Conservatively Managed Peyronie's Disease—Long-term Survey Results From Patients Undergoing Nonsurgical and Noninjection Therapies

Abstract

To evaluate patient-reported temporal changes in penile curvature, pain, shortening, sexual function, and quality of life in men undergoing conservative treatment for PD. Of 3840 patients who underwent evaluation at our institution between 1990 and 2012, 719 were randomly selected to receive a mail-in questionnaire with topics including penile curvature, pain, shortening, sexual function, and quality of life. Men endorsing prior intralesional or surgical therapy were excluded. A total of 125 patients completed the survey and met the inclusion criteria. The median duration between onset of PD symptoms and survey completion was 8.4 years. Overall, 38% felt that their condition had overall improved and 26% felt that their condition had worsened since onset. Penile curvature resolved in 43%, remained stable in 37%, and worsened in 20%. Twelve percent of the men developed a second de novo curvature. Penile pain occurred in 42%, among whom the pain worsened in 18% and completely resolved in 64%. Sixty-five percent reported penile shortening. Subjective erectile function decreased in 60%, and >40% experienced difficulties with penetrative intercourse. Sexual frequency decreased in 68% of the patients and 59% reported decreased relationship satisfaction. Approximately 50% described negative psychological impacts on self-esteem and image. The current report provides the most comprehensive and longest-term data on patient-reported outcomes in men undergoing nonsurgical and noninjection therapies. Although approximately 40% of the men reported overall and curvature improvement at a median 8.4-year follow-up, penile length loss, worsening sexual function, relationship dissatisfaction, and psychosocial distress occurred in the majority of PD men.