Urologists’ knowledge base and practice patterns in Peyronie’s disease. A national survey of members of the italian andrology society

Submitted: June 28, 2021
Accepted: August 9, 2021
Published: October 1, 2021
Abstract Views: 1049
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Peyronie’s disease is a chronic inflammatory disease involving the formation of plaque in the tunica albuginea of the corpora cavernosa, resulting in penis deformity. It is often associated with penile pain, especially in younger patients, but it is not rare for pain to be absent; the disease is also associated with erectile dysfunction and a depressive state in a large percentage of cases.
Objective: Aim of our study was to explore the basic knowledge base and diagnostic and therapeutic practice patterns in Peyronie's disease (PD) of a large number of physicians belonging to the Italian Andrology Society (SIA).
Methods: Our survey is based on two questionnaires which were e-mailed to the members of the SIA. The first questionnaire explored diagnostic and therapeutic practice patterns of SIA physicians, while the second questionnaire focused on their knowledge of the disease, as well as their training and level of experience in the specific field. We then planned to compare our outcomes with similar PD surveys from other countries. Results: The first questionnaire was answered by 142 SIA physicians. The second questionnaire was answered by 83 SIA physicians. Most respondents (74.6%) chose penile ultrasonography as first-line diagnostic approach and 47.1% prefer to perform a color Doppler ultrasound after pharmaco-induced erection. Concerning the therapeutic practice patterns in active stage of the disease, most respondents (99.29%) prefer conservative medical therapy. Additionally, most respondents (64.78%), when failure of conservative treatment had been established, considered surgical treatment necessary, specifically corporoplasty, which may be associated with other techniques.
Conclusions: The results of our survey show that, in comparison to their foreign counterparts, Italian SIA uro-andrologists have a more proactive diagnostic approach right from when patients first present. When PD is still in its active stage, SIA uro-andrologists mostly opt for medical therapy. In advanced disease or if conservative treatment fails, our survey indicates a greater preference for surgical treatment. Answers to the theoretical knowledge questions showed that SIA physicians have a good understanding of the disease’s etiology, epidemiology, and clinical picture, and of the appropriate indications for treatment.

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Pryor JP, Ralph DJ. Clinical presentations of Peyronie’s disease. Int J Impot Res. 2002; 14:414-417. DOI: https://doi.org/10.1038/sj.ijir.3900877
Nelson CJ, Diblasio C, Kendirci M, et al. The chronology of depression and distress in men with Peyronie’s disease. J Sex Med. 2008;5:1985-1990.
Weidner W, Schroeder-Printzen I, Weiske WH, et al. Sexual dysfunction in Peyronie’s disease: an analysis of 222 patients without previous local plaque therapy. J Urol. 1997; 157:325-328.
Jarow JP, Lowe FC. Penile trauma: an etiologic factor in Peyronie's disease and erectile dysfunction. J Urol. 1997;158:1388-1390. DOI: https://doi.org/10.1016/S0022-5347(01)64222-8
Devine CJ, Somers KD, Jordan GH, et al. Proposal: trauma as a cause of Peyronie's lesion. J Urol. 1997;157:285-290. DOI: https://doi.org/10.1016/S0022-5347(01)65361-8
Devine CJ Jr, Somers KD, Ladaga LE. Peyronie's disease: pathophysiology. Prog Clin Biol Res. 1991; 370:355-358.
