Despite many available treatments for Peyronie's disease (PD), practice patterns of available therapeutics are not well characterized.
We conducted a national survey of urologists to characterize real-world practice patterns of PD management and to characterize the use of therapies discouraged by the American Urological Association guidelines on PD management.
A 34-item survey was distributed via RedCap to urologists who treat patients with PD in all American Urological Association sections. Questions elicited demographic information as well as practices in diagnosis and treatment of PD. Comparisons were made with Pearson's chi-squared test. The primary outcome was reported use of therapies discouraged by the American Urological Association guidelines on PD.
A total of 145 respondents completed the survey, of whom 19% were fellowship trained in andrology/sexual medicine, 36% practiced in an academic setting, and 50% had at least 20 years in practice. Only 60% of respondents reporting performing in-office curvature assessment prior to commencing intralesional injection or surgical treatment, with higher prevalence in andrology/sexual medicine fellowship-trained vs. non-fellowship trained urologists (85% vs. 54%, p = 0.003). The most popular treatment modalities were collagenase clostridium histolyticum (61% of respondents), phosphodiesterase-5 inhibitors (54%), and penile traction (53%). Twenty-one percent of respondents reported currently using a treatment that is explicitly discouraged by the American Urological Association guidelines (extracorporeal shockwave therapy for curvature, L-carnitine, omega-3 fatty acids, or vitamin E).
Patients seeking PD treatment may be offered different therapies, some of which are not evidence based, depending on the treating urologist. This study is limited by self-selection and response bias. Its strength is that it represents a cross-sectional overview of real-world practice patterns in PD management, which has not been previously described.
A significant proportion of urologists reported PD management practices that are not evidence based and not guideline-supported. This article is protected by copyright. All rights reserved.
Andrology. 2023 Feb 23 [Epub ahead of print]
Aaron Brant, Spyridon P Basourakos, Patrick Lewicki, Caroline Kang, Jessica Marinaro, Nahid Punjani, James Kashanian
Department of Urology, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, USA.