The Surgical Treatment of Peyronie’s Disease in the Older Man: Patient Characteristics and Surgical Outcomes in Men 65 and Older

George A. Abdelsayed MD; Shaan A. Setia MD; Laurence A. Levine MD

FIRST PUBLISHED: September 6, 2019 – The Journal of Sexual Medicine

DOI: https://doi.org/10.1016/j.jsxm.2019.07.030

Introduction

Peyronie’s Disease is a connective tissue disorder that causes penile deformities that can make penetrative sex difficult or painful. For some patients, intercourse becomes impossible. Although the exact pathophysiology remains unclear, it is known that a man’s likelihood of developing Peyronie’s disease increases as he ages, with peak onset during when he is in his fifties. Surgery is considered the “gold standard” treatment, but there has been little research on the outcomes for older men who choose this option.

This study evaluated surgical outcomes of three surgical treatment options in men age 65 and older:

• Plaque incision or partial excision with grafting (PEG)
• Tunica albuginea plication (TAP)
• Placement of a penile prosthesis with subsequent straightening maneuvers (PP+SM)

Materials and Methods 

A retrospective chart review was conducted for 86 men age 65 and over who underwent surgical treatment for Peyronie’s disease at one center between January 2010 and September 2017.

Before surgery, all of the men had physical examinations that included penile duplex ultrasonography. A goniometer was used to measure penile curvature. The men also completed questionnaires to assess their medical and surgical history, Peyronie’s disease symptoms, prior interventions, sexual history, and erectile function.

After surgery, the men were followed for at least nine months, starting with an initial 3-month postoperative follow-up. After that, they were seen at least annually and completed surveys to evaluate their satisfaction, erectile and sexual function, and adverse effects.

Results 

Pre-operative Characteristics 

Patient’s average age at the time of surgery was 68 years, and the median postoperative follow up was 43.5 months. Penile curvature ranged from 0 to 105 degrees, with an overall average of 59.9 degrees. Most men (76%) had a mainly dorsal curvature, 14% had lateral curvature, and 10% had a mainly ventral curve.

Thirty-nine men (45%) underwent PP+SM, 25 (29%) underwent TAP, and 22 (26%) underwent PEG. Mean pre-operative curves were 49.1, 61.4, and 78.6 degrees, respectively. Ages were similar across the three groups.

Men in the PEG group were more likely to have better reported baseline erectile function and “complex deformities” such as narrowing and/or hinge effects.

Postoperative Outcomes

Functional straightness was defined as a residual curve of less than 20 degrees and the ability to have penetrative intercourse. This goal was achieved by 95% of the cohort, with “no observed differences between surgical approaches.”

Approximately 94% reported having penetrative intercourse at their last follow up, and overall patient-reported satisfaction was 85%. These rates were similar across all groups.

Complications

Three men had complications, which included urinary retention, neuropraxia, and sub-graft hematoma.

Discussion 

Surgical treatment is considered safe and effective for older men with Peyronie’s disease.

The high rate of patient satisfaction “is likely secondary to strict patient selection, surgical technique, and pre-operative counseling, which emphasizes the management of patient expectations.”

Several limitations were acknowledged, including the following:

• All procedures were conducted by one highly-experienced surgeon. Less-experienced surgeons might not achieve the same results.
• Validated questionnaires were not used.
• There was a low number of study participants.
• There was no comparison group.

Future studies are recommended to determine which men are the best candidates for surgical or nonsurgical treatments.