Trimodal mini-invasive therapy for stable-phase Peyronie's disease: a two-center real-life prospective pilot study

Trimodal mini-invasive therapy for stable-phase Peyronie's disease: a two-center real-life prospective pilot study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Trimodal mini-invasive therapy for stable-phase Peyronie's disease: a two-center real-life prospective pilot study Fausto Negri, Edoardo Pozzi, Leutrim Zahiti, Gabriele Birolini, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7634265/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Introduction : Platelet-Rich Plasma (PRP) into penile plaques has emerged as a promising approach for treating acquired penile curvature in men with stable-phase Peyronie's Disease (PD), although it is still investigational. We aimed to analyze the preliminary results of a two-center real-life prospective pilot study. Material and methods : Data from 38 patients undergoing PRP injections were prospectively collected. All patients underwent dynamic penile Color Doppler-duplex ultrasound (CDDU) at baseline and follow-up to assess penile hemodynamic parameters and objective measurement of penile morphometric parameters. Similarly, all men completed the International Index of Erectile Function (IIEF) and the Peyronie's Disease Questionnaire (PDQ) at baseline and follow-up. According to the center, PRP was obtained using double or single blood centrifugation (2-cycle vs. 1-cycle group). All patients received two injections, each consisting of an average of 8 mL of PRP, administered 4-week apart. Thereafter, patients started using tadalafil 5 mg one-daily. Likewise, one week apart from PRP injections, patients started daily penile stretching with Vacuum Device (5-15 minutes daily). All patients had three-month follow-up assessment, including IIEF-EF, PDQ and CDDU. Results : Median (IQR) age and BMI were 60.5 (55, 66.8) years and 25.9 (24.1, 27.3) kg/m 2 , respectively. Overall, 22 (57.9%) patients received PRP injection after two centrifuge cycles and 16 (42.1%) after one centrifuge cycle. In the 2-cycle group, baseline penile curvature was 45° (37, 70), decreasing to 40° (30, 50) at three-month follow-up (p=0.002). Conversely, in the 1-cycle group, baseline curvature was 60° (50, 66), decreasing to 50° (40, 56) at three-month follow-up (p=0.008). Overall, median baseline penile curvature was 55° (45, 70) and decreased to 45° (30, 55) after PRP treatment, with a median reduction of 10° (0, 15) (p<0.001). Median PDQ scores at baseline were 22 (20.5, 23) in the 2-cycle group and 22.5 (20, 32.75) in the 1-cycle group, respectively. At three-month follow-up, PDQ decreased to 20.5 (16, 22) and 18 (14.5, 22), respectively in the two groups (both p≤0.006). For both groups, IIEF-EF scores and CDDU parameters did not change over time. Median plaque diameter decreased from 18 (9.3, 21.7) and 8 (6, 9.6) to 17 (9.8, 20) and 7.5 (5, 9.7) mm, respectively, without statistical significance. No treatment-emergent adverse events were reported. Conclusions : Preliminary findings indicate that PRP injections are a safe therapeutic option to ameliorate penile morphometric parameters and PDQ scores in men with bothersome penile curvature in stable-phase PD. The observed decrease in penile curvature is still inadequate to extrapolate clinically significant long-term outcomes. Urology & Nephrology Peyronie’s disease Platelet-rich plasma PDE5i vacuum therapy Figures Figure 1 INTRODUCTION Even though quality of evidence remains low and is characterized by significant methodological limitations, a few methods have been suggested to improve signs and symptoms in the active phase of Peyronie’s disease (PD), including extracorporeal shockwave therapy (ESWT), injection and mechanical therapy (traction therapy and vacuum therapy) ( 1 ). On the contrary, non-surgical approaches for the stable phase are even more limited. As a matter of fact, if we exclude the surgical treatments - i.e., shortening or lengthening procedures, and penile prosthesis implantation which are usually reserved for non-responders or those with severe penile curvature, no clear and internally-approved treatments are currently available in Europe available for satisfactory relief of signs and symptoms in stable-phase PD ( 2 ). Based on pre-clinical and clinical findings, autologous platelet-rich plasma (PRP) intra-plaque injections have been proposed as a potential novel therapeutic treatment ( 3 – 5 ). The rationale of using PRP raises from the high concentrations of cytokines and growth factors (GFs) within platelets, which increase cell proliferation, modulate inflammatory response, and stimulate angiogenesis, thus leading to improved body’s healing response ( 6 ). However, only a few observational studies have evaluated its effect on stable-phase PD. Thus, we aimed to conduct a two-center real-life prospective pilot study to access the safety and efficacy of this intra-plaque treatment in a cohort of patients seeking medical help for bothersome penile curvatures associated with stable-phase PD. MATERIAL AND METHODS Study population and variables definition Data from 38 men seeking medical help for bothersome penile curvatures associated with stable-phase PD as their primary complaint and undergoing PRP injections at two academic centers were prospectively collected and analyzed. All subjects were assessed via a thorough medical and sexual history. Clinical data were collected as reported: arterial hypertension, defined by the measurement of arterial systolic pressure ≥ 140 mm/Hg and/or arterial diastolic pressure ≥ 90 mm/Hg, or by the daily use of one or more antihypertensive drugs ( 7 ); type 1 or 2 diabetes mellitus, according to the definition of ESC-EASD guidelines ( 8 ). Data on the history of previous penile traumas and recreational status, including smoking history, were also comprehensively investigated. Body Mass Index (BMI) was measured for each patient. According to our internal protocol, all patients underwent dynamic penile Color Doppler-duplex ultrasound (CDDU) following an intra-cavernous injection of 20 µg Alprostadil ( 9 , 10 ) both at baseline and follow-up assessments. All diagnostic procedures were performed by the same group of experienced physicians. Both peak systolic velocity (PSV) and the resistivity index (RI) were assessed bilaterally at 5 and 20 minutes after Alprostadil injection and manual stimulation, to minimize the influence of patient distress, technician skills, and variations in measurements location and timing. An average PSV value of < 35 cm/s between the right and left cavernosal arteries was used as a threshold to define penile cavernosal arterial insufficiency ( 11 – 13 ). Similarly, an average RI of < 0.85 was used to suggest the presence or coexistence of penile corporal veno-occlusive dysfunction ( 11 – 13 ). Lastly, to obtain an objective measurement of penile curvature, a manual measurement of penile curvature with a goniometer at maximum rigidity of the penis was performed for each patient at the time of CDDU ( 14 , 15 ). Venous blood samples were drawn from each patient between 6 AM and 10 AM after overnight fasting. Complete blood count, glycated hemoglobin (Hb1Ac), vitamin D, total cholesterol, triglycerides, low-density lipoprotein cholesterol (C-LDL) and high-density lipoprotein cholesterol (C-HDL) were measured for each patient at baseline. Moreover, all patients completed the International Index of Erectile Function (IIEF) ( 16 , 17 ) and the Peyronie’s disease questionnaire (PDQ) ( 18 ) both at baseline assessment and at 3-mo follow-up. ED severity was classified according to Cappelleri’s criteria ( 19 ). PRP protocol The PRP was prepared using a dedicated autologous platelet separator. Specifically, approximately 8 mL of autologous PRP was obtained at the end of the entire process through two different methodologies: i) Two-step centrifugation (2-cycle group): a total of 18 mL of peripheral venous blood and 2 mL of sodium citrate (3.8%) were collected and processed using the Duografter Il system. The samples were centrifugated first at 1,800 rpm (322 × g) for 8 minutes, followed by 2,000 rpm (456 x g) for 10 minutes; and, ii) One-step centrifugation (1-cycle group): PRP was prepared from 2 x 15 mL of peripheral venous blood, processed by using the Hettich Rotofix 32 A system at 1,500 rpm (377x g) for 5 minutes. Under local anesthesia (dorsal nerve penile block) with lidocaine (2%) at the base of the penis, the PRP was injected into the plaque(s) of the penile shaft. Half of the PRP was injected on one side and half on the other. Intra- and post-procedure complications and treatment-emergent adverse events (TEAEs) were monitored for each patient. A second injection of PRP, following the same procedural steps, was administered four-week apart in all cases. Thereafter, patients started using tadalafil 5 mg one-daily (OaD). Likewise, one week apart from PRP injections, patients started daily penile stretching with Vacuum Device (VED) (5–15 minutes daily). Statistical analysis We used descriptive statistics to detail the socio-demographic and clinical characteristics of the whole cohort. Medians and interquartile ranges (IQR) or frequencies and proportions were reported for continuous or categorical variables, respectively. Mann-Whitney U and Chi-square tests were used to compare the statistical significance of differences in the distribution of continuous or categorical variables, respectively. Subsequently, the cohort was stratified according to the number of centrifugation cycles (1 cycle vs 2 cycles), and differences in penile curvature between groups were assessed using Welch’s t-test. Finally, box plots were used to visualize the median curvature change after the PRP injections