BackTable / Urology / Podcast / Episode #72
Peyronie's Disease Challenges and Solutions
with Dr. Jonathan Clavell
In this episode of BackTable Urology, Dr. Jose Silva interviews Dr. Jonathan Clavell, a men’s health specialist, about workup and treatment options for Peyronie’s disease.
BackTable, LLC (Producer). (2022, December 28). Ep. 72 – Peyronie's Disease Challenges and Solutions [Audio podcast]. Retrieved from https://www.backtable.com
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Dr. Jonathan Clavell
Dr. Jonathan Clavell is a high-volume prosthetic urology surgeon and assistant professor of urology at UT Health Science Center Houston.
Dr. Jose Silva
Dr. Jose Silva is a board certified urologist practicing in Central Florida.
First, Dr. Clavell explains that Peyronie’s patients have extremely variable presentations. They can have distal or proximal curvatures, penile shortening, pain, hourglass deformities, and calcified plaques. However, Dr. Clavell believes that listening to the patient is the most important thing a urologist can do, as most patients take years to seek treatment and may be very distraught about their diagnosis. He notes that most men he sees are already in a stable phase (3 months of no change in curvature), as they are referred to him by other urologists. He also notes that penile pain is not unique to Peyronnie’s disease; patients need to also have an acquired penile deformity as well to be given an accurate diagnosis.
Dr. Clavell emphasizes that the treatment option and duration should be based on the degree of bother and degree of erectile function, instead of by the degree of curvature. Then, Dr. Clavell summarizes the surgical and non-surgical options for Peyronie’s disease. He notes that medications, such as pain medication and Cialis are always available. Additionally, non-pharmacological penile rehabilitation therapies, such as traction therapy and vacuum therapy have helped some of his patients. He notes that traction therapy combined with Xiaflex injections can be useful in patients who can still maintain good erections; however, injections should not be used in men with erectile dysfunctions or calcified plaques. In these patients, a penile prosthesis is indicated.
Other complex cases that will require surgery are Peyronie’s patients with severely calcified plaques, severe deformities, two points of angulation, corporal wasting, and an unstable penis. Besides penile implantation surgery, two other surgical options for Peyronie’s disease are grafting and plication surgery. The risks of all surgeries should be discussed with patients. Finally, Dr. Clavell explains his advanced surgical techniques for penile implant surgeries, such as alternative incision sites and the modified sliding technique.
[Dr. Jonathan Clavell]
The limiting factor for using XIAFLEX within the acute phase, there's actually been studies comparing acute phase, using XIAFLEX, acute versus stable. They actually respond during the acute phase but the limiting factor is the insurance company. Insurance companies will find whatever excuse to not approve this medication. I mean this medication is a little bit expensive, at least for a patient who's paying out of pocket. When it comes to offering these injections, I truly believe they can work.
However, when it comes to choosing which treatment to offer, the most important thing to remember is this. As I tell them, I start off to every patient, I tell this sentence, "We only treat Peyronie's depending on two things. Your degree of bother and the degree of erectile function." I will repeat that. Degree of bother, not the degree of curvature, but degree of bother and the degree of erectile function. A man who has good erections and is not bothered, we leave alone.
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