The AUA released its first guidelines for the management of Peyronie’s disease (PD) in 2015. A special session during Tuesday’s Plenary I program will review the guidelines and highlight current treatment options, including the only medical treatment for the disease approved by the U. S. Food and Drug Administration (FDA) as well as a variety of popular treatments that should not be used.
“There have been any number of advances in Peyronie’s treatment over the past couple of years,” said Lawrence S. Hakim, MD, FACS, President of the Sexual Medicine Society of North America (SMSNA) and Chair of Urology at Cleveland Clinic Florida, a Peyronie’s referral center. “We now have the first FDA approved medical therapy for PD, collagenase Clostridium histolyticum, in addition to a number of additional effective treatment options. There have been major advances in the surgical management of Peyronie’s disease and in prosthetics for men with both PD and erectile dysfunction. Unfortunately, many patients with PD often go untreated or are managed with therapies that are not recommended based on the data.”
Dr. Hakim will moderate Tuesday’s 30-minute session, titled Peyronie’s Disease, which will begin at 11:25 a.m. in Hall A in the San Diego Convention Center. He will present a series of complex cases to a panel of four experts.
“Our goal is to expose urologists to the high prevalence of Peyronie’s and give them an update on the new options that are available,” Dr. Hakim said. “Too many times we see patients who were misdiagnosed. Other patients were told they had Peyronie’s, but there is no effective treatment option. And far too many were given vitamin E or another therapy that is not recommended by the AUA guidelines.”
The 2015 guidelines were based on a systematic review of the literature from 1965 to 2015. They indicate that clinicians should not offer oral therapy with vitamin E, tamoxifen, procarbazine, omega-3 fatty acids or a combination of vitamin E with L-carnitine. Clinicians should also abstain from recommending electromotive therapy with verapamil, extracorporeal shock wave therapy, radiotherapy and other commonly used therapies.
The cases featured in Tuesday’s session will illustrate the current recommendations for the diagnosis of Peyronie’s disease, the natural history of the disease, typical presentations, latest diagnostic testing and current treatment options. The newest medication approved by the FDA for certain patients with PD is intralesional injection of Clostridium histolyticum. Intralesional interferon α-2b and intralesional verapamil can also be used in select patients.
On the surgical side, clinicians may offer tunical plication to improve penile curvature in patients with rigidity sufficient for intercourse. Other surgical options include plaque incision, and plaque excision and/or grafting for patients with deformities but rigidity is sufficient for intercourse.
Patients who cannot complete intercourse, either due to penile deformity or erectile dysfunction, may benefit from an inflatable penile prosthesis. Surgeons may also add adjunctive procedures such as modeling, plication or incision/grafting during prosthesis implantation as needed.
“Sexual dysfunction is one of the most common problems we treat as urologists,” Dr. Hakim said. “Epidemiological data tell us that Peyronie’s disease is quite common, increases with age and is often accompanied by erectile dysfunction. This is something you see on a regular basis, especially if you know to look for it. And the unfortunate reality is that there is a lot if misinformation out there, even among urologists. This is one of the areas in urology that is changing dramatically in terms of how we successfully manage our patients.”
Plenary I Preview
Presenter: Lawrence S. Hakim, MD, FACS
11:25 – 11:55 a.m. Tuesday
Hall A, San Diego Convention Center