Urologist practice patterns in the management of peyronie's disease: A nationwide survey

Introduction. Peyronie's disease (PD) is a poorly understood clinical entity. Aim. We endeavored to determine how contemporary urologists in the United States manage PD. Methods. A randomly generated mailing list of 996 practicing urologists was generated from the American Urologic Association member directory. A specifically designed survey was mailed with a cover letter and a postage-paid return envelope. Main Outcome Measure. Our survey assessed several practice-related factors and asked questions of how the subject would manage various presentations of PD in their practice. Four cases were presented: case 1, a healthy 55-year-old man with painless 30° dorsal curvature of 16 months duration; case 2, a 60-year-old man with 35° dorsal curvature, 4/10 pain on visual analog scale, of 6 months duration; case 3, a 62-year-old man with painless 60° dorsal curvature and erectile dysfunction responsive to alprostadil suppository of 2 years duration; and case 4, a 50-year-old man with mid-shaft waist deformity, foreshortening, no pain/curvature/erectile dysfunction. Results. Responses were received from 236 (24%) practicing urologists. Vitamin E was the preferred initial management for 70% of respondents, with observation, Potaba (Glenwood, Englewood, New Jersey, USA), colchicine, verapamil injections, and verapamil gel favored by 32, 20, 12, 7, and 10% of respondents, respectively. Fifty-seven percent of respondents performed surgery for PD, with penile prostheses, Nesbit procedure, grafting, and plication used by 76, 66, 55, and 51% of respondents, respectively. Medical therapy and/or observation was the preferred management for all of the cases except case 3, for which penile prosthesis placement and referral were the favored options by 39 and 30% of urologists, respectively. Conclusions. Medical therapy is the initial treatment for PD among American urologists. Penile prosthesis is the treatment of choice in impotent patients. Most American urologists conform to recommended practice patterns in the management of PD.