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30 CUAJ %u2022 FEBRUARY 2025 %u2022 VOLUME 19, ISSUE 2 Chan et alfractional CO2 laser therapy. Interestingly, when the PDQ was substratified into PDQ-PD, PDQ-BD, and PDQ-penile pain, there were no significant differences in the scores over the 52 weeks as compared to baseline, which may be related to an inadequate sample size.LimitationsAlthough the men in our study did experience improvement in their PD curvature and PDQ scores, this study is not without limitations. This was a small pilot study and was not powered to estimate the true treatment effect of the fractional CO2 laser in managing PD. Also, there are several confounders, as this was a single-arm study with no control group. As spontaneous resolution may occur in PD, the absence of a control group makes it difficult to assess if improvements in PD are truly due to laser therapy.24,26,27A spontaneous resolution rate of 3.2% has been documented to occur within a 8.4-month followup period.28Given that the median duration of disease in our study population was 1.5 years prior to initiating laser therapy, changes in our study are likely related to the CO2laser therapy. Another possible confounder is penile modeling. In the IMPRESS trials, it was observed that men who received a placebo injection and performed penile modeling experienced a mean reduction of penile curvature of 18.2%.6 Furthermore, this study involves the use of topical corticosteroids. Although steroids have not been shown to improve PD as a sole agent, when used as an adjunctive pharmacologic intervention, it has been demonstrated to have an effect on PD in some studies.29,30 With fractional CO2 laser, it is hypothesized that a depot effect of the topical steroid, caused by the laser channels may have contributed to improvement in penile curvature.19 Thus, the true effect of the fractional CO2 laser may have been augmented by the use of post-treatment corticosteroid.While we used the gold standard methodology for penile curvature assessment %u2014 incorporating in-office penile injections, ultrasound, and goniometer measurements %u2014 blinding to treatment was not possible and slight variation in erectile rigidity may have led to significant differences in penile curvature measurement. To mitigate the variability in curvature assessment and laser treatments, all measurements were performed by a single, experienced urologist and all treatments were performed by a single, experienced laser surgeon.CONCLUSIONSFractional CO2 laser therapy may serve as a safe and novel therapy for PD. While this pilot trial was not powered to assess effectiveness, initial results were positive. There was an observed reduction in penile curvature with limited and mild associated adverse events. Based on these findings, further research is warranted to evaluate the utility of fractional CO2 laser therapy in the treatment of PD before laser therapy is incorporated into clinical practice.COMPETING INTERESTS: Dr. Rivers has participated in advisory board and/or received consulting fees from AbbVie/Allergan, Bausch Health, Galderma, Leo Pharma, and MetaOptima; participated clinical trials supported by AbbVie/Allergan, Galderma, Leo Pharma, Medytox, and SaNOtise; owns stock in MedSpa Partners, MetaOptima, Pfizer; and is a co-owner/founder of Riversol Skin Care Solutions Inc. Dr. Flannigan has participated in advisory board and/or received consulting fees from Boston Scientific and Coloplast; and is a shareholder in Teumo health technologies Inc. The remaining authors do not report any competing personal or financial interests related to this work. FUNDING: Sexual Medicine Society of North America Scholars in Sexuality Research GrantThis paper has been peer reviewed.REFERENCES1. Ostrowski KA, Gannon JR, Walsh TJ. A review of the epidemiology and treatment of Peyronie%u2019s disease. Res Rep Urol 2016;8:61-70. https://doi.org/10.2147/RRU.S656202. Egui Rojo MA, Moncada Iribarren I, Carballido Rodriguez J, et al. Experience in the use of collagenase clostridium histolyticum in the management of Peyronie%u2019s disease: Current data and future prospects. Ther Adv Urol 2014;6:192-7. https://doi.org/10.1177/17562872145373313. Al-Thakafi S, Al-Hathal N. Peyronie%u2019s disease: A literature review on epidemiology, genetics, pathophysiology, diagnosis, and workup. Transl Androl Urol 2016;5:280-9. https://doi.org/10.21037/tau.2016.04.05Table 2. Adverse events after fractional CO2 laser therapy stratified by timeAdverse events (duration)Week 0 (1st CO2 laser therapy session)Week 6 (2nd CO2 laser therapy session)Week 12 (3rd CO2 laser therapy session)Week 26 (short-term followup)Week 52 (long-term followup)Patient #1 Mild penile bruising & skin scaling (2 weeks)Mild penile bruising & skin scaling (2 weeks)Mild penile bruising & skin scaling (2 weeks)None NonePatient #2 Mild penile bruising (5%u20137 days)Mild penile bruising (5%u20137 days)None None NonePatient #3 Mild penile bruising (3%u20134 days)Mild penile bruising (3%u20134 days)Mild penile bruising (3%u20134 days)None N/APatient #4 None None None None NonePatient #5 Mild penile bruising & pruritus (5 days)Mild penile bruising & pruritus (5 days)Mild penile bruising & pruritus (5 days)None NoneN/A: no data available.