Should assessment of penetrative sexual activity be used as the treatment arbiter in the management of Peyronie's disease?

Abstract

Peyronie's disease is an inflammatory disorder, which causes thickening of the tunica albuginea of the penis. Peyronie's disease has a variable natural history and the assessment and management of the disease has yet to be standardised. The case notes of 97 patients with a diagnosis of Peyronie's disease were retrospectively reviewed at a single tertiary referral centre. Patients who were able to achieve sexual penetrative activity to the satisfaction of both partners were managed conservatively. Patients who were unable to achieve penetrative sexual activity were given intra-cavernosal prostaglandin, with those achieving a satisfactory erection being offered appropriate surgical intervention. The mean age at presentation was 50 years (range 18-82). A total of 59 (61%) men were able to have penetrative sex at the time of presentation. Following initial conservative management, only five (8%) of this group had disease progression, which stopped them from being able to penetrate. In all 38 (39%) men who were not able to penetrate at presentation were offered surgical intervention. In all 24 (63%) of these men chose to have surgical intervention. Tunical plication resulted in the ability to penetrate in 77% of men choosing this option whereas only 46% of men undergoing autologous saphenous vein grafting were able to have penetrative sex. Assessment of penetrative sexual function is an essential component of the management of patients with Peyronie's disease. This enables appropriate counselling with respect to possible conservative management or the most appropriate surgical intervention. The majority of patients with Peyronie's disease can achieve sexual penetrative activity, many without surgical intervention.

Surgical therapy of Peyronie’s disease by partial plaque excision and grafting with collagen fleece: feasibility study of a new technique

“…Surgery is indicated when deviation leads to inability for sexual intercourse. 1,8 Generally, plication techniques are applied when deviations are o601, because penile curvatures 4601 will exacerbate penile shortening after plication leading to patient dissatisfaction. 9 In more advanced deviations, the preferred treatment is plaque incision or partial plaque excision followed by closing of the tunical defect by various grafts, as these procedures can maintain penile length.…”

Understanding the course of Peyronie's disease

“…Surgical intervention is considered in patients with ED and/or penile deformity precluding sexual activity. Prior to intervention, a period of ≥12 months of disease stability is typically required, given the evolving nature of the disease process early in its course . The surgical procedure performed depends on several factors, including degree, location, and extent of penile curvature, baseline erectile function, patient goals and surgeon preference.…”

All about Peyronie's disease

“…Surgery aims at the correction of curvature, maintaining satisfactory penile length and rigidity to allow penetrative intercourse [4] . Surgery should be done only for patients with stable disease for at least 12 months, although 3 months have been also suggested [1] , [74] , [75] . Potential risks of surgery include penile shortening, ED (higher risk with penile lengthening procedures [1] , [76] ), penile numbness, recurrent curvature (due to surgery before disease stabilization, reactivation of the condition, or the use of absorbable sutures [76] ), the potential for palpation of knots and stitches below the skin, and the potential need for circumcision at the time of surgery [1] .…”