at the three-month follow-up mark. All statistical tests were two-sided with a significance value set at 0.05. The analyses were conducted using R (2025), a language and environment for statistical computing, R Foundation for Statistical Computing, Vienna, Austria. Study approval Data collection followed the principles outlined in the Declaration of Helsinki. All patients signed an informed consent agreeing to provide anonymous information for future studies. The study was approved by the IRCCS San Raffaele Hospital Ethical Committee (Prot. 2014 – Outpatients). RESULTS Table 1 details the descriptive statistics of the whole cohort of patients. At baseline, 24 (63.1%) patients had a dorsal curvature, 5 (13.2%) a dorso-lateral curvature, 4 (10.5%) a lateral curvature, 3 (7.9%) a ventral curvature, and 2 (5.3%) a ventro-lateral curvature, respectively. Median (IQR) age and BMI were 60.5 (55, 66.8) years and 25.9 (24.1, 27.3) kg/m 2 , respectively. Of 38 patients, 25 (65.8%) used tadalafil 5 mg OaD, and 35 (92.1%) have regularly used a VED. Overall, after PRP injections, three-month follow-up evaluation showed a median significant reduction in penile curvature of 10° (0, 15) (p < 0.001). Table 2 presents CDDU parameters and questionnaires’ scores according to the number of centrifugations. Specifically, 22 (57.9%) received PRP injection after two centrifuge cycles and 16 (42.1%) after one cycle, respectively. In the 2-cycle group, median baseline penile curvature decreased significantly from 45° (37, 70) to 40° (30, 50) at three-month follow-up (p = 0.002). Patients also reported significant improvements in PDQ-A (p = 0.002), PDQ-C (p = 0.008), and PDQ total scores (p = 0.006) over the same time frame. In the 1-cycle group, patients showed a baseline median penile curvature of 60° (50, 66), which significantly decreased to 50° (40, 56) at three-month follow-up (p = 0.008). After PRP injections, patients reported a significant improvement in the overall satisfaction (OS) domain of the IIEF (p = 0.03), as well as significant improvements at in PDQ-A (p = 0.002), PDQ-C (p = 0.007), and PDQ total scores (p = 0.002). No significant difference in curvature change was found between the 1-cycle and 2-cycle centrifugation groups. Plaque diameter, CDDU parameters and IIEF-erectile function (EF) scores did not change over time in both groups. No TEAEs were registered during or after PRP injections. Figure 1 shows boxplots comparing median penile curvature before and after PRP injections in the whole cohort, stratified by the number of centrifugation cycles (1-cycle vs. 2-cycle). DISCUSSION This prospective two-center pilot study describes the real-life characteristics of men presenting with stable-phase PD as their primary complaint. After PRP injections combined with tadalafil 5 mg OaD and daily penile stretching with VED, three-month follow-up evaluation showed a median significant reduction in penile curvature of 10°. Moreover, a subgroup of men reported significant improvements in terms of IIEF-OS domain, total PDQ, PDQ-A and PDQ-C scores. In the context of conservative intralesional treatments for stable-phase PD, autologous PRP injection represents a promising option. However, due to lack of prospective randomized studies, the European Association of Urology (EAU) specifically denotes PRP as only experimental in PD ( 1 ). Conversely, in broader clinical practice, PRP appears to be a safe therapeutic option with encouraging results across multiple organ systems. Studies in orthopedics, cosmetology and dermatology, sports medicine, ophthalmology and reproductive medicine have suggested improved patient outcomes with its use ( 20 – 22 ). Platelets are a source of biologically active proteins known as platelet-derived GFs, including epidermal GF (EGF), insulin-like GF (IGF), platelet-derived GF (PDGF), fibroblast GF (FGF) as well some interleukin (IL). These GFs regulate all stages of the complex wound-healing process and, due to their high concentrations, influence the recruitment, proliferation, and differentiation of cells involved in tissue repair and regeneration, specifically inducing collagen deposition by activating fibroblasts ( 23 ). It remains difficult to compare current findings with previous studies. For instance, the first study on PRP in PD was published by Virag et al . in 2017, and the authors used a combined injection of PRP and hyaluronic acid in 90 participants with established penile plaques and deformity ( 24 ). Subsequent studies provided different protocols. Even more relevant, the composition of PRP is not standardized and may vary in platelets, leukocytes, and GFs concentrations depending on adopted methodological techniques ( 25 ). The level of secreted GFs depends on the number of active platelets, the timing of PRP preparation, the method of blood collection, the type of anticoagulant used, centrifugation parameters (i.e., duration, speed and temperature), the final pH of the solution, and any activating agents employed. Efficacy and efficiency are also influenced by general factors such as patient age, hematocrit, and concomitant medications ( 6 , 26 ). Moreover, variations in PRP protocols and study designs add further heterogeneity which prejudice the possibility of suggesting adequate clinical conclusions. Notwithstanding these methodological limitations, our results concerning penile curvature align with those of previous prospective studies. Achraf et al. ( 4 ) divided a cohort of 65 patients with stable symptomatic PD into two groups based on baseline curvature (25–35° vs. 35–45°). They reported a mean curvature decrease of 16.88° [standard deviation (SD) 3.35] and 17.27° (SD 4.22), respectively, using on average 6.1 (range 4–7) PRP injections, obtained by centrifugation of 10 mL of patient blood twice for 8 minutes at 2800 rpm. Interestingly, they also noted improvements in EF and pain, as assessed by the visual analog scale pain questionnaire (p = 0.04) and the IIEF-5 (p = 0.02), respectively. Similarly, in their randomized, placebo-controlled crossover clinical trial update, Ledesma et al. ( 27 ) showed that at 6 months the PRP-Placebo group experienced a significant reduction in curvature [i.e., from 40° (40, 45) to 25° (20, 40), p = 0.047], whilst the Placebo-PRP group showed a nonsignificant reduction [i.e., from 40° (20, 50) to 32.5° (20, 50)]. Since no significant differences were observed at three-month follow-up, these results suggested a possible delayed effect of PRP; however, given the limited evidence, its therapeutic effect should still be interpreted with clinical caution. Dachille et al. ( 28 ) proposed a protocol similar to ours, consisting of three injections of 6 mL PRP obtained after two centrifugation phases (the first at 3500 rpm, and the second at 3000 rpm), administered each two weeks apart. Of note, PRP aliquots were prepared on the same day, and those not used immediately were frozen at − 30° for subsequent treatments, according to their clinical protocol. They reported a significant reduction in plaque diameter (from 11.1 to 8.2 mm, p = 0.004) and penile curvature (from 50° to 40°, p < 0.001). In the same study, all PDQ domain scores decreased significantly (all p ≤ 0.006), whereas the IIEF-5 score improved slightly from 18 to 19 without statistical relevance (p = 0.3) ( 28 ), thus partially confirming our findings. Similarly, Shirmann et al. ( 3 ) reported significant decreases in the PDQ-A (Δ= -4.61, p = 0.002) and PDQ-C (Δ= -2.44, p = 0.017) domains at three-month follow-up. A significant decrease was also observed in the PDQ-B domain (Δ= -3.63, p = 0.015), though this effect was no longer significant at 6-mo assessment. Overall, those findings suggest that penile curvature is primarily responsible for the psychophysical distress and discomfort reported by patients. As expected during the stable phase, however, pain relief was not observed after the therapeutic treatment. The current study, along with the most recent ones, confirmed that following PRP injections patients experience a significant reduction in psychosexual anxiety, which in our cohort was also reflected by a notable improvement in the OS domain of the IIEF. Compared to previous studies, our protocol also took into consideration the use of oral tadalafil in combination with penile stretching via VED on a daily basis. The rationale behind this approach is that a triple therapy — PRP injections, tadalafil, and VED therapy — may provide superior outcomes compared to a single or double treatment modality ( 29 , 30 ). More in details, the antifibrotic role of tadalafil was demonstrated in 2011 in a study of 35 patients with isolated septal scars who received tadalafil 2.5 mg OaD for 6 months. The majority (69%) reported a reduction of their septal scar. In this context, tadalafil might therefore play a key role in stabilizing penile curvature and plaque fibrosis ( 31 ). Likewise, Park et al. confirmed that tadalafil 5 mg OaD could treat PD by reducing the degree of penile curvature and plaque size ( 32 ). MacDonald et al. showed that men who initiated VED traction therapy for 10 minutes twice a day had a significant mean (SD) improvement of 23° ( 16 ) (p < 0.001) compared to baseline. Finally, in a cohort of 153 patients affected by PD in stable phase with erectile dysfunction, Dell’Atti et al. reported that regular use of VED plus tadalafil in patients who had undergone ESWT significantly provided more benefit in patients with PD in terms of penile deformity ( 33 ). Although this field is undeniably still in its infancy, there remains a clear need to develop and refine conservative treatments for patients who prefer to avoid the risks associated with surgery. In this setting, in the absence of standardized PRP