Stern Noah, Punjani Nahid, Brock Gerald
Division of Urology, London Health Sciences Centre , London, Ontario, Canada.
Division of Urology, Weill Cornell Medicine , New York, NY, USA.
Sex Med. 2021 Jun;9(3):100346. doi: 10.1016/j.esxm.2021.100346. Epub 2021 May 30.
Atypical penile tunical lesions including isolated septal (ISS) and punctate scarring (PS) are an under recognized and difficult to treat subset of Peyronie's disease (PD) that often present with normal physical exams. Current guidelines provide little direction in the treatment of these men.
To review the results of our treatment approach in men with ISS and PS.
Data from all men undergoing duplex ultrasonography for either Peyronie's disease and/or erectile dysfunction over a 3-year period were reviewed. All men with ISS or PS and normal physical exams were included. First- and second-line treatment preferences and satisfaction with treatment in men with ISS and PS were retrospectively reviewed. Logistic regression was used to investigate associations between scar features and treatment preference MAIN OUTCOME MEASURES: Treatment preference patterns, treatment satisfaction.
A total of 217 men with ISS and 197 men with PS were identified. Of these, 71 ISS and 86 PS patients had normal physical exams. Majority of men in both ISS (70.4%) and PS (81.4%) cohorts initially opted for non-invasive management through either observation, oral therapy, or traction therapy. After initial management 84.5% of ISS and 93% of PS patients were satisfied with their results. A significant trend toward inflatable prostheses as second line therapy was seen in men with PS.
There is a mounting need for clinical guidance in order to best manage men with atypical PD in the absence of societal guidelines and high-quality studies. This series provides guidance to clinicians on the management of these men, suggesting that conservative therapy and education may be sufficient. A standardized approach of increasing invasiveness showed reasonable rates of satisfaction with minimally invasive therapies playing a prominent role. Stern N, Punjani N, Brock G, Management of Patients With Normal Physical Exams and Ultrasound Evidence of Isolated Septal and Punctate Penile Scarring. Sex Med 2021;9:100346.
非典型阴茎白膜病变，包括孤立性中隔病变（ISS）和点状瘢痕形成（PS），是佩罗尼氏病（PD）中未被充分认识且难以治疗的一个亚组，其体格检查通常正常。当前指南在这些男性患者的治疗方面提供的指导很少。
回顾我们对患有ISS和PS的男性患者的治疗方法的结果。
回顾了在3年期间因佩罗尼氏病和/或勃起功能障碍接受双功超声检查的所有男性患者的数据。纳入所有患有ISS或PS且体格检查正常的男性患者。回顾性分析了患有ISS和PS的男性患者的一线和二线治疗偏好以及对治疗的满意度。使用逻辑回归研究瘢痕特征与治疗偏好之间的关联。主要观察指标：治疗偏好模式、治疗满意度。
共识别出217例患有ISS的男性患者和197例患有PS的男性患者。其中，71例ISS患者和86例PS患者体格检查正常。ISS组（70.4%）和PS组（81.4%）的大多数男性最初选择通过观察、口服治疗或牵引治疗进行非侵入性管理。初始治疗后，84.5%的ISS患者和93%的PS患者对治疗结果满意。在患有PS的男性患者中，作为二线治疗的可膨胀假体有显著的使用趋势。
在缺乏社会指南和高质量研究的情况下，为了更好地管理非典型PD男性患者，对临床指导的需求日益增加。本系列研究为临床医生管理这些男性患者提供了指导，表明保守治疗和教育可能就足够了。一种逐渐增加侵入性的标准化方法显示，微创治疗的满意度较高，发挥了重要作用。斯特恩N、蓬贾尼N、布罗克G，体格检查正常且超声检查有孤立性中隔和点状阴茎瘢痕形成证据的患者的管理。性医学2021；9：100346。
