Data vs Dogma in Peyronie's Disease

Contemporary surgical and non-surgical management of Peyronie’s disease

“…In 1743, French Surgeon Francois De La Peyronie described a dorsal bend of the penis, attributed to irregular scarring of the shaft ( 1 ). Subsequent generations proposed a variety of surgical and non-surgical therapies for Peyronie’s disease (PD), though relatively few enjoy the support of high-level evidence ( 2 , 3 ). Today urologists are largely adopting collagenase clostridium hystolyticum (CCH) as the non-operative treatment of choice and have chosen between plication, plaque incision or excision and grafting (PIG or PEG), and prosthetic implantation for definitive, surgical management.…”

“…The Consultation also recommends that the patient’s symptoms be stable and painless for 6 months before treatment, with less emphasis on the requisite time-course of symptoms prior to stability ( 11 ). Others have recommended intervention in the active phase of evolving PD, including a proposal to investigate surgical outcomes during that stage ( 3 ). Evidently, the time-delimitation of active and stable phases appears to be highly-variable, and as the Consultation guidelines suggest, likely is of secondary value compared to clinical course.…”

A combination of phosphodiesterase type 5 inhibitor and tamoxifen for acute Peyronie’s disease: the first clinical signals

“…[10][11][12][13][14] It has been suggested that any observed effect of PDE5is on curvature might be due to their proerectile effect, not necessarily antifibrotic effect, since PDE5is might cause rigid erections and therefore may influence curvature measurements or prevent further microtrauma. 15 The clinical studies with tamoxifen suggested a possible clinical benefit if the treatment started within 4 to 6 months of the first signs or symptoms. 16 Tamoxifen was, however, ineffective in patients with chronic PD.…”

Abyssus abyssum invocat – Bleiben wir trotzdem dran!

“…Gegenwärtig gibt es zahlreiche Dogmen in der Medizin: Lerninhalte und Leitsätze, die nicht hinterfragt werden, weil sie nicht hinterfragbar sind, da resistent gegen jede Widerlegung. Beispiele existieren reichlich: zum Beispiel Volumensubstitution und deren Zusammensetzung in der Intensivmedizin [4]; „the golden hour in trauma“ [5], die Therapie des Morbus Peyronie [6] und viele andere mehr.…”