Interview With Dr. Mohit Khera
Dr. Mohit Khera M.D., M.B.A., M.P.H. is currently Assistant Professor in the Scott Department of Urology and the Director of the Laboratory for Sexual Medicine at Baylor College of Medicine in Houston, Texas.
Dr. Khera has served as a principal investigator or co–investigator on several research projects and has received various awards for his work in the field of Urology.
He is active member in the American Society of Andrology and was the Chair of Development Committee in 2010-2011.
Peyronie's disease has been one of Mr. Khera's MD specialty and he has conducted some pioneering studies in the field, like into the use of Botox to treat Peyronie's disease.
He has also conducted research into the relationship between Peyronie's disease and testosterone and is currently studying the genetic side of the disease.
Dr. Mohit Khera kindly agreed to an interview with My Peyronie's.
Dr. Khera, please tell us a little bit about your background and your experience of treating patients with Peyronie's disease
I earned my undergraduate degree at Vanderbilt University. I subsequently earned my Masters Degree in Business Administration and Masters Degree in Public Health from Boston University.
I received my Medical Degree from The University of Texas Medical School at San Antonio and completed my Residency training in the Scott Department of Urology at Baylor College of Medicine.
After finishing a six–year residency in Urology, I completed a one–year fellowship in Male Reproductive Medicine and Surgery with Dr. Larry I. Lipshultz.
I am currently an Assistant Professor in the Scott Department of Urology at Baylor College of Medicine and specialize in Male Infertility and Male and Female Sexual Dysfunction. I also serve as the Director of the Laboratory for Sexual Medicine at Baylor College of Medicine.
My fellowship training had a large focus on the diagnosis and treatment of Peyronie's disease. I have always had a strong interest in Peyronie's disease and several years ago started the first study on the use of Botox to treat Peyronie's disease.
I have also started the first randomized study to look at Peyronie's disease and testosterone. We demonstrated several years ago that up to 74% of Peyronie's patients have low testosterone and this could be a contributing cause to their Peyronie's.
Finally, I am currently studying genetic markers that may be linked to Peyronie's disease.
Roughly, how many Peyronie's patients do you treat each year?
I see roughly 10 Peyronie's patients a week. Many of these patients are on injection therapy and are coming in every 2 weeks for injections. I see roughly 100 new Peyronie's patients a year.
What is the average age of your Peyronie's patients?
Average age is roughly 50 but younger men can get it too. Younger men are more likely to have multiple plaques, more aggressive disease, and much more acute onset.
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?
Average age of onset is roughly 53, but younger men can get it too. Younger men are more likely to have multiple plaques, more aggressive disease, and much more acute onset.
I do think there is an increase in younger men with Peyronie's and that younger men are now more open to seeing their doctors.
Roughly, 70% of patients will see me within the first year of onset.
What Peyronie's treatments do you recommend to patients with mild or modern symptoms and why?
I typically offer them 3 treatment options. The first option is medications such as Pentoxifylline, daily Cialis, and L-Arginine. I also offer testosterone if their levels are low. I do not give testosterone to someone who wants to have children in the near future as this decreases sperm count.
I get a penile ultrasound on my patients and if they don't have calcifications I offer them penile plaque injections.
I also ask them to use a penile stretching device. I ask patients to do all 3 options for 6 months and at the end of 6 months if they are not satisfied we discuss possible surgery.
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?
Yes, I do think they are beneficial, but I find the traction device to be better ONLY if the patient is compliant. The traction device requires 2–6 hours per day for 6 months.
Do you have preferred surgical procedure for Peyronie's disease and if so, why?
I prefer to do a penile plication as I think there is less morbidity and adverse effects. If a patient has a sig curve, i.e. greater than 60 degrees, I do discuss excision and grafting as it mitigates the sig loss of penile length.
For patients who have undergone surgery to treat their Peyronie's disease, do you recommend some post operation treatment for them?
After surgery, either plication or excision and grafting, I ask my patients to use a traction device. I believe this helps with regaining penile length and maintains the straight penis.
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?
Collagenase is a great option and hopefully will be approved soon by the FDA. I believe that the use of Botox and testosterone are novel and can also help with improving penile curvature.
Do you think Peyronie's disease will ever be curable?
Yes I do. I believe that also depends on how you define curable. Cure can also be defined as preventing further curvature of disease. If a patient presents with a 10–degree curve and I can prevent it from going to a 60-degree curve many would also call this a cure.
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?
Some studies have shown that up to 9% of men have Peyronie's disease. I believe the actual prevalence in 5-10% and we also know that the disease is heavily under reported.
Can men do anything to prevent getting Peyronie's disease e.g. exercise, diet, lifestyle, etc.?
As I mentioned earlier, I believe low testosterone is a risk factor and Peyronie's patients should check their levels. Treating low testosterone may help prevent further curvature of disease and even improve curvature but more studies are needed.
The problem is with men who have only a 80 or 90% erection. They are able to penetrate but are also more susceptible to buckling trauma.
Are you aware of any environmental studies about common medical conditions in men that might increase the risk of them developing Peyronie's disease?
As I mentioned earlier, I believe low testosterone is a risk factor and Peyronie's patients should check their levels.
Genetics do play a role and we know that some men are much more predisposed to developing PD. 2% of men have family history. 20% of men with Dupatryen contracture will also have PD, DC is an AD disease.
What do you recommend men with Peyronie's disease should do (or not do) to prevent the disease getting worse?
We know that 35%–58% of men with Peyronie's disease will also have ED (erectile dysfunction). ED can be considered risk factor of PD as it may predispose a patient to be more likely to have buckling trauma during intercourse.
Men who start to develop ED should have their ED evaluated and treated ASAP as this can lead to PD later on.
Do you think any of your patients have developed depression or other mental disorder as a result of Peyronie's?
PD has real physical and psychological effects that can affect men every day (depression, negative sexual self-image, performance anxiety, difficulty or discomfort during sex, etc).
I give them educational materials and information that will help them talk about Peyronie's disease and help address sexual or intimacy problems it's caused. I also offer referral to psychologist or sex therapist. Finally, I give access to information and support groups also available.
Anything you would like to add?
PD affects both the patient and the partner. Partners need to be informed of the condition. I had one wife of patient express that she thought this was due to STD (sexually transmitted disease) and that she may contract the disease.
There needs to be more education for both the patient and the partner.
Dr. Mohit Khera, thank you very much for taking the time to do this interview with My Peyronie's.
For more information about Mr. Mohit Khera MD and his full CV, see Baylor College of Medicine .