preparation methods, treatment protocols, or consensus on injection timing and dosage ( 34 ), we have followed our internal protocol with encouraging results. Several caveats must be considered. First, although the protocol collects prospective data, the cohort size is modest, with limited long-term follow-up. Second, we did not include a placebo control group. Third, apart the use of validated questionnaires, we did not investigate patients’ subjective assessments regarding perceived improvement from initial condition. Fourth, the use of two different PRP preparation protocols, while useful for understanding which compound was actually more effective, may introduce bias into the data analysis. Fifth, the use of a trimodal therapy certainly impacts the encouraging benefit observed in these patients treated with PRP using two different protocols and may have at least partially obscured the true benefit of PRP injections alone, regardless of their composition. Sixth, we cannot exclude that a greater number of repeated doses of PRP is probably needed to sustain the benefit achieved at three-month assessment. Conversely, the prospective design and the use of rigorous measurements at maximal erections during penile CDDU evaluations before and after PRP injections, performed by the same group of experienced physicians, represent two key strengths of this study. CONCLUSIONS A trimodal mini-invasive approach - using PRP injections - suggests significant improvements in men with bothersome penile curvatures stable-phase PD. Given the limited sample size and the design of the study, the preliminary findings of this pilot study should be interpreted with caution. Therefore, despite encouraging results, several caveats must be considered before a definitive evaluation of therapeutic efficacy of PRP intra-plaque injections mya be provided. Declarations Author Contributions: Conceptualization: FN, AS. Data curation: FN, EP, LZ, GB, MR. Formal analysis: FN. Supervision: AS. Writing – original draft: FN. Writing – review & editing: EP, FM, AM, AS. All other co-authors reviewed the manuscript and participated in the revisions. Acknowledgements : None. Data Availability : The data underlying this article will be shared on reasonable request to the corresponding author. Funding : This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Ethical approval : The study was approved by the IRCCS San Raffaele Hospital Ethical Committee (Prot. 2014 – Outpatients). Competing interests : None. References Salonia A, Capogrosso P, Boeri L, Cocci A, Corona G, Dinkelman-Smit M, et al. 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Platelet-rich plasma intra-plaque injections rapidly reduce penile curvature and improve sexual function in Peyronie’s disease patients: results from a prospective large-cohort study. World J Urol. 2025 May 15;43(1):306. Cocci A, Cito G, Urzì D, Minervini A, Di Maida F, Sessa F, et al. Sildenafil 25 mg ODT + Collagenase Clostridium hystoliticum vs Collagenase Clostridium hystoliticum Alone for the Management of Peyronie’s Disease: A Matched-Pair Comparison Analysis. J Sex Med. 2018 Oct;15(10):1472–7. Alzubaidi RT, Abdelkareem M, Al-Zoubi RM, Al-Qudimat AR, Yasin A, Kamkoum H, et al. Outcomes and management of Peyronie’s disease with combined treatment of collagenase clostridium histolyticum, vacuum erection device, and tadalafil. Asian J Androl. 2025 May 2; Chung E, Deyoung L, Brock GB. The role of PDE5 inhibitors in penile septal scar remodeling: assessment of clinical and radiological outcomes. J Sex Med. 2011 May;8(5):1472–7. Park HJ, Park NC, Kim TN, Nam JK, Moon DG. 378 - Daily tadalafil therapy: A new treatment option for Peyronie’s disease? Eur Urol Suppl. 2017 Mar 1;16(3):e667. Dell’Atti L, Slyusar V, Ronchi P, Cambise C. Vacuum Erection Device Plus Once-Daily Tadalafil Improve Clinical Outcomes after Extracorporeal Shock Wave Therapy in Men Affected by Erectile Dysfunction Associated with Peyronie’s Disease. Life Basel Switz. 2024 Sept 13;14(9):1162. Asmundo MG, Durukan E, Von Rohden E, Thy SA, Jensen CFS, Fode M. Platelet-rich plasma therapy in erectile dysfunction and Peyronie’s disease: a systematic review of the literature. World J Urol. 2024 May 29;42(1):359. Tables Table 1. Socio-demographic and clinical characteristics of the whole cohort of patients with stable-phase PD who underwent PRP injections (N=38). Variable Baseline After PRP injections p-value Socio-demographic and clinical characteristics Patients 38 [100] 38 [100] Age (years) 60.5 [55, 66.8] \ Relation status \ Stable partner 35 [92.1] \ BMI (Kg/m 2 ) 25.9 [24.1, 27.3] \ Smoking \ Yes 10 [26.3] \ No/Ex-smoker 28 [73.7] \ Hypertension (Yes) 11 [29] \ Diabetes mellitus (Yes) 6 [15.8] \ Penile trauma (Yes) 6 [15.8] \ Vacuum device (Yes) 35 [92.1] \ Tadalafil (Yes) 25 [65.8] \ Curvature type \ Dorsal 24 [63.1] Dorso-lateral 5 [13.2] Lateral 4 [10.5] Ventral 3 [7.9] Lab data \ Hb (g/dL) 15.2 [14.4, 15.5] WBC (x10 9 /L) 6.9 [5.9, 7.7] Neutrophils 3.8 [3.5, 4.8] Lymphocytes 1.8 [1.5, 2.3] Monocytes 0.7 [0.6, 0.8] PLT (x10 9 /mL) 197 [165, 249] MPV (fL) 9.6 [9.2, 10.6] Hb1Ac (%) 5.4 [4.5, 5.8] Cholesterol (mg/dL) 191 [162, 221] C-LDL (mg/dL) 121 [94, 150] C-HDL (mg/dL) 56 [52, 62] Side effects (Yes) 0 (0) 0 (0) - CDDU Curvature (degree) 55 [45, 70] 45 [30, 55] <0.001 Plaque diameter (mm) 14 [7.5, 20] 10 [7.2, 18.5] 0.2 Calcified plaque 20 [52.6] 17 [44.7] 0.2 Mean PSV (cm/s) 38.6 [36.5, 54.7] 49.5 [37.9, 57.4] 0.6 Mean RI 0.98 [0.97, 0.99] 0.97 [0.93, 0.99] 0.2 Questionnaires PDQ score 22 [20, 23] 20 [16, 22] <0.001 PDQ A 11 [11, 13] 10.5 [8, 11.75] <0.001 PDQ B 0 [0, 3.75] 0 [0, 2.75] 0.2 PDQ C 9.5 [7, 11] 8 [7, 10.75] 0.03 IIEF domains EF score 21.5 [12.25, 26.75] 23 [14.25, 26] 0.1 IS score 7 [2, 10] 8 [2, 10] 0.4 OF score 8 [6, 9.5] 9 [5.75, 10] 0.4 SD score 8 [6.5, 9] 8 [6, 9] 0.2 OS score 6 [2, 7.5] 7 [4, 8] 0.04 Values are presented as number (%) or median (interquartile range). Keys : PRP: Platelet-rich plasma; BMI: Body Mass Index; PDE5is: phosphodiesterase type 5 inhibitors; CDDU: Dynamic – color doppler duplex ultrasonography; Hb: Hemoglobin; WBC: White blood cells; PLT: Platelets; MPV: Mean platelet volume; Hb1Ac: Hemoglobin A1c test; C-LDL: cholesterol-low density lipoprotein; C-HDL: cholesterol-high density lipoprotein; PDQ: Peyronie’s disease questionnaire; IIEF International Index of Erectile Function, EF – Erectile Function domain, IS – Intercourse Satisfaction domain, OF – Orgasmic Function domain, SD – Sexual Desire domain, OS – Overall Satisfaction domain. Table 2. Socio-demographic and clinical characteristics of the whole cohort of patients with stable-phase PD who underwent PRP injections (N=38) stratified by the number of centrifugations. Variable Baseline After PRP injections p-value 1 cycle group (n=16) CDDU Curvature (degree) 60 [50, 66] 50 [40, 56] 0.008 Plaque diameter (mm) 8 [6, 9.6] 7.5 [5, 9.7] 0.2 Calcified plaque 10 [62.5] 9 [56.2] 1 Mean PSV (cm/s) 37.5 [35.1, 38.1] 36.9 [33.1, 37.9] 0.5 Mean RI 0.98 [0.97, 0.98] 0.98 [0.97, 0.99] 0.7 Questionnaires PDQ score 22.5 [20, 32.75] 18 [14.5, 22] 0.002 PDQ A 12 [11, 17] 9 [8, 11] 0.002 PDQ B 0 [0, 3.75] 0 [0, 2.75] 0.4 PDQ C 9.5 [7, 11.75] 7.5 [4.5, 9.75] 0.007 IIEF domains EF score 22 [16, 27] 23 [18, 26] 0.4 IS score 8 [4, 10] 8 [5, 11] 0.8 OF score 8 [8, 9] 8 [7, 9] 0.8 SD score 8 [7, 9] 8 [7, 9] 0.6 OS score 6 [4, 8] 7 [4, 9] 0.03 2 cycles group (n=22) CDDU Curvature (degree) 45 [37, 70] 40 [30, 50] 0.002 Plaque diameter (mm) 18 [9.3, 21.7] 17 [9.8, 20] 0.3 Calcified plaque 10 [45.5] 8 [36.4] 0.5 Mean PSV (cm/s) 54.1 [42.6, 63.9] 55.6 [48.8, 62.2] 0.4 Mean RI 0.99 [0.96, 1] 0.97 [0.93, 1] 0.4 Questionnaires PDQ score 22 [20.5, 23] 20.5 [16, 22] 0.006 PDQ A 11 [11, 12] 11 [8, 11] 0.002 PDQ B 0 [0, 0] 0 [0, 0] 0.6 PDQ C 11 [9, 11] 8.5 [6.25, 11] 0.008 IIEF domains EF score 21 [7, 26] 23 [10, 27] 0.2 IS score 5 [0, 9.75] 10 [1, 10] 0.7 OF score 6 [1.5, 10] 9 [3.5, 10] 0.4 SD score 8 [6, 8.75] 8 [4.5, 9] 0.3 OS score 4.5 [2, 6.75] 5 [4.5, 8] 0.4 Values are presented as number (%) or median (interquartile range). Keys : CDDU: Dynamic – color doppler duplex ultrasonography; PDQ: Peyronie’s disease questionnaire; IIEF International Index of Erectile Function, EF – Erectile Function domain, IS – Intercourse Satisfaction domain, OF – Orgasmic Function domain, SD – Sexual Desire domain, OS – Overall Satisfaction domain. Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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07:52:49","extension":"html","order_by":8,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":91598,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7634265/v1/6806195ebf932d682afe9029.html"},{"id":91961215,"identity":"c3053a97-17ce-4616-ac2b-cc2ccaf44dcd","added_by":"auto","created_at":"2025-09-23 07:52:49","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":26302,"visible":true,"origin":"","legend":"\u003cp\u003eBoxplot showing median values of the penile curvature at baseline and after PRP injection for the entire cohort (n=38) based on number of centrifugations.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7634265/v1/1768eae93e9a4a89a60385d5.png"},{"id":91963146,"identity":"ecf84a33-0b03-466c-a3c3-1b97512b9aa5","added_by":"auto","created_at":"2025-09-23 08:00:49","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":823727,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7634265/v1/aa1b2f9e-a037-4e96-855a-e834f1b1b26f.