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Author Topic: American Urological Association - 2015 Guidelines for Peyronies  (Read 1775 times)

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Pfract

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Peyronie's Disease: American Urological Association

Searched before posting, and didn't seem to find anything about it, so think it's not a repost. Super up to date, and from a reputable source, IMO. Hope not to be wrong.

"Purpose: The purpose of this guideline is to provide a clinical framework for the diagnosis and treatment of Peyronie's disease (Peyronies Disease).

Methods: A systematic review of the literature using the Pubmed, Embase, and Cochrane databases (search dates 1/1/1965 to 1/26/15) was conducted to identify peer-reviewed publications relevant to the diagnosis and treatment of Peyronies Disease. The review yielded an evidence base of 303 articles after application of inclusion/exclusion criteria. [...]

Diagnosis

1. Clinicians should engage in a diagnostic process to document the signs and symptoms that characterize Peyronie's disease. The minimum requirements for this examination are a careful history (to assess penile deformity, interference with intercourse, penile pain, and/or distress) and a physical exam of the genitalia (to assess for palpable abnormalities of the penis). (Clinical Principle)

2. Clinicians should perform an in-office intracavernosal injection (ICI) test with or without duplex Doppler ultrasound prior to invasive intervention. (Expert Opinion)

3. Clinicians should evaluate and treat a man with Peyronie's disease only when he has the experience and diagnostic tools to appropriately evaluate, counsel, and treat the condition. (Expert Opinion)

Treatment

4. Clinicians should discuss with patients the available treatment options and the known benefits and risks/burdens associated with each treatment. (Clinical Principle)

5. Clinicians may offer oral non-steroidal anti-inflammatory medications to the patient suffering from active Peyronie's disease who is in need of pain management.

6. Clinicians should not offer oral therapy with vitamin E, tamoxifen, procarbazine, omega-3 fatty acids, or a combination of vitamin E with L-carnitine. [Moderate Recommendation; Evidence Strength Grade B(vitamin E/omega-3 fatty acids/Vitamin E + propionyl-L-carnitine )/ C( tamoxifen/procarbazine)]

7. Clinicians should not offer electromotive therapy with verapamil. (Moderate Recommendation; Evidence Strength Grade C)

8. Clinicians may administer intralesional collagenase clostridium histolyticum in combination with modeling by the clinician and by the patient for the reduction of penile curvature in patients with stable Peyronie's disease, penile curvature >30° and <90°, and intact erectile function (with or without the use of medications). (Moderate Recommendation; Evidence Strength Grade B)

9. Clinicians should counsel patients with Peyronie's disease prior to beginning treatment with intralesional collagenase regarding potential occurrence of adverse events, including penile ecchymosis, swelling, pain, and corporal rupture. (Clinical Principle)

10. Clinicians may administer intralesional interferon α-2b in patients with Peyronie's disease. (Moderate Recommendation; Evidence Strength Grade C)

11. Clinicians should counsel patients with Peyronie's disease prior to beginning treatment with intralesional interferon a-2b about potential adverse events, including sinusitis, flu-like symptoms, and minor penile swelling. (Clinical Principle)

12. Clinicians may offer intralesional verapamil for the treatment of patients with Peyronie's disease. (Conditional Recommendation; Evidence Strength Grade C)

13. Clinicians should counsel patients with Peyronie's disease prior to beginning treatment with intralesional verapamil about potential adverse events, including penile bruising, dizziness, nausea, and pain at the injection site. (Clinical Principle)

14. Clinicians should not use extracorporeal shock wave therapy (ESWT) for the reduction of penile curvature or plaque size. (Moderate Recommendation; Evidence Strength Grade B)

15. Clinicians may offer extracorporeal shock wave therapy (ESWT) to improve penile pain. (Conditional Recommendation; Evidence Strength Grade B)

16. Clinicians should not use radiotherapy (RT) to treat Peyronie's disease. (Moderate Recommendation; Evidence Strength Grade C)

17. Clinicians should assess patients as candidates for surgical reconstruction based on the presence of stable disease. (Clinical Principle)

18. Clinicians may offer tunical plication surgery to patients whose rigidity is adequate for coitus (with or without pharmacotherapy and/or vacuum device therapy) to improve penile curvature. (Moderate Recommendation; Evidence Strength Grade C)

19. Clinicians may offer plaque incision or excision and/or grafting to patients with deformities whose rigidity is adequate for coitus (with or without pharmacotherapy and/or vacuum device therapy) to improve penile curvature. (Moderate Recommendation; Evidence Strength Grade C)

