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NEWS IN BRIEF II
Evidence Based Guidelines for the
Treatment of Peyronies Disease
This research was authored by acknowledged experts
and long time researchers in the PD field such as
Lawrence Levine, Nestor Gonzalez-Cadavid, etc. It
appeared in an article sponsored by the International
Society of Sexual Medicine 2010.
The article presents the degree and quality of evidence
currently available for evaluating treatment options for
Peyronies. In reading this article, please keep in mind
that a grade B simply means there is good evidence to
evaluate a treatment option. The treatment option may
or may not be effective. Let me warn you that this make
for discouraging reading.
Clinical Diagnosis - Grade D
There are no international standards for evaluating and
reporting on treatment outcomes for Peyronies.
Plaque Size - Grade D
Plaque measurement is inaccurate by any modality as
well as operator dependent and not a reliable
assessment of treatment response.
Co-Morbidities - Grade D
It is often mentioned that PD is related to erectile
dysfunction, hypertension, diabetes, low testosterone,
etc. It remains unclear if any of these contribute to
Peyronies.
Oral Therapy – Grade B
vitamin E, colchicines, tamoxifen, carnitine. Evidence
supports a conclusion that these are of no benefit.
What this means is that there is good evidence that
these treatment approaches are a waste of time. My
comment.
Injection Therapy
Verapamil-Grade C. Appears to make sense, but no
large scale placebo controlled trials
Interferon-Grade B. One placebo controlled trial
showed benefit.
Collagenase-Grade D
Currently in trial with Xiaflex. Previous studies showed
limited benefit.
Traction Therapy-Grade C
Early evidence from two small non-controlled
experiments report a reduction in deformity
Surgery-Grade C
Gold Standard for correction of deformity
Surgery PreOperative Consent-Grade D
Critical to discuss with patient and set realistic
outcomes. Patient should be aware of the potential
negative outcomes such as of loss of length, decreased
sensation and rigidity
Peyronies And The Law – Guilty or Innocent?
A 41 year old male was charge by the police for
committing a sexual assault on his step daughter. He
was arrested, but denied the charge. An injection was
administered to induce an erection. Erection hardness
was considered a 10 on a 1 – 10 scale. Length was 7
inches (no shrinkage here!) and 5 inch circumference.
Angle of bend was 45 degrees at the ventral aspect of
the penis. His wife gave evidence at the trial that they
did have intercourse, but with difficulty. He had to use
lubricant and was restricted to the missionary position.
The jury found that he could not have assaulted his
daughter. Verdict – Not Guilty
A 65 year old man was charged with commission of a
rape upon a 45 yard old widow. Defendant had a
girlfriend and experienced significant difficulty with
intercourse. An injection induced erection showed an
upward curvature at midpoint 30 degrees. Verdict -
Guilty
Evidence Based Guidelines for the
Treatment of Peyronies Disease
This research was authored by acknowledged experts
and long time researchers in the PD field such as
Lawrence Levine, Nestor Gonzalez-Cadavid, etc. It
appeared in an article sponsored by the International
Society of Sexual Medicine 2010.
The article presents the degree and quality of evidence
currently available for evaluating treatment options for
Peyronies. In reading this article, please keep in mind
that a grade B simply means there is good evidence to
evaluate a treatment option. The treatment option may
or may not be effective. Let me warn you that this make
for discouraging reading.
Clinical Diagnosis - Grade D
There are no international standards for evaluating and
reporting on treatment outcomes for Peyronies.
Plaque Size - Grade D
Plaque measurement is inaccurate by any modality as
well as operator dependent and not a reliable
assessment of treatment response.
Co-Morbidities - Grade D
It is often mentioned that PD is related to erectile
dysfunction, hypertension, diabetes, low testosterone,
etc. It remains unclear if any of these contribute to
Peyronies.
Oral Therapy – Grade B
vitamin E, colchicines, tamoxifen, carnitine. Evidence
supports a conclusion that these are of no benefit.
What this means is that there is good evidence that
these treatment approaches are a waste of time. My
comment.
Injection Therapy
Verapamil-Grade C. Appears to make sense, but no
large scale placebo controlled trials
Interferon-Grade B. One placebo controlled trial
showed benefit.
Collagenase-Grade D
Currently in trial with Xiaflex. Previous studies showed
limited benefit.
Traction Therapy-Grade C
Early evidence from two small non-controlled
experiments report a reduction in deformity
Surgery-Grade C
Gold Standard for correction of deformity
Surgery PreOperative Consent-Grade D
Critical to discuss with patient and set realistic
outcomes. Patient should be aware of the potential
negative outcomes such as of loss of length, decreased
sensation and rigidity
Peyronies And The Law – Guilty or Innocent?
A 41 year old male was charge by the police for
committing a sexual assault on his step daughter. He
was arrested, but denied the charge. An injection was
administered to induce an erection. Erection hardness
was considered a 10 on a 1 – 10 scale. Length was 7
inches (no shrinkage here!) and 5 inch circumference.
Angle of bend was 45 degrees at the ventral aspect of
the penis. His wife gave evidence at the trial that they
did have intercourse, but with difficulty. He had to use
lubricant and was restricted to the missionary position.
The jury found that he could not have assaulted his
daughter. Verdict – Not Guilty
A 65 year old man was charged with commission of a
rape upon a 45 yard old widow. Defendant had a
girlfriend and experienced significant difficulty with
intercourse. An injection induced erection showed an
upward curvature at midpoint 30 degrees. Verdict -
Guilty