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eTrimodal mini-invasive therapy for stable-phase Peyronie's disease: a two-center real-life prospective pilot study\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eEven though quality of evidence remains low and is characterized by significant methodological limitations, a few methods have been suggested to improve signs and symptoms in the active phase of Peyronie\u0026rsquo;s disease (PD), including extracorporeal shockwave therapy (ESWT), injection and mechanical therapy (traction therapy and vacuum therapy) (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). On the contrary, non-surgical approaches for the stable phase are even more limited. As a matter of fact, if we exclude the surgical treatments - i.e., shortening or lengthening procedures, and penile prosthesis implantation which are usually reserved for non-responders or those with severe penile curvature, no clear and internally-approved treatments are currently available in Europe available for satisfactory relief of signs and symptoms in stable-phase PD (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Based on pre-clinical and clinical findings, autologous platelet-rich plasma (PRP) intra-plaque injections have been proposed as a potential novel therapeutic treatment (\u003cspan additionalcitationids=\"CR4\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). The rationale of using PRP raises from the high concentrations of cytokines and growth factors (GFs) within platelets, which increase cell proliferation, modulate inflammatory response, and stimulate angiogenesis, thus leading to improved body\u0026rsquo;s healing response (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). However, only a few observational studies have evaluated its effect on stable-phase PD. Thus, we aimed to conduct a two-center real-life prospective pilot study to access the safety and efficacy of this intra-plaque treatment in a cohort of patients seeking medical help for bothersome penile curvatures associated with stable-phase PD.\u003c/p\u003e"},{"header":"MATERIAL AND METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy population and variables definition\u003c/h2\u003e\u003cp\u003eData from 38 men seeking medical help for bothersome penile curvatures associated with stable-phase PD as their primary complaint and undergoing PRP injections at two academic centers were prospectively collected and analyzed. All subjects were assessed via a thorough medical and sexual history. Clinical data were collected as reported: arterial hypertension, defined by the measurement of arterial systolic pressure\u0026thinsp;\u0026ge;\u0026thinsp;140 mm/Hg and/or arterial diastolic pressure\u0026thinsp;\u0026ge;\u0026thinsp;90 mm/Hg, or by the daily use of one or more antihypertensive drugs (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e); type 1 or 2 diabetes mellitus, according to the definition of ESC-EASD guidelines (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Data on the history of previous penile traumas and recreational status, including smoking history, were also comprehensively investigated. Body Mass Index (BMI) was measured for each patient. According to our internal protocol, all patients underwent dynamic penile Color Doppler-duplex ultrasound (CDDU) following an intra-cavernous injection of 20 \u0026micro;g Alprostadil (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e) both at baseline and follow-up assessments. All diagnostic procedures were performed by the same group of experienced physicians. Both peak systolic velocity (PSV) and the resistivity index (RI) were assessed bilaterally at 5 and 20 minutes after Alprostadil injection and manual stimulation, to minimize the influence of patient distress, technician skills, and variations in measurements location and timing. An average PSV value of \u0026lt;\u0026thinsp;35 cm/s between the right and left cavernosal arteries was used as a threshold to define penile cavernosal arterial insufficiency (\u003cspan additionalcitationids=\"CR12\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Similarly, an average RI of \u0026lt;\u0026thinsp;0.85 was used to suggest the presence or coexistence of penile corporal veno-occlusive dysfunction (\u003cspan additionalcitationids=\"CR12\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Lastly, to obtain an objective measurement of penile curvature, a manual measurement of penile curvature with a goniometer at maximum rigidity of the penis was performed for each patient at the time of CDDU (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Venous blood samples were drawn from each patient between 6 AM and 10 AM after overnight fasting. Complete blood count, glycated hemoglobin (Hb1Ac), vitamin D, total cholesterol, triglycerides, low-density lipoprotein cholesterol (C-LDL) and high-density lipoprotein cholesterol (C-HDL) were measured for each patient at baseline. Moreover, all patients completed the International Index of Erectile Function (IIEF) (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e) and the Peyronie\u0026rsquo;s disease questionnaire (PDQ) (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e) both at baseline assessment and at 3-mo follow-up. ED severity was classified according to Cappelleri\u0026rsquo;s criteria (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003ePRP protocol\u003c/h3\u003e\n\u003cp\u003eThe PRP was prepared using a dedicated autologous platelet separator. Specifically, approximately 8 mL of autologous PRP was obtained at the end of the entire process through two different methodologies: i) Two-step centrifugation (2-cycle group): a total of 18 mL of peripheral venous blood and 2 mL of sodium citrate (3.8%) were collected and processed using the Duografter Il system. The samples were centrifugated first at 1,800 rpm (322 \u0026times; g) for 8 minutes, followed by 2,000 rpm (456 x g) for 10 minutes; and, ii) One-step centrifugation (1-cycle group): PRP was prepared from 2 x 15 mL of peripheral venous blood, processed by using the Hettich Rotofix 32 A system at 1,500 rpm (377x g) for 5 minutes.\u003c/p\u003e\u003cp\u003eUnder local anesthesia (dorsal nerve penile block) with lidocaine (2%) at the base of the penis, the PRP was injected into the plaque(s) of the penile shaft. Half of the PRP was injected on one side and half on the other. Intra- and post-procedure complications and treatment-emergent adverse events (TEAEs) were monitored for each patient. A second injection of PRP, following the same procedural steps, was administered four-week apart in all cases. Thereafter, patients started using tadalafil 5 mg one-daily (OaD). Likewise, one week apart from PRP injections, patients started daily penile stretching with Vacuum Device (VED) (5\u0026ndash;15 minutes daily).\u003c/p\u003e\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003eStatistical analysis\u003c/h2\u003e\u003cp\u003eWe used descriptive statistics to detail the socio-demographic and clinical characteristics of the whole cohort. Medians and interquartile ranges (IQR) or frequencies and proportions were reported for continuous or categorical variables, respectively. Mann-Whitney U and Chi-square tests were used to compare the statistical significance of differences in the distribution of continuous or categorical variables, respectively. Subsequently, the cohort was stratified according to the number of centrifugation cycles (1 cycle vs 2 cycles), and differences in penile curvature between groups were assessed using Welch\u0026rsquo;s t-test. Finally, box plots were used to visualize the median curvature change after the PRP injections at the three-month follow-up mark. All statistical tests were two-sided with a significance value set at 0.05. The analyses were conducted using R (2025), a language and environment for statistical computing, R Foundation for Statistical Computing, Vienna, Austria.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eStudy approval\u003c/h3\u003e\n\u003cp\u003e Data collection followed the principles outlined in the Declaration of Helsinki. All patients signed an informed consent agreeing to provide anonymous information for future studies. The study was approved by the IRCCS San Raffaele Hospital Ethical Committee (Prot. 2014 \u0026ndash; Outpatients).\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003e\u003cb\u003eTable\u0026nbsp;1\u003c/b\u003e details the descriptive statistics of the whole cohort of patients. At baseline, 24 (63.1%) patients had a dorsal curvature, 5 (13.2%) a dorso-lateral curvature, 4 (10.5%) a lateral curvature, 3 (7.9%) a ventral curvature, and 2 (5.3%) a ventro-lateral curvature, respectively. Median (IQR) age and BMI were 60.5 (55, 66.8) years and 25.9 (24.1, 27.3) kg/m\u003csup\u003e2\u003c/sup\u003e, respectively. Of 38 patients, 25 (65.8%) used tadalafil 5 mg OaD, and 35 (92.1%) have regularly used a VED. Overall, after PRP injections, three-month follow-up evaluation showed a median significant reduction in penile curvature of 10\u0026deg; (0, 15) (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\u003cp\u003e\u003cb\u003eTable\u0026nbsp;2\u003c/b\u003e presents CDDU parameters and questionnaires\u0026rsquo; scores according to the number of centrifugations. Specifically, 22 (57.9%) received PRP injection after two centrifuge cycles and 16 (42.1%) after one cycle, respectively. In the 2-cycle group, median baseline penile curvature decreased significantly from 45\u0026deg; (37, 70) to 40\u0026deg; (30, 50) at three-month follow-up (p\u0026thinsp;=\u0026thinsp;0.002). Patients also reported significant improvements in PDQ-A (p\u0026thinsp;=\u0026thinsp;0.002), PDQ-C (p\u0026thinsp;=\u0026thinsp;0.008), and PDQ total scores (p\u0026thinsp;=\u0026thinsp;0.006) over the same time frame. In the 1-cycle group, patients showed a baseline median penile curvature of 60\u0026deg; (50, 66), which significantly decreased to 50\u0026deg; (40, 56) at three-month follow-up (p\u0026thinsp;=\u0026thinsp;0.008). After PRP injections, patients reported a significant improvement in the overall satisfaction (OS) domain of the IIEF (p\u0026thinsp;=\u0026thinsp;0.03), as well as significant improvements at in PDQ-A (p\u0026thinsp;=\u0026thinsp;0.002), PDQ-C (p\u0026thinsp;=\u0026thinsp;0.007), and PDQ total scores (p\u0026thinsp;=\u0026thinsp;0.002). No significant difference in curvature change was found between the 1-cycle and 2-cycle centrifugation groups. Plaque diameter, CDDU parameters and IIEF-erectile function (EF) scores did not change over time in both groups. No TEAEs were registered during or after PRP injections.