title: Intralesional Injection of Hyaluronic Acid in Patients Affected With Peyronie's Disease: Preliminary Results From a Prospective, Multicenter, Pilot Study.
abstract: BACKGROUND
  Hyaluronic acid has been shown to be efficacious in decreasing scar formation, inflammation, and oxidative stress.
  
  
  OBJECTIVE
  To assess the efficacy of intralesional injection of hyaluronic acid in patients affected by Peyronie's disease.
  
  
  METHODS
  In this prospective, single-arm, self-controlled, interventional, multicenter pilot study, 65 patients underwent a 10-week cycle of weekly intraplaque injections with hyaluronic acid (0.8% highly purified sodium salt hyaluronic acid 16 mg/2 mL; Sinovial, IBSA, Lodi, Italy). Patients were re-evaluated 2 months after the end of therapy.
  
  
  METHODS
  Plaque size (millimeters), penile curvature (degrees), International Index of Erectile Function (IIEF-5) score, visual analog scale (VAS) score for sexual satisfaction, and Patient's Global Impressions of Improvement (PGI-I) score.
  
  
  RESULTS
  Median age was 57 years (range = 23-70). At baseline, mean plaque size was 10 mm (range = 3-30 mm), mean penile curvature was 30° (range = 0°-50°), and mean IIEF-5 score was 20 (range = 0-25), with slight to moderate erectile dysfunction (IIEF score < 21) in 36 of 65 patients (55%). A median VAS score of 6 (range = 2-10) was found. Mean follow-up was 12 months (range = 6-24 months). Statistically significant post-treatment improvements were detected for plaque size (before treatment = 10 mm [3-30 mm], after treatment = 8 mm [1-30 mm], P < .0001), penile curvature (before treatment = 30° [0°-50°], after treatment = 20° [0°-40°], P < .0001), IIEF-5 score (before treatment = 20 [11-25], after treatment = 21 [15-25], P < .0001), and VAS score (before treatment = 6 [2-10], after treatment 8 [2-10], P < .0001). After treatment, the rate of patients with an IIEF score lower than 21 decreased from 55% (36 patients) to 40% (25 patients). Overall improvement on the PGI-I questionnaire was 69%.
  
  
  CONCLUSIONS
  Intralesional treatment with hyaluronic acid can improve plaque size, penile curvature, and overall sexual satisfaction and seems preferably indicated in the early (active) phase of the disease. Furthermore, it is easy to perform and well tolerated.
authors.affiliation: Urology and Andrology Department, University of Perugia, Perugia, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Zucchi
authors.affiliation: Urology and Andrology Department, University of Perugia, Perugia, Italy.
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Costantini
authors.affiliation: Urology Unit, Santa Chiara Regional Hospital, Trento, Italy.
authors.forename: Tommaso
authors.initials: T
authors.lastname: Cai
authors.affiliation: Medicitalia Andrology Section, Outpatient Clinic of Ferrara, Ferrara, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Cavallini
authors.affiliation: Urology Unit, Cattinara Hospital, Trieste, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Liguori
authors.affiliation: Urology Department, University of Catania, Catania, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Favilla
authors.affiliation: Urology Unit, Umberto I Hospital, Siracusa, Italy.
authors.forename: Gaetano
authors.initials: G
authors.lastname: De Grande
authors.affiliation: Urology Unit, San Giacomo Hospital, Monopoli, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: D'Achille
authors.affiliation: Urology Unit, "degli Infermi" Hospital, Biella, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Silvani
authors.affiliation: Urology Department, University "La Sapienza", Rome, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Franco
authors.affiliation: Urology Department, University of Naples Federico II, Naples, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Palmieri
authors.affiliation: Urology Department, University of Naples Federico II, Naples, Italy. Electronic address: pverze@gmail.com.
authors.forename: Paolo
authors.initials: P
authors.lastname: Verze
authors.affiliation: Urology Department, University of Naples Federico II, Naples, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Mirone
keywords: Hyaluronic Acid; Intralesional Therapy; Penile Curvature; Peyronie's Disease