2018 Canadian Urological Association guideline for Peyronie's disease and congenital penile curvature

Abstract

Peyronie’s disease (PD) is a highly prevalent condition that affects the physical and psychosocial well-being and quality of life (QoL) for thousands of Canadian men. The specific etiology of PD remains poorly understood and there remains a paucity of randomized placebo-controlled trials evaluating treatment interventions.1-3 PD can be found in up to 8.9% of men, a remarkable increase in cited prevalence that is attributable to growing awareness (as historical data suggested a rate of less than 1%); the burden of disease is significant, and PD is often present in otherwise healthy men. The following guidelines were crafted by the committee with a full awareness of the limitations of the literature, and sought to provide actionable recommendations to guide PD care in the Canadian health system.

Clinical pearls to managing men’s health conditions during the COVID-19 pandemic

“…Erectile dysfunction (ED) is the recurrent and persistent inability to achieve and/or maintain an erection adequate to permit sexual performance for at least three months. 10 ED affects more than 50% of men between the ages of 40 and 70 years and rates rise over 70% for patients above 70. 11 Serious conditions to screen for: Peyronie's disease (PD), cardiovascular disease, neurologic disorders, unstable mental health.…”

“…Suggested investigations: Sexual Health Inventory for Men (SHIM)/International Index of Erectile Function (IIEF) questionnaire, fasting glucose or hemoglobin A1C, lipid profile, testosterone and hormone profile (if warranted). 10 Treatment: Identifying reversible causes and suggesting lifestyle modifications (smoking cessation, medication changes, exercise, etc.) should be considered first.…”

“…CUA guidelines suggest that morphological assessment may be performed with digital photos of the erect penis. 10 Having patients send your clinic digital photos of the erect penis from dorsal and lateral views can be a beneficial tool for assessment. However, it is important for the patient to report the firmness of the erection, as softer erections underestimate deformities.…”

“…25,26 It should be noted that there are no recommended oral therapies. 10 Followup: Given that PD does not pose an imminent danger to our patients, delayed in-office assessment until resolution of the pandemic is warranted. In the interim, followup should focus on symptom management and treatment planning to expedite care once surgical and clinical services resume.…”

Peyronie’s disease: Contemporary evaluation and management

“…There is no strong evidence to date that supports the use of oral monotherapy for PD. The AUA and CUA guidelines on PD recommend against oral therapy with vitamin E, tamoxifen, omega‐3‐fatty acids, procarbazine and vitamin E/L‐carnitine combination 12,36 . Non‐steroidal anti‐inflammatories are indicated for penile pain, particularly in the early phase 12 .…”