(164) Real-World Practice in Peyronie’s Disease Management: Results from a National Survey of Urologists

Abstract

Abstract Introduction There are many treatment options for men with Peyronie's disease, some which have been shown in randomized controlled trials to be more effective than placebo in reducing curvature and plaque size and others which do not have strong evidence of efficacy for use. It is unclear which of the many Peyronie's disease treatment choices are preferred by practicing urologists. Objective To survey practicing urologists on their preferred methods for diagnosing and treating Peyronie's disease. Methods A 34-item survey was distributed via REDCap to urologists in all American Urological Association (AUA) sections. Questions elicited demographic information as well as practices in diagnosis and treatment of Peyronie’s disease. Comparisons were made with Pearson’s chi-squared test. Results A total of 145 respondents completed the survey, of whom 19% were fellowship trained in andrology/sexual medicine, 36% practiced in an academic setting, and 50% had at least 20 years in practice. Only 60% of respondents reporting performing in-office curvature assessment prior to commencing intralesional injection or surgical treatment, with higher prevalence in andrology/sexual medicine fellowship-trained vs. non-fellowship trained urologists (85% vs. 54%, p=0.003). The most popular treatment modalities were collagenase clostridium histolyticum (CCH) (61% of respondents), phosphodiesterase-5 (PDE-5) inhibitors (54%), and penile traction (53%). Twenty-one percent of respondents reported currently using a treatment that is explicitly discouraged by the AUA guidelines (extracorporeal shockwave therapy for curvature, L-carnitine, omega-3 fatty acids, procarbazine, tamoxifen, or vitamin E). Conclusions We found reported use of a variety of Peyronie's disease treatments, despite poor evidence of efficacy for several of these therapies. PDE-5 inhibitors, penile traction, and CCH were among the most popular non-surgical treatments, with a significant proportion of urologists reporting “off-label” use of CCH. Efforts are needed to identify optimal regimens for Peyronie's disease treatment and to better educate urologists on the up-to-date evidence and guidelines in Peyronie's disease management. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Roman Health