Low-Dose Tadalafil May Reduce Penile Curvature Progression Rate in Acute PD Patients

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[00:00] [Music] so hello everyone uh my name is Jonathan clavell I'm a private practice urologist in Houston uh focus in men's health and sexual medicine uh and I'm here today with my very good friend Matt zigelman
[00:18] Matt introduce yourself all right hi Jonathan thanks so much so my name is Matt zigelman I am the membership committee chair for the smsna and a uh member at large on the board of
[00:30] directors and I practice Sexual Health at Mayo Clinic in Rochester Minnesota you can you can be a bit more informal with that he is the ponis expert which we're going to be talking about today uh he is the ponis expert at Mayo Clinic so
[00:44] uh Matt we we have this session right now we want to talk about research studies and and research studies that probably people don't have the time to read and we're going to analyze an article and there was this article that
[00:55] was published uh last year right and you had a really really good critique to it uh afterwards and it was a med article looking specifically at the use of a daily low low do tadalafil a medication
[01:09] that we well know to uh that we well use it all the time to treat both lower urinary tract symptoms after BPH and also erectile dysfunction and there's this article that was looking into using this medication during the acute phase for paronis disease um and basically
[01:24] this was a retrospective single institutional analysis they looked at 191 men who were within the acute phase and they stratified them between those that were taking daily talil versus those that were not taking daily talil
[01:37] and they followed these patients for 12 weeks correct you got it and then they were looking at the progression of the curvature were were men taking the tadala fil able to progress less uh you know than those who were not taking it
[01:52] correct yeah that is exactly right and and their outcomes uh do you remember the I mean the outcomes like what what what did they show yeah I mean what they were trying to see is does using tadalfil to to treat ponus disease in the acute phase prevent progression and
[02:06] potentially even improve the curvature and they did find now this was a retrospective Series right so this included uh a chart analysis of a single institution I think it was a single provider as well that's correct and uh
[02:20] uh they wanted to look at um you know after this thre Monon course of tadalfil what happened so the there was a statistically significant difference in the likelihood of progression so of a worse curve after
[02:35] that three months of therapy if you were if you were not taking the correct so it was favoring the tadalfil so the patients who took the tadalfil essentially had very little curve on average and the likelihood of
[02:48] progression was you know around 25% as opposed to about 40% in those who did not take the daily tid alfil which good I mean and like if we talk to you know talk about the theoretical aspect behind this again with a dism medication
[03:03] we're dilating blood vessels we're delivering more oxygen to tissues therefore you know things should stay healthier and we can possibly prevent that scar tissue from forming yeah the idea at least the way I counsel patients is protecting the penis right so you're
[03:17] you're promoting stronger erections you're preventing that repetitive trauma to the penis during sexual intercourse with a soft erection but there's probably more to it too there's great this is a couple decades now where
[03:31] they've looked at um the mechanism of pd5 Inhibitors which is what tadalfil is and it actually can modulate Scar Tissue formation it can it can affect those
[03:43] various inflammatory and profi Cascades in animal models and so you can sort of um extrapolate that does that work at a at a human level right and so that's the theory here that's the hypothesis in
[03:57] addition to causing stronger directions it's actually preventing that profibrotic milu the other thing that they also found in this study was that the mean I I EF scores and also the bdq scores uh were actually higher on talal
[04:12] Group which again is expected if we're giving a medication that will also enhance your erection um so most importantly again there you did an analysis of this article because again it looks promising but we still do cannot uh consider this a scripture
[04:26] because again there are things that we have to also consider tell me about yeah so yeah so this was published in igir international Journal of impotence research and they asked me to do a review of the article essentially
[04:38] commentary um so great like Innovative data exciting what we're seeing in practice I mean I've been using this well before I reviewed this article but um the the idea here is how strong is
[04:52] this level of evidence and I would say not very strong right it's a retrospective series single Institution relatively small cohort patients weren't weren't randomized to one treatment versus another they they self- selected
[05:07] essentially uh there were a couple other things so they were looking at the acute phase of pyron's disease and what defines the acute phase of ponus disease is not entirely clear that's right so I think the average duration of symptoms
[05:21] was 10 months so one of the questions is are most of those guys actually in the acute phase of PD or are we looking at a yeah are we looking at a chronic stable phase so they did do analysis they did a sub analysis looking at less than 9
[05:36] months versus greater than 9 months and it seemed to have the greatest benefit in patients who were less than 9 months out from symptom onset so suggesting that the acute phase is probably where you're getting your most bang for your
[05:49] buck which is what you know most people who have historically prescribed oral therapies uh were doing they were using this in the acute phase when that scar tissue is setting in and and last but not least this was also a single institution analysis right AB everything
[06:03] was done by a single surgeon so we also have to take that into consideration were was there a level of bias uh when it comes to you know to a study like this but again it is still a very promising study this is something that we've been prescribing uh you as experts
[06:18] we've been prescribing this it's really good that we can finally have some data uh at least something to support you know what we've been doing again I I know you agree you know at least somewhat agree with me and should we already start putting this tadalu
[06:32] medication in water I we call it vitamin C like at our you know we prescribe it so often SE vitamin C seis for the trade name but um I think there's a ton of utility in these types of of medications
[06:46] uh beyond the you know the erectile dysfunction and lower urinary tract symptoms and this is one example of uh a potential utility well great well thank you for uh you know for being here with us today pleas thank you to the social
[07:00] media Committee of the smsna and again hopefully we can do this again at sometime again it's always a pleasure and an honor to be sharing such a platform with you I agree 100% please become a member of smsna if you're not
[07:12] already one go to the website and click on the membership link to learn more
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