Minimally Invasive Therapy Using Intralesional OnabotulinumtoxinA in Peyronie's Disease.
OBJECTIVE
To determine the effectiveness of intralesional administration of onabotulinumtoxinA in patients with Peyronie’s disease (PD).


METHODS
A prospective therapeutic cohort study was undertaken in patients aged ≥ 18 years with stable PD. Intervention included one-time intralesional application of 100 U of onabotulinumtoxinA. We included 22 patients who attended the urology clinic from October 1, 2011 to June 30, 2012. Primary outcome measure was degree of curvature. Secondary outcome measures were thickness of the fibrous plaque, improvement in erectile function and pain. Erectile function was evaluated using the International Index of Erectile Function (IIEF-5) questionnaire. The Visual Analog Scale (VAS) was used to measure pain during an erection. Statistical analyses were performed by Pearson’s chi-squared test for categorical variables and student’s t-test for quantitative variables. Any P value < .05 was considered statistically significant.


RESULTS
The size of the fibrous plaque was reduced from 0.34 ± 0.20 to 0.27 ± 0.13 cm after treatment (P = .014). The curvature initially averaged 32.95 ± 9.21°, and improved to 25 ± 9.38° (P = .025). According to the Kelami classification, the curvature was < 30° in 14 cases (63.6%) and was 30°-60° in eight cases (36.4%). At 16 weeks, the curvature was < 30° in 19 cases (86.4%) and 30°-60° in three cases (13.6%). The IIEF-5 score was 16.18 ± 4.46 before treatment and 18.22 ± 4.55 after treatment (P = .002). Pain was reduced from 3.36 ± 3.48 before treatment to 1.14 ± 1.58 after treatment (P = .001).


CONCLUSIONS
The administration of onabotulinumtoxinA may improve the clinical manifestations of PD resulting from fibrosis, thus improving sexual function in patients.
Department of Urology, Medical Unit of High Specialty, Specialties Hospital of the Western Medical Center, Mexican Institute of Social Security, Guadalajara 44349, Jalisco, Mexico.
Carlos Arturo
CA
Muñoz-Rangel
Department of Urology, Medical Unit of High Specialty, Specialties Hospital of the Western Medical Center, Mexican Institute of Social Security, Guadalajara 44349, Jalisco, Mexico.
Elieser
E
Fernandez-Vivar
Department of Bañuelos Radiologos, Medical Unit of High Specialty, Specialties Hospital of the Western Medical Center, Mexican Institute of Social Security, Guadalajara 44349, Jalisco, Mexico.
Ruben Alejandro
RA
Bañuelos-Gallo
Department of Research Unit in Clinical Epidemiology, Medical Unit of High Specialty, Specialties Hospital of the Western Medical Center, Mexican Institute of Social Security, Guadalajara 44349, Jalisco, Mexico.
Alejandro
A
Gonzalez-Ojeda
Department of Research Unit in Clinical Epidemiology, Medical Unit of High Specialty, Specialties Hospital of the Western Medical Center, Mexican Institute of Social Security, Guadalajara 44349, Jalisco, Mexico.
Michel Dassaejv
MD
Macias-Amezcua
Department of Research Unit in Clinical Epidemiology, Medical Unit of High Specialty, Specialties Hospital of the Western Medical Center, Mexican Institute of Social Security, Guadalajara 44349, Jalisco, Mexico.
Mariana
M
Chavez-Tostado
Department of Research Unit in Clinical Epidemiology, Medical Unit of High Specialty, Specialties Hospital of the Western Medical Center, Mexican Institute of Social Security, Guadalajara 44349, Jalisco, Mexico.
Kenia Militzi
KM
Ramirez-Campos
Department of Research Unit in Clinical Epidemiology, Medical Unit of High Specialty, Specialties Hospital of the Western Medical Center, Mexican Institute of Social Security, Guadalajara 44349, Jalisco, Mexico.
Anais del Rocio
Adel R
Ramirez-Arce
Department of Research Unit in Clinical Epidemiology, Medical Unit of High Specialty, Specialties Hospital of the Western Medical Center, Mexican Institute of Social Security, Guadalajara 44349, Jalisco, Mexico.
Jose Antonio
JA
Cortes-Lares
Department of Research Unit in Clinical Epidemiology, Medical Unit of High Specialty, Specialties Hospital of the Western Medical Center, Mexican Institute of Social Security, Guadalajara 44349, Jalisco, Mexico. clotilde.fuentes@gmail.com.
Clotilde
C
Fuentes-Orozco
D065087:Acetylcholine Release Inhibitors / Q000008:administration & dosage; D000328:Adult; D000368:Aged; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D005500:Follow-Up Studies; D006801:Humans; D015552:Injections, Intralesional; D008297:Male; D008875:Middle Aged; D010410:Penile Erection / Q000187:drug effects*; D010411:Penile Induration / Q000188:drug therapy* / Q000503:physiopathology; D011446:Prospective Studies; D016896:Treatment Outcome
D065087:Acetylcholine Release Inhibitors; D019274:Botulinum Toxins, Type A