Dr. Loloi on urology resident exposure to CCH for Peyronie’s disease


“Then finally, when we asked about Xiaflex, it was only two-thirds of programs, less than 70% of programs listed that they were having the residents exposed to Xiaflex,” says Justin Loloi, MD.

In this video, Justin Loloi, MD, highlights notable findings and potential next steps based on the study, “A survey of exposure to the use of Xiaflex for the treatment of Peyronie’s disease among United States urology residency programs,” which he will present at the 2023 SMSNA Annual Meeting in San Diego, California. Loloi is a urology resident at Montefiore Medical Center in Bronx, New York.

Video Transcript:

Initially we asked, “are you exposed to Peyronie's disease in general in residency? That was nearly 100% of residents, or at least programs that we asked that we got responses for, said that the residents are exposed to Peyronie's disease. Secondly, we asked them "Are you exposed to the surgical management of Peyronie's disease, whether it's plication, incision and grafting, or an IPP of penile prosthesis? And, again, nearly 100% of programs demonstrated or showed that the residents were exposed to this. Then finally, when we asked about Xiaflex, it was only two-thirds of programs, less than 70% of programs listed that they were having the residents exposed to Xiaflex. What we were thinking is what drives this difference? Why are residents being shown or demonstrated all these different types of treatments for Peyronie's, but the 1 FDA approved treatment is not what's being taught in programs. We came up with a couple of thoughts. One was maybe that there's just not enough resources or programs just not doing much Xiaflex. Maybe they don't have an academic urologist who's trained in men's health who has a high volume of these procedures, who they could be learning from. It did seem like most of the residents who were getting training in any procedure for Peyronie's disease were actually getting their training from an academic urologist who was trained in men's health or andrology. The third thinking is, we have these case logs that we all have to fill out, and there's specific case logs for the surgical treatments of Peyronie's disease, whether it's a penile plication, grafting, or penile prosthesis placement, but there's no real measure of whether residents are getting Xiaflex. So, we're thinking maybe because that's not explicitly stated in these case logs that residents really must abide by throughout their training, maybe that's the reason why this disparity exists.

In terms of what the next steps would be, it's really just cracking down more into programs, asking them specifically what they think the drivers of this are. We have their information in terms of whether they have the providers there, but we didn't explicitly ask "Are there resources there for Xiaflex? Does your institution even offer Xiaflex?" That could be something that we could have asked as well. It does open the door for a lot of future studies that we're definitely looking into. But definitely a very important gap in residency training, considering that this is probably the most widely used treatment for Peyronie's disease and is the sole FDA medical treatment for these patients. A lot of patients are getting this treatment, so residents do need to be trained in how to effectively use it. Hopefully, the goal is that this will just increase the number of providers who are more capable in providing this treatment to patients. Obviously, it's a very vulnerable population, so having more readily trained providers who are able to give this service is something that's important.

This transcription has been edited for clarity.

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