AIM:To review the relevant literature in an effort to examine the body of evidence available to date.METHODS:Ovid MEDLINE search database was queried using MeS H terms"penile induration","peyronie’s di...AIM:To review the relevant literature in an effort to examine the body of evidence available to date.METHODS:Ovid MEDLINE search database was queried using MeS H terms"penile induration","peyronie’s disease","Collagenases"and"Collagenase"using various permutations.No temporal parameters were employed.RESULTS:In all,5 relevant clinical trials were isolated from 34 results.These trials were analyzed using the Oxford Centre for Evidence-Based Medicine criteria.They were further examined based on study design and methods;the primary and secondary outcomes were reviewed for treatment efficacy and collagenase-related side effects.CONCLUSION:Intralesional collagenase appears to be safe and effective in the non-surgical treatment of Peyronie’s disease.However,the data remains limited and further inquiries into the safety of collagenase,treatment standardization and standardized outcomesreporting remain necessary.Furthermore,studies comparing intralesional collagenase to alternative medical and surgical therapy will be important in guiding the future treatment decision process.展开更多
Surgical treatment of Peyronie's disease(PD) is still a challenge and a gold standard approach does not exist; however the main goal is to straight penile shaft, and to restore penetrative and coital capacity. The...Surgical treatment of Peyronie's disease(PD) is still a challenge and a gold standard approach does not exist; however the main goal is to straight penile shaft, and to restore penetrative and coital capacity. The less invasive approach aims to correct curvature without intervening directly on the fibrous plaque while the more complex "corporoplasty" applies specific geometric criteria and uses different autologous and heterologous grafts. Each approach has its pros and cons and decisionmaking should be tailored to the individual patient's expectations. Other surgical options include different use of patches to cover the tunica albuginea defect, with the choice depending on the surgeon's personal experience. Despite the wide range of autologous(buccal mucosa, vein, dermis, etc.) and heterologous grafts(bovine pericardium, swine intestinal submucosa, porcine dermis, etc.) none currently represents the real "gold standard" because the data are extremely variable and frequently not representative. Several factors seem to favor buccal mucosa grafts over inert biocompatible materials: as vital tissue, buccal mucosa tends to heal rapidly, immediately integrating with the surrounding albuginea tissue. This translates into a more rapid resumption of spontaneous erections(after 3/4 d) and sexual activity and into a reduced risk of curvature relapse and erectile dysfunction after surgery. Another advantage of the buccal mucosa graft is its low cost. In conclusion, despite the recent development of some exciting new surgical techniques we are still unable to deliver a definitive take-home message about reconstructive surgery in PD because the majority of the studies reported insufficient data. However, since it is clear that major outcomes, besides the cosmetic result, are the patient's and partner's satisfaction and the economic impact of each technique, we recommend they be included among the outcome assessment parameters in further展开更多
The primary systemic vasculitides(PSV) are a group of rare inflammatory disorders affecting blood vessels of varying size and multiple organs. Urological manifestations of PSV are uncommon. Testicular vasculitis is th...The primary systemic vasculitides(PSV) are a group of rare inflammatory disorders affecting blood vessels of varying size and multiple organs. Urological manifestations of PSV are uncommon. Testicular vasculitis is the most commonly reported finding and is associated with Polyarteritis Nodosa(PAN), Henoch-Sch?nleinPurpura(HSP), anti-neutrophil cytoplasm antibody associated Vasculitides(AAV), Giant Cell Arteritis(GCA) and Kawasaki disease. Prostatic vasculitis has been reported in association with GCA and AAV. Ureteric involvement has been noted in PAN, HSP and AAV. Other urogenital manifestations of PSV include genital ulceration and bladder dysfunction in Beh?ets Disease and haematuria which is commonly seen in many of the PSV. Finally, therapies used to treat the PSV, especially cyclophosphamide, are associated with urological sideeffects including haemorrhagic cystitis and urothelial malignancy. The aim of this review is to examine how the urological system is involved in the PSV. Each PSV is examined in turn, with a brief clinical description of the disease followed by a description of the urological manifestations and management. Identification of urological manifestations of PSV is important as in many cases symptoms may improve with immunosuppressive therapy, avoiding the need for invasive surgery. Additionally, patients who present with isolated urogenital PSV are at higher risk of developing subsequent systemic vasculitis and will need to be followed up closely.展开更多
Objective:To investigate the changes in elective private urological procedures in Australia during the coronavirus disease 2019 pandemic.Methods:Data were extracted from publicly available datasets from Medicare Ben e...Objective:To investigate the changes in elective private urological procedures in Australia during the coronavirus disease 2019 pandemic.Methods:Data were extracted from publicly available datasets from Medicare Ben efits Schedule using item nu mbers assig ned to each comm only performed urological interve ntion.These procedures were divided into three groups:Oncological therapeutic,diagnostic,and non-oncological therapeutic procedures.A smoothing model,based on the historic procedure numbers from 2017 to 2019,was used to forecast monthly number of procedures performed in each category between January 2020 and June 2020.These forecasted models were compared with reported figures.Results:A total of 108169 procedures were performed between January 2020 and June 2020 based on the Medicare Ben efits Schedule item nu mbers listed.There was a sign ifica nt reducti on(perce nt-age cha nge)in total procedures performed in April 2020(22.6%,95%con fide nee in terval[CI]:-28.7%to-15.4%)and May 2020(-33.2%,95%CI:-37.5%to 28.3%).There was a significant reduction in oncological therapeutic,non-oncological therapeutic,and diagnostic procedures performed in April 2020 and May 2020(p<0.05).These nu mbers did not in elude procedures performed in public sector.Conclusion:There was a significant reduction in total urological procedures(including diagnostic,oncological,and non-on cological)performed in mon ths of April 2020 and May 2020 during time of federal restrictions.Both public and private healthcare sectors need to be supported in the up-comi ng mon ths to preve nt further delays in treatme nt and poorer clinical outcomes.展开更多
文摘AIM:To review the relevant literature in an effort to examine the body of evidence available to date.METHODS:Ovid MEDLINE search database was queried using MeS H terms"penile induration","peyronie’s disease","Collagenases"and"Collagenase"using various permutations.No temporal parameters were employed.RESULTS:In all,5 relevant clinical trials were isolated from 34 results.These trials were analyzed using the Oxford Centre for Evidence-Based Medicine criteria.They were further examined based on study design and methods;the primary and secondary outcomes were reviewed for treatment efficacy and collagenase-related side effects.CONCLUSION:Intralesional collagenase appears to be safe and effective in the non-surgical treatment of Peyronie’s disease.However,the data remains limited and further inquiries into the safety of collagenase,treatment standardization and standardized outcomesreporting remain necessary.Furthermore,studies comparing intralesional collagenase to alternative medical and surgical therapy will be important in guiding the future treatment decision process.
