Urologist practice patterns in the management of Peyronie's disease: a nationwide survey.
BACKGROUND
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.


METHODS
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 degrees dorsal curvature of 16 months duration; case 2, a 60-year-old man with 35 degrees dorsal curvature, 4/10 pain on visual analog scale, of 6 months duration; case 3, a 62-year-old man with painless 60 degrees 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.
Shindel
Alan W
AW
Washington University in Saint Louis-Department of Surgery, Division of Urology, St. Louis, MO, USA. Electronic address: shindela@urology.ucsf.edu.
Bullock
Travis L
TL
Washington University in Saint Louis-Department of Surgery, Division of Urology, St. Louis, MO, USA.
Brandes
Steven
S
Washington University in Saint Louis-Department of Surgery, Division of Urology, St. Louis, MO, USA.
D000328:Adult; D001291:Attitude of Health Personnel; D002983:Clinical Competence / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010411:Penile Induration / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*; D015917:Penile Prosthesis / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011369:Professional-Patient Relations; D011785:Quality Assurance, Health Care / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D014481:United States; D014572:Urology / Q000706:statistics & numerical data*; D014810:Vitamin E / Q000627:therapeutic use
D014810:Vitamin E