General urologists' attitudes towards the use of collagenase clostridium histolyticum (Xiapex) in Peyronie's Disease
Tal, R1; Greenstein, A2; Kitrey, N3
1: Neuro-Urology Unit, Department of Urology, Rambam Health Care Campus, Haifa, Israel; 2: Department of Urology, Sourasky Medical Center, Tel-Aviv, Israel; 3: Department of Urology, Sheba Medical Center, Tel-Hashomer, Israel
Objectives: Peyronie's disease (PD) is commonly treated by general urologists, rather than sexual medicine specialists. Recently, Collagenase Clostridium Histolyticum (Xiapex) has been added to armamentarium of PD interventions. This study outlines the general urologists' attitudes towards Xiapex and their practice patterns.
Material and Methods: A web survey was conducted among 220 general urologists. The survey included questions about general urologists' experience, their PD patients' volume and considerations in choosing the right treatment for the right patient, with an emphasis on their attitudes towards the use of Xiapex.
Results: Sixty responses were returned (27.3% response rate). Most responders (60%) had more than 20 years of experience. Eighty-seven percent had seen less than 10 PD patients in the preceding 3 months. Penile curvature angle was commonly assessed by self-photography only (85%). It was assessed at the erect state in-clinic only by 13%. When treatment for stable PD was indicated, 36% offered surgical treatment only and 39% offered either surgery or Xiapex injections. When the chosen treatment was Xiapex injections, 70% of the urologists couldn't perform it themselves and had to refer the patient to another urologist. The leading consideration (70% of responders) in selection of Xiapex as the preferred treatment was patients' inclination. Additional considerations were difficulty in penetration (52%) and curvature angle (48%). The predicted success rate and the existence of calcified plaques (known to decrease the success rate) were considered only by 2% of general urologists. The leading considerations in patient selection for Xiapex were realistic expectations (65%), willingness to adhere to the treatment protocol (58%) and curvature angle (48%), but not treatment adequacy or the predicted success rate.
Conclusions: General urologists have relatively limited PD patients' volume. When treatment is indicated, more than a third of general urologists offer only surgical treatment. When Xiapex injections treatment is chosen, most general urologists prefer to refer the patient to sexual medicine specialists rather than to perform the treatment themselves. Treatment and patients' selection is mainly based on patients' preference and realistic expectations, rather than on the predicted success. Sexual medicine experts should be aware of the limitations of PD care by general urologists and encourage them to refer these patients to specializing centers.
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