Interview With Dr. Wayne J. G. Hellstrom
Dr. Wayne J. G. Hellstrom MD, FACS is Professor of Urology and Chief of Andrology at Tulane University School of Medicine in New Orleans, US. He specializes in the diagnosis and treatment of sexual dysfunction, including Peyronie's disease.
Dr. Hellstrom has published over 250 peer-reviewed articles in professional publications and has contributed to numerous chapters in textbooks. He is also the editor of “Male Infertility and Sexual Dysfunction” and “The Handbook of Sexual Dysfunction.”
Dr. Wayne J. G. Hellstrom has been awarded many honors in the field of Urology.
He has served as president of the Sexual Medical Society of North America, committee chair of the International Society of Sexual Medicine (ISSM), president-elect of the American Society of Andrology, associate editor for The Journal of Sexual Medicine and specialty editor for the Journal of Urology.
Dr. Wayne J. G. Hellstrom kindly agreed to an interview with My Peyronie's.
Dr. Hellstrom, please tell us a little bit about your background and your experience of treating patients with Peyronie's disease
My research is directed to elucidating the unknowns in medicine and deriving new treatment paradigms from medical to surgical. Peyronie’s disease has affected a sizeable population of men for hundreds of years with still no definitive understanding of cause and appropriate treatment.
I also enjoy reconstructive surgery and many of my advanced Peyronie’s disease cases need surgical treatment.
Roughly, how many Peyronie's patients do you treat each year?
I see more than 500 Peyronie’s patients per year.
What is the average age of your Peyronie's patients?
How many of your patients fall approximately into each of the following groups: mild, moderate, and severe Peyronie's symptoms?
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 do not believe there is an actual increase in the rate of development of Peyronie’s in younger men; however, I do believe that there is a greater availability of information, thanks to the internet and patient forums.
This has similarly led to greater awareness among primary care physicians and will hopefully lead to earlier recognition and referrals to appropriate specialists.
What Peyronie's treatments do you recommend to patients with mild or modern symptoms and why?
Patients who present with PD are all unique and have variable histories in regards to duration of PD, degree of impact on erectile function, curvature, bother, and pain, among others. During my evaluation of patients, I will commonly obtain a penile duplex ultrasound to objectively assess the degree of penile curvature and its impact on erectile function.
Pending results of that study, I will frequently offer several treatment options including oral therapy with pentoxifylline and L-arginine or intralesional injections with interferon alpha 2b. Patients undergoing intralesional injections will also be recommended to undergo concurrent penile traction therapy.
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 both device types offer the same results?
I tend to prefer penile traction devises over penile pumps, in that they result in less penile discomfort and permit longer sustained duration of use.
I do feel that when combined with intralesional injection therapies, there may be benefit in concomitant use of the penile traction device, and I routinely recommend their use in my patients, regardless of acuity of disease.
Do you have preferred surgical procedure for Peyronie's disease and if so, why?
I offer all types of PD surgery depending upon patient characteristics and preferences. Patients with baseline erectile dysfunction will often benefit most from a combined insertion of penile prosthesis with manual modeling +/- incision of plaque.
I will frequently discuss the advantages and disadvantages of each approach, and will ultimately come to a decision as to optimal treatment with the patient.
For patients who have undergone surgery to treat their Peyronie's disease, do you recommend some post operation treatment for them?
For patients who undergo insertion of an inflatable penile prosthesis, I routinely recommend inflating the device nightly to further improve any residual curvature.
For patients treated with plication or incision/grafting procedures, I usually start them on a combination of nightly phosphodiesterase inhibitors and penile traction therapy for a few months.
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?
Recently, the manufacturers of Xiaflex have applied for FDA approval for its collagenase product. This has demonstrated benefits in men with PD and may be a viable treatment option in this patient population, pending approval.
Additionally, there has been some advancement in the field of adult-derived adipose stem cell therapies, which may provide an alternative therapy either for the direct treatment of PD and associated erectile dysfunction or as an adjunctive measure at the time of surgery.
Do you think Peyronie's disease will ever be curable?
Gene therapy/modification has created the promise of cure for multiple diseases, however, numerous issues with this type of treatment will likely preclude its use for the foreseeable future.
However, ongoing improvements in care as well as increasing awareness of the disease are key to early diagnosis and effective therapies being instituted.
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 1-3% is an outdated estimate and that the true prevalence is probably in the neighborhood of 5% of adult men. Patients with comorbidities, including diabetes or pre-existing erectile dysfunction, are even more likely to suffer from this condition.
Can men do anything to prevent getting Peyronie's disease e.g. exercise, diet, lifestyle, etc.?
We do not know the exact answer to this question. Most authorities feel that reflective (micro) trauma to the penis is important. There are several aspects of PD, which are not fully understood, including the exact mechanism or genes implicated in its development.
Currently, no published findings show that making a specific change in lifestyle would decrease the likelihood of developing 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?
There is a well-known association between PD and Dupuytren’s disease. Additionally, patients with diabetes, erectile dysfunction, or having undergone a prior prostatectomy experience PD at higher rates than the general population.
It is unclear if these conditions cause the disease or are just an unrelated associated condition.
What do you recommend men with Peyronie's disease should do (or not do) to prevent the disease getting worse?
Although there is no widely accepted recommendation as to behavioral modifications to prevent disease progression, I routinely counsel patients to limit aggressive intercourse in an attempt to avoid any further trauma to the penis.
Do you think any of your patients have developed depression or other mental disorder as a result of Peyronie's?
Patients with PD frequently experience psychological distress, including depression. Those with significant distress, which impairs their activities of daily living will often benefit from consultation with a mental health expert, including psychologists/psychiatrists who specifically deal with sexual problems.
Anything you would like to add?
Peyronie’s disease is a common condition. Education to both patients and their general physicians is important to increase awareness. Continuing research and development in the field of PD will lead to answers on causation and to new effective treatments in the coming years.
Dr. Wayne J. G. Hellstrom, thank you very much for taking the time to do this interview with My Peyronie's.
For more information about Dr. Wayne J. G. Hellstrom and his full CV, see Tulane University .