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WHY ARE MEN SO IGNORANT CONCERNING PD
Let’s take a look at what men know about PD and the
potential adverse affects of a RP, performed either robotically
assisted prostatectomy (RPP) or as an open RP (ORP). In a
recent study (Urology Times Daily Meeting Report 19 May,
2008), 336 consecutive patients were enrolled within approx 3
months post op their RP and were questioned about a
number of factors concerning their erectile function including
PD and penile shortening. The mean age of this group was 64
+ or – 11 years. A minority, only 38%, had recollection of their
nerve sparing status.
The conclusion of the study is that men who have undergone
either RP have largely unrealistic expectations with regard to
their post op sexual functioning. The results were divided into
2 groups; ORP and RRP. Men undergoing RPPs were even
more unaware of the potential side effects those who have an
ORP.
According to this study, what percentage of men in both
groups were aware of the potential for developing PD post
surgery? The results were the same for both groups.
These results are very easy to understand – Zero, 0, Nada,
Zilch. Yes. Absolutely none of the men knew about the
possibility of PD. Remember according to the retrospective
study noted earlier, almost 1 in 5 men will develop PD after
this surgery.
The percentage of men in the RPP group who knew about the
possibility of post op penile shorting was:
The number for the ORP was slightly better, but still 90% of
the men in this group were unaware of this potential side
effect.
It has been speculated that this ignorance is due to the
patient not being adequately informed by his physician or that
he acquired misinformation from the Internet. My comment is
that the patient was not informed because his physician,
despite taking on the responsibility of removing the prostate,
was not very knowledgeable about the potential adverse side
effects of a RP, including PD, shortening and loss of girth.
There is evidence that illustrates how little experience most
urologists have treating PD. In 2008, a 46 item questionnaire
was emailed to American Urological Association members and
639 responded. The results show that a large percentage of
responders consider themselves experts in sexual medicine
(40%), but a majority saw fewer than 5 PD patients per
month. However, the vast majority perform surgery for this
disease; almost 80%. This group performs plaque excision
with grafting, the most demanding PD surgical corrective
procedure and the procedure most prone to adverse side
effects .
Seventy-two percent (72%) said that Vitamin E was their first
line therapy. Stop. Any physician who prescribes Vitamin E
either does not know what he is doing or is giving you a non
effective agent to make you feel better. I don’t want to use the
word placebo because some studies show that Vitamin E
maybe harmful. (Put Vitamin E into this site’s search engine
for further details). If your doctor prescribes Vitamin E, your
next action should be to say goodbye.
I will donate $250 to any reader’s favorite charity who can
show me a placebo, double blind study from a legitimate
researcher which demonstrates Vitamin E efficacy in reducing
Peyronies related penile curvature by at least 20%.
Dr Mulhall, one of the true (and few) PD experts concludes
the following after his study, “ The findings on PD knowledge
and especially those that show many urologists are operating
on patients despite seeing very few patients, are somewhat
concerning.” He adds that PD patients are very litigious and
this is not the kind of surgery urologists should be
performing on an occasional basis. Further, in the area of
patient informed consent, Dr. Mulhall properly suggests that
the medical profession has to develop a detailed structured
discussion instrument for patients prior to treatment so they
can be informed about possible post RP adverse side effects.
