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ABU Oral Boards > Peyronie's > Flashcards

Peyronie's Flashcards

1
Q

Pathophysiology of Peyronie’s

A

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

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2
Q

Symptoms of Peyronie’s

A

penile curvature
penile deformity
penile discomfort/pan
ED

usually a man in mid 50s with onset of curvature and pain

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3
Q

Describe active and stable Peyronie’s:

A

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

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4
Q

Don’t forget a questionnaire for ED/PD

A
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5
Q

Initial evaluation of patient with suspected Peyronie’s includes:

A

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

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6
Q

Clinicians should perform this procedure in office to assess for Peyronie’s:

A

GUIDELINE STATEMENT 2

ICI with or w/o duplex doppler US

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7
Q

Clinicians should evaluate and treat Peyronie’s only when:

A

GUIDELINE STATEMENT 3

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

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8
Q

Clinicians should discuss with patients regarding Peyronie’s dz:

A

GUIDELINE STATEMENT 4

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

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9
Q

Clinicians may offer this for patients suffering from active PD?

A

GUIDELINE STATEMENT 5

NSAIDs

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10
Q

Clinicians SHOULD NOT offer these options for patients with PD?

A

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

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11
Q

For patients with penile curvature >30 and <90 and intact ED, clinicians may administer what? How?

A

GUIDELINE STATEMENT 8

intralesional collagenase clostridium histolyticum

in COMBO with modeling

only when stable dz

Tx curvature NOT pain or ED

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12
Q

What should clinicians counsel patients of the risk of intralesional collagenase clostridium histolyticum of the risks?

A

GUIDELINE STATEMENT 9

penile ecchymosis
swelling
pain
corporal rupture
erythema
painful erections/ED

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13
Q

Besides intralesional collagenase, what else may be administered for PD?

A

GUIDELINE STATEMENT 10

intralesional interferon alpha-2b

improves curvature, plaque size, pain, ED

GUIDELINE STATEMENT 12

intralesional verapamil

active

pain, plaque, curvature

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14
Q

What should clinicians counsel as risk of alpha-2b intralesional treatments?

A

GUIDELINE STATEMENT 11

sinusitis
flu-like
minor penile swelling
ecchymosis

tx with OTC NSAIDs (last 48h)

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15
Q

What should clinicians counsel as risk of verapamil intralesional treatments?

A

GUIDELINE STATEMENT 13

penile bruising
dizziness
nausea
pain at injection site

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16
Q

Treatment with extracorporeal shock wave therapy (ESWT) for PD is indicated for:

A

GUIDELINE STATEMENT 14/15

for pain

NOT

reduction in curvature or plaque size

17
Q

In the presence of stable PD, clinicians should assess patients as candidates for what?

A

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

18
Q

What surgical options are appropriate for adequate rigidity (w or w/o meds and VED) for improving penile curvature?

A

GUIDELINE STATEMENT 18

tunical plication

GUIDELINE STATEMENT

plaque incision or excision and/or grafting

19
Q

Risks and a/e of tunical plication surgery:

A

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)

20
Q

What surgery may be offered to patients with PD and ED and/or significant penile deformity?

A

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

21
Q

Grafting techniques are indicated when penile curvature is:

A

>60 degrees, hourglass deformity, or penile shortening

22
Q

What type of grafts can be used in PD surgery?

A

autologous (vein, dermis, buccal) → increased morbidity

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

23
Q

Peyronie’s Algorithm

A
24
Q

How does intralesional interferon alpha-2b work?

A

cytokine thought to inhibit fibroblasts

works for curvature, pain, plaque

stable dz, curvature > 30 without calcified plaque

25
Q

How does intralesional collagenase clostridium histolyticum in combination with modeling work?

A

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)

26
Q

types of penile plication:

A
  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
27
Q

Important questions to ask patient presenting with suspected PD?

A

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

28
Q

What are risks of IPP when done for PD?

A

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

29
Q

Critical steps of modeling?

A

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

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