Assuta Medical Center, Ben Gurion University of the Negev, Beer Sheva.
Arch Ital Urol Androl. 2020 Oct 2;92(3). doi: 10.4081/aiua.2020.3.253.
To assess the effectiveness of an intralesional injection of verapamil in men with Peyronie's disease (PD).
The data provided in the current review are based on a thorough review of the available original articles on PD retrieved with a systematic literature search using PubMed- Medline, and the Cochrane Central Register of Controlled Trials, up to December 2019, to identify studies dealing with Peyronie's disease and its treatment. Included were only original articles, that we thoroughly evaluated. We searched for the primary and secondary terms of: "Peyronie's disease," "Penile curvature," "Erectile dysfunction," "Verapamil and Peyronie's disease," "Calcium channel blocker," and "Intralesional injection."
The initial search of the databases yielded a total of 1240 studies (PubMed: 1058; Cochrane: 182), as of December 2019. Seventy studies were removed due to duplication. Further 986 studies were removed due to not being in English (except for one study by Arena F. for which we got a translation form Italian), being about animal experimentations, not being full-text, and not being clinical trials. Likewise, studies not referring at all to verapamil were excluded (148). From the remaining 36 full-text articles we focused on 13 studies which met the inclusion criteria, mainly being deemed relevant to the context of this study.
Calcium channel blockers have been shown in both in vitro and in vivo studies to inhibit the synthesis and secretion of extracellular matrix molecules, as well as to increase collagenase activity. Patients with localised plaque are the best candidates for intralesional injections of verapamil. The beneficial effects of intralesional verapamil are apparent within the first three months. For patients who respond to treatment, the injections should be continued for six months. Patients who fail to respond to intralesional verapamil or whose angulation is greater than 30° at presentation should be considered candidates for surgery. Injection of verapamil is clinically safe for patients with Peyronie's disease, and it appears to induce a rapid, beneficial effect in patients for the reduction of plaque size. Intralesional verapamil injection for Peyronie's disease could reduce pain, decrease penile curvature, and improve sexual function.
评估局部注射维拉帕米治疗男性 Peyronie 病（PD）的效果。
本综述提供的数据基于对 PubMed-Medline 和 Cochrane 对照试验中心注册库中 PD 相关原始文献的系统检索，检索时间截至 2019 年 12 月，以确定与 Peyronie 病及其治疗相关的研究。仅纳入经全面评估的原始研究。我们检索了以下主要和次要术语：“Peyronie 病”、“阴茎弯曲”、“勃起功能障碍”、“维拉帕米与 Peyronie 病”、“钙通道阻滞剂”和“局部注射”。
截至 2019 年 12 月，数据库最初检索共获得 1240 项研究（PubMed：1058 项；Cochrane：182 项）。由于重复，有 70 项研究被排除。另外，由于非英语文献（除了 Arena F 的一篇研究，我们通过意大利语获得了翻译版本）、动物实验、非全文文献和非临床试验，有 986 项研究被排除。同样，由于完全不涉及维拉帕米的研究也被排除（148 项）。在剩下的 36 篇全文文章中，我们重点关注了符合纳入标准的 13 项研究，主要是因为这些研究与本研究的背景相关。
在体外和体内研究中，钙通道阻滞剂已被证明可以抑制细胞外基质分子的合成和分泌，并增加胶原酶活性。局部斑块患者是局部注射维拉帕米的最佳人选。局部注射维拉帕米的有益效果在最初的三个月内就显现出来。对于对治疗有反应的患者，应继续注射 6 个月。对于对局部维拉帕米治疗无反应或初始弯曲角度大于 30°的患者，应考虑手术治疗。维拉帕米注射对 Peyronie 病患者是安全的，它似乎可以迅速改善患者的斑块大小，从而带来有益的效果。局部注射维拉帕米治疗 Peyronie 病可以减轻疼痛、降低阴茎弯曲度并改善性功能。
