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Introduction
Non-curvature penile deformities associated with loss of erect penile volume are often overlooked and have not been thoroughly investigated.
Aim
To describe the prevalence and functional impact of penile volume-loss deformities in our cohort of men with Peyronie’s disease (PD).
Methods
We retrospectively examined medical records of p...
Context in source publication
Similar publications
Objective
To investigate if there is a correlation between penile size measured preoperatively and erect penis after penile implant surgery (PI). A common cause of patient dissatisfaction after PI is caused by patients complaining that surgery has shortened the penis. It has been suggested that stretched penile length preoperatively is almost the s...
Citations
... [68][69][70][71]. In our results, we found penile curvature in 90.6% of cases, which is similar to the findings of other studies on PD patients reported in the literature, which detected penile curvature in 87.6-94% of cases [25,27,72]. ...
... Regarding the type of penile curvature, in our study, dorsal curvature was the most commonly observed type, followed by left lateral curvature, right lateral curvature, and, less commonly, ventral curvature. Similar results have been described in numerous studies and reviews already published [25,53,63,[72][73][74][75][76]. Regarding the angle of penile curvature, we agree with other authors that the measurement of the angle should be carried out directly by the uro-andrologist because patients suffering from Peyronie's disease tend to overestimate their own degree of curvature of the penis [53]. ...
... We observed the presence of penile pain in 53.3% of cases in our study. In the scientific literature, the prevalence of penile pain has been observed by various authors, with percentages ranging from 17 to 70% [25,53,[72][73][74][75]. Additionally, we discovered a highly significant statistical correlation between the VAS score and age. ...
Peyronie’s disease (PD) affects the penile albuginea, resulting in penile deformity, pain, erectile dysfunction (ED), and an anxious–depressive state. PD diagnosis involves a thorough medical history, penile palpation, documentation of the penile deformation, a dynamic penile echo color Doppler ultrasound (PCDU), and the completion of questionnaires for the evaluation of pain, ED, and psychometric tests. The aim of this study was to evaluate the symptoms of PD and their prevalence in PD patients in the active phase who had access to our andrology clinic. Inclusion criteria: availability of data on patients diagnosed with PD, including detailed medical history, blood tests, penile palpation, photographic documentation of penile deformity, and penile PCDU. Exclusion criteria: PD patients in the stable phase or those without the specified tests and data mentioned above. Our study found a higher prevalence of PD in younger patients (24.2%), a higher coexistence of PD with chronic prostatitis (35.6%), a higher percentage of cases of association between penile deformity and penile curvature (84.4%), a higher prevalence of “significant anxiety” (88.4%), a higher presence of plaque calcification (35.6%), and the detection of a longer duration of the first phase of PD (>18 months). The most frequently observed type of penile curvature was dorsal, followed by left lateral, right lateral, and, less commonly, ventral. We observed a significant statistical correlation between patient age and IIEF score, indicating that patients over the age of 40 years are at a higher risk of experiencing ED. We found a strong statistical relationship between VAS score and age. As age increases, the VAS score decreases, suggesting that younger patients reported more penile pain compared to those who were older than 40 years. Furthermore, we found that penile pain has a significant impact on the psychological state of PD patients. We also found that 38.8% of PD patients suffered from severe anxiety. In relation to this, psychotherapy should be integrated into PD treatment to improve the quality of life and treatment adherence.
... Most commonly, PD patients will have a singular plaque and uniplanar curvature in the dorsal or lateral direction of the erect penis, although there are numerous presentations including those categorized as "atypical". Previous studies have reported 10-39% of patients with PD have atypical features (ventral plaques, hourglass deformities, unilateral indentations, severely shortened penile length, and multiplanar curvatures) [11,12]. Most series do not provide details on how they classified these atypical features, although hourglass deformities are typically bilateral notching or indentation at the same level of the penile shaft (>10% of penile girth discrepancy and distal from the greatest curvature); and multiplanar curvatures (plaques causing multiple angulations at different levels of the penis) [13]. ...