\u003c/p\u003e\u003cp\u003eFigure \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e1\u003c/span\u003e shows boxplots comparing median penile curvature before and after PRP injections in the whole cohort, stratified by the number of centrifugation cycles (1-cycle vs. 2-cycle).\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThis prospective two-center pilot study describes the real-life characteristics of men presenting with stable-phase PD as their primary complaint. After PRP injections combined with tadalafil 5 mg OaD and daily penile stretching with VED, three-month follow-up evaluation showed a median significant reduction in penile curvature of 10\u0026deg;. Moreover, a subgroup of men reported significant improvements in terms of IIEF-OS domain, total PDQ, PDQ-A and PDQ-C scores.\u003c/p\u003e\u003cp\u003eIn the context of conservative intralesional treatments for stable-phase PD, autologous PRP injection represents a promising option. However, due to lack of prospective randomized studies, the European Association of Urology (EAU) specifically denotes PRP as only experimental in PD (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Conversely, in broader clinical practice, PRP appears to be a safe therapeutic option with encouraging results across multiple organ systems. Studies in orthopedics, cosmetology and dermatology, sports medicine, ophthalmology and reproductive medicine have suggested improved patient outcomes with its use (\u003cspan additionalcitationids=\"CR21\" citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e).\u003c/p\u003e\u003cp\u003ePlatelets are a source of biologically active proteins known as platelet-derived GFs, including epidermal GF (EGF), insulin-like GF (IGF), platelet-derived GF (PDGF), fibroblast GF (FGF) as well some interleukin (IL). These GFs regulate all stages of the complex wound-healing process and, due to their high concentrations, influence the recruitment, proliferation, and differentiation of cells involved in tissue repair and regeneration, specifically inducing collagen deposition by activating fibroblasts (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIt remains difficult to compare current findings with previous studies. For instance, the first study on PRP in PD was published by Virag \u003cem\u003eet al\u003c/em\u003e. in 2017, and the authors used a combined injection of PRP and hyaluronic acid in 90 participants with established penile plaques and deformity (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). Subsequent studies provided different protocols. Even more relevant, the composition of PRP is not standardized and may vary in platelets, leukocytes, and GFs concentrations depending on adopted methodological techniques (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). The level of secreted GFs depends on the number of active platelets, the timing of PRP preparation, the method of blood collection, the type of anticoagulant used, centrifugation parameters (i.e., duration, speed and temperature), the final pH of the solution, and any activating agents employed. Efficacy and efficiency are also influenced by general factors such as patient age, hematocrit, and concomitant medications (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). Moreover, variations in PRP protocols and study designs add further heterogeneity which prejudice the possibility of suggesting adequate clinical conclusions.\u003c/p\u003e\u003cp\u003eNotwithstanding these methodological limitations, our results concerning penile curvature align with those of previous prospective studies. Achraf \u003cem\u003eet al.\u003c/em\u003e (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) divided a cohort of 65 patients with stable symptomatic PD into two groups based on baseline curvature (25\u0026ndash;35\u0026deg; vs. 35\u0026ndash;45\u0026deg;). They reported a mean curvature decrease of 16.88\u0026deg; [standard deviation (SD) 3.35] and 17.27\u0026deg; (SD 4.22), respectively, using on average 6.1 (range 4\u0026ndash;7) PRP injections, obtained by centrifugation of 10 mL of patient blood twice for 8 minutes at 2800 rpm. Interestingly, they also noted improvements in EF and pain, as assessed by the visual analog scale pain questionnaire (p\u0026thinsp;=\u0026thinsp;0.04) and the IIEF-5 (p\u0026thinsp;=\u0026thinsp;0.02), respectively. Similarly, in their randomized, placebo-controlled crossover clinical trial update, Ledesma \u003cem\u003eet al.\u003c/em\u003e (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e) showed that at 6 months the PRP-Placebo group experienced a significant reduction in curvature [i.e., from 40\u0026deg; (40, 45) to 25\u0026deg; (20, 40), p\u0026thinsp;=\u0026thinsp;0.047], whilst the Placebo-PRP group showed a nonsignificant reduction [i.e., from 40\u0026deg; (20, 50) to 32.5\u0026deg; (20, 50)]. Since no significant differences were observed at three-month follow-up, these results suggested a possible delayed effect of PRP; however, given the limited evidence, its therapeutic effect should still be interpreted with clinical caution. Dachille \u003cem\u003eet al.\u003c/em\u003e (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e) proposed a protocol similar to ours, consisting of three injections of 6 mL PRP obtained after two centrifugation phases (the first at 3500 rpm, and the second at 3000 rpm), administered each two weeks apart. Of note, PRP aliquots were prepared on the same day, and those not used immediately were frozen at \u0026minus;\u0026thinsp;30\u0026deg; for subsequent treatments, according to their clinical protocol. They reported a significant reduction in plaque diameter (from 11.1 to 8.2 mm, p\u0026thinsp;=\u0026thinsp;0.004) and penile curvature (from 50\u0026deg; to 40\u0026deg;, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). In the same study, all PDQ domain scores decreased significantly (all p\u0026thinsp;\u0026le;\u0026thinsp;0.006), whereas the IIEF-5 score improved slightly from 18 to 19 without statistical relevance (p\u0026thinsp;=\u0026thinsp;0.3) (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e), thus partially confirming our findings. Similarly, Shirmann \u003cem\u003eet al.\u003c/em\u003e (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) reported significant decreases in the PDQ-A (Δ= -4.61, p\u0026thinsp;=\u0026thinsp;0.002) and PDQ-C (Δ= -2.44, p\u0026thinsp;=\u0026thinsp;0.017) domains at three-month follow-up. A significant decrease was also observed in the PDQ-B domain (Δ= -3.63, p\u0026thinsp;=\u0026thinsp;0.015), though this effect was no longer significant at 6-mo assessment. Overall, those findings suggest that penile curvature is primarily responsible for the psychophysical distress and discomfort reported by patients. As expected during the stable phase, however, pain relief was not observed after the therapeutic treatment.\u003c/p\u003e\u003cp\u003eThe current study, along with the most recent ones, confirmed that following PRP injections patients experience a significant reduction in psychosexual anxiety, which in our cohort was also reflected by a notable improvement in the OS domain of the IIEF.\u003c/p\u003e\u003cp\u003eCompared to previous studies, our protocol also took into consideration the use of oral tadalafil in combination with penile stretching via VED on a daily basis. The rationale behind this approach is that a triple therapy \u0026mdash; PRP injections, tadalafil, and VED therapy \u0026mdash; may provide superior outcomes compared to a single or double treatment modality (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). More in details, the antifibrotic role of tadalafil was demonstrated in 2011 in a study of 35 patients with isolated septal scars who received tadalafil 2.5 mg OaD for 6 months. The majority (69%) reported a reduction of their septal scar. In this context, tadalafil might therefore play a key role in stabilizing penile curvature and plaque fibrosis (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). Likewise, Park et al. confirmed that tadalafil 5 mg OaD could treat PD by reducing the degree of penile curvature and plaque size (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). MacDonald et al. showed that men who initiated VED traction therapy for 10 minutes twice a day had a significant mean (SD) improvement of 23\u0026deg; (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e) (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) compared to baseline. Finally, in a cohort of 153 patients affected by PD in stable phase with erectile dysfunction, Dell\u0026rsquo;Atti et al. reported that regular use of VED plus tadalafil in patients who had undergone ESWT significantly provided more benefit in patients with PD in terms of penile deformity (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAlthough this field is undeniably still in its infancy, there remains a clear need to develop and refine conservative treatments for patients who prefer to avoid the risks associated with surgery. In this setting, in the absence of standardized PRP preparation methods, treatment protocols, or consensus on injection timing and dosage (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e), we have followed our internal protocol with encouraging results.