BERKELEY, CA (UroToday.com) - Owing mainly to an incomplete understanding of the exact pathogenesis, the optimal management of Peyronie’s disease (PD) remains a clinical dilemma, particularly the nonsurgical approach. Despite a wide spectrum of currently available treatment options including oral agents, intralesional injection, extracorporeal shock wave therapy, and external traction therapy, none of these has demonstrated conclusive effects and most studies of these treatments did not have a placebo-controlled design. On the basis of contemporary Western guidelines, surgery is the only recommended treatment option; thus, the clinical strategy for management of PD is primarily dependent on the preferences of physicians and patients. However, incorrect and outdated information on this condition from the first-encountered physician may cause misdiagnosis or mislead the patient into unrealistic beliefs. With this background, we conducted a survey to elucidate the actual diagnosis and treatment patterns. This is the largest number of urologists recruited by use of a detailed survey, particularly on PD.
The outcomes of this study include several interesting findings. First, the Korean urologists’ perceptions regarding the natural course of PD and diagnostic approaches were analogous with currently available Western guidelines. The majority of urologists (87.8%) believed that PD is a progressive condition, and more than 81% of respondents believed that spontaneous healing in PD occurs in fewer than 20% of patients. As for diagnostic approaches, most of the respondents in this survey performed physical examination, and approximately 40% evaluated potentially concomitant ED by use of the IIEF questionnaire. Second, regarding a nonsurgical approach, whereas vitamin E was used primarily for initial oral management by more than 80% of respondents, its reported efficacy was relatively lower, both according to the physicians’ perception of treatment suitability and patient satisfaction in comparison with other oral agents. In contrast, for intralesional injection, physicians’ perception of treatment suitability and patient satisfaction were not affected by the agents injected. Indeed, several double-blind, placebo-controlled trials on the use of vitamin E, Potaba, propoleum, tamoxifen, colchicine, acetyl-L-carnitine, propionyl-L-carnitine, and omega-3 fatty acids for the treatment of PD have been conducted, usually with minor or little proven effect. In terms of intralesional injection therapy, whereas 90% of the studies reported positive outcomes, most of those studies did not offer convincing evidence-based data. Third, the most peculiar finding in this survey was that the highest grade in both patient satisfaction and physicians’ perception of the suitability of treatment was achieved by the surgical approach, as shown in Figure 1. If PD is not responding to pharmacologic treatment, the best option from contemporary guidelines is the implantation of an inflatable penile prosthesis, with or without an associated procedure over the penis (modeling, plication, or even grafting plus the prosthesis). As demonstrated in Figure 2, the urologists’ perception and patient satisfaction for the surgical techniques were significantly different, favoring penile prosthesis implantation with a relatively higher grade in both aspects. Finally, in this survey, the duration of time to a doctor visit of within 6 months in nearly half of cases was relatively shorter than that reported in Western countries, where approximately one-third of PD patients did not see a doctor until 4 years after the emergence of penile symptoms. While distinctions including medical insurance systems, accessibility to medical suppliers, and cultural differences should be considered, this aspect reflects the urgent need for active treatment for patients suffering from this embarrassing condition.
In conclusion, through this study we validated that the practice pattern of urologists depicted in this survey is in line with currently available Western guidelines, which indicates the need for development of further local guidelines based on solid clinical data.
Young Hwii Ko as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.
Yeungnam University College of Medicine, Department of Urology, Daegu, Korea