PEYRONIE’S DISEASE: AUA GUIDELINE (2015) Flashcards

Question

What is the differential diagnosis for Peyronie's Disease? A) Congenital penile curvature B) Dorsal penile vein thrombosis C) Penile fracture D) All of the above

Answer 1

D) All of the above

Answer 2

A) Congenital penile curvature is present from birth

Answer 3

C) Penile fracture

Answer 4

C. Both careful history and physical exam Explanation: The AUA guideline states that the minimum requirement for a diagnostic examination of Peyronie's disease is 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.

Answer 5

A. Onset, precipitating factors, duration, changes over time, prior treatments used, and other conditions Explanation: The AUA guideline states that the clinician should meticulously elicit the patient's history of penile symptoms, including onset, precipitating factors, duration, changes over time, prior treatments used, and other conditions (e.g., ED) that may affect treatment options.

Answer 6

C. To assess the patient's satisfaction with intercourse Explanation: The AUA guideline states that assessment of sexual function is of particular importance in patients with Peyronie's disease. Penile sensation, ejaculatory function, erectile function (including relevant comorbidities), difficulty/pain with penile penetration, and concerns regarding penile length and girth should be assessed. Patient and partner comfort and satisfaction with intercourse should also be assessed.

Answer 7

C. Measurement of stretched penile length Explanation: The physical examination of the genitalia should include stretching and palpation of the flaccid penis, documentation of circumcision status and any anomalies, and measurement of stretched penile length from the penopubic skin junction to the coronal sulcus or the tip to establish baseline penile length prior to any intervention.

Answer 8

B. ICI test with duplex Doppler ultrasound is recommended before initiating any invasive treatment for Peyronie's Disease.

Answer 9

D. All of the above can be determined with an ICI test.

Answer 10

An ICI test is recommended prior to invasive intervention for PD as it enables assessment of penile deformity, plaque(s), and pain in the erect state. The point of maximum curvature can be determined, measurements of erect penile length and girth can be obtained, and erectile function can be assessed. When the ICI test is combined with duplex ultrasound, additional measurements of plaque size and/or density can be made, calcified and non-calcified plaques can be differentiated, and information on the vascular integrity of the penis can be obtained. In the patient with complex deformity (e.g., hourglass deformity or bidirectional curvature) and/or who reports ED, confirmation of these conditions with ICI is central to developing an effective treatment plan.

Answer 11

The clinician should have the training, experience, and resources to conduct a full diagnostic evaluation, interpret the evaluation appropriately, and counsel the patient on the various treatment options. Treatment options may include medication, injection therapy, or surgery. The choice of treatment depends on the severity of the symptoms and the patient's preferences. It is important to weigh the risks and benefits of each treatment option and involve the patient in the decision-making process. Follow-up care is also important to monitor the patient's progress and adjust treatment as needed.

Answer 12

D. All of the above Explanation: According to the guideline, the clinician should carefully weigh the potential benefit to the patient of a particular treatment against that treatment's risk for adverse events, the severity of adverse events, and the reversibility of adverse events.

Answer 13

B. 10-90 degrees Explanation: According to the guideline, in published studies across intervention types that reported average baseline curvature, the range is 10 to 90 degrees, and the median is approximately 48 degrees.

Answer 14

Patient concern is an important component of the patient experience of Peyronie's Disease. The distress over symptoms, penile appearance, and penile function can significantly affect the patient's quality of life. Therefore, the patient's level of concern regarding his symptoms and his willingness to undergo various types of treatment should be fully considered in the treatment decision-making process in addition to objective measures of curvature and erectile function. This can help to ensure that the patient is fully informed and involved in the decision-making process and that the chosen treatment plan is individualized to optimize sexual function and QoL.

Answer 15

: b. To explain the available treatment options for Peyronie's disease to patients. Explanation: The main purpose of Guideline Statement 4 is to discuss the available treatment options for Peyronie's disease and the benefits and risks associated with each option.

Answer 16

c. To increase patient satisfaction with the chosen treatment option. Explanation: Realistic expectations help patients to choose a treatment option that is right for them and to be satisfied with the outcome of the treatment.

Answer 17

c. Pain with or without erection Explanation: Pain is a common symptom of active Peyronie’s disease and can cause significant distress to the patient.

Answer 18

d. Using a visual analog scale (VAS) Explanation: A VAS is a commonly used tool to assess pain level in patients with Peyronie’s disease.

