Dr. Paulis, please tell us a little bit about your background and your experience of treating patients with Peyronie's disease

I was Medical Director (First Level) in Complex Operative Unit of Urology (Regina Apostolorum Hospital-Albano L., ROME, ITALY) and Director of Service of Andrology until June 2013. Currently I am Andrologist Consultant at Regina Apostolorum Hospital where I direct the Center of Andrology. I also head the "Center for the Treatment of Peyronie's disease" (Castefidardo Medical Team, ROME, ITALY).

I treat Peyronie's disease (PD) since 1988, in that time I treated PD patients with Orgotein penile injections and oral-Vitamin E. Subsequently, in case of acute and active disease I have always treated patients with Verapamil penile injections associated with iontophoresis (with Verapamil) and oral therapy with antioxidants including vitamin E. Since 2011, I replaced the Verapamil with Pentoxifylline, that does not require a treatment of iontophoresis associated because the drug can be taken orally.

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

I treat roughly 300 patients with Peyronie's disease each year.

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

The average age of patients with PD is about 50 years, but at present 60% of PD patients that I am treating are men aged less than 40 years.

How many of your patients fall approximately into each of the following groups: mild, moderate, and severe Peyronie's symptoms?

Mild 20%

Moderate 60%

Severe 20%

I have received some letters from younger men (under 40) with Peyronie’s. Do you think there is an increase in younger men developing the disease or are younger men these days more open about seeing their doctors?

I believe that young PD patients are more interested in treat their Peyronie's disease.

What Peyronie's treatments do you recommend to patients with mild or modern symptoms and why?

I normally care them with two treatment options.

The first is a medical therapy with Pentoxifylline, plus Vitamin E, other antioxidants (Flavonoids) and local gel Diclofenac 4% for 6 months.

The second option is the same "multimodal" treatment as the previous, associated with penile peri-lesional injections (every 2 weeks) with Pentoxifylline for 6 months.

Some doctors recommend patients who are in their acute phase to use traction device or penile pumps as part of their treatment plan. What is your view on using these devices? Do you think they are beneficial? Do you think both device types offer the same results?

In some cases I use penile pumps-vacuum devices as part of treatment.

Do you have preferred surgical procedure for Peyronie's disease and if so, why?

I treat surgically these patients only when they have failed conservative therapy (... rarely) and when the patients are not able to perform a sexual intercourse caused by strong penile curvature or erectile dysfunction.

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

I suggest vacuum devices.

What do you see the future bring for Peyronie's patients? Are the any new treatments on the horizon that may bring new hope in treating the disease?

Currently with my treatments I achieve already good results but obviously I hope always for better treatments.

Xiaflex has had a lot of press lately and many patients are waiting for this drug to be available. So, in the light of recent outcomes from trials for Xiaflex, do you think Xiaflex is appropriate for all patients regardless of the degree of curvature?

I think that the main goal of Peyronie's disease treatment is to cure the disease and not only the symptom. So, any treatment is useful regardless of the degree of curvature.

In fact, paradoxically, an improvement of penile curvature may occur in case of increase of volume of the Peyronie’s plaque (growth in the opposite direction). The official collagenase study did not provide for an ultrasound evaluation of penile plaque before and after treatment.

Based on your experience and the outcome from Xiaflex trials, do you think Xiaflex offers better results than using Verapamil injections, especially when cost and risk of side effects are evaluated?

I think that the outcome from Xiaflex trials are not proportional to its high cost.

Would you consider using Xiaflex as part of a treatment even though it would not gain FDA approval in the USA?

No.

Do you think Peyronie's disease will ever be curable?

Peyronie's disease is curable already today.

It is often quoted that Peyronie's occurs in 1-3% of the male population but some specialists believe the figure to be much higher. In your opinion, how common do you think Peyronie's disease really is?

I believe that the true prevalence of Peyronie's disease is much higher.

Can men do anything to prevent getting Peyronie's disease e.g. exercise, diet, lifestyle, etc.?

I believe that a healthy and varied diet, a non-competitive sport-exercise and no smoking can help the body to prevent many diseases, including PD.

Are you aware of any environmental studies about common medical conditions in men that might increase the risk of them developing Peyronie's disease?

Yes, I'm aware of them.

What advice do you give your patients in order to prevent the disease getting worse?

...to treat the disease immediately since its debut, moreover I suggest regular sexual intercourse and attention to avoid any further penile trauma.

Do you think any of your patients have developed depression or other mental disorder as a result of Peyronie's? How do you advice your patients about the emotional side of the disease?

Yes I think, but I reassure PD patients since the first visit. I explain them that the PD can be cured.

Anything you would like to add?

I would like to end with this phrase:

"Perhaps, after all, America never has been discovered.... I myself would say that it had merely been detected."

The Picture of Dorian Gray

Oscar Wilde

Dr. Gianni Paulis, thank you very much for taking the time to do this interview with My Peyronie's.