Peyronie’s disease continues to be poorly understood. We characterize the presenting features of Peyronie’s disease within a large cohort and elucidate the factors that correlate with surgical intervention. Univariate and multivariate analyses were performed on 1483 consecutive patients to assess pre-operative predictors of surgical intervention for Peyronie’s disease. Overall, 1263 patients met inclusion criteria. Mean age was 55.4 ± 11.1 years with a mean duration of disease at presentation of 33.2 ± 42.5 months. Mean primary curvature was 49.8 ± 20.8°. Primary ventral curvature was present in 11.4% and 36.5% of patient had a multiplanar curvature. During penile duplex ultrasound evaluation indentation/narrowing deformities were appreciated in 76.0%, hourglass deformity in 10.1%, and hinge effect in 33.0% of patients. Calcification was seen in 30.1% of patients. Operative intervention occurred in 35.3% of patients. Degree of primary curvature (1.03 OR, p < 0.001), hourglass deformity (1.82 OR, p = 0.01), decreased tunical elasticity (1.20 OR, p = 0.03), and prior intralesional collagenase clostridium histolyticum injections (2.94 OR, p < 0.001) predicted surgical correction on multivariate analysis. Compared to historical studies, we found a higher incidence of severe degree of curvature (27.5% >60°), indentation deformities, hinge-effect, multiplanar curvature and penile calcifications. Ultimately, predictors of surgical intervention included those with worse erectile function and more severe characteristics.
... The largest study of patients with unilateral indentation included 50 patients and found indentation at the distal end of the penis resulted in 88% of patients having decreased sexual activity. 30 Men with combined volume-loss deformity and penile curvature were 5x more likely to report psychological distress related to their condition compared to men with the same degree of curvature but no volume loss. 30 Given the clinical significance, office examinations should make every effort to induce a sufficient erection to accurately characterize the deformity. ...
... 30 Men with combined volume-loss deformity and penile curvature were 5x more likely to report psychological distress related to their condition compared to men with the same degree of curvature but no volume loss. 30 Given the clinical significance, office examinations should make every effort to induce a sufficient erection to accurately characterize the deformity. ...
Purpose:
In this narrative review we explore additional indications for which intralesional collagenase Clostridium histolyticum (CCH) injection therapy may be used, in addition to those utilized in the IMPRESS trials. The goal is to provide updated assessment of available intralesional therapies and justify whether to expand clinical indications based on advancements over the last decade.
Results:
Patients receiving CCH in the acute phase of PD have shown significant improvement in penile curvature - which may be even more significant than reported due to progressive curvature over the longitudinal course of injection therapy. Across studies, patients with ventral plaques achieved the greatest curvature improvement (~30°) compared to PD patients with dorsal or lateral plaques. Patients with curvature > 90° have been minimally documented. However, the concept of patients with higher degree of curvature achieving more significant degrees of improvement prevails across studies. Studies including PD patients with volume loss deformities or indentation(s) focus on curvature improvement and do not gauge improvement in these girth loss or indentation features specifically. PD patients with calcification may benefit from CCH, however, critical analysis of included study designs and results compared to placebo do not lend for strong support of CCH in PD at this time.
Conclusion:
Based on the most recent research, the use of CCH in the acute phase of PD and patients with ventral penile plaques may be effective and safe. The limited available research on the efficacy of CCH on calcified plaque(s) and curvature greater than 90° is promising, however, more research is needed to ensure safety and success in this patient cohort. Finally, the current literature continues to show the use of CCH is not effective in PD patients with volume loss, indentation, or hourglass deformity. When expanding the use of CCH to patients not originally included in the IMPRESS trials, providers must prioritize minimizing chances of potential injury to urethral tissue. Finally, further investigation is required to determine whether CCH has utility for curvature greater than 90° or calcified plaques, although the limited available literature is promising.
... Most commonly, PD patients will have a singular plaque and uniplanar curvature in the dorsal or lateral direction of the erect penis, although there are numerous presentations including those categorized as "atypical". Previous studies have reported approximately 10-39% of patients with PD have atypical features (ventral plaques, hourglass deformities, unilateral indentations, severely shortened penile length, and multiplanar curvatures) [13][14][15]. Most series do not provide details on how they classi ed these atypical features, although hourglass deformities are typically bilateral notching or indentation at the same level of the penile shaft (> 10% of penile girth discrepancy and distal from the greatest curvature); and multiplanar curvatures (plaques causing multiple angulations at different levels of the penis) [15,16]. ...