Answer 19

B. Vitamin E Explanation: According to Guideline Statement 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.

Answer 20

According to Guideline Statement 6, the use of these therapies without efficacy, even in the absence of significant adverse events, constitutes a moderate risk/burden in terms of postponing or preempting the use of other efficacious treatments, the inability to alleviate patient distress, the time expended on treatments that do not work, and the costs associated with these medications or substances. In other words, there is little evidence to support the use of these therapies in the treatment of Peyronie's disease, and their use may delay or prevent the use of more effective treatments. The Panel also notes that oral therapies are not appropriate for patients with stable disease.

Answer 21

The seven studies are Safarinejad 2007, Inal 2006, Pryor & Farrell 1983, Claro 2004, and three additional studies that were not specified in the guideline. The findings varied among the studies, but overall, there was no compelling evidence that vitamin E reduces curvature, plaque, or pain. The RCT reported that the vitamin E and placebo groups had similar curvature and plaque increases, and similar percentages of patients reported improvement or worsening in the vitamin E and placebo groups with nearly two-thirds of patients with worsened curvature in both groups. The observational study reported minimal curvature and plaque decreases, but Inal (2006) reported that curvature and plaque, on average, increased. In terms of pain, the vitamin E and placebo groups improved similarly, and there was no significant difference between the vitamin E group and the placebo group in terms of pain relief.

Answer 22

c) Clinicians should not offer electromotive therapy with verapamil. Explanation: The guideline statement clearly mentions that clinicians should not offer this treatment for Peyronie's disease.

Answer 23

c. Intralesional collagenase in combination with modeling by the clinician and patient.

Answer 24

c. Between 30 and 90 degrees.

Answer 25

The use of intralesional collagenase in combination with modeling is appropriate only in patients with stable Peyronie's disease, a penile curvature between 30 and 90 degrees, and intact erectile function with or without the use of medications. The treatment has not been evaluated in patients with hourglass deformity, ventral curvature, calcified plaque, or plaque located proximal to the base of the penis, and outcomes for these subgroups are unknown. The therapy is for curvature and does not treat pain or erectile dysfunction. Patients should be thoroughly counseled regarding the expected average curvature reduction of 17 degrees. Clinicians should be aware that the magnitude of treatment effect beyond placebo is modest, with an average difference of 7.7 degrees between the collagenase and placebo groups. The treatment effect should be considered carefully in the context of potential adverse events, some of which can be serious, such as corporal rupture, penile hematoma, and penile fracture. The Panel notes that the provision of collagenase is contingent on completion of a certification procedure provided by the manufacturer.

Answer 26

B. Penile ecchymosis

Answer 27

The most common adverse events associated with the use of intralesional collagenase in the treatment of Peyronie’s disease are penile ecchymosis (80%), penile swelling (55%), and penile pain (45.4%). Additional adverse events reported in <5% of collagenase-treated patients were blood blister, penile blister, erythema, general pruritus, painful erection, ED, skin discoloration, procedural pain, injection site vesicles, localized edema, dyspareunia, injection site pruritus, nodule, and suprapubic pain. In the IMPRESS I and II trials, 84.2% of patients in the collagenase groups and 36.3% of patients in the placebo groups experienced at least one adverse event after up to 4 treatment cycles. Most adverse events were considered mild or moderate by the investigators and resolved without intervention.

Answer 28

Based on the RCT inclusion and exclusion criteria, the use of intralesional interferon is appropriate in the patient with stable disease with curvature > 30 degrees and without calcified plaque. Patients should be administered 5 MU interferon α-2b every 2 weeks for 12 weeks (total of 6 injections). Thorough counseling should be given to patients regarding the expected average curvature reduction of 13.5 degrees. The treatment effect beyond placebo is modest, with an average difference of 9 degrees. However, improvements in other PD outcomes such as plaque size, pain, and vascular outcomes have been observed. Therefore, clinicians should bear in mind that the treatment effect is modest but still significant.

Answer 29

A) Clinicians should counsel patients about potential adverse events, including sinusitis, flu-like symptoms, and minor penile swelling before beginning treatment with intralesional interferon α-2b.

Answer 30

Intralesional interferon α-2b is a type of medication that is injected directly into the scar tissue in the penis. It works by reducing inflammation and promoting the growth of healthy tissue.

