Nursing practice: a primary care approach to intralesional injection therapy for Peyronie's disease

Peyronie's disease (PD) is defined pathologically as an inflammatory condition leading to the formation of a fibrous inelastic plaque of the tunica albuginea of the penis. Scar formation causes deleterious changes in the girth, length and shape of the penis with erection. PD has an unknown aetiology and was first attributed to a sexually transmitted disease. Proper diagnosis of PD includes a comprehensive medical history, focused physical examination, administration of the International Index of Erectile Function questionnaire, and, when indicated, diagnostic testing using penile duplex Doppler ultrasound with a vasoactive agent. Intralesional injection therapies with verapamil and interferon alpha-2b have shown efficacy in placebo-controlled studies. This minimally invasive therapy is applicable to patients with either acute or stable disease and for those patients who decide to defer surgical correction. After a confirmatory diagnosis of PD, intralesional injection therapy can be initiated in the primary care setting. Appropriate demonstration of penile injection technique on actual patients to the primary care physician and the nurse practitioner is the most effective means of education. This can be accomplished by an urologist or a nurse educator with prior experience in intralesional injection therapy.