Peyronie’s disease continues to be poorly understood. We characterize the presenting features of Peyronie’s disease within a large cohort and elucidate the factors that correlate with surgical intervention. Univariate and multivariate analyses were performed on 1483 consecutive patients to assess pre-operative predictors of surgical intervention for Peyronie’s disease. 1263 patients met inclusion criteria. Mean age was 55 ± 11 years with a mean duration of disease at presentation of 33.2 ± 42.5 months. Mean primary curvature was 49.8 ± 20.8°. Primary ventral curvature was present in 11.4% and 36.5% of patient had a multiplanar curvature. During penile duplex ultrasound evaluation indentation/narrowing deformities were appreciated in 76.0%, hourglass deformity in 10.1%, and hinge effect in 33.0% of patients. Calcification was seen in 30.1% of patients. Operative intervention occurred in 35.3% of patients. Severity of primary curvature (1.03 OR, p<0.001), hourglass deformity (1.82 OR, p=0.01), decreased tunical elasticity (1.20 OR, p=0.03), and prior intralesional collagenase clostridium histolyticum injections (2.94 OR, p <0.001) predicted surgical correction. Compared to historical studies, we found a higher incidence of severe degree of curvature, indentation deformities, hinge-effect, multiplanar curvature and penile calcifications. Ultimately, predictors of surgical intervention included those with worse erectile function and more severe characteristics.
... B. Sanduhr-ähnliche Deformitäten werden bei ca. 23 % der Patienten beobachtet (Margolin et al. 2018). Durch die Fibrosierung kommt es bei 70 % der Patienten zu einem Längenverlust des Penis (Farrell et al. 2013). ...
... Das Aussehen des Penis trug hauptsächlich zur Belastung der betroffenen Männer bei (Burri und Porst 2018). Eine weitere retrospektive Singlecenter-Studie an 128 IPP-Patienten konnte herausarbeiten, dass Deformitäten, die zu einem Verlust des Penis-Volumen führen, mit einem erhöhten Risiko von psychischer Belastung (OR: 2.6) und reduzierter sexueller Aktivität (OR: 2.7) assoziiert waren (Margolin et al. 2018). Eine Penisverkürzung kann in 70 % Fälle auftreten und zwischen einem bis 10 cm betragen (Rosen et al. 2008;Smith et al. 2008). ...
Zusammenfassung
Einleitung Die Induratio penis plastica (IPP) ist eine erworbene chronische Erkrankung der Tunica albuginea und/oder des Septums der Corpora cavernosa, die zu Deformitäten und Verkrümmungen des Penis führen und die Sexualität der Betroffenen stark beeinträchtigen kann. Darüber hinaus kann die IPP bei den betroffenen Patienten zu emotionalen Problemen und zu Beziehungsproblemen führen.
Forschungsziele Die vorliegende Übersichtsarbeit gibt einen Überblick über die konservativen und chirurgischen Therapieoptionen der IPP, geht detailliert auf die psychischen Besonderheiten und Probleme der Betroffenen ein und stellt mögliche psycho- und sexualtherapeutische Interventionen dar.
Methoden Es handelt sich um eine nicht-systematische narrative Übersichtsarbeit. Mithilfe einer Pubmed-Datenbankanalyse wurden Original- und Übersichtsarbeiten zur IPP identifiziert und im Hinblick auf Methodik und Ergebnisse ausgewertet. Überlegungen zur interdisziplinären Integration einer unterstützenden Psychotherapie werden angestellt.
