Page 1 - 2018 Canadian Urological Association guideline for Peyronie’s disease and congenital penile curvature

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CUA gUideline

2018 Canadian Urological Association guideline for Peyronie’s

disease and congenital penile curvature

Anthony J. Bella, MD ; Jay C. Lee, MD ; Ethan D. Grober, MD ; Serge Carrier, MD ; Francois Benard, MD ;
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Gerald B. Brock, MD 6
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1 Ottawa Urology and Men’s Health and Ottawa Hospital Research Institute, Ottawa ON; Department of Surgery, Division of Urology, University of Calgary, Calgary, AB; Division of Urology, Department
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of Surgery, University of Toronto, Toronto, ON; Division of Urology, McGill University Health Centre, Montreal, QC; Department of Surgery, Université de Montreal, Montreal, QC; Department of Surgery,
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Division of Urology Western University, London, ON; Canada
Cite as: Can Urol Assoc J 2018;12(5):E197-209. http://dx.doi.org/10.5489/cuaj.5255 followup. Patients’ baseline pain improved in all men, with
complete pain resolution documented in 89% of patients. In
contrast, penile curvature was only reported to improve in
Published online February 22, 2018 12% of untreated men with the condition. Penile curvature
worsened for 48% and remained stable in 40% of men. More
recently, in a smaller series of 176 patients, Berookhim et
Introduction al reported curvature improvement in 12%, worsening in
21%, and unchanged curvature in 76% of untreated patients
Peyronie’s disease (PD) is a highly prevalent condition that followed for at least 12 months. Natural history studies are
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affects the physical and psychosocial well-being and quality influenced by the duration of followup. Over the longest
of life (QoL) for thousands of Canadian men. The specific reported observation period, Grasso et al studied 110 men
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etiology of PD remains poorly understood and there remains followed for at least five years (mean follow up 6.4 years).
a paucity of randomized placebo-controlled trials evaluating In contrast to reports of shorter followup durations, disease
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treatment interventions. PD can be found in up to 8.9% of progression was more common with 68% of men <50 years
men, a remarkable increase in cited prevalence that is attrib- of age requiring surgical therapy and 31.5% of men >50
utable to growing awareness (as historical data suggested a years of age opting for surgical treatment.
rate of less than 1%); the burden of disease is significant, Collectively, the natural history studies related to PD
and PD is often present in otherwise healthy men. The fol- suggest that plaque-related pain improves and/or resolves
lowing guidelines were crafted by the committee with a full in the majority of patients with time even in the absence
awareness of the limitations of the literature, and sought to of treatment. 1,3-7 Conversely, spontaneous resolution or sig-
provide actionable recommendations to guide PD care in nificant improvement of penile deformity is rare, and pre-
the Canadian health system. dictors of disease progression/resolution are inconsistent
or absent. As such, patients with penile deformities that
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Natural history result in sexual dysfunction or distress should be counselled
regarding treatment options that may influence the natural
PD is an acquired penile disorder characterized by benign history of the condition and restore functionality.
fibrotic changes primarily to the tunica albuginea (TA),
resulting in a constellation of signs and symptoms occurring PD and QoL impact
alone or in combination, including penile deformity (curva-
ture, narrowing, indentation, hinging), erectile dysfunction The relationship between PD and ED due to resultant physi-
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(ED), penile pain, shortening, and plaque formation. The cal penile deformity is clear, as are most diagnoses of PD.
presence and severity of these symptoms, as well as the In the clinical practice setting, a diagnosis of ED or failed
timing of the presentation for medical evaluation is variable, first- and second-line ED treatments warrants ruling out PD.
as is the degree of morbidity and impact on sexual function. Many cases of PD are initially treated unsuccessfully as ED
The natural history of PD is not that of improvement/and or without identifying and addressing the penile deformity. A
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resolution of the features of the condition. The largest series careful history may identify the impact of deformity on erec-
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(Mulhall et al ) to report on the natural history of untreated tile function or the presence of a flail segment (satisfactory
patients with PD included 246 patients with at least one year rigidity present in the penis proximal to the plaque(s)). The

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