Answer 31

Patients who receive intralesional interferon α-2b may experience sinusitis, flu-like symptoms of fever, chills, and arthralgia, and minor penile swelling with ecchymosis. These symptoms are typically mild and can be effectively treated with over-the-counter nonsteroidal anti-inflammatory medications. They typically do not last longer than 48 hours. Clinicians should counsel patients about these potential adverse events before beginning treatment with intralesional interferon α-2b.

Answer 32

The evidence for the use of intralesional verapamil in the treatment of Peyronie's disease is weak. The available literature is challenging to interpret due to varied patient inclusion criteria, treatment protocols, and conflicting findings. While some studies have reported significant decreases in plaque length, width, and volume, others have reported only small curvature decreases and mixed findings with regard to plaque. Most studies have evaluated combination treatments, making definitive interpretation difficult. Additionally, most studies have focused on patients in the acute phase with dynamic and evolving symptoms, making it difficult to control for Peyronie's disease's natural history and for placebo effects. Therefore, the overall balance between benefits and risks/burdens of intralesional verapamil remains unclear. Clinicians who consider the use of intralesional verapamil should be aware of the lack of control for Peyronie's disease natural history and the substantial uncertainty regarding its efficacy.

Answer 33

According to Guideline Statement 13, potential adverse events associated with intralesional verapamil treatment for Peyronie's disease include penile bruising, dizziness, nausea, pain at the injection site, loss of libido, weakness, transient pain at the injection site, and sweating. Studies evaluating this treatment have reported a range of minor adverse events, including penile bruising in 15% to 66% of patients, dizziness or nausea in 2% to 10% of patients, loss of libido in 10% of patients, weakness in 16.7% of patients, transient pain at the injection site in 2% of patients, and sweating in 23.3% of patients. It is important for clinicians to counsel patients about the possibility of these adverse events prior to beginning treatment with intralesional verapamil.

Answer 34

b. Clinicians should not use ESWT for the reduction of penile curvature or plaque size. Explanation: Guideline Statement 14 recommends that clinicians should not use ESWT for the reduction of penile curvature or plaque size in Peyronie's disease.

Answer 35

C) Penile pain Explanation: According to the guideline statement, clinicians may offer extracorporeal shock wave therapy (ESWT) to improve penile pain in PD patients.

Answer 36

D) 85% Explanation: Hatzichristodoulou (2013) reported that 85% of ESWT patients with pain reported decreases compared to 48% of the placebo/sham group.

Answer 37

B) Petechial bleeding or bruising, urethral bleeding or transient hematuria, and minor ecchymosis Explanation: ESWT is associated with frequent adverse events, including localized petechial bleeding or bruising, urethral bleeding or transient hematuria, and minor ecchymosis. Severe adverse events are infrequent, but the most common severe adverse event is pain.

Answer 38

A) Pain is the PD symptom that is most likely to resolve over time without intervention. Explanation: The guideline statement for ESWT to improve penile pain is conditional because pain is the PD symptom that is most likely to resolve over time without intervention, the patient burden involved in obtaining ESWT treatment to treat pain may be substantial, and other treatments may be equally effective at alleviating pain. Additionally, ESWT is associated with frequent adverse events, which must be weighed against the potential benefit of pain relief.

Answer 39

B) No, it is not recommended due to potential risks and uncertain benefits.

Answer 40

The observational studies evaluating the use of RT to treat PD have several limitations. Firstly, they used a wide range of RT doses, which makes it difficult to draw meaningful conclusions about the efficacy of the treatment. Secondly, most studies had single group designs, which means there was no comparison group for assessing the efficacy of the treatment. Thirdly, the inclusion criteria for the studies were minimally reported, which makes it difficult to assess whether the patients had a consistent diagnosis of PD. In addition, the studies relied on subjective patient impressions of curvature and plaque changes, which are known to be poorly correlated with objective measures. Finally, the studies did not use rigorous measurement protocols to assess changes in symptoms over time, which makes it difficult to determine whether the observed changes were due to the passage of time or the treatment itself. Given these limitations, the Panel interpreted the data to mean that RT should not be offered to patients with PD, as the potential risks of exposing patients to RT in the context of unproven benefits outweigh any potential benefits of the treatment.

Answer 41

c. Stable disease for at least 12 months. Patients who are considering surgical reconstruction as a treatment for PD should be in the stable phase of the disease. Typically, PD lesions become stable at 12 to 18 months after symptom onset. The most common inclusion criteria for surgical studies are the presence of PD symptoms for at least 12 months and stable curvature for 3 to 6 months.