Ergebnisse Die konservative und die chirurgische Therapie stellen keine kausale, sondern eine symptomatische Behandlung dar. Die Effektivität der konservativen Therapie ist eingeschränkt. Die chirurgische Therapie stellt den Goldstandard zur Behandlung der schweren IPP dar, kann aber Nebenwirkungen wie erektile Dysfunktion und Längenverlust des Penis zur Folge haben. Die IPP führt häufig zu psychischen Belastungen, die im Rahmen einer interdisziplinär integrierten Psychotherapie adressiert werden sollten. Ein entsprechend kombiniertes Vorgehen wird vorgeschlagen.
Schlussfolgerung Um die Erwartungen an die konservative und chirurgische Therapie nicht zu überhöhen, müssen die Patienten über die Möglichkeiten und Limitationen realistisch und ausführlich aufgeklärt werden. Die psychischen Spezifika und Belastungen sollten bei der Therapie der IPP interdisziplinär integriert berücksichtigt werden.
... 34 Abnormalities in the penis can also cause changes in penile size, such as Peyronie's disease (PD), which is characterized by the formation of palpable penile plaque and penile deformity due to a fibrosis disease occurring in the tunica albuginea. 41 Loss of focal elasticity in tunica albuginea results in non-uniform tunica expansion during erection, causing deformity in the penis, including deformity of the penile curvature. 41 Non-curvature deformity in PD is caused by a reduction in overall penile length due to loss of longitudinal tunica elasticity, while EPC can also be focally or globally reduced, especially when elasticity loss occurs in the radial part of the tunica. ...
... 41 Loss of focal elasticity in tunica albuginea results in non-uniform tunica expansion during erection, causing deformity in the penis, including deformity of the penile curvature. 41 Non-curvature deformity in PD is caused by a reduction in overall penile length due to loss of longitudinal tunica elasticity, while EPC can also be focally or globally reduced, especially when elasticity loss occurs in the radial part of the tunica. 41,42 In 7.3-90% of patients undergoing surgical procedures for PD treatment, undergo shortening of penile measurement up to 5cm. ...
... 41 Non-curvature deformity in PD is caused by a reduction in overall penile length due to loss of longitudinal tunica elasticity, while EPC can also be focally or globally reduced, especially when elasticity loss occurs in the radial part of the tunica. 41,42 In 7.3-90% of patients undergoing surgical procedures for PD treatment, undergo shortening of penile measurement up to 5cm. 43 Congenital abnormalities, priapism with corporal fibrosis, and severe hypospadias can also affect penile size. ...
Background: In the general population, it is estimated that 91% of adult males perceive their penile size to be smaller than average. Concern about penile size can affect one’s self-esteem, which then affects its sexual function, satisfaction, as well as physical and mental health. Therefore, accurate penile measurements are needed for clinical and academic purposes. Reviews: Measurement of penile size can be performed in an erect, stretched, even flaccid condition. However, from various researches, there is no standardization of such a measurement method. Various researches have carried out average penile measurement but many factors can affect these results such as race, genital conditions, systemic diseases, surgical procedures, and aging. Summary: There is no internationally agreed way of measuring an adult male's penis and many other factors can make the results of penile measurements vary. Proper measurement and finding out the right average of penile size in adult male with regard to other affecting factors, will be indispensable for both clinical and academic purposes.
... We found that volumetric measurement of the penis was the most susceptible to inter-provider variability for accuracy and precision (Fig. 3). For context, Margolin et al. conducted a volumetric study on 83 patients and found that 65% of PD patients experienced some level of volumetric loss which correlated to higher axial instability, psychological distress, and decreased sexual activity compared to changes in angle of curvature [19]. Additionally, volumetric and physical appearance changes in the penis were also contributory to psychiatric conditions in a self-reported analysis in PD patients [20]. ...
