Peyronie's disease in the early phase: what to do?
Bibliographic record
Abstract
Peyronie's disease (PD) is an abnormality characterized by fibrosis of the tunica albuginea that can be accompanied by pain, deformity, erectile dysfunction, discomfort, and/or dissatisfaction with one's self-image 1 .The prevalence ranges from 0.5 to 20.3%, but recent studies indicate underestimated data 1 .In a study of guidelines for the diagnosis and treatment of PD of the American Urological Association (AUA), International Society for Sexual Medicine (ISSM), Canadian Urological Association (CUA), and European Association of Urology (EAU), Manka et al. 2 reported that oral therapies present low level of evidence.Penile traction and intralesional injections are therapeutic options with unsatisfactory resullts 3 .There is consensus that the initial phase implies stability of the penile curvature for at least 3 months as well as a minimum period of 12 months without symptoms.Surgery should be reserved only after the stabilization of the disease.Therefore, what should the clinical approach be during the first 12 months?This is a critical period in which many men deal not only with pain, erectile dysfunction, and deformity, the oral medicinal treatment of which is ineffective, but may also experience depression, low self-esteem, difficulty or inability having sexual relations, restrictions to intimacy, social isolation, and stigmatization 4 .Considering the lack of standardization in the available literature on PD, much information used for therapeutic counseling of patients is based on a low level of evidence 1 .Thus, physicians face an ethical dilemma.Oral therapies are indicated without adequate scientific evidence, whereas patients deal with psychological and social issues concomitantly to the disease.One can say that both the physician and patient find themselves helpless in this period, despite the advances of current medicine.Thus, there is a need for long-term clinical trials in the early phase of treatment.In the meantime, patients should be duly counseled on the risks and benefits of current therapies, highlighting sharing in the definition of the conduct with the physician and multidisciplinary team.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.008 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.003 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.007 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.004 | 0.003 |
| Insufficient payload (model declined to judge) | 0.005 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".