文摘Surgical treatment of Peyronie's disease(PD) is still a challenge and a gold standard approach does not exist; however the main goal is to straight penile shaft, and to restore penetrative and coital capacity. The less invasive approach aims to correct curvature without intervening directly on the fibrous plaque while the more complex "corporoplasty" applies specific geometric criteria and uses different autologous and heterologous grafts. Each approach has its pros and cons and decisionmaking should be tailored to the individual patient's expectations. Other surgical options include different use of patches to cover the tunica albuginea defect, with the choice depending on the surgeon's personal experience. Despite the wide range of autologous(buccal mucosa, vein, dermis, etc.) and heterologous grafts(bovine pericardium, swine intestinal submucosa, porcine dermis, etc.) none currently represents the real "gold standard" because the data are extremely variable and frequently not representative. Several factors seem to favor buccal mucosa grafts over inert biocompatible materials: as vital tissue, buccal mucosa tends to heal rapidly, immediately integrating with the surrounding albuginea tissue. This translates into a more rapid resumption of spontaneous erections(after 3/4 d) and sexual activity and into a reduced risk of curvature relapse and erectile dysfunction after surgery. Another advantage of the buccal mucosa graft is its low cost. In conclusion, despite the recent development of some exciting new surgical techniques we are still unable to deliver a definitive take-home message about reconstructive surgery in PD because the majority of the studies reported insufficient data. However, since it is clear that major outcomes, besides the cosmetic result, are the patient's and partner's satisfaction and the economic impact of each technique, we recommend they be included among the outcome assessment parameters in further
文摘The primary systemic vasculitides(PSV) are a group of rare inflammatory disorders affecting blood vessels of varying size and multiple organs. Urological manifestations of PSV are uncommon. Testicular vasculitis is the most commonly reported finding and is associated with Polyarteritis Nodosa(PAN), Henoch-Sch?nleinPurpura(HSP), anti-neutrophil cytoplasm antibody associated Vasculitides(AAV), Giant Cell Arteritis(GCA) and Kawasaki disease. Prostatic vasculitis has been reported in association with GCA and AAV. Ureteric involvement has been noted in PAN, HSP and AAV. Other urogenital manifestations of PSV include genital ulceration and bladder dysfunction in Beh?ets Disease and haematuria which is commonly seen in many of the PSV. Finally, therapies used to treat the PSV, especially cyclophosphamide, are associated with urological sideeffects including haemorrhagic cystitis and urothelial malignancy. The aim of this review is to examine how the urological system is involved in the PSV. Each PSV is examined in turn, with a brief clinical description of the disease followed by a description of the urological manifestations and management. Identification of urological manifestations of PSV is important as in many cases symptoms may improve with immunosuppressive therapy, avoiding the need for invasive surgery. Additionally, patients who present with isolated urogenital PSV are at higher risk of developing subsequent systemic vasculitis and will need to be followed up closely.
文摘Objective:To investigate the changes in elective private urological procedures in Australia during the coronavirus disease 2019 pandemic.Methods:Data were extracted from publicly available datasets from Medicare Ben efits Schedule using item nu mbers assig ned to each comm only performed urological interve ntion.These procedures were divided into three groups:Oncological therapeutic,diagnostic,and non-oncological therapeutic procedures.A smoothing model,based on the historic procedure numbers from 2017 to 2019,was used to forecast monthly number of procedures performed in each category between January 2020 and June 2020.These forecasted models were compared with reported figures.Results:A total of 108169 procedures were performed between January 2020 and June 2020 based on the Medicare Ben efits Schedule item nu mbers listed.There was a sign ifica nt reducti on(perce nt-age cha nge)in total procedures performed in April 2020(22.6%,95%con fide nee in terval[CI]:-28.7%to-15.4%)and May 2020(-33.2%,95%CI:-37.5%to 28.3%).There was a significant reduction in oncological therapeutic,non-oncological therapeutic,and diagnostic procedures performed in April 2020 and May 2020(p<0.05).These nu mbers did not in elude procedures performed in public sector.Conclusion:There was a significant reduction in total urological procedures(including diagnostic,oncological,and non-on cological)performed in mon ths of April 2020 and May 2020 during time of federal restrictions.Both public and private healthcare sectors need to be supported in the up-comi ng mon ths to preve nt further delays in treatme nt and poorer clinical outcomes.
