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Sources of Funding: Boston Scientific

Introduction

Surgical management for the treatment of Peyronie&[prime]s disease (PD) is indicated when men fail medical therapy such as intralesional collagenase clostridium histolyticum (CCH) injections. For men with severe curvature and concomitant erectile dysfunction (ED) not responsive to CCH and phosphodiesterase 5 inhibitor (PDEi) therapy, penile prosthesis (PP) surgery is a treatment option. We sought to evaluate trends in PP surgery for the treatment of PD and examine the effect of medical therapy on practice patterns.

Methods

Analysis of 21 years of a national prospectively maintained American Medical Systems database was performed (1995-2015). Utilization of PP was compared with ANOVA analysis between four distinct time periods: Pre-PDEi use for ED treatment (1995-1997); post-sildenafil (1998-2003); post-tadalafil and vardenafil (2004-2013); post-CCH approval (2014-2015). Comparison was made between patients who underwent PP surgery for PD as sole etiology versus all other patients (non-PD) using Chi-square or t-test.

Results

6701 PP surgeries for the treatment of PD were included in the study period. Number of PP cases decreased annually from 494 (7.4%) in 1995 to 203 (3.0%) in 2015 (Figure 1). Significant decrease in PP surgery occurred for PD patients between each of the time intervals (&[prime]95-&[prime]97, &[prime]98-&[prime]03, &[prime]04-&[prime]13, &[prime]14-&[prime]15) [p<0.05] (Table 1). For non-PD patients, PP surgery decreased after the introduction of sildenafil only. PD patients were younger than those without PD (59.4 ±8.6 vs. 62.2 ±10.0 years, p<0.001). Proximal and distal measurements were lower in PD vs. non-PD group (Proximal 9.6 ±2.4 vs. 10.0 ±2.6 cm; Distal 9.0 ±2.4 vs. 9.5 ±2.7 cm, p<0.001). Penoscrotal is the most common surgical approach (p<0.05).

Conclusions

Decrease in PP surgery for the treatment of PD was observed between 1995-2015 notably due to the introduction of PDEi and CCH therapy. In contrast, PP surgery for men without PD has remained stable over the past decade. Further study is needed to determine if similar trends in utilization of PP surgery will continue for PD patients.

Funding

Boston Scientific