Penile curvature is the most debilitating symptom of Peyronie's disease (PD); the evaluation of the degree of angulation is essential for planning treatment strategy. However, the most used method of penile at-home autophotography (AHP) is associated with some potential pitfalls and discrepancies compared with different assessment methods.
To compare the degree of penile curvature quantified by AHP and in-office intracavernosal alprostadil injection (ICI) prior to therapy.
Data from 55 PD patients of a single tertiary referral center were analyzed. All patients provided standardized AHP of the erect phallus. Clinic-based assessment included ICI with curvature measurement and completion of the International Index of Erectile Function (IIEF-15).
The Wilcoxon and/or chi-square test was used to compare the degree of curvature obtained using AHP and ICI, and to evaluate whether erectile dysfunction was a predictor of a relevant difference of >10° in curvature assessment between AHP and ICI.
Our study showed a significant (p < 0.001) difference in the degree of penile curvature between AHP (48° [38°; 55°]) and ICI (50° [40°; 65°]). Patients suffering from erectile dysfunction tend to have a higher difference in the degree of penile curvature between AHP and ICI than patients with good erectile function (p < 0.001). Our study is not devoid of limitations. First, we did not use Peyronie's Disease Questionnaire, as suggested by the European Association of Urology guidelines. Second, we did not evaluate inter- and intraobserver variations in the measurements.
AHP tends to underestimate the extent of penile curvature compared to ICI. Erectile dysfunction is an independent predictor of measurement differences of >10° between AHP and ICI.
It is necessary to evaluate the degree of penile curvature in Peyronie's disease prior to therapy decision. The at-home self-photography underestimates the real degree of penile curvature compared with an erection by in-office penile drug injection. Especially men suffering from erectile dysfunction carry the risk of a high difference in the measured degree of penile curvature, with a potential impact on the further treatment.
European urology focus. 2022 Nov 02 [Epub ahead of print]
Max Traeger, Christian Leiber-Caspers, Francesco Chierigo, Omer Onur Cakir, Christian Gratzke, Daniel Schlager
Department of Urology, Faculty of Medicine, Medical Center, University of Freiburg, Freiburg, Germany. Electronic address: ., Department of Urology, Faculty of Medicine, Medical Center, University of Freiburg, Freiburg, Germany; Department of Urology, Alexianer Hospital, Krefeld, Germany., Department of Urology, IRCCS San Martino Hospital, University of Genoa, Genoa, Italy., Department of Urology, King's College Hospitals, London, UK; University College London, Division of Surgery & Interventional Science, London, UK., Department of Urology, Faculty of Medicine, Medical Center, University of Freiburg, Freiburg, Germany.