Factors Associated With Erectile Dysfunction and the Peyronie's Disease Questionnaire in Patients With Peyronie Disease

Abstract

OBJECTIVETo elucidate patient characteristics that impact symptom-related bother and erectile function in patients with Peyronie disease (PD). METHODSA post hoc analysis used data from patients with PD (ie, had PD symptoms ≥12 months and penile curvature deformity of 30-90 degrees) who received ≥1 injection of study medication in 2 phase 3 trials of collagenase clostridium histolyticum ( RESULTSPain during intercourse (P = .02) and PD bother (P <.0001) had a significant impact on International Index of Erectile Function, erectile function scores. The Peyronie's Disease Questionnaire bother domain score was significantly affected by penile curvature deformity, penile shortening, pain during intercourse, and the presence of plaques (P ≤.0005 for all), with pain during intercourse having the greatest impact (maximum likelihood estimation ± standard error = .496 ± .030; P <.0001). Erectile function did not appear to be directly influenced by the presence of plaques, penile curvature deformity, or penile shortening but was associated with PD bother and penile pain. CONCLUSIONThis post hoc analysis provides a conceptual framework through which disease characteristics may impact PD-related bother and erectile function in patients with PD. UROLOGY 107: 155-160, 2017. © 2017 The Author(s). Published by Elsevier Inc. P eyronie disease (PD) is a penile condition that is characterized by focal fibrosis of the tunica albuginea that results in the formation of plaque(s), curvature or deformation of the penis, and, in some cases, pain. 1 The prevalence of PD ranges from 3.2% to 11.8% of men, depending on the definition of PD used and the population studied. [2][3][4] The underlying cause of PD is unknown but likely involves abnormal wound healing. 5 This abnormal response facilitates collagen deposition, changes in collagen fiber content, and plaque formation. [5][6][7] Most patients with PD present between the ages of 52 and 57 years. 2,8 Although pain typically resolves over time, 1 penile curvature or deformity persists and may impact patients' psychological health, relationships with their sexual partners, and emotional well-being. 9,10 For example, a singlecenter, cross-sectional study demonstrated that more than half of patients with PD experienced relationship problems because of the condition, and 81% reported emotional problems. 9 Furthermore, an observational study of 92 men with PD demonstrated that almost half (48%) indicated that they were depressed and that the depression had not resolved over time. 11 Interestingly, in that study, depression was significantly associated with patients' perception of penile shortening, 11 suggesting that depression may

Patient‐reported outcomes from a single‐centre prospective post‐marketing study on Collagenase Clostridium Histolyticum injections for Peyronie's disease

“…This suggests that patient satisfaction is tied to other factors than curvature reduction. Serefoglu et al (2017) The main limitation of our study is the relatively small sample size for a single institution and the lack of a control group. Sample size was restricted due to the limitations of commercial insurance coverage, which also indicated a more homogeneous sample in terms of socioeconomic status.…”

Contemporary surgical and non-surgical management of Peyronie’s disease

“…These experiences may vary with the physical extent of the disease, but may improve with treatment ( 18 , 19 ), and qualitatively consist of feelings of sexual anxiety, isolation, and concerns of self-image ( 19 , 20 ). Furthermore, a more recent analysis of data from the Investigation for Maximal Peyronie’s Reduction Efficacy and Safety Studies I and II (IMPRESS I and II) ( 21 ) found that pain during intercourse and patients’ sense of bother was more predictive of associated ED than the severity of physical characteristics—penile curvature, shortening ( 22 ). In sum, these results indicate the need for a psychological component to the successful treatment of a PD patient—regardless of whether he undergoes operative management or not.…”

Intralesional collagenase Clostridium histolyticum in the management of Peyronie’s disease: current best practice

“…Peyronie's disease (PD) is a localized connective tissue disorder of the penis marked by focal fibrosis leading to penile deformity, sexual dysfunction, emotional distress, and pain. [1][2][3][4][5][6][7][8][9][10][11] Prevalence of the condition ranges from 3% to 9% with most men presenting between the ages of 52 and 57. 6,7 PD is thought to be due to abnormal wound healing and aberrant collagen deposition leading to the formation of fibro-collagenous plaques within the tunica albuginea.…”

“…16 As a result, many patients with PD continue to suffer from both psychological distress and negative effects on their emotional and sexual relationships with their partners. [9][10][11] These can be profound, with patients noting numerous issues impacting their quality of life including performance anxiety, concern regarding physical appearance, painful intercourse, loss of sexual confidence, concerns regarding partner satisfaction, and concerns regarding attractiveness. 10,17 In a single study in 2008, 54% of men experienced relationship problems and 81% emotional distress attributable to PD.…”