Please tell us a little bit about your background and your experience of treating patients with Peyronie's disease

I became interested in male sexual dysfunction including Peyronies (PD) 15 years ago.  I decided then to limit my practice to this part of urology. Five years ago I traveled to Brazil to spend a week with world renowned PD surgeon Paulo Egydio.  I am comfortable with the full spectrum of treatment from conservative to the very latest surgical approaches. 

Roughly, how many Peyronie's patients do you treat each year?

Perhaps fifty

What is the average age of your Peyronie's patients?

55 years

Approximately, how many of your patients fall into each of the following groups: mild, modern, and severe Peyronie's condition?

Mild - 25%, moderate - 50%, severe - 25%

How common do you think Peyronie's is? Do you think it is on the rise, e.g. due to lifestyle changes or environmental issues, or are men becoming more open about seeking assistance?

The curvature or other deformities of PD are more pronounced with better erections. Thus the advent of new drugs to treat erectile dysfunction(ED) has made men more aware of their problem with PD. The incidence is usually quoted as 9-10%.

In your opinion, are some men more likely than others to develop Peyronie's disease?

I believe that PD is an injury of the penis. I think a good erection is the best protection. It seems that many patients with PD also have low testosterone.

How important is early diagnosis in your opinion? Can men expect better results the sooner they start treatment and why?

Early conservative treatment is effective, assuming the man does not continue to injure his penis - usually at coitus.

Can you describe the non-surgical treatments you recommend to your patients? What influences which treatments you recommend?

I use nonsurgical therapy when the deformity is not "fixed" in my judgement. A patient with ED and severe (over 50 degrees) of curvature will probably not do well with conservative therapy.

Nonsurgical therapy includes vacuum device or stretchers, plaque injection with verapamil or Xiaflex, drugs to treat ED, arginine, trental. Iontophoresis has been helpful in some patients.

What do you consider satisfying result from non-surgical Peyronie's treatment?

Enough improvement to allow satisfactory coitus which was not possible before. Perfection is not always possible or necessary.

What oral medication do you recommend to your patients and why?

See #8

What is your view on using supplements as part of Peyronie's treatment plan?

Arginine, daily small dose Cialis, testosterone may help. Any others are anecdotal at best.

Have you used Xiaflex and / or Verapamil injections? If so, what is your experience of them? How does Xiaflex compare to Verapamil in your opinion?

I've found Xiaflex far superior to verapamil and has clinical trial support. Unfortunately it is much more expensive and not always covered by insurance. It requires fewer and less frequent injections.

Some clinical studies on injection therapies have shown improvements in patients in the placebo groups. This has led some to believe that injecting needle into the Peyronie's plaque may be beneficial on its own. What is your view on this?

Xiaflex release was preceded by a placebo-controlled study. Both sets of patients were injected. Those who received Xiaflex did much better. This has been attributed to the drug, not the injection.

Have you recommended using traction device or penis pump to treat penis curvature? If so, what is your experience of them? When do you recommend using each device?

Answered above under nonsurgical treatment. Traction devices are much more time consuming and I've abandoned them.

What do you recommend for men that also suffer from low erection quality / erectile dysfunction?

See above

Approximately how many (%) of your patients do not respond to non-surgical treatment and therefore require penis surgery? Have you been able to identify any common characteristics among those patients?

Perhaps 20-25%. They have longer histories, more rigid fixed curve, ED, and instability of the penis shaft.

What types of surgery do you perform and what is your experience of each?

Simple plication to just correct curve with no ED. Incision and grafting for more severe curve without ED. Incision with penile prosthesis if curve and ED. Results quite good with proper selection and evaluation.

There is some risk involved with any surgery. In your experience, how common are serious side effects after penis surgery (e.g. erectile dysfunction, penile shortening, reduced penile sensation, loss of elasticity)?

Most Infrequent. Patient must accept risks.

For patients that have undergone surgery to treat their Peyronie's disease, do you recommend some post operation treatment for them? If yes, what do you recommend?

If have an implant, pump up and down asap - 2 to 3 weeks. No implant use vacuum device twice a week ~ 20 minutes or as able.

What do you recommend that men with Peyronie's disease should do (or not do) to prevent the disease from getting worse?

Answered above

How do you address the emotional side of Peyronie's? What can men do to deal with the distress caused by the disease?

They must get over the embarassment and seek treatment with a qualified urologist.

In your opinion, how can partner or friend best support man with Peyronie's disease?

"Gentle" intercourse to prevent further injury

What can be done to raise the awareness of Peyronie's, both among the public and health professionals?

More internet publicity such as yours, community health talks, seminars.

What does the future hold for Peyronie's patients? Are there any interesting new treatments on the horizon (short term and long term)? Do you think Peyronie's will ever become curable?

It is curable now when handled properly. An effective topical treatment would be nice. Topical verapamil is ineffective.

Dr. Fred Grossman, thank you very much for taking the time to do this interview with My Peyronie's. For more information about Dr. Grossman, visit Male Care Center .