A new biopsy technique to investigate Peyronie's disease associated histologic alterations: results with two different forms of therapy.
OBJECTIVE
Peyronie's disease is the most frequent cause of penile curvature and occurs particularly in middle-age patients. The best technique for penile biopsy, in the evaluation of albuginea and cavernous tissue, has not been delineated yet. We present a new technique of penile biopsy, useful in the study of Peyronie's plaque, fibrosis and erectile dysfunction or any other pathological condition of the penis requiring a biopsy.


METHODS
A treatment group (A) of 380 patients underwent Extra Shock Waves Treatment (ESWT) three times a week for 20 minutes, followed by a complete cycle of 12 injections of verapamil (10mg), every two weeks for six months. A control group (B) of 92 patients underwent verapamil injections alone. Three months after the end of the treatment, each patient underwent penile biopsy performed with Acu-Punch (Acuderm Inc.), a biopsy-punch armed with a well-sharpened rotating cylindrical blade, first used by dermatologists for cutaneous lesions.


RESULTS
A reduction of the plaque volume was found in 260/380 patients (68.4%) of group A and in 28/92 (30.4%) of group B; painful erection weaned off in 312/340 patients of group A (91.7%) and in 36/82 patients (43.9%) of group B. In all 472 patients an excellent specimen was obtained and both the tunica albuginea and the cavernous tissue were easily identified. In the 260 cases, in which the Extra Shock Waves Treatment was successful, scanning and transmission electron microscopy demonstrated a reduction in packing and clumping of the collagen fibers.


CONCLUSIONS
This new technique of penile biopsy with Acu-Punch can replace surgical biopsies when a surgical operation is not indicated. Such a low-invasive technique could be performed in all cases of Peyronie's disease and allows a more extensive use of microscopic analysis in the study of Peyronie's disease.
Mirone
Vincenzo
V
Department of Urology, University of Naples "Federico II", Via Morghen 181, 80129, Naples, Italy.
Imbimbo
Ciro
C
Palmieri
Alessandro
A
Longo
Nicola
N
Fusco
Ferdinando
F
Tajana
Gianfranco
G
D000328:Adult; D000368:Aged; D001707:Biopsy, Needle / Q000379:methods*; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D010411:Penile Induration / Q000473:pathology*; D010413:Penis / Q000473:pathology* / Q000601:surgery; D016896:Treatment Outcome; D014464:Ultrasonic Therapy; D014700:Verapamil / Q000627:therapeutic use
D002121:Calcium Channel Blockers; D014700:Verapamil