Somers KD, Dawson DM. Fibrin deposition in Peyronie's disease plaque. J Urol. 1997; 157:311-315. DOI: https://doi.org/10.1016/S0022-5347(01)65367-9
Sikka SC, Hellstrom WJ. Role of oxidative stress and antioxidants in Peyronie’s disease. Int J Impot Res. 2002;14:353-360. DOI: https://doi.org/10.1038/sj.ijir.3900880
Davila HH, Magee TR, Vernet D, et al. Gene transfer of inducible nitric oxide synthase complementary DNA regresses the fibrotic plaque in an animal model of Peyronie's disease. Biol Reprod. 2004;71:1568-1577. DOI: https://doi.org/10.1095/biolreprod.104.030833
Bivalacqua TJ, Champion HC, Hellstrom WJ. Implications of nitric oxide synthase isoforms in the pathophysiology of Peyronie's disease. Int J Impot Res. 2002; 14:345-352. DOI: https://doi.org/10.1038/sj.ijir.3900872
El-Sakka AI, Salabas E, Dinçer M, et al. The pathophysiology of Peyronie's disease. Arab J Urol. 2013; 11:272-277. DOI: https://doi.org/10.1016/j.aju.2013.06.006
Paulis G, Romano G, Paulis L, et al. Recent pathophysiological aspects of Peyronie's disease: role of free radicals, rationale, and therapeutic implications for antioxidant treatment-literature review. Adv Urol. 2017; 2017:4653512. DOI: https://doi.org/10.1155/2017/4653512
Herati AS, Pastuszak AW. The genetic basis of Peyronie's disease: a review. Sex Med Rev. 2016;4:85-94. DOI: https://doi.org/10.1016/j.sxmr.2015.10.002
Bias WB, Nyberg LM, Jr, Hochberg MC, et al. Peyronie's disease: a newly recognized autosomal-dominant trait. American journal of medical genetics. 1982; 12:227-235. DOI: https://doi.org/10.1002/ajmg.1320120213
Rompel R, Mueller-Eckhardt G, Schroeder-Printzen I, et al. HLA antigens in Peyronie's disease. Urol Int. 1994;52:34-37. DOI: https://doi.org/10.1159/000282566
Willscher MK, Cwazka WF, Novicki DE. The association of histocompatibility antigens of the B7 cross-reacting group with Peyronie's disease. J Urol 1979; 122:34-35. DOI: https://doi.org/10.1016/S0022-5347(17)56238-2
Schwarzer U, Sommer F, Klotz T, et al. The prevalence of Peyronie’s disease: results of a large survey. BJU Int. 2001; 88:727-730. DOI: https://doi.org/10.1046/j.1464-4096.2001.02436.x
Dibenedetti DB, Nguyen D, Zografos L, et al. A population-based study of Peyronie’s disease: prevalence and treat- ment patterns in the United States. Adv Urol. 2011; 2011:282503.
La Pera G, Pescatori ES, Calabrese M, et al. SIMONA Study Group Peyronie’s disease: prevalence and association with cigarette smoking. A multicenter population-based study in men aged 50-69 years. Eur Urol. 2001; 40:525-530. DOI: https://doi.org/10.1159/000049830
Deveci S, Hopps CV, O’Brien K, et al. Defining the clinical characteristics of Peyronie’s disease in young men. J Sex Med. 2007;4:485-490. DOI: https://doi.org/10.1111/j.1743-6109.2006.00344.x
Paulis G, Cavallini G, Barletta D, et al. Clinical and epidemiological characteristics of young patients with Peyronie's disease: a retrospective study. Res Rep Urol. 2015; 7:107-11. DOI: https://doi.org/10.2147/RRU.S85708
Gonzalez-Cadavid NF. Mechanisms of penile fibrosis. J Sex Med-2009; 6(Suppl 3): 353-362.
Paulis G, Brancato T. Inflammatory mechanisms and oxidative stress in Peyronie's disease: therapeutic "rationale" and related emerging treatment strategies. Inflamm Allergy Drug Targets. 2012; 11:48-57. DOI: https://doi.org/10.2174/187152812798889321
El-Sakka AI, Hassoba HM, Pillarisetty RJ, et al. Peyronie's disease is associated with an increase in transforming growth factor-beta protein expression. J Urol. 1997; 158:1391-1394. DOI: https://doi.org/10.1016/S0022-5347(01)64223-X
Zimmermann RP, Feil G, Bock C, et al. Significant alterations of serum cytokine levels in patients with Peyronie's disease. Int Braz J Urol. 2008; 34:457-466. DOI: https://doi.org/10.1590/S1677-55382008000400008
Gentile V, Modesti A, La Pera G, et al. Ultrastructural and immunohistochemical characterization of the tunica albuginea in Peyronie’s disease and veno-occlusive function. J Androl. 1996;17:96-103.
