Urologie médicale et chirurgicale
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Minimally Invasive Therapy with Intralesional Onabotulinum Toxin A in Peyronie Disease

Fuentes-Orozco Clotilde3*, Muñoz-Rangel Carlos Arturo1, Fernandez-Vivar Elieser1, Bañuelos-Gallo Ruben Alejandro2, Gonzalez-Ojeda Alejandro3, Macias-Amezcua Michel Dassaejv3, Chavez-Tostado Mariana3, Ramirez-Campos Kenia Militzi3, Ramirez-Arce Anais del Rocio3 and Cortes Lares Jose Antonio3

Objective: To determine the effectiveness of intralesional application of onabotulinum toxin A in patients with Peyronie disease. Materials & Methods: A prospective therapeutic cohort study was undertaken in patients ≥18 year with stable disease were included. Intervention: One-time intralesional application of 100 IU of onabotulinum toxin A. We included 22 patients from Urology consult from october 1st 2011 to june 30th 2012. Primary outcome measure: Grade of curvature. Secondary outcome measures: Thickness of the fibrous plaque, erectile dysfunction improvement and pain. Statistical analysis included the Pearson chi-square test for categorical variables and the student t test for 
quantitative variables. Any p value <0.05 was considered statistically significant. Results: The size of the fibrous plaque was reduced from 0.34±0.20 cm to 0.27±0.13 cm after treatment (p=0.014). The curvature initially averaged 32.95±9.21°, improving to 25±9.38° (p=0.025). According to the Kelami classification, the curvature was <30° in 14 cases (63.6%) and was 30–60° in 8 cases (36.4%). At 16 wk, the curvature was <30° in 19 cases (86.4%) and 30– 60° in 3 cases (13.6%). The erectile dysfunction grade was 16.18±4.46 before treatment and 18.22±4.55 after treatment (p=0.002). Pain was reduced from 3.36±3.48 before treatment to 1.14 1.58 after treatment (p=0.001). Conclusions: The application of onabotulinum toxin A can improve the clinical manifestations of Peyronie disease due to fibrosis, increasing sexual function in affected patients.