Interview With Dr Franklin Kuehhas
Dr Franklin Kuehhas is a medical specialist in the field of urology and andrology. He specializes in reconstructive andrology, which deals with complex issues surrounding the male genitalia.
Dr. Kuehhas received his specialization training at the University College London. He also underwent his training at the prestigious University Hospital in Heidelberg (Germany) and at the University Hospital of Vienna (Austria).
Dr Kuehhas focuses on the treatment of congenital and acquired penile curvatures (Peyronie’s disease). His research activities have resulted in many publications and improvements of surgical techniques such as the STAGE technique for congenital penile curvature treatment.
Furthermore Dr Kuehhas also focuses on the surgical treatment of therapy-resistant erectile dysfunction. The implantation of penile prostheses is another big focus of Dr Kuehhas.
Please tell us a little bit about your background and your experience of treating patients with Peyronie's disease
Peyronie’s disease and congenital penile curvatures make up a significant amount of my daily practice. My decision to focus on penis deformities was based on the fact, that none of my senior colleagues in Vienna were really interested or focused on treating such patients although we had a big number of patients seeking advice. Since my early days of being a urologist I have tried to understand these diseases and deformities and help patients to resume a normal life with a straight penis.
Roughly, how many Peyronie's patients do you treat each year?
I see patients with penis curvatures on a daily basis. This includes patients with Peyronie’s disease and congenital penile curvatures. I treat up to 300 patients per year with Peyronie’s disease or a congenital penile curvature.
What is the average age of your Peyronie's patients?
The average age of patients who seek advice for Peyronie’s disease is between 40 and 60 years. However, I have noticed that younger patients are seeking advice for Peyronie’s more often these days. The youngest patients I have seen with Peyronie’s was 18 years old.
Approximately, how many of your patients fall into each of the following groups: mild, moderate, and severe Peyronie's condition?
Let’s define mild as a curvature of less than 30°, moderate would mean 30-60° and severe Peyronie’s disease is anything above 60° deviation. Considering this definition, I would say that the distribution is 20%, 50% and 30% respectively.
How common do you think Peyronie's is? Do you think it is on the rise, e.g. due to lifestyle changes or environmental issues, or are men becoming more open about seeking assistance?
My personal feeling is very clear on this question. Peyronie’s disease is becoming more common these days, as men are more aware of the disease and are becoming more open about seeking assistance. Previous generations might have had problems gathering information about the disease. Also seeking advice from a physician might not have been that easy. The widespread availability of information online definitely helps to enlighten patients and also physicians who are not familiar with such a disease.
How important is early diagnosis in your opinion? Can men expect better results the sooner they start treatment and why?
I strongly believe that early diagnosis of Peyronie’s disease helps patients to stop the disease at an earlier stage, as we can start with conservative measures to control the disease.
Can you describe the non-surgical treatments you recommend to your patients? What influences which treatments you recommend?
My approach on conservative management of Peyronie’s disease consists of a mixture of available tools such as penile traction devices, vacuum pumps, the use of tadalafil and of course collagenase injections. There is plenty of evidence available that traction devices can reduce (but not straighten) penis curvatures caused by Peyronie’s disease. The use of PDE 5 inhibitors such as tadalafil is based on the fact that we want to enhance the rigidity of the erection in order to avoid any kinks during sexual intercourse. These kinks might further stimulate the Peyronie’s plaque.
What do you consider satisfying result from non-surgical Peyronie's treatment?
A satisfying result for me is when the patient is happy with the outcome of non-surgical measures. The target is to have a straight penis of course, but conservative measurements do not straighten the penis completely in most cases. That is why I believe that any conservative measure is meant to stabilize the disease and in the best case to reduce the curvature. Surgery is and will always be an option to look into.
Have you recommended using traction device or penis pump to treat penis curvature? If so, what is your experience of them? When do you recommend using each device?
I recommend the use of traction devices such as Phallosan forte and also vacuum pumps when I treat patients with collagenase injections. In my experience these additional measures help to increase the effect of the plaque rupture.
