Symptoms: pain, deformity, palpable plaque, and erectile dysfunction
ED vs PD: ask, "if your penis was straight with the same quality of rigidity you have now, do you think it would be adequate for penetrative sexual activity?"
Assess ED risk factors: DM, HTN, HLD, smoking
50% see worsening curvature 12-18 months after presentation, 13% or less see some improvement
1/3 PD patients have diabetes
ED treatments unlikely to cause Peyronie, but more likely to expose patients who would otherwise not notice
Associated with depression, anxiety, and other psychosocial issues
Some association with Dupuytren disease (hand/foot contractures)
Plication: not adequate for severe curvatures or hourglass deformities, can use Nesbit, Yachia, or dot techniques
Grafting: more likely to result in inadequate erections, better choice for severe curvature or hourglass deformity, can use autologous, xenografts, or synthetic grafts
IPP: place for PD + ED, perform modeling while placing device to avoid tunical tearing, biggest patient concern is postoperative loss of length, urethral injury occurs 2-3% during modeling
Complications: persistent pain, indentation, curvature, hematoma, infection, loss of length, palpable sutures
Postop care: avoid intercourse for 4-6 weeks, can perform massage/stretching (unclear benefits), consider traction if tolerable
Sources
AUA Core Curriculum
Nehra, Ajay, et al. "Peyronie’s disease: AUA guideline." The Journal of urology 194.3 (2015): 745-753.
Seftel, A. and H. Yang. "Diagnosis and Management of Peyronie's Disease." Campbell-Walsh Urology 12 (2020).