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How Willing Are Individuals to Undergo Surgery for Peyronie’s Disease?



Peyronie’s disease (PD) is a sexual dysfunction that impacts individuals with penises. With PD, scar tissue or plaques form under the skin of the penis, causing curved, sometimes painful erections. Other times, PD can result in penile deformities such as an hourglass indentation in the shaft of the penis. Some people with PD also experience erectile dysfunction (ED), a condition in which a person is unable to get or maintain an erection long enough for satisfactory sexual activity.


Currently, PD can be treated through injections of a medication that can break up the plaques (collagenase clostridium histolyticum, CCH or Xiaflex), penile traction therapy, or surgery. Nevertheless, some individuals may be hesitant to undergo surgery for Peyronie’s disease, perhaps due to a limited understanding of the risks and benefits associated with this type of surgery.


A new study published in the Journal of Sexual Medicine explored factors influencing European patients’ willingness to have surgery for PD, aiming to improve tailored treatment recommendations and overall quality of life for affected individuals.


The study involved 343 men seeking help for PD across five European tertiary referral centers from 2016 to 2020. Data, including medical history and treatment outcomes, were extracted from a diverse database.


Most of the individuals involved in this study had penile curvature, pain, and penile deformities. The patients received various conservative treatments, and surgical options were considered on a case-to-case basis.

For this study, ethical guidelines were followed, and the researchers employed statistical analyses to determine factors influencing patients’ willingness for PD surgery.


The average age of the participants was 57 years. Nearly half of the individuals experienced difficulty with penetration during sexual activity, and 39% had ED.


Conservative treatments were common for the 343 men with PD in this study, but just 37% were open to surgery. Younger age, more severe curvature, and difficulty in penetration were factors associated with a greater willingness to consider surgical treatment. Overall, 20% reported significant curvature reduction after conservative treatment such as daily tadalafil for at least 12 months (37%), injections of verapamil (16%) or CCH (14%), oral potassium para-aminobenzoate (15%), and low-intensity shock wave therapy.


The results of this study shed light on factors that may influence European patients’ willingness for corrective surgery for PD. Younger patients with severe penile curvature and penetration difficulties are more likely than other patients to consider surgery. Additionally, men with more severe curvature and prior unsuccessful treatments may view surgery as a more effective option.


Since the time of this study, CCH is no longer available in Europe, a situation which may sway more men with PD to opt for surgery. Furthermore, the increasing incidence of PD in younger men may contribute to the trend of surgery, as the younger men in this sample were more open to this treatment option. Despite this, the fact that only 37% of this sample was open to surgery for PD highlights the need for effective non-surgical options.


In a recent randomized controlled trial in the United States, 38 men were randomized to CCH with Restorex penile stretching device and sildenafil versus surgery with Restorex and sildenafil. While a smaller data set than the European study, this randomized trial showed that surgery had a higher degree of curvature improvement of 65 degrees as opposed to 32.5 degrees. However, at 3 months, 21% of men in the surgery arm were very satisfied compared to 50% in CCH arm.


The findings from these two different studies highlight the importance of shared decision making while counseling patients on PD treatment options. A multidisciplinary treatment approach involving urologists and mental health professionals is very important for treating PD of different severities, and comprehensive counseling is essential for informed patient decisions.


For more information on this topic, please read these publications from the ISSM Journals: The Journal of Sexual Medicine, Sexual Medicine Reviews, and Sexual Medicine Open Access:





References:

Capogrosso, P., Pozzi, E., Russo, G. I., Hatzichristodoulou, G., Cocci, A., Falcone, M., Martinez-Salamanca, J. I., Fernández-Pascual, E., Candela, L., Schifano, N., Dehò, F., & Salonia, A. (2024). Patients' attitude with surgery for Peyronie's disease: Results from a multicentric European study. The Journal of Sexual Medicine, 21(1), 54–58. https://doi.org/10.1093/jsxmed/qdad145


Green, B., Flores, A., Warner, J., Kohler, T., Helo, S., & Trost, L. (2023). Comparison of collagenase Clostridium histolyticum to surgery for the management of Peyronie’s disease: a randomized trial. The Journal of urology210(5), 791-802. https://www.auajournals.org/doi/10.1097/JU.0000000000003634

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