Answer 42

c. Tunical plication surgery Explanation: According to Guideline Statement 18, tunical plication surgery is the most common surgical strategy used to treat Peyronie's disease, representing approximately half of all surgeries conducted on PD patients.

Answer 43

a. Improvement of penile curvature Explanation: According to Guideline Statement 18, clinicians may offer tunical plication surgery to patients whose rigidity is adequate for coitus to improve penile curvature.

Answer 44

a. Patients with intact erectile function or with ED responsive to oral medications or vacuum pump therapy or ICI therapy. Explanation: According to the panel's interpretation of the data, the most appropriate candidates for tunical plication surgery are patients with intact erectile function or with ED responsive to oral medications or vacuum pump therapy or ICI therapy, as plication surgery is not a treatment for ED, and the consequences of plication surgery with regard to erectile function remain unclear.

Answer 45

C. Plaque incision and/or excision with grafting is the second most common surgical strategy used to treat PD patients.

Answer 46

B. Improvement rates ranged from 25% to 100% in the studies reported, with most reporting rates >80% and some reporting rates >90%.

Answer 47

The most appropriate candidates for plaque incision and/or excision with grafting are patients with intact erectile function or with ED responsive to oral medications or vacuum pump therapy. This is because these surgical strategies are not treatments for ED, and the consequences of surgery with regard to erectile function remain unclear. Additionally, the range of patient inclusion criteria, the variations in surgical techniques performed, and the range of follow-up durations make the body of evidence strength Grade C. However, the recommendation for plaque incision and/or excision with grafting is Moderate given the clear benefit of surgery to ameliorate curvature in most patients in the setting of relatively few serious adverse events.

Answer 48

a) Surgery Explanation: According to Guideline Statement 20, clinicians may offer penile prosthesis surgery to patients with Peyronie's Disease and erectile dysfunction and/or penile deformity sufficient to impair coitus despite pharmacotherapy and/or vacuum device therapy.

Answer 49

c. Intra-operative procedures such as modeling, plication, or incision/grafting may be performed to address significant penile deformity after insertion of a penile prosthesis.

Answer 50

b. Inflatable prostheses containing reinforced silicone or bioflex® material are recommended for patients undergoing penile prosthetic surgery for Peyronie’s disease.

Answer 51

Complications of penile prosthetic surgery for Peyronie’s disease include infection, mechanical failure of the prosthesis, erosion or extrusion of the prosthesis, and persistent penile curvature or deformity. However, inflatable prostheses containing reinforced silicone or bioflex® material are associated with fewer adverse events and higher patient satisfaction rates.

Answer 52

Five studies have evaluated the effects of colchicine either alone or in combination with another oral treatment. Although studies generally reported that large proportions of patients exhibited improvements in curvature, plaque, and pain, without controls for the natural history of PD these data remain of uncertain utility. Therefore, the evidence base for the use of colchicine in the treatment of Peyronie's Disease is considered unproven until a larger and/or more rigorous evidence base is available.

Answer 53

B) An oral medication for Peyronie's Disease

Answer 54

C) Intralesional Verapamil

Answer 55

: D) All of the above

Answer 56

The exact mechanism of action of Pentoxifylline in Peyronie's Disease is not fully understood. However, it is believed to work by improving blood flow and reducing inflammation. Pentoxifylline is a type of methylxanthine and a non-specific phosphodiesterase inhibitor. It has been shown to increase red blood cell flexibility and reduce blood viscosity, which may improve circulation in the penis. Pentoxifylline is also thought to have anti-inflammatory effects by inhibiting the production of inflammatory cytokines and reducing the activity of white blood cells. These effects may help to reduce the size of the plaque and improve curvature of the penis in Peyronie's Disease.

Answer 57

The mechanism of action of colchicine in Peyronie's Disease is not completely understood, but it is believed to work by reducing inflammation and preventing the buildup of collagen. Colchicine is an alkaloid that is derived from the autumn crocus plant, and it has been used as a treatment for a variety of inflammatory conditions. In Peyronie's Disease, colchicine is thought to reduce inflammation by inhibiting the activity of white blood cells and reducing the production of inflammatory cytokines. It is also believed to prevent the buildup of collagen, which is a component of the plaque that forms on the penis in Peyronie's Disease. Collagen is produced by a type of cell called a fibroblast, and colchicine is thought to inhibit fibroblast activity, which may help to reduce the size of the plaque and improve curvature of the penis. However, the exact mechanism of action of colchicine in Peyronie's Disease is still being studied and is not completely understood.

