ESSM Position Statement on Surgical Treatment of Peyronie's Disease

Peyronie's disease (PD) can be a cosmetically and functionally disturbing medical condition to men and their partners. Although management of PD may be non-surgical in the form of oral medications or intralesional injections during the acute phase, once the disease stabilizes, surgical treatment remains the gold standard definitive treatment when indicated. Cases associated with significant angles of penile curvature or with treatment-refractory erectile dysfunction hindering sexual intercourse demand surgical intervention. Various surgical approaches have been proposed in the chronic stages of PD whether penile shortening procedures such as simple plication or others preserving penile length as plaque incision/excision with grafting. All with or without the utilization of a penile implant according to the associated erectile function.

Through this special series of guiding statements, our goal is to provide, on behalf of the European Society for Sexual Medicine (ESSM), a comprehensive review of the current evidence on the surgical management of PD. Our recommendations result from the review of over 130 relevant peer-reviewed studies and systematic reviews published during the past decade. In a stepwise manner, we begin by emphasizing the importance of proper patient preoperative counseling. After discussing the indications for surgery, we explore the different surgical approaches currently available. In order to identify the ideal graft in patients indicated for plaque incision/excision and grafting, the various grafting materials adopted are compared side to side. To conclude our statement, we summarize all reported postoperative complications ranging from the mildest to the most devastating. The levels of evidence were provided according to the Oxford 2011 criteria and Oxford Centre for Evidence-Based Medicine recommendations.

These ESSM recommendations cover several important aspects of PD management. We aspire to these recommendations to ensure that patients and their partners have accurate and realistic expectations of their treatment options. Another aim is to formulate algorithms to guide clinicians during their daily practice.

Written by: Ahmed M. Ragheb, MD, PhD, FECSM, Assistant Professor of Urology, Department of Urology, Faculty of Medicine, Beni-Suef University, Director of Men’s Health Unit, Bedayet Hayah Hospital

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