Mulhall JP, Schiff J, Guhring P. An analysis of the natural history of Peyronie's disease. J Urol. 2006;175:2115-2118. DOI: https://doi.org/10.1016/S0022-5347(06)00270-9
Hatzimouratidis K, Eardley I, Giuliano F, et al. EAU guidelines on penile curvature. Eur Urol. 2012; 62:543-552.
Garaffa G, Trost LW, Serefoglu EC, et al. Understanding the course of Peyronie's disease. Int J Clin Pract. 2013;67:781-788. DOI: https://doi.org/10.1111/ijcp.12129
Levine LA, Larsen S. Diagnosis and Management of Peyronie Disease. In: Wein AJ, Kavoussi LR, Partin AW, Peters CA, eds.Campbell-Walsh Urology. 11th Ed. ed Vol 1. Elsevier Saunders; Philadelphia: 2015. Chap 31 pp. 722-748.
Tsambarlis P, Levine LA. Nonsurgical management of Peyronie's disease. Nat Rev Urol. 2019; 16:172-186. DOI: https://doi.org/10.1038/s41585-018-0117-7
Nguyen HNT, Anaissie J, DeLay KJ, et al. Safety and efficacy of collagenase Clostridium histolyticum in the treatment of acute-phase Peyronie’s disease. J Sex Med 2017; 14:1220-1225. DOI: https://doi.org/10.1016/j.jsxm.2017.08.008
Zucchi A, Costantini E, Cai T, et al. Intralesional injection of hyaluronic acid in patients affected with Peyronie's disease: preliminary results from a prospective, multicenter, pilot study. Sex Med. 2016; 4:e85-e90. DOI: https://doi.org/10.1016/j.esxm.2016.01.002
Yafi FA, Pinsky MR, Sangkum P, et al. Therapeutic advances in the treatment of Peyronie's disease. Andrology. 2015; 3:650-660. DOI: https://doi.org/10.1111/andr.12058
Gennaro R, Barletta D, Paulis G. Intralesional hyaluronic acid: an innovative treatment for Peyronie's disease. Int Urol Nephrol. 2015; 47:1595-1602. DOI: https://doi.org/10.1007/s11255-015-1074-1
Paulis G, Barletta D, Turchi P, et al. Efficacy and safety evaluation of pentoxifylline associated with other antioxidants in medical treatment of Peyronie's disease: a case-control study. Res Rep Urol. 2015; 8:1-10. DOI: https://doi.org/10.2147/RRU.S97194
Paulis G, Brancato T, D'Ascenzo R, et al. Efficacy of vitamin E in the conservative treatment of Peyronie's disease: legend or reality? A controlled study of 70 cases. Andrology. 2013; 1:120-128. DOI: https://doi.org/10.1111/j.2047-2927.2012.00007.x
Nehra A, Alterowitz R, Culkin DJ, et al. Peyronie’s disease: AUA guideline. J Urol. 2015; 194:745-753.
El-Khatib FM, Towe M, Yafi FA. Management of Peyronie's disease with collagenase Clostridium histolyticum in the acute phase. World J Urol. 2020;38:299-304. DOI: https://doi.org/10.1007/s00345-019-02791-x
Ralph D, Gonzalez-Cadavid N, Mirone V, et al. The management of Peyronie's disease: evidence-based 2010 guidelines. J Sex Med. 2010; 7:2359-2374. DOI: https://doi.org/10.1111/j.1743-6109.2010.01850.x
Kendirci M, Hellstrom WJ. Critical analysis of surgery for Peyronie’s disease. Curr Opin Urol. 2004; 6:381-388.
