APPOINTMENT KIT — Peyronie's Disease

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Your Situation

• 41 years old, ~9 months post-injury. Single dorsal plaque, mid-to-distal shaft, 40° upward curvature (March 2026 Doppler).
• Active disease — curvature visibly worsening in last month. Pain resolved (8-9 → 2-3) but curvature still progressing = still active phase by ICSM 2024 definition.
• Currently on verapamil at 3-month intervals — no published protocol supports this schedule. Only double-blind RCT (Favilla 2017, n=140): zero curvature change.
• Normal vascular flow on Doppler. ED likely PD-secondary or psychogenic, not vascular.
• Volume-loss deformity (thinning upper 1/3) self-observed — NOT assessed by prior urologist.

5 QUESTIONS + 1 BONUS (ask in this order)

First — Get Information

1. "I'm noticing distinct thinning in the upper third with a clear restriction. Can you assess for hourglass deformity, indentation, and axial instability? I've read that this may actually predict better Xiaflex response." → 65% of PD patients have volume-loss deformities (Margolin 2018, n=128). Often overlooked. ⊕ Cahill 2025 (n=826, multivariate P=.02): moderate/severe hourglass/indentation predicts 3-10° MORE CCH improvement.

2. "My March Doppler didn't characterize calcification. Can you grade it — stippled or dense?" → Worth documenting for baseline. However, Cahill 2025 (n=826, P=.37) shows calcification is NOT a reliable predictor of CCH failure — CCH remains viable regardless of calcification status.

3. "My March Doppler showed 40° dorsal. Can you measure today and compare? I'm noticing visible progression. Am I in stable phase — and how are you determining that: curvature measurement, pain, or both?" → Pain alone is NOT a reliable stability indicator (ICSM 2024, Trost 2024). Curvature stability ≥3 months is the criterion. Phase determines treatment options.

Then — Test Whether They're Current

4. "I've been on verapamil at 3-month intervals. Published protocols use biweekly to monthly. The only double-blind RCT showed zero curvature change. What's your assessment?" → Favilla 2017, n=140, double-blind: verapamil 0.00° ± 0.00. AUA calls verapamil evidence "weak" with "clearly more effective" alternatives. CUA is the only society that recommends it (Level 3, Grade C — practice-based).

5. "Given my 40° dorsal curvature and normal vascular flow, would I be a candidate for Xiaflex with RestoreX traction? Cahill 2025 shows RestoreX is the strongest predictor of CCH improvement." → Dorsal responds best: 50% median improvement (Lumbiganon 2025, n=292). RestoreX: 19.5° greater improvement on multivariate (Cahill 2025, P=.02, strongest predictor). 6.9× more likely ≥20° improvement (Alom 2019). ⚠️ Confound: 98% used RestoreX — cannot fully separate from concurrent protocol changes.

If #4 Goes Well

6. "Are you familiar with intralesional hyaluronic acid for PD? Two double-blind RCTs show it outperforms verapamil — with zero adverse events." → Favilla 2017: HA -4.6° vs V 0.0°. Abdel Fattah 2024: HA -9.4° vs V -5.4°. BUT: EAU 2026 and ICSM 2024 both recommend against HA outside clinical trials. Approved only in Italy.

IF THEY SAY X — THE EVIDENCE SAYS Y

BEFORE THE APPOINTMENT — Describe your ED pattern

"My ED isn't constant — I can achieve and maintain erection, but if anything disrupts it during intercourse, it collapses and I can't recover that session. I think it's physical + anxiety. Doppler showed normal vascular flow. Would daily tadalafil help break the recovery-failure pattern?"

→ This is a fragile-recovery pattern — textbook for daily tadalafil (not PRN). Describe BEFORE asking about PD treatment so dosing decision is informed.

If they dismiss any of these questions, ask: "What citation are you relying on?"

This kit was prepared from 30+ peer-reviewed articles, independently verified by two AI readers with structured pair review. Every claim traces to a specific published source. Full evidence at [Evidence Reference URL].