients with PD who had treatment with CCH
at a single center using a new modified protocol.
The angle of curvature assessment after an intra-
cavernosal injection of PGE1, IIEF and Peyronie’s
disease questionnaires (PDQ) were performed at
baseline and at week 12 (4 weeks after the last
injection). The global assessment of PD question-
naire was performed at week 12. Under a penile
block of 10ml of plain lignocaine 1%, a total of
3 intra-lesional injections of CCH (0.9 mg) were
given at 4 weekly intervals using a new modified
injection technique. In between injections patients
used a combination of home modelling, stretch-
ing and a vacuum device on a daily basis in order
to mechanically stretch the plaque. Investigator
modelling was not performed.
The mean penile curvature at baseline was
54° (30 – 90°). Of the 53 patients in the study,
51 patients (96.2%) had an improvement in the
angel of curvature with a mean value of 17.36°
(0°– 40°) or 31.4% from baseline (0 – 57%)
after 3 CCH injections. The end mean curvature
was 36.9° (12 °– 75°; p<0.001). There was an
improvement in each of the IIEF questionnaire
domains, all 3 PDQ domains and the global as-
sessment of PD questionnaire. CCH was well tol-
erated by all patients with only mild and transient
local adverse events.The new shortened protocol
using CCH treatment is safe, effective and cost
efficient. The results of using only 3 CCH in-
jections according to this modified protocol are
comparable to those of the clinical trials which
used 8 CCH injections. This article is protected
by copyright. All rights reserved.
ERECTILE DYSFUNCTION
Corona G et alt: Sexual dysfunction in subjects
treated with inhibitors of 5α-reductase for
benign prostatic hyperplasia: a comprehen-
sive review and meta-analysis. Andrology.
2017 Apr 28.
Despite their efficacy in the treatment of be-
nign prostatic hyperplasia, the popularity of
inhibitors of 5α-reductase (5ARIs) is limited by
their association with adverse sexual side ef-
fects. The aim of this study was to review and
meta-analyze currently available randomized
clinical trials evaluating the rate of sexual side
effects in men treated with 5ARIs. An exten-
sive Medline Embase and Cochrane search
was performed including the following words:
‘finasteride’, ‘dutasteride’, ‘benign prostatic hy-
perplasia’. Only placebo-controlled randomized
clinical trials evaluating the effect of 5ARI in
subjects with benign prostatic hyperplasia were
considered. Of 383 retrieved articles, 17 were
included in this study. Randomized clinical tri-
als enrolled 24,463 in the active and 22,270
patients in the placebo arms, respectively, with
a mean follow-up of 99 weeks and mean age of
64.0 years. No difference was observed between
trials using finasteride or dutasteride as the ac-
tive arm considering age, trial duration, pros-
tate volume or International Prostatic Symptoms
Score at enrollment. Overall, 5ARIs determined
an increased risk of hypoactive sexual desire
[OR = 1.54 (1.29; 1.82); p < 0.0001] and
erectile dysfunction [OR = 1.47 (1.29; 1.68);
p < 0.0001]. No difference between finasteride
and dutasteride regarding the risk of hypoac-
tive sexual desire and erectile dysfunction was
observed. Meta-regression analysis showed that
the risk of hypoactive sexual desire and erectile
dysfunction was higher in subjects with lower
Qmax at enrollment and decreased as a function
of trial follow-up. Conversely, no effect of age,
low urinary tract symptom or prostate volume
at enrollment as well as Qmax at end-point was
observed. In conclusion, present data show that
the use of 5ARI significantly increases the risk of
erectile dysfunction and hypoactive sexual desire
in subjects with benign prostatic hyperplasia.
Patients should be adequately informed before
5ARIs are prescribed.
ORGASMIC DYSFUNCTION
Orgasmic dysfunction after
radical prostatectomy
Capogrosso P et alt: Orgasmic Dysfunction
after Radical Prostatectomy. World J Mens
Health. 2017 Apr;35(1):1-13.
In addition to urinary incontinence and erectile
dysfunction, several other impairments of sexual
function potentially occurring after radical pros-
tatectomy (RP) have been described; as a whole,
these less frequently assessed disorders are
referred to as neglected side effects. In particular,
orgasmic dysfunctions (ODs) have been reported
in a non-negligible number of cases, with detri-
mental impacts on patients’ overall sexual life.
This review aimed to comprehensively discuss
the prevalence and physiopathology of post-RP
ODs, as well as potential treatment options.
Orgasm-associated incontinence (climacturia)
has been reported to occur in between 20%
and 93% of patients after RP. Similarly, up to
19% of patients complain of postoperative
orgasm-associated pain, mainly referred pain
at the level of the penis. Moreover, impairment
in the sensation of orgasm or even complete
anorgasmia has been reported in 33% to 77%
of patients after surgery. Clinical and surgical
factors including age, the use of a nerve-sparing
technique, and robotic surgery have been vari-
ably associated with the risk of ODs after RP,
although robust and reliable data allowing for