Mp36-10 does Doppler Classification of Peyronie’s Disease Affect Surgical Intervention Pursued by Patient?

Abstract

INTRODUCTION AND OBJECTIVE: Our institution utilizes a unique classification system for Color Doppler Duplex Ultrasound (CDDU) evaluation and grading of Peyronie's disease. The purpose of this study is to examine the relationship between the grades assigned during initial CDDU encounter for Peyronie's disease (PyD) and ultimate intervention pursued for treatment of the primary PyD defect.METHODS: During work-up for PyD, 522 patients were examined using penile CDDU performed by a single surgeon at our institution from 2005 to 2018. Doppler 2D images were reviewed by an independent examiner based on classification criteria as follows: Grade I-hypoechoic shadowing without calcification; Grade II-focal microcalcifications; Grade III-scattered microcalcifications; Grade IVconfluent calcified and palpable plaque (a) of the tunica albuginea or (b) of the septum. Retrospective review allowed identification of treatments pursued in each case.RESULTS: 522 patients were evaluated with median age of 60 years (IQR 54, 65). Degree of curvature measured at the time of CDDU was < 30 degrees in 10.8%, > 30 and <45 degrees in 14.2%, > 45 and <60 degrees in 27.2%, > 60 and <90 degrees in 15.1%, and > 90 degrees in 11.6%, with 21.1% of patients having an hourglass defect. A number of patients had concomitant Doppler diagnosis of arterial insufficiency (19.7%), CVOD (35.6%), or mixed arterial and venous insufficiency (9%). Review of Doppler imaging with application of the grading criteria for 522 patients resulted in the primary diagnosis of Grade I ultrasonographic appearance in 237 (45.4%) of patients, Grade II in 104 (29.9%) of patients, Grade III in 91 (17.4%) of patients, and Grade IV(a) and IV(b) in 83 (15.9%) and 7 (1.3%) of patients. Only 187 patients ultimately had invasive treatment for their PyD, with 50 patients undergoing xiaflex, 40 undergoing penile plication, 49 undergoing plaque incision and grafting, and 48 undergoing IPP placement. Our study did not find evidence of trends in surgery with increasing or decreasing CDDU classification score (p[0.83). Most patients (334, 64.1%) did not pursue invasive treatment for their PyD.CONCLUSIONS: Most patients in our cohort did not pursue invasive treatment for their PyD. There was no trend in surgery pursued based on classification score.