Answer 58

a) Plaque volume decreased more in the active treatment arm than in the placebo arm.

Answer 59

Potassium aminobenzoate is a form of the B vitamin PABA (para-aminobenzoic acid) that is believed to improve blood flow to the penis and reduce inflammation in the tissues. It is thought to work by promoting the production of collagen, which can help to break down the scar tissue that causes the curvature in PD.

Answer 60

B) A co-enzyme Explanation: Co-enzyme Q10 is a co-enzyme that plays a key role in the production of energy within cells. It is found in every cell in the body and is especially concentrated in the heart, liver, and kidneys.

Answer 61

B) CoQ10 significantly reduced curvature and plaque size but had no effect on pain Explanation: The authors of the RCT reported that CoQ10 significantly reduced curvature and plaque size in the active treatment group compared to the placebo group. However, there were no effects on pain.

Answer 62

B) No, the study provides weak evidence and further research is needed to determine the efficacy of CoQ10 as a PD treatment Explanation: The authors of the RCT noted that while CoQ10 showed promise in reducing curvature and plaque size, the efficacy of CoQ10 is unproven given the existence of only one study and the fact that <100 patients were administered CoQ10. Replication in a high-quality randomized design is needed before it can be recommended as a PD treatment. Therefore, the study provides weak evidence and further research is needed to determine the efficacy of CoQ10 as a PD treatment.

Answer 63

The RCT evaluated the efficacy of topical magnesium and verapamil for PD treatment in comparison to placebo. The results showed that topical verapamil improved curvature and reduced plaque compared to placebo, while the magnesium sulfate group had comparable results to the placebo group. More patients in the verapamil group experienced curvature improvement and plaque reduction compared to the placebo group. However, uncertainty remains regarding the efficacy of topical verapamil as there was only one study conducted and <20 patients were administered verapamil. Therefore, replication in a high-quality randomized design with a larger sample size is necessary before recommending verapamil as a PD treatment.

Answer 64

Topical liposomal recombinant human superoxide dismutase (LrhSOD) is a drug that is thought to work by reducing oxidative stress and inflammation in the penis, thereby promoting healing of the fibrous plaques and reducing curvature and pain.

Answer 65

b) Significant reduction in pain compared to placebo Explanation: According to the two studies mentioned, topical LrhSOD for four weeks significantly reduced pain compared to placebo.

Answer 66

c) 56% Explanation: The observational study mentioned that 56% of patients reported plaque improvement.

Answer 67

The two studies mentioned in the article found that topical LrhSOD for four weeks significantly reduced pain compared to placebo. In the open-label phase of one trial, pain improvement continued and curvature improvements were noted in 23% of patients and plaque reductions in 47% of patients. In the observational study, 25% of patients reported curvature improvement, 56% reported plaque improvement, and 100% reported pain improvement. However, the article notes that the body of evidence is small and replication in a high-quality randomized design with a larger sample size is needed before it can be recommended as a PD treatment.

Answer 68

c) An electromotive therapy for Peyronie's disease Explanation: Electromotive verapamil + dexamethasone is a type of therapy used to treat Peyronie's disease, a condition where there is an abnormal curvature of the penis due to the development of fibrous scar tissue within the tunica albuginea.

Answer 69

a) Electromotive therapy is non-invasive, while intralesional therapy involves injections Explanation: Electromotive therapy involves the use of a small electrical current to facilitate the absorption of verapamil and dexamethasone through the skin and into the tissue of the penis, while intralesional therapy involves injecting the medication directly into the plaque.

Answer 70

a) Electromotive verapamil + dexamethasone was more effective than lidocaine electromotive in reducing plaque volume and penile curvature Explanation: In the study by Di Stasi (2004), electromotive verapamil + dexamethasone was compared to lidocaine electromotive in the treatment of Peyronie's disease. The results showed that while both treatments improved pain, electromotive verapamil + dexamethasone was more effective in reducing plaque volume and penile curvature.

