A Worldwide Survey on Peyronie's Disease Surgical Practice Patterns Among Surgeons
Eric Chung, FRACS; Run Wang, MD; David Ralph, FRCS; Laurence Levine, MD; Gerald Brock, FRCS
FIRST PUBLISHED: March 14, 2018 – The Journal of Sexual Medicine
DOI: https://doi.org/10.1016/j.jsxm.2018.01.025
Introduction
While there are published guidelines for the treatment of Peyronie’s disease (PD), there is no consensus among surgeons on the best strategies.
This study examined surgeons’ practice patterns for pre-, intra-, and postoperative PD care in different continents and among members of sexual medicine societies.
Methods
A 26-question anonymous survey was developed and members of the International Society of Sexual Medicine (ISSM) and its affiliated societies were invited to participate through a web-based platform.
The affiliated societies were:
- The Sexual Medicine Society of North America (SMSNA)
- The European Society of Sexual Medicine (ESSM)
- The Asia Pacific Society for Sexual Medicine (APSSM)
- The South Latin American Society of Sexual Medicine (SLAMS)
- The Middle East Society of Sexual Medicine (MESSM)
Respondents who were not members of the above societies were invited to complete an anonymous printed survey at international meetings.
Results
The survey was completed by 390 respondents. Ninety-three percent were members of the ISSM and affiliated societies:
| Society | Number of Respondents |
| SMSNA | 90 |
| ESSM | 80 |
| APSSM | 150 |
| SLAMS | 30 |
| MESSM | 20 |
Twenty respondents were not society members.
Over two-thirds of the surgeons in all societies performed fewer than 10 cases of plication surgery each year. Less than one-sixth were “high-volume” surgeons with over 20 plications annually. Over 80% of the surgeons performed fewer than 10 graft surgeries each year.
Over a third of respondents were not aware of a published clinical guideline for PD management. About a quarter said they were current with the medical literature.
Preoperative Factors
Most APSSM, SLAMS, and MESSM members believed that coexisting erectile dysfunction (ED) and PD diagnoses could be made solely through medical history. Over half of SMSNA and ESSM members believed that medical history and penile color duplex ultrasound (CDU) was needed to determine whether ED was present.
Over half the society respondents agreed that the acute phase of PD was defined as curvature for less than 12 months. Most respondents believed that surgery should be performed only after six months of stable penile curvature.
Intraoperative Factors
ESSM, APSSM, and MESSM members were more likely to routinely circumcise patients at the time of surgery compared to SMSNA and SLAMS members.
Fewer than a quarter of the surgeons routinely performed traditional Nesbit excision. Modified and combination plication techniques were more common.
Twice as many surgeons used allograft materials over autologous grafts.
For men with preoperative ED, over half the surgeons chose to perform penile prosthesis implantation.
Postoperative Factors
Over two-thirds of the surgeons did not use additional therapy (e.g. penile traction) after PD surgery.
Over half of SMSNA and APSSM members waited 3 months before performing any additional surgery. Over 60% of other society members waited at least 6 months.
Over 90% of the society surgeons said that patients should be followed for at least a year.
Discussion
Discussion highlights included the following:
- Only a small percentage of surgeons were considered high-volume. This result might have been influenced by the referral process, sociocultural and economic differences, clinical triage, and surgeon expertise.
- CDU is a helpful assessment tool for PD patients, especially those who have complex deformities and associated ED.
- Surgeons should always let patients know what they might expect from surgery and help them understand the potential complications.
- There is little published literature concerning revision surgery for ongoing or recurring curvature.
Strengths of the study included the large number of surgeons from different continents and sexual medicine societies.
There were limitations as well. The survey questionnaire was not validated and did not provide information on outcomes and patient satisfaction. The results might not reflect how general urologists would approach surgery.
“It is our expectation that this survey will provide a platform within the literature to further discuss PD, its surgical management, and the current approach to treatment,” the authors wrote, adding that the results could contribute to the formation of a new practice guideline.