Apply for the Physician Finder

The Physician Finder allows patients to search for urologists in their area who have experience diagnosing and treating Peyronie's disease. To be included in the Physician Finder, please provide the following information. (*Required fields.)

I. Contact Information

 
Full name*
Group / Practice Name
Practice address, line 1
Practice address, line 2
Practice City
Practice State or Province
Practice ZIP or Postal code

Practice Country

Phone

Fax

E-mail*

*Indicate which of the information above you would like displayed on the APDA Physician Finder. Only the information you select will be posted.

 Full name Group/practice name Practice address line 1 Practice address line 2 City ZIP code Phone Fax E-mail

II. Practice Information

 
Years in practice

How many Peyronie's disease patients do you see each month?

 0-5 6-15 16-30 >31

 

Do you perform or have access to:

1) Penile duplex ultrasonography  Yes No

2) DICC  Yes No

3) Intracavernosal injection  Yes No

 

Do you measure stretched flaccid penile length?  Yes No

Do you measure erect penile:

1) curvature with a protractor  Yes No

2) girth with a string/ruler  Yes No

III. Treatments

Which of the following do you offer? Check all that apply.

1) Oral therapy
 Vitamin E Potaba® Colchicine Tamoxifen Carnitine L-arginine Pentoxifylline

Others (please list)

2) Intralesional injection therapy
 Steroids Verapamil Interferon

How many patients have you treated with intralesional injection therapy:

3) Topical therapy
 Verapamil Superoxide dismutase DMSO cocktails

Others (Please list.)

4) Shock-wave therapy  Yes No

If yes, how many patients?

5) External penile stretching devices
 Fastsize Andro-Penis

Other brand (Please specify.)

How many patients?

6) Vacuum therapy  Yes No

 SOMA Osbon
Other (Please specify.)

7) Surgical straightening — plication techniques
 Nesbit Tunica plication without excision 16-Dot Yachia (Heincke-Mikuwicz)

How many plication-type operations have you done in the last year?

8) Surgical straightening — plaque incision or partial

Excision and grafting  Yes No

Graft Type:

Autologous
 Dermis Vein Temporalis fascia Tunica vaginalis

Cadaveric
 Dermis Pericardium Fascia lata

Xenograft (porcine)
 SIS Dermis

Synthetic
 Dacron Goretex (PTFE)

Others (Please list.)


9) Iontophoreses (EMDA) Yes No

How many patients have you treated?

10) Surgical straightening with penile prosthesis placement
Straightening maneuver
 Manual molding Incision +/- graft

Which prosthesis?
 2-piece Ambicor 3-piece AMS 3-piece Mentor/Coloplast Non-inflatable

How many of these operations straighten & place prosthesis for PD have you done in the last year?

Have you ever been sued in a medical malpractice case associated with your care of a man with PD?

 Yes No

Read the APDA Disclaimer and Limitation of Liability.
 

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