Answer 71

acquired inflammation disorder of tunica albuguinea microvascular trauma to penile shaft associated with penile buckling, repetitive minor trauma, protein deposition, macrophage, collagen changes from 1→3

Answer 72

penile curvature penile deformity penile discomfort/pan ED usually a man in mid 50s with onset of curvature and pain

Answer 73

Active dz: changing sxs, pain/discomfort, induration, palpable plaque, deformity/curvature, shortening, indentation, hinge effect, narrowing, hourglass, distress Stable dz: unchanged for at least 3 mo, plaque palpated or US, ED, penile deformity stable, no pain, distress

Answer 74

GUIDELINE STATEMENT 1 document signs and symptoms - characterize history to assess deformity, interference with intercourse, pain, distress, frequency of sexual activity/changes PE - for palpable nodules and curvature (often need to **stretch**), tenderness, DRE, scrotal exam, fibrosis/plaque

Answer 75

GUIDELINE STATEMENT 2 ICI with or w/o duplex doppler US

Answer 76

GUIDELINE STATEMENT 3 he/she has expertise and diagnostic tools to appropriately evaluate, counsel, and treat the condition

Answer 77

GUIDELINE STATEMENT 4 the available treatment options and known benefits and risks/burdens associated with each tx

Answer 78

GUIDELINE STATEMENT 5 NSAIDs

Answer 79

GUIDELINE STATEMENT 6 oral vitamin E tamoxifen procarbazine omega-3 fatty acids or a combo of vitamin E and L-cartnitine no efficacy GUIDELINE STATEMENT 7 electromotive therapy with verapamil GUIDELINE STATEMENT 16 radiotherapy

Answer 80

GUIDELINE STATEMENT 8 intralesional collagenase clostridium histolyticum in COMBO with modeling only when stable dz Tx curvature NOT pain or ED

Answer 81

GUIDELINE STATEMENT 9 penile ecchymosis swelling pain corporal rupture erythema painful erections/ED

Answer 82

GUIDELINE STATEMENT 10 intralesional interferon alpha-2b improves curvature, plaque size, **pain**, ED GUIDELINE STATEMENT 12 intralesional verapamil active **pain**, plaque, curvature

Answer 83

GUIDELINE STATEMENT 11 sinusitis flu-like minor penile swelling ecchymosis tx with OTC NSAIDs (last 48h)

Answer 84

GUIDELINE STATEMENT 13 penile bruising dizziness nausea pain at injection site

Answer 85

GUIDELINE STATEMENT 14/15 for pain NOT reduction in curvature or plaque size

Answer 86

GUIDELINE STATEMENT 17 surgical reconstruction 12-18m after onset, stable curvature 3-6 mo in stable dz, pain only with erection establish: location (proximal, mid, distal) direction of curvature (dorsal, lateral, ventral) degree of curvature presence of other deformities (indentation, hinge, narrowing, hourglass, shortening, uniplanar, biplanar) presence, location, extent of plaque (calcification) presence and extent of ED interference with intercourse for patient/partner degree of distress

Answer 87

GUIDELINE STATEMENT 18 tunical plication GUIDELINE STATEMENT plaque incision or excision and/or grafting

Answer 88

urethral laceration urinary retention UTI superficial skin necrosis (minor/major) hematoma (obs vs. re-operation) wound infection chest infection painful/palpable suture suture granuloma phimosis ED or penile pain (persistent)

Answer 89

GUIDELINE STATEMENT 20 IPP when deformity sufficient to impair coitus despite meds and/or VED GUIDELINE STATEMENT 21 may perform adjunctive intra-operative procedures such as. modeling, plication, or incision/grafting when significant deformity persists after insertion of IPP modeling/maneuvers when \>30 after IPP GUIDELINES STATEMENT 22 should use IPP

Answer 90

\>60 degrees, hourglass deformity, or penile shortening

Answer 91

autologous (vein, dermis, buccal) → increased morbidity non-autologous (trend towards tissue engineered, pericardium, small intestine, or collagen fleece → no sutures required)

Answer 92

cytokine thought to inhibit fibroblasts works for curvature, pain, plaque **stable dz**, curvature \> 30 without calcified plaque

Answer 93

stable curvature \> 30 \< 90 break down plaque and model to straighten can improve 35-75% (not for hourglass, calcified or ventral plaques or acute dz)

Answer 94

1. excising and ellipse (Nesbit) 2. vertical incision closed horizontally (Yachia) 3. dot technique that imbricates tunica 4. graft (incise/excise at point of m ax curvature), repair tunica with graft

Answer 95

direction of curvature presence of UI presence of pain w or w/o erection current ability to have intercourse degree of ED stability curvature presence of pain with intercourse for patient or partners hx of intercourse injury