Fabiani A, Fioretti F, Pavia MP, et al. Buccal mucosa graft in surgical management of Peyronie's disease: Ultrasound features and clinical outcomes. Arch Ital Urol Androl. 2021; 93:107-110. DOI: https://doi.org/10.4081/aiua.2021.1.107
Asali, M. Intralesional injection of the calcium channel blocker Verapamil in Peyronie's disease: A critical review. Arch Ital Urol Androl. 2020; 92:253. DOI: https://doi.org/10.4081/aiua.2020.3.253
De Rose AF, Ambrosini F, Mantica G, et al. Prepuce-sparing corporoplasty as a safe alternative for patients with acquired penile curvature. Arch Ital Urol Androl. 2020; 92:182. DOI: https://doi.org/10.4081/aiua.2020.3.182
Hatzimouratidis K, Eardley I, Giuliano F, et al. EAU guidelines on penile curvature. Eur Urol 2012; 62:543-552. DOI: https://doi.org/10.1016/j.eururo.2012.05.040
Nehra A, Alterowitz R, Culkin DJ, et al. Peyronie’s disease: AUA Guideline. J Urol. 2015; 194:745-753. DOI: https://doi.org/10.1016/j.juro.2015.05.098
Chung E, Ralph D, Kagioglu A, et al. Evidence-based management guidelines on Peyronie's disease. J Sex Med. 2016; 13:905-923. DOI: https://doi.org/10.1016/j.jsxm.2016.04.062
Bella AJ, Lee JC, Grober ED, et al. Canadian Urological Association guideline for Peyronie's disease and congenital penile curvature. Can Urol Assoc J. 2018; 12:E197-E209. DOI: https://doi.org/10.5489/cuaj.5255
Hauck EW, Bschleipfer T, Haag SM, et al. Assessment among German urologists of various conservative treatment modalities for Peyronie's disease. Results of a survey. Urologe A. 2005; 44:1189-1196. DOI: https://doi.org/10.1007/s00120-005-0867-8
LaRochelle JC, Levine LA. A Survey of primary-care physicians and urologists regarding Peyronie's disease. J Sex Med. 2007;4:1167-1173. DOI: https://doi.org/10.1111/j.1743-6109.2007.00537.x
Shindel AW, Bullock TL, Brandes S. Urologist practice patterns in the management of Peyronie's disease: a nationwide survey. J Sex Med. 2008; 5:954-964. DOI: https://doi.org/10.1111/j.1743-6109.2007.00674.x
Sullivan J, Moskovic D, Nelson C, et al. Peyronie's disease: urologist's knowledge base and practice patterns. Andrology 2015; 3:260-264. DOI: https://doi.org/10.1111/andr.292
Oberlin DT, Liu JS, Hofer MD, et al. An analysis of case logs from American urologists in the treatment of Peyronie's disease. Urology. 2016; 87:205-209. DOI: https://doi.org/10.1016/j.urology.2015.08.033
Ko YH, Moon KH, Lee SW, et al. Urologists' perceptions and practice patterns in Peyronie's disease: A Korean nationwide survey including patient satisfaction. Korean J Urol. 2014; 55:57-63. DOI: https://doi.org/10.4111/kju.2014.55.1.57
DiBenedetti DB, Nguyen D, Zografos L, et al. A population-based study of Peyronie's disease: prevalence and treatment patterns in the United States. Adv Urol. 2011; 2011:9. DOI: https://doi.org/10.1155/2011/282503
Stuntz M, Perlaky A, des Vignes F, et al. The prevalence of Peyronie's disease in the United States: a population-based study. PLoS One. 2016; 11:e0150157. DOI: https://doi.org/10.1371/journal.pone.0150157
Weidner W, Schroeder-Printzen I, Weiske WH, Sexual dysfunction in Peyronie's disease: an analysis of 222 patients without previous local plaque therapy. J Urol. 1997: 157:325-328. DOI: https://doi.org/10.1016/S0022-5347(01)65370-9
