Moving Toward Individualized Care of Patients with Type 2 Diabetes
(6.4% of all men with the condition) sought treatment for their deformity. An estimated one-third of these men (n = 38,646) had moderate to severe curvature deformity of at least 30°.8 The Burden of Peyronie’s Disease Men with PD experience significant anxiety and psychological distress, and related effects may include depression, emotional distress, reduced quality of life because of PD-related pain and discomfort, and diminished self-esteem. These factors have been reported to negatively impact sexual relationships, restrict intimacy, and cause social isolation and stigmatization.4
The etiology of PD has not been well characterized. A leading hypothesis postulates that trauma is the most likely trigger for PD, activating an abnormal response to local injury in a man who has a genetic predisposition to abnormal scar formation and healing. Psychosocial function and sexual function are important issues for men with PD. In a series of interviews, patients with PD indicated that they experienced significant issues with PD-related pain and discomfort, physical appearance and self-image, sexual performance and function, and social stigmatization and isolation. In this analysis, the major themes and patterns of response were consistent across the groups of men with PD.9 Sustained depression is relatively common among men with
PD. In a survey of 92 men with diagnosed PD, 48% were classified as clinically depressed based on their scores on the Center for Epidemiological Studies Depression Scale. Furthermore, the percentage of these patients with depression did not change significantly with time since diagnosis, suggesting lack of mental adjustment to the diagnosis of PD. Given the high initial rate of depression, the authors concluded that all men with PD should be screened for mental illness.10 Etiology, Pathophysiology, and Natural History of Peyronie’s Disease The etiology of PD has not been well characterized. A leading hypothesis postulates that trauma is the most likely trigger for PD, activating an abnormal response to local injury in a man who has a genetic predisposition to abnormal scar formation and healing. Specifically, repeated mechanical stress and microvascular trauma of the penis resulting from excessive bending or single blunt trauma to the erect penis causes bleeding into the subtunical spaces and subsequent tissue damage.4,6,11 In these individuals, collagen synthesis is thought to increase abnormally, and resulting plaque formations interfere with the elasticity of the tunica albuginea. Although the specific mechanisms have not been elucidated, it is thought that changes in elastin fibers and collagen types can contribute to the formation of penile deformities. Fibrin deposits in the injured tissue may initiate an inflammatory wound healing response with resultant recruitment of macrophages, neutrophils, and fibroblasts.4,6,11 First symptoms of PD vary. In about half (52%) of men with the disorder, the first noticeable symptom is a penile deformity.
KEY POINTS In order to thrive in today’s healthcare environment, urology practices must innovate to maintain financial health; this may involve consolidation, expanding coverage areas, or taking steps to attract new patients. ➤ Urologists play a central role in treating men’s health issues. In 2009, the American Urological Association created the Committee on Male Health as a comprehensive approach to men’s healthcare. ➤ Peyronie’s Disease (PD) is an underrecognized disorder that affects 0.5% to 13% of men within the United States; however, its prevalence is believed to be underreported. ➤ Men with PD experience significant anxiety and psychological distress, and related effects may include depression, emotional distress, and reduced quality of life. ➤ The etiology of PD has not been well characterized. A leading hypothesis postulates that trauma is the most likely trigger for PD, activating an abnormal response to local injury. ➤ Effective treatment options for PD are limited. In treating PD, a number of nonsurgical interventions are used in clinical practice, including oral and topical treatments (vitamin E, tamoxifen, pentoxifylline, potassium para-aminobenzoate, colchicine) and intralesional injections (corticosteroids, interferons, verapamil). ➤
4 I August 2014