Answer 96

pain infection need for ectopic placement of reservoir if after RP adjacent organ injury need for additional surgery device erosion device malfunction residual curvature decreased sensation loss of penile length and girth bleeding

Answer 97

assure not injury to urethra or corpora cycling device and repeating as necessary applying force opposite the point of max curvature for 90 seconds mark point of max curvature protecting pump with rubber shods completely inflating IPP prior to modeling

Answer 98

Answer: D Peyronie's Disease (PD) is not solely age-dependent and can affect men at different ages. Its management isn't always straightforward, and deformity less than 30 degrees usually does not impair function. Thus, PD mainly affects the quality of life of those who suffer from it.

Answer 99

Answer: D No oral agents are approved for the standard care of PD in Canada. Both vitamin E and Tamoxifen have been tried, but neither has shown consistent efficacy in clinical trials.

Answer 100

Answer: D The evidence supporting the use of PDE-5 inhibitors for modifying plaque progression in PD is limited to a single published study.

Answer 101

Answer: C The CUA does not recommend iontophoresis for the treatment of PD, given the lack of convincing evidence.

Answer 102

Answer: C Collagenase (Xiaflex) is considered the first-line intralesional therapy, according to CUA guidelines.

Answer 103

Answer: B The grade of recommendation for using clostridial collagenase in the management of PD in Canada is Grade B.

Answer 104

Answer: D The use of intralesional collagenase has not been evaluated for curvature greater than 90°, isolated hourglass deformity, or curvature less than 30°.

Answer 105

Answer: A A common side effect of intralesional verapamil is penile bruising, not myocardial infarction or systemic toxicity.

Answer 106

Answer: C The CUA indicates that the efficacy of verapamil gel in the treatment of PD is uncertain.

Answer 107

Answer: B Smaller baseline curvature can be a predictor of efficacy in intralesional verapamil treatment for PD.

Answer 108

Answer: B Clostridial collagenase belongs to the group of collagenases.

Answer 109

Answer: D All the options (Lack of long-term follow-up studies, Heterogeneity of treatments, and Small sample size) represent limitations to the evidence for using oral agents in PD.

Answer 110

Answer: D The CUA guidelines do not provide a specific recommendation for managing pain in the active phase of PD.

Answer 111

Answer: C The CUA guidelines do not specify a minimum degree of deformity for a patient to seek treatment for PD.

Answer 112

Answer: B The use of iontophoresis in PD has Level 3 evidence and receives a Grade C recommendation, according to the CUA.

Answer 113

Answer: D The panel does not recommend the use of potassium para-aminobenzoate (POTABA) as a treatment for PD.

Answer 114

Answer: A Congenital penile curvature is typically diagnosed during adolescence.

Answer 115

Answer: D For ventral curvature of congenital penile curvature, the CUA recommends the Plication technique as the preferred surgical approach.

Answer 116

Answer: B Hormonal therapy has no role or is not recommended in the management of congenital penile curvature according to CUA guidelines.

Answer 117

Answer: A Post-operative erectile function assessment is recommended for all patients who undergo surgery for congenital penile curvature.

Answer 118

D Explanation: The overarching goal of all PD treatments is to correct penile deformity while preserving penile length and the ability to attain and maintain an erection sufficient for satisfactory sexual intercourse. Memory tool: Think of "D for Deformity, Duration (length), and Dysfunction (erectile)."

Answer 119

C Explanation: Surgical procedures for PD include penile plication, plaque incision/excision with grafting, and penile prosthesis implantation. Memory tool: Think of the Three P's for surgery: Plication, Plaque incision, and Prosthesis.

Answer 120

B Explanation: A general criterion for surgical intervention is a minimum of 6-12 months after disease onset with plaque stability for 3-6 months. Memory tool: Remember "6-12, 3-6" as a sequence for stability: 6-12 months of disease, 3-6 months of plaque stability.

Answer 121

B Explanation: Combination of CDU with intracavernosal injection is the gold standard and recommended by the Committee as an integral part of preoperative evaluation. Memory tool: Think of "Gold CDU" as if it's a gold album, making it a hit in preoperative evaluations.

Answer 122

C Explanation: Patients should be made aware of the concept of “functionally straight” (penetrative intromission not compromised, residual curvature less than 20º) vs. completely straight. Memory tool: "F-C, 20 degrees" - Functionally straight to Completely straight with under 20 degrees of curvature

Answer 123

B Explanation: Dissatisfaction after plication surgery correlates with postoperative penile shortening. Memory tool: "B for Beware" of penile shortening after plication surgery.