Kadioglu A, Sanli O, Akman T, et al. Factors affecting the degree of penile deformity in Peyronie disease: an analysis of 1001 patients. J Androl. 2011; 32:502-508. DOI: https://doi.org/10.2164/jandrol.110.011031
Paulis G, Romano G, Paulis, A. Prevalence, psychological impact, and risk factors of erectile dysfunction in patients with Peyronie’s disease: a retrospective analysis of 309 cases. Res Rep Urol. 2016; 8:95-103. DOI: https://doi.org/10.2147/RRU.S109319
Paulis G, Cavallini G. Clinical evaluation of natural history of Peyronie’s disease: our experience, old myths and new certainties. Inflamm Allergy Drug Targets. 2013; 12:341-348. DOI: https://doi.org/10.2174/18715281113129990055
Smith JF, Walsh TJ, Conti SL, et al. Risk factors for emotional and relationship problems in Peyronie’s disease. J Sex Med. 2008; 5:2179-2184. DOI: https://doi.org/10.1111/j.1743-6109.2008.00949.x
Gelbard MK, Dorey F, James K. The natural history of Peyronie’s disease. J Urol. 1990;144:1376-1379. DOI: https://doi.org/10.1016/S0022-5347(17)39746-X
Nelson CJ, Diblasio C, Kendirci M, et al. The chronology of depression and distress in men with Peyronie’s disease. J Sex Med. 2008; 5:1985-1990. DOI: https://doi.org/10.1111/j.1743-6109.2008.00895.x
Levine L, Rybak J, Corder C, et al. Peyronie's disease plaque calcification-Prevalence, time to identification, and development of a new grading classification. J Sex Med. 2013; 10:3121-3128. DOI: https://doi.org/10.1111/jsm.12334
Kadioglu A, Akman T, Sanli O, et al. Surgical treatment of Peyronie’s disease: a critical analysis. Eur Urol. 2006; 50:235-248. DOI: https://doi.org/10.1016/j.eururo.2006.04.030
Kendirci M, Hellstrom WJ. Critical analysis of surgery for Peyronie's disease. Curr Opin Urol. 2004; 14:381-388. DOI: https://doi.org/10.1097/00042307-200411000-00015
Jalkut M, Gonzalez-Cadavid N, Rajfer J. Peyronie’s disease: a review. Rev. Urol. 2003; 5:142-148. DOI: https://doi.org/10.1007/s11934-004-0074-y
Hellstrom WJ, Bivalacqua TJ. Peyronie’s disease: etiology, medical, and surgical therapy. J Androl. 2000; 21:347-354.
Levine LA, Burnett AL. Standard operating procedures for Peyronie's disease. J Sex Med. 2013; 10:230-244. DOI: https://doi.org/10.1111/j.1743-6109.2012.03003.x
Dolmans GH, Werker PM, de Jong IJ, et al. WNT2 locus is involved in genetic susceptibility of Peyronie's disease. J Sex Med. 2012; 9:1430-1434. DOI: https://doi.org/10.1111/j.1743-6109.2012.02704.x
Sharma KL, Alom M, Trost L. The etiology of Peyronie’s disease: pathogenesis and genetic contributions. Sex Med Rev. 2020; 8:314-323. DOI: https://doi.org/10.1016/j.sxmr.2019.06.004
Gonzalez-Cadavid NF. Mechanisms of penile fibrosis. J Sex Med. 2009; 6(Suppl. 3):353-362. DOI: https://doi.org/10.1111/j.1743-6109.2008.01195.x
Chung E, De Young L, Brock GB. Rat as an animal model for Peyronie’s disease research: a review of current methods and the peerreviewed literature. Int J Impot Res. 2011; 23:235-241. DOI: https://doi.org/10.1038/ijir.2011.36

How to Cite

Paulis, G., Pisano, F., Palmieri, A., Cai, T., Palumbo, F., & Giammusso, B. (2021). Urologists’ knowledge base and practice patterns in Peyronie’s disease. A national survey of members of the italian andrology society. Archivio Italiano Di Urologia E Andrologia, 93(3), 348–355. https://doi.org/10.4081/aiua.2021.3.348