Characterization of Peyronie’s disease (PD) involves manual goniometry and penile length measurement. These techniques neglect volume loss or hourglass deformities. Inter-provider variability complicates accuracy. Using 3D-printed models, we aimed to evaluate measurement accuracy and variability and establish computational assessment workflows. Five digital phantoms were created: 13.0 cm cylinder, 13.0 cm hourglass cylinder, 15.0 cm cylinder with 40° angulation, 12.0 cm straight penis, and 12.9 cm PD penis with 68° angulation and hourglass. Lengths, volumes, and angles were determined computationally. Each phantom was 3D-printed. Ten urology providers determined lengths, angles, and volumes with measuring tape, goniometer, and volume calculator. Provider versus computational measurements were compared to determine accuracy using t-tests or Wilcoxon rank-sum tests. No significant differences were observed between manual assessment of length of penile models and designed length in penile models. Average curvature angles from providers for bent cylinder and PD phantoms were 38.3° ± 3.9° (p = 0.25) and 57.5° ± 7.2° (p = 0.006), respectively. When assessing for volume, hourglass cylinder and bent cylinder showed significant differences between designed volume and provider averages. All assessments of length, angle, and volume showed significant provider variability. Our results suggest manual measurements suffer from inaccuracy and variability. Computational workflows are useful for improved accuracy and volume assessment.
... All patients did consent for health data review for research purpose. For this study, we collected the following data: patient age, PD duration (in months), relationship (yes/no and duration), erection hardness scale (between 1 large but not hard to 4 full erection), 13,14 penile pain, penile curvature (degree, direction and location: base, midshaft, distal), history of penile trauma, difficulty penetrating, psychological bother, prior treatments for PD, calcification status evaluated during curvature assessment with doppler ultrasound, penile instability, defined as penile buckling after an axial force application, 15,16 anxiety disorder, and depression both completed as part of the past medical history checklist. This information was collected during the patient's first visit and serially thereafter. ...
Introduction
Penile pain is one of the most stressful symptoms in men with Peyronie's disease (PD).
Aim
To evaluate the prevalence, clinical presentation and risk factors associated with penile pain in men with PD as well as to assess the psychosocial impact.
Methods
We revised our institution's database of men diagnosed with PD. The information collected included penile pain assessments, and the scores of the PD Questionnaire (PDQ), Self-Esteem and Relationship Questionnaire (SEAR) and Center for Epidemiologic Studies Depression Scale Questionnaire (CES-D). Descriptive and comparative statistics were used. Logistic regression analyses were performed to evaluate predictive factors associated with penile pain.
Main outcome measures
Penile pain descriptive assessment and factors associated with penile pain in men with PD. Comparison of SEAR, CES-D and PDQ domain scores of men with and without penile pain.
Results
431 men with PD were included for this analysis with a mean age of 55.9 years. Penile pain was reported by 36.7%; 65.2% of those had painful erection, 7% pain with flaccid state only, and 20% in both stages. The median pain severity was 3 with erection and 1 with flaccid stage. After adjusted logistic regression analyses, advanced age was associated with less pain (OR 0.94, P ≤ 0.001). Men with penile pain had no significant difference in CES-D and SEAR mean scores compared to men without penile pain. The PDQ scores for the physical/psychological symptoms domain and the bother domain were significantly higher in men with penile pain (12 vs 8.7; P < 0.01 and 9 vs 7.1; P < 0.01 respectively). Men with penile pain had a higher rate of clinically significant bother scores than men without penile pain (52% vs 35%, P ≤ 0.001).
Conclusion
Penile pain is common in men with PD. It was more common in young men and was associated with physical and psychological bothers in this population.
Flores JM, Salter CA, Nascimento B, et al. The Prevalence and Predictors of Penile Pain in Men with Peyronie's Disease. Sex Med 2021;XX:XXXXXX.
... Peyronie's disease (PD) is a connective tissue disorder characterized by fibrosis of the tunica albuginea lining the corpora cavernosa of the penis. 1 The formation of a plaque prevents expansion of the corporal body and tunical lengthening during erection, resulting in penile pain for some men, deformity of the erect penis, and possibly erectile dysfunction for some patients. [2][3][4] The reported prevalence is variable depending on the population studied and the definition of PD, with commonly reported ranges of 3-9% and up to 20% in some series. 1,5,6 In addition to physical symptoms, PD is also associated with significant psychological symptoms including reduced self-esteem, low confidence, depression, stigmatization and relationship discord. ...
Background:
Intralesional collagenase such as Xiaflex (ILX) has become a standard treatment for Peyronie's disease (PD). Many robust studies have demonstrated its clear efficacy in the treatment algorithm.
