Men’s Health

Section Editor: Martin M. Miner, MD

Around the world, men die an average of 6 years earlier than women, and the mortality rate for men is higher than for women in 12 out of 15 leading causes of death. Health outcomes among boys and men are substantially worse than among girls and women. Men engage in riskier behavior, are less likely to practice preventative health measures, and more likely to avoid important screenings.

I am Martin M. Miner, MD, a primary care physician and internationally recognized expert in the field of improving longevity and quality of life for men. I have curated the Grand Rounds in Urology Next Generation Men’s Health Learning Center in order to educate PCPs, urologists, oncologists, and APPs who work with men on the latest clinical research and practice for addressing the needs of this population. Topics covered andrology and sexual health; Peyronie’s disease; male infertility; health, exercise, and wellness; BPH and other prostate conditions; and urinary incontinence I hope you find this resource valuable for improving outcomes for your patients.


This section will build your expertise in andrology, with a focus on testosterone replacement therapy.


This section will provide you with the latest updates on AUA Guidelines for the early screening of prostate cancer.


This section will guide your understanding of the use of biomarkers in localized prostate cancer screening, treatment, and surveillance.


This section will build your understanding of fertility testing and treatments.


This section will build your understanding of how to provide an integrated men’s health experience for your patients.



Peyronie’s Disease (PD) is a disorder in which fibrous scar tissue, called plaques form under the skin of the penis. The plaque builds up in the thick elastic membrane called the tunica albuginea. As it develops, the plaque pulls on the surrounding tissues and causes the penis to curve,bend and limit length and girth expansion during an erection. Curves in the penis can make erections painful and may make penetration painful for patient and partner, difficult or impossible. We do not know the exact cause of PD although there is a strong genetic component and may develop as a result of. repeated low impact penile injury. Only 20% of men recall an inciting event leading to the alterations in penile shape and function.

The estimated prevalence of Peyronie’s Disease (PD) is 5%-7%. Up to 9% of all men have PD. Prevalence increases with erectile dysfunction, hypogonadism (40%) and diabetes (20.3%)

Penises vary in shape and size, and having a curved erection is not necessarily a cause for concern. In PD, the bend is significant and may occur along with pain or interfere with sexual function. Erectile Dysfunction (ED) is a common presenting symptom of PD. ED can pre-date PD in up to 50% of patients. The location of penile plaque often corresponds with the direction of the curvature deformity. 80% of the time PD typically presents as a dorsal upward curvature.

Risk factors associated with PD include genetic factors such as Paget’s disease, or a family history of PD, trauma from vigorous intercourse, cystoscopic procedures, urethritis, prostatectomy; injection therapy such as vasoactive drugs for ED, and vascular conditions such as diabetes, hyperlipidemia, hypertension, heart disease, smoking and low testosterone.

Peyronie’s Disease carries a significant mental health burden; up to 40 % of PD patients are clinically depressed. Patients are often distressed and need clear communication and understanding. Managing patient expectations is critical; the provider must at the first visit let patients know they will likely never regain their pre-PD penis but can reasonably expect to achieve erections suitable for penetration and painless sex.

AUA Guidelines: require a subjective assessment of a patient with PD; a careful history (to assess penile deformity, interference with intercourse, penile pain, and/or distress) and a physical exam of the genitalia (to assess for palpable abnormalities of the penis). They also state that clinicians should perform an in-office intracavernosal injection (ICI) test with or without duplex Doppler ultrasound prior to invasive intervention.

PD has traditionally been categorized into two phases, the acute phase and the chronic phase.

Acute Phase: During the acute phase, plaque forms in the penis, the bending/curving of the penis actively worsens, and patients may feel pain. The acute phase usually lasts for 5-7 months but can last up to 18 months in rare cases.

Treatment during the active phase consists of nonsurgical medical therapy such as medications like sildenafil and tadalafil which can stabilize progression of plaque and rarely reverse plaque formation. Collagenase clostridium histolyticum (Xiaflex), is the only FDA approved treatment and is indicated in the acute phase with emerging data that it is at least as effective as in chronic phase and potentially more beneficial. Collagenase is an enzyme that breaks down specific types of collagen that make up the plaques. Breaking down the plaques reduces penile curving and improves erectile function. This treatment is approved for men with penises curving more than 30 degrees.

Nondrug medical therapies include medical traction and vacuum devices aimed at stretching or bending the penis to reduce curving, and shockwave therapy-focused, low-intensity electroshock waves directed at the plaque may be used only to reduce pain.

Chronic Phase: The chronic phase occurs after the plaque stops growing and the penis does not get worse or bend any further. Typically pain has resolved in chronic phase. Treatment includes all acute phase therapies as well assurgery. Surgical therapies will depend on the man’s erectile function and include plication, plaque incision/excision and grafting and lastly, penile prosthesis. Men must be counselled that all surgical therapies run the risk of further length loss.


This section will build your expertise in sexual health, with a focus on Erectile Dysfunction treatments and other areas of sexual function.


This section focuses on causes and the range of available and upcoming treatments for BPH.


This section will build your understanding of causes of and treatments for Peyronie’s disease.


This section will build your understanding of male urinary incontinence issues.


This section will expand your awareness of how conditions such as sarcopenia and obesity interact with urological diseases like prostate cancer. Presentations focus on management of patients with these increasingly common comorbidities and will also emphasize how diet and exercise can be used to help prevent and mitigate the effects of urologic disease.


This section will expand your awareness of diagnosis and treatment options for prostate cancer.



Dr. A George - Thumb

Martin M. Miner, MD
Miriam Hospital
Providence, Rhode Island

Martin M. Miner, MD, is Co-Director of the Men’s Health Center and Chief of Family and Community Medicine for Miriam Hospital in Providence, Rhode Island. He is also Clinical Professor of Family Medicine and Urology at the Warren Alpert Medical School of Brown University in Providence and has been charged with the development of a multidisciplinary Men’s Health Center within the Lifespan/Brown University system. Click here for his full GRU bio and publications.


Dr. A George - Thumb

Jesse N. Mills, MD
University of California Los Angeles 
Los Angeles, California

Health Science Clinical Professor, Dr. Mills is the Director of the Men’s Clinic at UCLA, fellowship director of the UCLA male reproductive medicine and surgery program, and director of UCLA Urology Santa Monica. His practice is solely devoted to urologic men’s health issues. He is internationally recognized as a thought leader in male fertility, hypogonadism, erectile dysfunction, Peyronie’s disease, and microsurgery. Dr. Mills has performed thousands of penile implants, vasectomy reversal, varicocelectomy and complex Peyronie’s disease surgeries, and Xiaflex injections. He proctors internationally in microsurgery and penile implant procedures. He is a leader in fertility preservation in the gender health program at UCLA as well as in the adult and adolescent oncology programs. His clinical specialties revolve around men’s health and include male hormone management, sexual and ejaculatory dysfunction, male fertility, and Peyronie’s disease. He also has a special interest in restoring fertility and sexuality in men with spinal cord injuries.​ Click here for his full GRU bio and publications.