Answer 124

C Explanation: Plication procedures represent the most common type of surgical approach for PD and are attractive due to a high degree of curvature correction. Memory tool: Plication is for Precision in Curvature correction

Answer 125

B Explanation: Complications may include persistent pain, persistence or recurrence of penile curvature, penile hematoma, and sensation loss. Memory tool: "PHPS" - Pain, Hematoma, Penile curvature, Sensation loss, are complications you need to consider.

Answer 126

A Explanation: Autologous dermal matrix grafts are most commonly used in grafting procedures for PD. Memory tool: "Dermal graft is the A-graft." As in, the top choice for grafting.

Answer 127

C Explanation: The primary disadvantage of plaque incision and grafting is the risk of postoperative erectile dysfunction (ED). Memory tool: “ED after I & G” - Erectile Dysfunction after Incision & Grafting.

Answer 128

B Explanation: IPP remains the gold standard treatment for PD requiring surgery and occurring concurrently with refractory ED, especially when dealing with severe deformity. Memory Tool: "Golden B's - Bad ED and Big deformity need IPP."

Answer 129

C Explanation: The surgeon must be prepared for additional procedures like manual modelling, plication, plaque-releasing incisions, and grafting, especially if the TA defect size confers risk of herniation. Memory Tool: "C's the Day" with Complete procedures – Manual modelling, Plication, Plaque-releasing incisions, and Grafting.

Answer 130

B Explanation: The commonly used cutoff size for TA defect that requires additional grafting is 2 cm. Memory Tool: "Two to Do" - 2 cm defect requires you to do grafting.

Answer 131

D Explanation: PD deformity correction rates with penile prosthesis implantation range from 84-100%. Memory Tool: "D for Delightful outcomes" - 84-100% correction rates are possible.

Answer 132

D Explanation: During the consent process, patients should be informed of the risks of prosthesis infection, persistent penile shortening or curvature, diminished sensitivity, and mechanical device failure. Memory Tool: "D for Discuss everything" – Disclose all risks involved.

Answer 133

3. No Level 1–4, Grade A–C Explanation & Memory Aid: There's no robust evidence supporting PRP for PD. Think of PRP like a flashy car with no engine; it may look appealing but doesn't go anywhere in terms of evidence.

Answer 134

2. Mention accruing trials on www.clinicaltrials.gov Explanation & Memory Aid: Stem cell treatments are in clinical trials and aren't yet proven for PD. Think of stem cells like a mysterious novel; it's intriguing, but you don't yet know the ending (outcome).

Answer 135

3. Level 4 evidence, Grade C recommendation Explanation & Memory Aid: Penile traction has Level 4 evidence and Grade C recommendation. It's like a low-budget movie that still has a cult following. Some like it; others need more evidence.

Answer 136

2. Improvement in stretched penile length Explanation & Memory Aid: According to Hellstrom's group, routine penile traction may improve stretched penile length. It's like stretching a rubber band; the longer you stretch, the more you gain, but it won't bend back to the original shape (won't affect curvature).

Answer 137

2. Recommend with Level 2 evidence, Grade C Explanation & Memory Aid: ESWT has Level 2 evidence and Grade C recommendation for potential penile pain improvement. Think of ESWT like an over-the-counter painkiller: it may reduce pain, but it's not a cure-all.

Answer 138

2. No Explanation & Memory Aid: ESWT does not have evidence-based support for reducing curvature. Imagine ESWT like a rain dance: it might be fascinating, but it doesn't guarantee rain (curvature reduction).

Answer 139

4. None Explanation & Memory Aid: Radiation therapy is not supported for PD. Think of RT like skydiving without a parachute: it's a risky endeavor with no guaranteed benefit.

Answer 140

2. Collagen and tissue metalloproteinase expression Explanation & Memory Aid: Think of collagen and tissue metalloproteinase like the ingredients in a recipe; they're the key factors that influence the final dish (plaque integrity in PD).

Answer 141

2. Resolution or improvement of penile pain Explanation & Memory Aid: ESWT is like your mom's home remedy for a cold. It might help you feel better (pain), but it won't cure you.

PEYRONIE’S DISEASE: AUA GUIDELINE (2015) Flashcards

(170 cards)