Despite the existence of conservative therapies for Peyronie's disease (PD), surgery is commonly utilized for the treatment of bothersome curvatures due to its potential effectiveness, although it carries intrinsic risks and may not universally lead to satisfactory outcomes.
To explore the rate and factors influencing patients' willingness to undergo surgery for PD.
Data were prospectively collected in 5 European academic centers between 2016 and 2020. Data included age, time from PD onset, penile pain, curvature degree, difficulty at penetration, hourglass deformity, erectile dysfunction (ED), and previous treatments. All patients were offered conservative treatments, either medications or injections. Tunical shortening or lengthening procedures were offered as an alternative to conservative treatments, when indicated. Penile prosthesis was offered to those with concomitant ED. Patients' attitudes with surgery were recorded. Logistic regression analyses tested the profile of patients who were more likely to be willing to undergo surgery.
Patients' willingness to undergo surgery for PD.
This study included 343 patients with a median age of 57.3 years (IQR, 49.8-63.6) and a median penile curvature of 40.0° (IQR, 30.0°-65.0°). Overall, 161 (47%) experienced penetration difficulties and 134 (39%) reported ED. Additionally, hourglass deformity and penile shortening were reported by 48 (14%) and 157 (46%), respectively. As for previous treatments, 128 (37%) received tadalafil once daily; 54 (16%) and 44 (13%), intraplaque verapamil and collagenase injections; and 30 (9%), low-intensity shock wave therapy. Significant curvature reduction (≥20°) was observed in 69 (20%) cases. Only 126 (37%) patients were open to surgery for PD when suggested. At logistic regression analysis after adjusting for confounders, younger age (odds ratio [OR], 0.97; 95% CI, 0.95-1.00; P = .02), more severe curvatures (OR, 1.04; 95% CI, 1.03-1.06; P < .0001), and difficulty in penetration (OR, 1.88; 95% CI, 1.04-3.41; P = .03) were associated with a greater attitude to consider surgical treatment.
The need for effective nonsurgical treatments for PD is crucial, as is comprehensive patient counseling regarding surgical risks and benefits, particularly to younger males with severe curvatures.
Main limitations are the cross-sectional design and the potential neglect of confounding factors.
Patients with PD, having a lower inclination toward surgery, emphasize the need for effective nonsurgical alternatives and accurate counseling on the risks and benefits of PD surgery, particularly for younger men with severe curvatures.
The journal of sexual medicine. 2023 Nov 16 [Epub ahead of print]
Paolo Capogrosso, Edoardo Pozzi, Giorgio I Russo, Georgios Hatzichristodoulou, Andrea Cocci, Marco Falcone, Juan I Martinez-Salamanca, Esaù Fernández-Pascual, Luigi Candela, Nicolò Schifano, Federico Dehò, Andrea Salonia, European Association of Urology–Young Academic Urologists Sexual and Reproductive Working Group
Department of Urology, Circolo & Fondazione Macchi Hospital-ASST Sette Laghi, Varese 28001, Italy., Vita-Salute San Raffaele University, Milan 20151, Italy., Urology Section, Department of Surgery, University of Catania, Catania 95100, Italy., Department of Urology, Martha-Maria Hospital Nuremberg, Nuremberg 90402, Germany., Department of Urology, University of Florence, Careggi Hospital, Florence 50100, Italy., Division of Urology, Department of Surgical Sciences, Molinette Hospital, University of Turin, Turin 10024, Italy., Department of Urology, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid 28001, Spain., Urology Department, Hospital Universitario La Paz, 28046 Madrid, Spain.