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which patients may or may not benefit from such treatment since not allso treated have beneficial outcomes. It is hoped that further studiesemanating from these authors and others will provide these guidelines.
Another important reason for investigators to attempt to unravel thepathophysiology of Peyronie’s disease is that the fibrosis of Pey-ronie’s disease is probably no different than that seen in otherinternal organs, for example the kidney, heart and liver. Theselatter organs are inaccessible for study but because the penishangs off the body making it relatively accessible for obtainingtissue and observing therapeutic effects from any intervention, itbecomes by default the tissue of choice for studying a variety ofsystemic diseases that also affect the penis such as tissue fibrosis.And because the urologist is closer to the penis than any otherspecialist, he/she should be expected to have a central role inhelping to decipher the pathophysiology of many of these disor-ders.
Jacob RajferDivision of UrologyHarbor UCLA Medical CenterTorrance, California
1. Magee, T. R., Qian, A., Rajfer, J., Sander, F. C., Levine, L. A.and Gonzalez-Cadavid, N. F.: Gene expression profiles inthe Peyronie’s disease plaque. Urology, 59: 451, 2002
2. Ferrini, M. G., Vernet, D., Magee, T. R., Shahed, A., Qian, A.,Rajfer, J. et al: Antifibrotic role of inducible nitric oxide syn-thase. Nitric Oxide, 6: 283, 2002
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Clearly, there is much to learn about this disorder. It is encourag-ing that we may soon have a better understanding of the pathophys-iology of Peyronie’s disease and, as a result, may be able to offer morespecific therapy due to the new technology available in the labora-tory and the burgeoning interest in research as suggested by Rajfer.With respect to the definition of sexual function, this refers to im-provement as perceived by the patient including an enhanced abilityto engage in sexual intercourse as a result of better quality erections,diminished pain and improved deformity. Although the IIEF isclearly a useful instrument for monitoring changes in erectile func-tion, orgasmic function and overall satisfaction, it does not necessar-ily address all issues regarding treatment outcomes for patients withPeyronie’s disease. An alternate and possibly more appropriate in-strument would be the Erectile Dysfunction Index of TreatmentSatisfaction.1
Regardless, Wessells is correct in suggesting that a questionnaireinvestigating criteria that are specific to treatment outcome for pa-tients with Peyronie’s disease would be most useful. This question-naire should include an overall assessment of improvement in sexualfunction, deformity change (curvature, indentation and hinging),rigidity, as well as pain. This survey would be most useful particu-larly as there are advances in medical and surgical therapy devel-oped for this clinically difficult and under studied disorder.
1. Althof, S. E., Corty, E. W., Levine, S. B. Levine, F., Burnett,A. L., McVary, K. et al: EDITS: development of questionnairesfor evaluating satisfaction with treatments for erectile dys-function. Urology, 53: 793, 1999
VERAPAMIL INJECTION FOR PEYRONIE’S DISEASE626