\u003c/p\u003e\u003cp\u003eSeveral caveats must be considered. First, although the protocol collects prospective data, the cohort size is modest, with limited long-term follow-up. Second, we did not include a placebo control group. Third, apart the use of validated questionnaires, we did not investigate patients\u0026rsquo; subjective assessments regarding perceived improvement from initial condition. Fourth, the use of two different PRP preparation protocols, while useful for understanding which compound was actually more effective, may introduce bias into the data analysis. Fifth, the use of a trimodal therapy certainly impacts the encouraging benefit observed in these patients treated with PRP using two different protocols and may have at least partially obscured the true benefit of PRP injections alone, regardless of their composition. Sixth, we cannot exclude that a greater number of repeated doses of PRP is probably needed to sustain the benefit achieved at three-month assessment. Conversely, the prospective design and the use of rigorous measurements at maximal erections during penile CDDU evaluations before and after PRP injections, performed by the same group of experienced physicians, represent two key strengths of this study.\u003c/p\u003e"},{"header":"CONCLUSIONS","content":"\u003cp\u003eA trimodal mini-invasive approach - using PRP injections - suggests significant improvements in men with bothersome penile curvatures stable-phase PD. Given the limited sample size and the design of the study, the preliminary findings of this pilot study should be interpreted with caution. Therefore, despite encouraging results, several caveats must be considered before a definitive evaluation of therapeutic efficacy of PRP intra-plaque injections mya be provided.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthor Contributions:\u0026nbsp;\u003c/strong\u003eConceptualization: FN, AS. Data curation: FN, EP, LZ, GB, MR. Formal analysis: FN. Supervision: AS. Writing – original draft: FN. Writing – review \u0026amp; editing: EP, FM, AM, AS.\u0026nbsp;All other co-authors reviewed the manuscript and participated in the revisions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e: None.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability\u003c/strong\u003e: The data underlying this article will be shared on reasonable request to the corresponding author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e: This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval\u003c/strong\u003e:\u0026nbsp;The study was approved by the IRCCS San Raffaele Hospital Ethical Committee (Prot. 2014 – Outpatients).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e: None.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eSalonia A, Capogrosso P, Boeri L, Cocci A, Corona G, Dinkelman-Smit M, et al. 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Int J Impot Res. 2024 Dec;36(8):813\u0026ndash;7.\u003c/li\u003e\n \u003cli\u003eDachille G, Panunzio A, Bizzotto L, D\u0026rsquo;Agostino MV, Greco F, Guglielmi G, et al. Platelet-rich plasma intra-plaque injections rapidly reduce penile curvature and improve sexual function in Peyronie\u0026rsquo;s disease patients: results from a prospective large-cohort study. World J Urol. 2025 May 15;43(1):306.\u003c/li\u003e\n \u003cli\u003eCocci A, Cito G, Urz\u0026igrave; D, Minervini A, Di Maida F, Sessa F, et al. Sildenafil 25 mg ODT + Collagenase Clostridium hystoliticum vs Collagenase Clostridium hystoliticum Alone for the Management of Peyronie\u0026rsquo;s Disease: A Matched-Pair Comparison Analysis. J Sex Med. 2018 Oct;15(10):1472\u0026ndash;7.\u003c/li\u003e\n \u003cli\u003eAlzubaidi RT, Abdelkareem M, Al-Zoubi RM, Al-Qudimat AR, Yasin A, Kamkoum H, et al. Outcomes and management of Peyronie\u0026rsquo;s disease with combined treatment of collagenase clostridium histolyticum, vacuum erection device, and tadalafil. Asian J Androl. 2025 May 2;\u003c/li\u003e\n \u003cli\u003eChung E, Deyoung L, Brock GB. The role of PDE5 inhibitors in penile septal scar remodeling: assessment of clinical and radiological outcomes. J Sex Med. 2011 May;8(5):1472\u0026ndash;7.\u003c/li\u003e\n \u003cli\u003ePark HJ, Park NC, Kim TN, Nam JK, Moon DG. 378 - Daily tadalafil therapy: A new treatment option for Peyronie\u0026rsquo;s disease? Eur Urol Suppl. 2017 Mar 1;16(3):e667.\u003c/li\u003e\n \u003cli\u003eDell\u0026rsquo;Atti L, Slyusar V, Ronchi P, Cambise C. Vacuum Erection Device Plus Once-Daily Tadalafil Improve Clinical Outcomes after Extracorporeal Shock Wave Therapy in Men Affected by Erectile Dysfunction Associated with Peyronie\u0026rsquo;s Disease. Life Basel Switz. 2024 Sept 13;14(9):1162.\u003c/li\u003e\n \u003cli\u003eAsmundo MG, Durukan E, Von Rohden E, Thy SA, Jensen CFS, Fode M. Platelet-rich plasma therapy in erectile dysfunction and Peyronie\u0026rsquo;s disease: a systematic review of the literature. World J Urol. 2024 May 29;42(1):359.\u003cstrong\u003e\u003cbr\u003e\u003c/strong\u003e\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1.\u003c/strong\u003e Socio-demographic and clinical characteristics of the whole cohort of patients with stable-phase PD who underwent PRP injections (N=38).\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"955\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBaseline\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 233px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAfter PRP injections\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSocio-demographic and clinical characteristics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 233px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003ePatients\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003e38 [100]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 233px;\"\u003e\n \u003cp\u003e38 [100]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003eAge (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003e60.5 [55, 66.8]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 233px;\"\u003e\n \u003cp\u003e\\\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003eRelation status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 233px;\"\u003e\n \u003cp\u003e\\\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003eStable partner\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003e35 [92.1]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 233px;\"\u003e\n \u003cp\u003e\\\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003eBMI (Kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003e25.9 [24.1, 27.3]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 233px;\"\u003e\n \u003cp\u003e\\\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003eSmoking\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 233px;\"\u003e\n \u003cp\u003e\\\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003e10 [26.3]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 233px;\"\u003e\n \u003cp\u003e\\\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003eNo/Ex-smoker\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003e28 [73.7]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 233px;\"\u003e\n \u003cp\u003e\\\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003eHypertension (Yes)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003e11 [29]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 233px;\"\u003e\n \u003cp\u003e\\\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003eDiabetes mellitus (Yes)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003e6 [15.8]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 233px;\"\u003e\n \u003cp\u003e\\\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003ePenile trauma (Yes)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003e6 [15.8]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 233px;\"\u003e\n \u003cp\u003e\\\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003eVacuum device (Yes)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003e35 [92.1]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 233px;\"\u003e\n \u003cp\u003e\\\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003eTadalafil (Yes)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003e25 [65.8]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 233px;\"\u003e\n \u003cp\u003e\\\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCurvature type\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 233px;\"\u003e\n \u003cp\u003e\\\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003eDorsal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003e24 [63.1]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 233px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003eDorso-lateral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003e5 [13.2]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 233px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003eLateral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003e4 [10.5]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 233px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003eVentral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003e3 [7.9]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 233px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLab data\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 233px;\"\u003e\n \u003cp\u003e\\\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003eHb (g/dL)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003e15.2 [14.4, 15.5]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 233px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003eWBC (x10\u003csup\u003e9\u003c/sup\u003e/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003e6.9 [5.9, 7.7]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 233px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003eNeutrophils\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003e3.8 [3.5, 4.8]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 233px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003eLymphocytes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003e1.8 [1.5, 2.3] \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 233px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003eMonocytes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003e0.7 [0.6, 0.8]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 233px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003ePLT (x10\u003csup\u003e9\u003c/sup\u003e/mL)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003e197 [165, 249]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 233px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003eMPV (fL)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003e9.6 [9.2, 10.6]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 233px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003eHb1Ac (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003e5.4 [4.5, 5.8] \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 233px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003eCholesterol (mg/dL)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003e191 [162, 221]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 233px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003eC-LDL (mg/dL)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003e121 [94, 150]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 233px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003eC-HDL (mg/dL)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003e56 [52, 62] \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 233px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003eSide effects (Yes)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 233px;\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCDDU\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 233px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003eCurvature (degree)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003e55 [45, 70]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 233px;\"\u003e\n \u003cp\u003e45 [30, 55]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003ePlaque diameter (mm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003e14 [7.5, 20]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 233px;\"\u003e\n \u003cp\u003e10 [7.2, 18.5]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003eCalcified plaque\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003e20 [52.6]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 233px;\"\u003e\n \u003cp\u003e17 [44.7]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003eMean PSV (cm/s)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003e38.6 [36.5, 54.7]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 233px;\"\u003e\n \u003cp\u003e49.5 [37.9, 57.4]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003eMean RI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003e0.98 [0.97, 0.99]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 233px;\"\u003e\n \u003cp\u003e0.97 [0.93, 0.99]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eQuestionnaires\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 233px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003ePDQ score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003e22 [20, 23]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 233px;\"\u003e\n \u003cp\u003e20 [16, 22]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003ePDQ A\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003e11 [11, 13] \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 233px;\"\u003e\n \u003cp\u003e10.5 [8, 11.75]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003ePDQ B\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003e0 [0, 3.75]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 233px;\"\u003e\n \u003cp\u003e0 [0, 2.75]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003ePDQ C\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003e9.5 [7, 11] \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 233px;\"\u003e\n \u003cp\u003e8 [7, 10.75]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003eIIEF domains\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 233px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003eEF score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003e21.5 [12.25, 26.75] \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 233px;\"\u003e\n \u003cp\u003e23 [14.25, 26]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003eIS score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003e7 [2, 10]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 233px;\"\u003e\n \u003cp\u003e8 [2, 10]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003eOF score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003e8 [6, 9.5]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 233px;\"\u003e\n \u003cp\u003e9 [5.75, 10]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003eSD score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003e8 [6.5, 9] \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 233px;\"\u003e\n \u003cp\u003e8 [6, 9]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003eOS score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003e6 [2, 7.5]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 233px;\"\u003e\n \u003cp\u003e7 [4, 8]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eValues are presented as number (%) or median (interquartile range).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eKeys\u003c/strong\u003e: PRP: Platelet-rich plasma; BMI: Body Mass Index; PDE5is: phosphodiesterase type 5 inhibitors; CDDU: Dynamic \u0026ndash; color doppler duplex ultrasonography; Hb: Hemoglobin; WBC: White blood cells; PLT: Platelets; MPV: Mean platelet volume; Hb1Ac: Hemoglobin A1c test; C-LDL: cholesterol-low density lipoprotein; C-HDL: cholesterol-high density lipoprotein; PDQ: Peyronie\u0026rsquo;s disease questionnaire; IIEF International Index of Erectile Function, EF \u0026ndash; Erectile Function domain, IS \u0026ndash; Intercourse Satisfaction domain, OF \u0026ndash; Orgasmic Function domain, SD \u0026ndash; Sexual Desire domain, OS \u0026ndash; Overall Satisfaction domain.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2.\u003c/strong\u003e Socio-demographic and clinical characteristics of the whole cohort of patients with stable-phase PD who underwent PRP injections (N=38) stratified by the number of centrifugations.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"left\" width=\"955\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBaseline\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 233px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAfter PRP injections\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1 cycle group (n=16)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 233px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCDDU\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 233px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003eCurvature (degree)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003e60 [50, 66]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 233px;\"\u003e\n \u003cp\u003e50 [40, 56]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e0.008\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003ePlaque diameter (mm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003e8 [6, 9.6]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 233px;\"\u003e\n \u003cp\u003e7.5 [5, 9.7]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003eCalcified plaque\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003e10 [62.5]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 233px;\"\u003e\n \u003cp\u003e9 [56.2]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003eMean PSV (cm/s)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003e37.5 [35.1, 38.1]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 233px;\"\u003e\n \u003cp\u003e36.9 [33.1, 37.9]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003eMean RI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003e0.98 [0.97, 0.98]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 233px;\"\u003e\n \u003cp\u003e0.98 [0.97, 0.99]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eQuestionnaires\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 233px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003ePDQ score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003e22.5 [20, 32.75]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 233px;\"\u003e\n \u003cp\u003e18 [14.5, 22]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003ePDQ A\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003e12 [11, 17] \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 233px;\"\u003e\n \u003cp\u003e9 [8, 11]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003ePDQ B\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003e0 [0, 3.75]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 233px;\"\u003e\n \u003cp\u003e0 [0, 2.75]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003ePDQ C\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003e9.5 [7, 11.75]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 233px;\"\u003e\n \u003cp\u003e7.5 [4.5, 9.75]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e0.007\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003eIIEF domains\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 