What do you recommend for men who also suffer from low erection quality / erectile dysfunction?
If patients suffer from low erection quality, it is always recommended to discuss the severity of the erectile dysfunction. In some cases, the axial deviation and the erectile dysfunction can be treated with a straightening procedure and the intake of PDE 5 inhibitors such as sildenafil, or tadalafil, etc. In severe cases of Peyronie’s and erectile dysfunction a penile implant is inevitable. The decision should always be based on a thorough physical examination of the penis and an honest and in-depth history taking on the day of the consultation.
What is your view on using supplements as part of the Peyronie's treatment plan?
I think the published data is very clear. Nutritional supplements have no real justification in the treatment of Peyronie’s disease.
Approximately how many (%) of your patients do not respond to non-surgical treatment and therefore require penis surgery? Have you been able to identify any common characteristics among those patients?
Approximately 80% of my patients will ultimately need surgery to fix the underlying deformity. Calcified plaques are definitely associated with les response to conservative measures.
There is some risk involved with any surgery. In your experience, how common are serious side effects after penis surgery (e.g. erectile dysfunction, penile shortening, reduced penile sensation, loss of elasticity)?
A very important aspect of surgery is patient selection. Patients need to understand that their erection quality will not be better after Peyronie’s surgery (regardless of the technique used) if they already suffer from erectile dysfunction prior to the surgery. It is therefore important to assess the problem of weak erections in depth with the patient and sometimes also with the induction of an artificial erection and a duplex sonography.
Surgery for Peyronie’s disease is complex and should only be offered by experienced physicians in order to avoid and minimize the risk of side effects and complications. Especially grafting procedures are complex and should be referred to a specialist in case of any doubt. As I said, the basis of a successful outcome is the preoperative assessment of the problem and of the patient’s expectations.
For patients that have undergone surgery to treat their Peyronie's disease, do you recommend some post operation treatment for them? If yes, what do you recommend?
Penis rehabilitation following surgery is mandatory. I always recommend the use of tadalafil 5 mg starting 2-3 weeks after surgery and also the use of traction devices to counter act any contraction or loss of elasticity. These adjunct measures help patients to recover more quickly.
What do you recommend that men with Peyronie's disease should do (or not do) to prevent the disease from getting worse?
If a patient suspects Peyronie’s disease one should seek advice from a specialist. It is better to see a specialist sooner rather than later.
How do you address the emotional side of Peyronie's? What can men do to deal with the distress caused by the disease?
We know that Peyronie’s disease is not only a disease that affects the functionality of the penis, but it also has a negative effect on the psychosexual well-being of patients. This can lead to depression, low self-esteem and relationship problems.
My recommendation is to discuss the problem with your partner and also bring your partner to the initial consultations with you, as this creates an open atmosphere in which all concerns and questions can be discussed.
What can a partner or friend do to support a man with Peyronie's disease?
It is important to understand that the disease does not only cause functional problems, but it can also affect the psychosexual well-being of affected men. That is why it is very important to have an open attitude when it comes to discussing and addressing problems within the relationship.
How can we raise the awareness of Peyronie's, both among the public and health professionals?
Health problems concerning the penis do not seem to get as much traction in media as other health issues. Especially in the case of Peyronie’s disease it is sad to see that even physicians sometimes do not even know what to do or where to send the patients. It would be great if Peyronie’s disease would not be seen as a taboo topic in the media. This could help raising the awareness in the public and also with health professionals.
What does the future hold for Peyronie's patients? Are there any interesting new treatments on the horizon (short term and long term)? Will Peyronie's ever become curable?
Science moves on and I am positive that we will understand the etiology of Peyronie’s disease better in the future. This will also enable us to intervene at an earlier stage of the course of Peyronie’s disease. We can already tackle the functional issues associated with Peyronie’s disease, and I hope that we will someday be able to offer more effective conservative treatment options.
Dr Franklin Kuehhas, thank you very much for taking the time to do this interview with My Peyronie's. For more information about Dr. Kuehhas, visit his website .