(426) Peyronie’s Disease Treatment Pathways in the TriNetX Global Database

Abstract

Abstract Introduction Peyronie’s disease (PD) is a fibrosing condition which commonly leads to penile pain, curvature, plaque development, change in penile shape, and sexual dysfunction. Urologists will benefit from understanding the utilization of the most common treatment pathways followed in practice. Objective To identify the pathways of treatment between pentoxifylline, injection therapy, penile plication, plaque excision with/without grafting (PEG), and penile prosthesis in the treatment of PD. Methods TriNetX is a research network of real-time data from 58 Healthcare Organizations globally. We queried the network for adult men with Peyronie’s disease and interventions from 2002-2022. Patients were identified based on the International Classification of Disease Tenth Edition (ICD-10) code for Peyronie’s disease (N48.6). Interventions were identified using Current Procedural Terminology (CPT) codes for injection therapy (54200), penile plication (54360), plaque excision +/− grafting (PEG) (54110, 54111, 54112), and penile implant (54400, 54401, 54405). Use of oral pentoxifylline (8013) was identifiable using RxNorm Concept Unique Identifier, part of the Unified Medical Language System. The analysis was run on June 16, 2022. Results There were 45,944 cases of PD within the database with a mean age of 62 +/− 13 years. The cohort identified as 73% white, 8% black, and 18% race unknown. Figure 1 shows the cases by treatments and pathways. The most common management was no treatment in 69.5% of cases (n=31,912). A single medical or surgical therapy was used in 79.6% of patients who received treatment (n=11,166). Of single medical therapy cases, pentoxifylline (60.0%, n=4,541) was the more commonly used medical treatment followed by injection therapy (40.0%, n=3,033), while penile plication was the most frequently utilized surgical therapy (54.2%, n=1,946) followed by penile prosthesis (30.6%, n=1,100), PEG (15.2%, n=546). Patients required multiple therapies 20.4% of the time (n=2,866). Of patients requiring multiple therapies, a progression of medical to surgical treatment occurred in 20.4% (n=584). Conclusions PD was predominantly managed without any intervention, followed by medical therapy, and then surgery. Surgical therapy occurred less frequently after medical treatment suggesting that few patients are interested or require a stepwise approach to PD. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific and Coloplast.