233px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003eEF score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003e22 [16, 27]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 233px;\"\u003e\n \u003cp\u003e23 [18, 26]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003eIS score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003e8 [4, 10] \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 233px;\"\u003e\n \u003cp\u003e8 [5, 11]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003eOF score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003e8 [8, 9] \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 233px;\"\u003e\n \u003cp\u003e8 [7, 9]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003eSD score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003e8 [7, 9]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 233px;\"\u003e\n \u003cp\u003e8 [7, 9]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003eOS score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003e6 [4, 8] \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 233px;\"\u003e\n \u003cp\u003e7 [4, 9]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2 cycles group (n=22)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 233px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCDDU\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 233px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003eCurvature (degree)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003e45 [37, 70]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 233px;\"\u003e\n \u003cp\u003e40 [30, 50]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003ePlaque diameter (mm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003e18 [9.3, 21.7]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 233px;\"\u003e\n \u003cp\u003e17 [9.8, 20]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003eCalcified plaque\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003e10 [45.5]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 233px;\"\u003e\n \u003cp\u003e8 [36.4]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003eMean PSV (cm/s)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003e54.1 [42.6, 63.9]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 233px;\"\u003e\n \u003cp\u003e55.6 [48.8, 62.2]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003eMean RI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003e0.99 [0.96, 1]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 233px;\"\u003e\n \u003cp\u003e0.97 [0.93, 1]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eQuestionnaires\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 233px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003ePDQ score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003e22 [20.5, 23]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 233px;\"\u003e\n \u003cp\u003e20.5 [16, 22]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e0.006\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003ePDQ A\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003e11 [11, 12] \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 233px;\"\u003e\n \u003cp\u003e11 [8, 11]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003ePDQ B\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003e0 [0, 0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 233px;\"\u003e\n \u003cp\u003e0 [0, 0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003ePDQ C\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003e11 [9, 11]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 233px;\"\u003e\n \u003cp\u003e8.5 [6.25, 11] \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e0.008\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003eIIEF domains\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 233px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003eEF score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003e21 [7, 26]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 233px;\"\u003e\n \u003cp\u003e23 [10, 27]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003eIS score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003e5 [0, 9.75] \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 233px;\"\u003e\n \u003cp\u003e10 [1, 10]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003eOF score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003e6 [1.5, 10] \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 233px;\"\u003e\n \u003cp\u003e9 [3.5, 10]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003eSD score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003e8 [6, 8.75] \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 233px;\"\u003e\n \u003cp\u003e8 [4.5, 9]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003eOS score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003e4.5 [2, 6.75]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 233px;\"\u003e\n \u003cp\u003e5 [4.5, 8]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eValues are presented as number (%) or median (interquartile range).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eKeys\u003c/strong\u003e: CDDU: Dynamic \u0026ndash; color doppler duplex ultrasonography; PDQ: Peyronie\u0026rsquo;s disease questionnaire; IIEF International Index of Erectile Function, EF \u0026ndash; Erectile Function domain, IS \u0026ndash; Intercourse Satisfaction domain, OF \u0026ndash; Orgasmic Function domain, SD \u0026ndash; Sexual Desire domain, OS \u0026ndash; Overall Satisfaction domain.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"IRCCS Ospedale San Raffaele","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Peyronie’s disease, Platelet-rich plasma, PDE5i, vacuum therapy","lastPublishedDoi":"10.21203/rs.3.rs-7634265/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7634265/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cbr\u003e\n\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIntroduction\u003c/strong\u003e: Platelet-Rich Plasma (PRP) into penile plaques has emerged as a promising approach for treating acquired penile curvature in men with stable-phase Peyronie's Disease (PD), although it is still investigational. We aimed to analyze the preliminary results of a two-center real-life prospective pilot study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMaterial and methods\u003c/strong\u003e: Data from 38 patients undergoing PRP injections were prospectively collected. All patients underwent dynamic penile Color Doppler-duplex ultrasound (CDDU) at baseline and follow-up to assess penile hemodynamic parameters and objective measurement of penile morphometric parameters. Similarly, all men completed the International Index of Erectile Function (IIEF) and the Peyronie's Disease Questionnaire (PDQ) at baseline and follow-up. According to the center, PRP was obtained using double or single blood centrifugation (2-cycle vs. 1-cycle group). All patients received two injections, each consisting of an average of 8 mL of PRP, administered 4-week apart. Thereafter, patients started using tadalafil 5 mg one-daily. Likewise, one week apart from PRP injections, patients started daily penile stretching with Vacuum Device (5-15 minutes daily). All patients had three-month follow-up assessment, including IIEF-EF, PDQ and CDDU.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: Median (IQR) age and BMI were 60.5 (55, 66.8) years and 25.9 (24.1, 27.3) kg/m\u003csup\u003e2\u003c/sup\u003e, respectively. Overall, 22 (57.9%) patients received PRP injection after two centrifuge cycles and 16 (42.1%) after one centrifuge cycle. In the 2-cycle group, baseline penile curvature was 45° (37, 70), decreasing to 40° (30, 50) at three-month follow-up (p=0.002). Conversely, in the 1-cycle group, baseline curvature was 60° (50, 66), decreasing to 50° (40, 56) at three-month follow-up (p=0.008). Overall, median baseline penile curvature was 55° (45, 70) and decreased to 45° (30, 55) after PRP treatment, with a median reduction of 10° (0, 15) (p\u0026lt;0.001). Median PDQ scores at baseline were 22 (20.5, 23) in the 2-cycle group and 22.5 (20, 32.75) in the 1-cycle group, respectively. At three-month follow-up, PDQ decreased to 20.5 (16, 22) and 18 (14.5, 22), respectively in the two groups (both p≤0.006). For both groups, IIEF-EF scores and CDDU parameters did not change over time. Median plaque diameter decreased from 18 (9.3, 21.7) and 8 (6, 9.6) to 17 (9.8, 20) and 7.5 (5, 9.7) mm, respectively, without statistical significance. No treatment-emergent adverse events were reported.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e: Preliminary findings indicate that PRP injections are a safe therapeutic option to ameliorate penile morphometric parameters and PDQ scores in men with bothersome penile curvature in stable-phase PD. The observed decrease in penile curvature is still inadequate to extrapolate clinically significant long-term outcomes.\u003c/p\u003e","manuscriptTitle":"Trimodal mini-invasive therapy for stable-phase Peyronie's disease: a two-center real-life prospective pilot study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-23 07:52:44","doi":"10.21203/rs.3.rs-7634265/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"2c335fa5-bb86-4ee1-8c50-5e0f683edbb2","owner":[],"postedDate":"September 23rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":54839710,"name":"Urology \u0026 Nephrology"}],"tags":[],"updatedAt":"2025-09-23T07:52:44+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-23 07:52:44","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7634265","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7634265","identity":"rs-7634265","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}