Presentation Authors: Edward Capoccia*, Matthew Ziegelmann, Jacob Emerson, Claudia Ofori-Marfoh, Joseph Lankford, Laurence Levine, Chicago, IL
Introduction: We sought to evaluate patient-reported outcomes in men with PD who elect conservative management without surgery or intralesional collagenase Clostridium histolyticum (CCH).
Methods: We identified all patients with PD evaluated at our institution by a single provider between May 2012 and January 2018 who elected non-surgical and non-CCH management. A PD-specific questionnaire was sent via email software to all who met inclusion criteria. The questionnaire included assessments of changes in penile deformity, sexual function, and psychological aspects of PD from the time of initial diagnosis to present.
Results: A total of 101/514 (19.7%) patients responded to our email questionnaire. The median age was 55 (IQR 48;60) and median PD duration prior to survey completion was 45 months (IQR 28.5;64). Prior treatments included penile traction (PT; 55%), oral therapy (37%), intralesional injections other than CCH (8%), and 29% reported no prior treatment. 49% of patients reported at least some improvement in their curvature including 18% with â€œmild improvementâ€ ( < 30 degrees), 23% with â€œsignificant improvementâ€ (>30 degrees), and 8% with resolution. 84% of patients reported penile length loss at baseline, with > 30% reporting further shortening. Moreover, 63% reported that PD negatively impacted their self-esteem and 68% reported that PD negatively impacted their partnersâ€™ well-being. Men ranked length loss as the most bothersome aspect of PD. In subgroup analysis, men reporting at least a mild improvement in their curvature were more likely to also have improvement in their length loss (50% vs 24%, p=0.001) and were less likely to have a negative impact on current or prior sexual relationships (51% vs 68%, p=0.04). In those patients who did not pursue any treatment, penile curvature improvement rates were lower (24% vs 49%; p=0.017). Men who underwent PT more likely to report improvement in their curvature (64% vs 27%, p=0.0005) and length loss (35% vs 10%, p=0.0075).
Conclusions: Our survey provides important data on patient-reported outcomes in men electing non-surgical and non-CCH interventions. Although 49% of men noted at least a mild improvement in their curvature over time, a majority had declining erectile function, decreased intercourse satisfaction, and psychosocial distress. Men who elected treatment with oral, PT, and non-CCH intralesional injections were more likely to report subjective improvement in curvature and penile length. These data are useful when counseling men with PD.