Demographics And Mental Health Status Of Men With Peyronie's Disease: An Association Of Peyronie's Disease Advocates (APDA) Survey

Main Category: Urology / Nephrology
Also Included In: Psychology / Psychiatry;  Men's health
Article Date: 04 Nov 2006 - 0:00 PDT

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UroToday.com - This abstract presented an Internet based survey from the association of Peyronie's disease Advocates that examined the demographics and mental health status of men with Peyronie's disease.

Data was obtained from 454 men with a mean age of 50 years. Seventy-three percent were married and 88% were Caucasian. Forty percent diagnosed themselves with Peyronie's disease prior to physician consultation. 91.5% had penile curvature, 49.5% reported indentation and 39% had pain with erection. 56% percent noted diminished erectile rigidity since developing PD, and 63% had difficulty with penetration.

The most revealing data reported was that 12% of these men had become depressed and 4% developed an anxiety order after onset of PD. The most common treatments used by this population were Vitamin E (35%), Potaba (19%) and topical Verapamil gel (12%), in spite of absence of reported benefits for these agents.

CJ Nelson, S Hardin, M McKown, LA Levine, JP Mulhal.

Editor's note:
The internet is revolutionizing communications, and in this case has with the energy of a small number of volunteers served as a platform for the largest database in Peyronie's Disease. I encourage all my patients to go online www.peyroniesassociation.org to: learn about the condition and if so inclined participate in the database. With this database we may learn whether the epidemiologic observations made over the years by centers of excellence are accurate. In this case the authors have highlighted how devastated emotionally these sexually active men are by their condition.

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Copyright © 2006 - UroToday Abstract #999 Outcomes and Complications of Porcine small intestinal submucosal graft in the surgical management of Peyronie's disease. BN Breyer, MM Garcia, WO Brant and AJ Bella and TF Lue, San Francisco. UroToday.com - This was a respective study on a single center experience with a small number of men (N = 99) undergoing penile reconstruction for PD with plaque incision/partial excision and 1-layer porcine SIS grafting. Patients were evaluated postop with clinical visits and telephone interviews using non-validated instruments. The mean age was 54 years with mean follow-up of 15 months (range 3 to 43 months). Postoperatively patients reported less pain with coitus (74% to 26%). No change in SHIM scores (15 to 15) and satisfaction ratings of 2.4/5 versus 2.7/5. 63% percent had some degree of erectile dysfunction preoperatively versus 53% postoperatively. Post operatively seven of 19 (37%) had recurrent penile curvature and 26% had plaque recurrence, both of which are remarkably high compared to other published reports. In addition, 63% of patients reported (e.g. not measured) penile shortening versus 21% noted a lengthening of their shaft. The authors observed that the adverse events in this group far exceeded their prior experience with saphenous vein grafting repair of PD. One outstanding question was whether the 1-layer SIS graft contributed to these undesirable results as most centers use a 4-layer graft. Editor's Note: In correcting Peyronie's Disease the surgeon has traditionally turned to autologous tissues: dermal grafts, tunica vaginalis, temporalis fascia, vein patch. This group has the world's largest experience with vein patch grafting with plaque incision or excision. In this abstract they investigate their early experience with xenograft - porcine SIS. The advantage of using commercially available graft is obvious - no need for second incision, harvesting or preparation of tissue. Clearly they were disappointed with their initial experience compared to autologous vein. Others have reported much more favorable experience with this and similar products. Will randomized studies be done? Probably not, but I anticipate with the ready availability of xenografts, and increasing number of patients presenting with Peyronie's disease that we will soon have many series with varying techniques to review. Abstract #1000 Circumscribed Septal Fibrosis: Sequelae of Septal Fracture? WO Brant, AJ Bella, MM Garcia, RC Dean, K Tantiwongse, and TF Lue. UroToday.com - This was one of two reports during the Peyronie's podium session on isolated septal fibrosis. In this review of 600 men with PD, 34 had a circumscribed septal defect noted during color duplex ultrasonography. 19/34 had penile curvature, 11/34 recalled a significant history of trauma during coitus, although none had classic stigmata of penile fracture (i.e., ecchymosis). 5/34 complained of penile shortening or focal lack of rigidity only. Two of the men who presented with trauma had a septal hematoma, which was aspirated under ultrasound guidance. Follow-up in these 2 men revealed a minimal septal fibrosis. The authors believe the hematomas are the result of septal fracture, which may progress to septal fibrosis when left untreated. Editor's Note: Trauma is a reported etiology of Peyronie's Disease. One theory of Peyronie's plaque formation is that chronic micro-trauma is occurring on the dorsum of the penile shaft; this results in inflammation occurring between the two major layers of the tunica albuginea resulting in a scar or callous which fuses the layers together at the focus of injury. These authors are describing a much more acute presentation in their description of Peyronie's secondary to septal fibrosis. The majority of patients in this series can recall a 'pop' or painful episode of coitus, where there was no big hematoma as in classic penile fracture. The authors theorize that the septum between the two corporal bodies' ruptures and the trauma is confined with no evident bleed. The long term sequelae of such an injury is a scar most easily identified with duplex Doppler. In fact duplex ultrasonography may be the only way to distinguish this variant of 'central' Peyronie's plaque from typical nodules or 'peripheral plaques'. Abstract #1003 Correction of Penile Deformity: Long-term Outcomes of Penile Plication versus Plaque Incision with Venous Graft: DH Kim, MH Ree, JR Kaswick, AS Pathak, JP Brusky, and SR Aboseif. UroToday.com - This was a retrospective comparison study of long-term efficacy and patient satisfaction with corporal plication (N=18) versus incision and venous grafting (N=24) for men with stable Peyronie's disease. Men who had ED which did not respond to PDE5 inhibitors, intracorporeal injection or vacuum device were excluded. Preoperative evaluation includes dynamic color duplex ultrasonography. Patient ultimately chose the surgical approach that they would prefer after consultation with the surgeon. Plication was performed under local anesthesia while grafting required general or regional anesthesia. Telephone interview at one year of follow-up was conducted to obtain subjective reports on outcomes. Surgical success was defined as correction of curvature with patient satisfaction of at least 75%. For the plication group, 85% were very satisfied and had no change in erection quality. One had persistent pain and two complained of significant shortening which interfered with coitus. In the grafting group, 70% were very satisfied. Of the six unsatisfied men, two were due to the persistent curvature and four due to poor erection with decrease in penile sensation. 33% complained of shortening with significant bother in three men. The authors concluded that plication was a simpler operation with minimal complications, which were comparable to incision with venous grafting. Editor's note: There is an art to surgery; the operative management of Peyronie's Disease reflects this. What is the deformity, what is the erectile status, how best to correct the deformity and not further shorten the penis, how best to preserve the erections - these are the questions each thoughtful surgeon asks. I question whether patients are actually 'choosing the surgical approach' in this series. Clearly the presentation of risks and anticipated outcome given by surgeon is the main determinant of what patients 'choose' when facing options for reconstructive surgery. Plication is technically easier, faster and less risky than plaque incision, excision and grafting but 'one size does not fit all'. It takes a good deal of experience with a variety of techniques to make the best recommendation to your patient, and even with that most experienced surgeons will tell you that satisfaction with outcomes from these operations is modest, with the patient's recall of what his penis looked liked before Peyronie's disease assuming mythical proportions. Reviewed by UroToday.com Contributing Editor Larry Levine, MD