Apply for the Physician Finder – Association of Peyronie’s Disease Advocates

Contact Information

Name*

Prefix First Last

Group / Practice Name

Practice Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone*

Email*

Enter Email Confirm Email

Information to display*

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

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Full Name
Group / Practice Name
Practice Address
City
Phone
Email

Practice Information

Years in Practice

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

0-5
6-15
16-30
Over 30

Do you perform or have access to Penile duplex ultrasonography?

Yes
No

Do you perform or have access to DICC?

Yes
No

Do you perform or have access to Intracavernosal injection?

Yes
No

Do you measure stretched flaccid penile length?

Yes
No

Do you measure erect penile curvature with a protractor?

Yes
No

Do you measure erect penile girth with a string/ruler?

Yes
No

Treatment

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

Oral therapy

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Vitamin E
Potoba®
Colchicine
Tamoxifen
Carnitine
L-arginine

Intralesional Injection therapy

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Steroids
Verapamil
Interferon

Topical therapy

Select All
Verapamil
Superoxide dismzutase
DMSO cocktails

Shock Wave Therapy

Yes
No

External penile stretching devices

Select All
PhysioMed
Andro-Penis

Vacuum therapy

Yes
No

Surgical Straightening - plication techniques

Select All
Nesbit
Tunica plication without excision
16-Dot
Yachia (Heincke-Mikuwicz)

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

Surgical straightening — plaque incision or partial

Yes
No

Excision and grafting

Yes
No

Graft Type

Iontophoreses (EMDA)

Yes
No

Surgical straightening with penile prosthesis placement

Straightening Maneuver - Manual Molding
Straightening Maneuver - Incision +/- graft
Prosthesis - 2-piece Ambicor
Prosthesis - 3 piece AMS
Prosthesis - 3 piece Mentor/Coloplast
Prosthesis - Non-inflatable

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

Yes
No