LAUSR

In a recent publication by Brisbane et al. in this journal, the authors evaluate a smartphone app developed to access penile angulation in the diagnosis of Peyronie’s disease [1]. This is done by comparing results obtained with the app to the golden standard of in clinic alprostadil injection with subsequent measurement. The study evaluated a total of 18 men with good to strong correlation between the app and physical measurement for all penile dimensions. Not surprisingly, all of the participants preferred measurement by the app over injections. However, with only 18 participants and potentially clinically meaningful differences between the app and goniometer measurements in individual patients, the paper represents a pilot study. This is reflected in the careful discussion by the authors and in the conclusion that optimization of the app is needed, especially with regard to patient generated measurement accuracy. So, in spite of the promising preliminary results, the app is not ready for clinical practice and it would be premature to base treatment decisions on its results [1]. Technology has been an integral part of healthcare treatments for as long as anyone can remember and both availability and innovation are often taken for granted. This is also true for sexual medicine, with a large number of new treatments are continuously being tested [2]. Likewise, the possibilities offered by the internet has been implemented as tools for clinicians for example through electronic health records and teleconferences. Meanwhile, the application of online resources offering information and diagnostic support directly to patients in areas of sexual medicine is still in its infancy in spite of its obvious potential [3]. With this in mind, the study on a new digital tool for Peyronie’s disease published in this month’s IJIR by Brisbane et al. is both important and timely [1]. There is no doubt that weband app-based information and tools will play a large role in the future of medicine in general and sexual medicine in particular. Our field seems especially suited for online tools with high availability and potential anonymity due to the taboo and embarrassment experienced by many of our patients [4]. This means that there is a great potential, which can be fulfilled by innovative clinicians and researchers. However, currently, the lack of a barrier for publication means that a large number of websites offer information on health conditions, of varying quality, and there is concern that financial biases may in some cases influence the advice [5, 6]. Within sexual medicine, a few trusted institutions such as the International Society for Sexual Medicine, the European Society for Sexual Medicine, and the European Association of Urology offer resources for patients but one can fear that this drowns in the noise created by the private websites [7–9]. Likewise, anyone with a smartphone can access an abundance of healthcare related apps, offering the user anything from exercise tracking to personal health record keeping and treatment schedules for herbal remedies. While some apps for specific conditions such as diabetes have undergone serious scientific examination, the market suffers from the same lack of structure and overall quality control as the websites. Specifically, within sexual medicine, a simple search in the Google Play store will reveal that apps offering diagnostic tools and suggested home treatments for erectile dysfunction are especially popular. However, to our knowledge, none of these apps have undergone any kind of validation or scientific scrutiny and only a minority reports the identity of a healthcare professional or a healthcare center involved [6]. Therefore, we find that the most important aspect of the Brisbane study is not the app itself, but the mindset behind its development. Firstly, the idea is simple and logical; to use technology to create a new standardized diagnostic tool, which has the potential to replace an invasive and bothersome current standard. Secondly, the study group has been systematic as they started by evaluating their method in benchtop * Mikkel Fode [email protected]