What do patients with Peyronie's disease expect from therapy? A prospective multi‐center study

Abstract

BackgroundLittle is known about patients’ pre‐treatment expectations in Peyronie's disease (PD).ObjectiveTo evaluate in detail patients’ expectations of conservative therapy and surgery.Patients and methodsThis multi‐center study prospectively enrolled 317 PD patients, who were scheduled to receive conservative therapy or surgery between 2019 and 2022 at the Department of Urology of the University Medical Center Hamburg‐Eppendorf, and the Center of Reproductive Medicine and Andrology, University Medical Center Muenster, both Germany. The primary end‐point was patients’ pre‐treatment expectations of conservative therapy and surgery, measured with the Stanford Expectations of Treatment Scale (SETS). Secondary end‐points included patient‐reported psychological and physical symptoms, penile pain, symptom bother and erectile function, measured with the Peyronie's disease questionnaire (PDQ) and International Index of Erectile Function Erectile Function Domain (IIEF‐EF).ResultsIn total, 239 (75%) and 78 (25%) patients were scheduled for the conservative therapy and surgery, respectively. Patients undergoing surgery had higher positive and negative mean SETS expectations scores (14 vs. 11, p < 0.001; 9.6 vs. 6.0, p < 0.001). In multivariable analysis, surgery was an independent predictor of positive and negative patients’ pre‐treatment expectations (all p ≤ 0.001). In thematic analysis, patients undergoing surgery emphasized distinct themes of pre‐treatment expectations. Patients undergoing surgery had higher mean PDQ symptom bother as well as higher psychological and physical symptom scores (14 vs. 10, p < 0.001; 9.2 vs. 7.1, p = 0.001). There were significant positive correlations between SETS negative expectation score and PDQ symptom bother (|ρ| = 0.25; p < 0.001) as well as PDQ psychological and physical symptoms score, respectively (|ρ| = 0.21; p = 0.001).ConclusionPD patients expect both more benefit and more harm from surgery. In addition, patients undergoing surgery have more psychological and physical symptoms and more symptom bother. To set realistic expectations, it is of pivotal importance to assess patients’ expectations before starting treatment.

Letter: Comparison of Collagenase Clostridium histolyticum to Surgery for the Management of Peyronie's Disease: A Randomized Trial

“…Subjective outcomes reported by patients can be better understood through a recent multicenter study of 317 PD patients assessing patient expectations of conservative therapy vs surgery using the validated Stanford Expectations of Treatment Scale. 4 Patient preference and expectations play a significant role, the authors found that men with PD expect both more benefit and more harm from surgery compared to conservative therapy. In addition, they reported patients who undergo surgery have more psychological and physical symptoms and more symptom bother.…”