Aim:
To examine predictors of the patient decision to pursue ILX in PD patients.
Methods:
The study included PD patients (i) with stable disease (ii) who had doppler duplex ultrasonography (DUS) at least 6 months prior to analysis date and (iii) did not choose an operation. All patients received a standard discussion regarding treatment options, specifically, observation, ILX and penile reconstructive surgery (plication, plaque incision and grafting, implant surgery). Patients who opted to use ILX were compared to those who opted against it. Comorbidity, demographic and PD characteristics were recorded at the initial PD visit. All patients completed three validated questionnaires including the PD questionnaire (PDQ), Self-Esteem and Relationship (SEAR) questionnaire and a depression questionnaire (CES-D). Logistic regression was used to determine predictors of ILX use.
Outcomes:
Predictors of ILX utilization.
Results:
Four hundred and fifty stable PD men had DUS completed 6 months before to allow sufficient time for treatment decision. Of these, 111 (24.7%) patients had ILX treatment and 339 (75.3%) did not. Mean age, relationship status and pain occurrence were similar between groups, but ILX patients had less bother defined as PDQ ≥ 9 (46.8% vs 53.7%, P = .02). ILX patients had more complex curves (79.3% vs 47.8%, P < .01) and more severe instability (32.4% vs 15.3%, P = .01). ILX patients also had higher PDQ domain scores (Psychological 11.5 ± 6.4 vs 7.5 ± 6.2, P < .01; Pain 6.2 ± 6.0 vs 4.3 ± 5.6, P = .02; and Bother 9.8 ± 4.7 vs 6.6 ± 4.8, P < .01). On univariable statistics, significant bother (OR 2.41, 95% CI 1.36-4.28, P<0.01), complex curvature (OR 4.18, 95%CI 2.52-6.93, P < .01), moderate and/or severe instability (OR 1.98, 95%CI 1.18-3.30, P < .01) and PDQ-Bother scores (OR 1.15, 95%CI 1.08-1.22 P < .01) predicted ILX use. On multivariable analysis, instability (OR 2.58, 95%CI 1.02-6.57, P = .05) and significant bother (OR 1.23, 95%CI 1.04-1.45, P = .01) predicted ILX use.
Clinical implications:
Educates providers as to which patients are more likely to choose ILX.
Strengths & limitations:
Our study has a large sample size and all patients received the same standardized treatment discussion. Our study is limited by the absence of insurance data on all patients, and its retrospective single center design.
Conclusion:
ILX was chosen by the minority of stable PD patients. While moderate to severe instability and significant bother is predictive of ILX use, other demographic factors including relationship status, sexual orientation or pain were not. Punjani N, Nascimento B, Salter C, et al. Predictors of Pursuing Intralesional Xiaflex in Peyronie's Disease Patients. J Sex Med 2021;XX:XXX-XXX.
... Location of the plaque considerably differs across previous studies, being dorsal location the most frequent at disease onset (Table 1) [18][19][20][21]. Similarly, deviation of erect penis is significantly changeable according to previous reports (Table 2) [18,[20][21][22][23]. Clearly, there might be some patients who traumatize their penis and, thus, develop a secondary curvature due to the inflammation process and loss of compliance. ...
Peyronie's disease (PD), a fibrotic disorder of the tunica albuginea fully described in 1793 by French physician Francois de la Peyronie, is characterized by pain, plaque formation, penile deformity, and ultimately sexual function decline. The epidemiological data on PD vary considerably across previous studies, with recent evidence reporting a prevalence of up to 9%. PD is generally divided into two different phases: active or acute and stable or chronic. Plaque formation generally occurs during the acute phase, while during chronic phase pain usually tends to complete resolution and penile deformity stabilizes. PD's pathophysiology is still subject of great discussion. Tunical mechanical stress and microvascular trauma are major contributory factors. However, better understanding of the molecular pathophysiology of this condition remains paramount towards an in-depth comprehension of the disorder and the development of newer and more effective disease-targeted interventions. In this review we provide a detailed overview of natural history of PD, specifically focusing on clinical manifestations and the underlying molecular regulation patterns.
