Case Logs From American Urologists in the Treatment of Peyronie's Disease - Beyond the Abstract

Surgical practice patterns of Peyronie’s Disease (PD) in the United States (US) are underreported; we therefore sought to clarify the recent trends in the treatment of PD. We hypothesized that a growing trend towards more minimally invasive treatment patterns may exist, and that plication is more widely used than plaque manipulation to surgically correct curvature. 

We utilized independently reviewed and approved case logs from the American Board of Urology as a representation of the average workload of urologists.  These logs embody one of the most accurate representations of practice patterns of urologists in the US and avoid many of the biases of retrospective surveys and academic-institution case studies, which may be biased by referral patterns and skewed toward more complex PD cases.  Furthermore, over the decade-long study interval, we estimate that more than two-thirds of all American board-certified urologists contributed to the dataset.

We found that only a minority of urologists reported doing surgery for the treatment of PD, which coincides with previous reports that most urologists may manage PD conservatively.1 Overall a relatively small number of urologists perform PD procedures, with urologists who subspecialize in andrology performing a disproportionate number of these procedures.

Although several nonsurgical injection options exist, the evaluation of their efficacy has been compromised by small clinical trials and case series with mixed results.2, 3 The few available studies are non-randomized with no control group and show minimal success with conservative, non-surgical treatments.4, 5 We were therefore surprised to find such a significant rise in the rate of plaque injection treatments over the study period with injection therapies accounting for 82% of all procedures -- four times as many injections as surgical corrections for PD.

            Our findings suggest that of those urologists that manage PD and do not specialize in andrology, most prefer only medical treatment approaches, or they refer these patients to other urologists. In one survey it was shown that 17% of primary care physicians and 38% of urologists believed that PD resolves spontaneously in more than half of all cases.1 Similarly, another survey based study demonstrated a wide disparity in management approaches, and the authors concluded that significant strides were needed to better educate the urologic community on the diagnosis and management options for PD.6

In summary, we are in an era of ‘big data’ analytics, which has the potential to advance patient care and lower costs. It has been estimated that big data initiatives can save as much as $300 billion/year in health spending in the United States alone.  We strongly encourage the expanding use of surgical outcomes databases to improve upon health outcomes, and provide substance for future hypothesis-generated investigation into surgical practice patterns.

Written by: Daniel T. Oberlin MD.

References: 

1. LaRochelle, J. C., Levine, L. A.: A Survey of primary-care physicians and urologists regarding Peyronie's disease. J Sex Med, 4: 1167, 2007

2. Egui Rojo, M. A., Moncada Iribarren, I., Carballido Rodriguez, J. et al.: Experience in the use of collagenase clostridium histolyticum in the management of Peyronie's disease: current data and future prospects. Ther Adv Urol, 6: 192, 2014

3. Goldstein, I., Hartzell, R., Shabsigh, R.: The Impact of Peyronie's Disease on the Patient: Gaps in Our Current Understanding. J Sex Marital Ther: 0, 2014

4. Levine, L. A., Merrick, P. F., Lee, R. C.: Intralesional verapamil injection for the treatment of Peyronie's disease. J Urol, 151: 1522, 1994

5. Tan, R. B., Sangkum, P., Mitchell, G. C. et al.: Update on medical management of Peyronie's disease. Curr Urol Rep, 15: 415, 2014

6. Sullivan, J., Moskovic, D., Nelson, C. et al.: Peyronie's disease: urologist's knowledge base and practice patterns. Andrology, 2014

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