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 nameGroup/practice namePractice address line 1Practice address line 2CityZIP codePhoneFaxE-mail

II. Practice Information

 
Years in practice

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

0-56-1516-30>31

 

Do you perform or have access to:

1) Penile duplex ultrasonography YesNo

2) DICC YesNo

3) Intracavernosal injection YesNo

 

Do you measure stretched flaccid penile length? YesNo

Do you measure erect penile:

1) curvature with a protractor YesNo

2) girth with a string/ruler YesNo

III. Treatments

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

1) Oral therapy
Vitamin EPotaba®ColchicineTamoxifenCarnitineL-argininePentoxifylline

Others (please list)

2) Intralesional injection therapy
SteroidsVerapamilInterferon

How many patients have you treated with intralesional injection therapy:

3) Topical therapy
VerapamilSuperoxide dismutaseDMSO cocktails

Others (Please list.)

4) Shock-wave therapy YesNo

If yes, how many patients?

5) External penile stretching devices
PhysioMedAndro-Penis

Other brand (Please specify.)

How many patients?

6) Vacuum therapy YesNo

SOMAOsbon
Other (Please specify.)

7) Surgical straightening — plication techniques
NesbitTunica plication without excision16-DotYachia (Heincke-Mikuwicz)

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

8) Surgical straightening — plaque incision or partial

Excision and grafting YesNo

Graft Type:

Autologous
DermisVeinTemporalis fasciaTunica vaginalis

Cadaveric
DermisPericardiumFascia lata

Xenograft (porcine)
SISDermis

Synthetic
DacronGoretex (PTFE)

Others (Please list.)


9) Iontophoreses (EMDA)YesNo

How many patients have you treated?

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

Which prosthesis?
2-piece Ambicor3-piece AMS3-piece Mentor/ColoplastNon-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?

YesNo

Read the APDA Disclaimer and Limitation of Liability.
 

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