Patients’ attitude with surgery for Peyronie’s disease: results from a multicentric European study
Authors: Capogrosso Paolo , Pozzi Edoardo , Russo Giorgio I , Hatzichristodoulou Georgios , Cocci Andrea , Falcone Marco , Martinez-Salamanca Juan I , Fernández-Pascual Esaù , Candela Luigi , Schifano Nicolò , Dehò Federico , Salonia Andrea ,   European Association of Urology–Young Academic Urologists Sexual and Reproductive Working Group
Published: November 2023

Abstract

Background
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.

Aim
To explore the rate and factors influencing patients’ willingness to undergo surgery for PD.

Methods
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.

Outcomes
Patients’ willingness to undergo surgery for PD.

Results
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 &lt; .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.

Clinical Implications
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.

Strengths and Limitations
Main limitations are the cross-sectional design and the potential neglect of confounding factors,

Conclusions
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.