20. Clinicians may offer penile prosthesis surgery to patients with Peyronie's disease with erectile dysfunction (Erectile Dysfunction) and/or penile deformity sufficient to prevent coitus despite pharmacotherapy and/or vacuum device therapy. (Moderate Recommendation; Evidence Strength Grade C)

21. Clinicians may perform adjunctive intra-operative procedures, such as modeling, plication or incision/grafting, when significant penile deformity persists after insertion of the penile prosthesis. (Moderate Recommendation; Evidence Strength Grade C)

22. Clinicians should use inflatable penile prosthesis for patients undergoing penile prosthetic surgery for the treatment of Peyronie's
disease. (Expert Opinion)

james1947

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Re: American Urological Association - 2015 Guidelines for Peyronies
« Reply #1 on: May 22, 2015, 02:32:58 PM »

pfract

Your new topic have nothing to do with oral treatment except the advice not to use vitamin E as Peyronies treatment, this is the reason I moved it to here.
Please think before opening a topic to find the most adequate board for it.

Three remarks:
* I didn't see any of the leading Peyronies specialists signed on the paper.
* I didn't see any guidance regarding oral treatments.
* The paper still advising VI, while the testimonies on our forum are that it makes Peyronies worst and not better.
By the way, what you can buy from them? They have a Shopping Cart at the top of all they web pages.

James
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Age 71, Peyronies from Jan 2009 following penis fracture during sex. Severe Erectile Dysfunction.
Lost 2" length and a lot of girth. Late start, still VED, Cialis & Pentox helped. Prostate surgery 2014.
Got amazing support on the forum

Pfract

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Re: American Urological Association - 2015 Guidelines for Peyronies
« Reply #2 on: May 22, 2015, 03:02:56 PM »

Thanks for moving the post James. I was unsure where to put it. Regarding your remarks:

* I didn't see any of the leading Peyronies specialists signed on the paper.
In the bibliography section a quick glance showed me some very known doctors around here:
245:Djordjevic ML and Kojovic V, -248, 249:Egydio PH, Kuehhas FE and Sansalone S, 255: Levine LA, Benson J and Hoover C,
48: M gelbard

* I didn't see any guidance regarding oral treatments.

Almost in the end or the article, they have this section:
"Other Treatments

The Panel identified the treatments reviewed below as possibly promising but for which insufficient evidence currently exists to support even a Conditional Recommendation for their use. In the Panel's view, the treatments in this category are unproven until a larger and/or more rigorous evidence base is available.

Not that i fully agree with it, nor that i discredit the information on this forum. Apparently, this is what the AUA recommends for doctors to follow. At least, this is my understanding of what this article is. Correct me if i'm wrong please.

james1947

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Re: American Urological Association - 2015 Guidelines for Peyronies
« Reply #3 on: May 22, 2015, 07:52:22 PM »

pfract

Bibliography section says that the authors wrote they paper after reading the documents there, not more, not less.
The people and documents in the bibliography are not endorsing those guidelines.
The authors are:
Ajay Nehra, Ralph Alterowitz, Daniel J. Culkin, Martha M. Faraday, Lawrence S. Hakim, Joel J. Heidelbaugh, Mohit Khera, Kevin T. McVary, Martin M. Miner, Christian J. Nelson, Hossein Sadeghi-Nejad, Allen D. Seftel, Alan W. Shindel, and Arthur L. Burnett
Regarding oral treatments, have much more to say than is written in the document.
Many other subjects also are treated very superficially, this is my opinion in any case, but I am not a doctor so I may be wrong.
Do you think that Dr. Tom Lue, Dr. Levine or Dr. Kuehass will start working according to those guidance's?
They even noted that an ultrasound is optional to diagnose Peyronies, while all the leading Peyronies experts are making ultrasound as an important tool to diagnose this disease.
I must to admit I didn't read deeply all the paragraphs and I will not do it.

James
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Age 71, Peyronies from Jan 2009 following penis fracture during sex. Severe Erectile Dysfunction.
Lost 2" length and a lot of girth. Late start, still VED, Cialis & Pentox helped. Prostate surgery 2014.
Got amazing support on the forum

Thisismyusername

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Re: American Urological Association - 2015 Guidelines for Peyronies
« Reply #4 on: May 22, 2015, 11:10:27 PM »

What is this interferon a-2b?  I haven't heard of this one before.
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