Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Penile prosthesis implantation is safe and effective in Peyronie’s disease patients with and without erectile dysfunction

Abstract

Penile prosthesis (PP) is the mainstay of treatment in Peyronie’s disease (PD) with co-existent refractory erectile dysfunction (ED). This study aimed to assess the clinical outcomes of patients who underwent PP as the first-line surgical treatment in PD without ED. A total of 636 patients underwent PP for PD from 2012 to 2022, but only 168 patients who underwent PP as first-line surgical management for PD with or without ED were included in the study. The mean (SD) age of 168 patients was 56.3 years (12.4). The mean curvature of the “PD with ED” group and the “PD without ED” group were 38.2 (5.6) degrees and 42.2 (5.9) degrees. The median (IQR) follow-up was 56.0 months (34.5– 61.4). Most (86.9%) patients underwent 3-piece inflatable PP. An important finding is that 33 patients (19.6%) without ED had undergone PP. Mechanical failure requiring revision surgery was less common in the ‘without ED’ group than in the ED group (6.8% vs. 10.2%, p 0.04). Most PD patients without ED (87.9%, 29/33) and with ED (88.9%, 120/135) were “satisfied” after PP implantation at six months, as defined by a score of ≥4 on a 5-point Likert scale. If surgery is offered in PD, PP may be considered a safe and effective first-line surgical treatment regardless of the ED, given the acceptable complications and high satisfaction rates. However, this new concept warrants further research.

This is a preview of subscription content, access via your institution

Access options

Buy this article

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Preoperative picture of Peyronie’s disease without Erectile Dysfunction.
Fig. 2: Intraoperative picture of Inflatable Penile Prosthesis of the same patient in Fig. 1.

Similar content being viewed by others

Data availability

The datasets generated and analysed during the current study are available from the corresponding author upon reasonable request.

References

  1. Kadioglu A, Tefekli A, Erol B, Oktar T, Tunc M, Tellaloglu S. A retrospective review of 307 men with Peyronie’s disease. J Urol. 2002;168:1075–9.

    Article  PubMed  Google Scholar 

  2. Nelson CJ, Mulhall JP. Psychological impact of Peyronie’s disease: a review. J Sex Med. 2013;10:653–60.

    Article  PubMed  Google Scholar 

  3. Goldstein I, Hartzell R, Shabsigh R. The impact of Peyronie’s disease on the patient: gaps in our current understanding. J Sex Marital Ther. 2016;42:178–90.

    Article  PubMed  Google Scholar 

  4. Berookhim BM, Choi J, Alex B, Mulhall JP. Deformity stabilization and improvement in men with untreated Peyronie’s disease. BJU Int. 2014;113:133–6.

    Article  PubMed  Google Scholar 

  5. Mulhall JP, Schiff J, Guhring P. An analysis of the natural history of Peyronie’s disease. J Urol. 2006;175:2115–8.

    Article  PubMed  Google Scholar 

  6. Segundo A, Glina S. Prevalence, risk factors, and erectile dysfunction associated with Peyronie’s disease among men seeking urological care. Sex Med. 2020;8:230–6.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Sharma KL, Alom M, Trost L. The etiology of Peyronie’s disease: pathogenesis and genetic contributions. Sex Med Rev. 2020;8:314–23.

    Article  PubMed  Google Scholar 

  8. Nehra A, Alterowitz R, Culkin DJ, Faraday MM, Hakim LS, Heidelbaugh JJ, et al. Peyronie’s disease: AUA guideline. J Urol. 2015;194:745–53.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Salonia A, Bettocchi C, Capogrosso P, Carvalho J, Corona G, Hatzichristodoulou G, et al. EAU guidelines: sexual and reproductive health. 2023. https://uroweb.org/guideline/sexual-and-reproductive-health/.

  10. Public statement on IntronA: withdrawal of the marketing authorisation in the European Union (Reference Number: EMA/935216/2022). 2024. https://www.ema.europa.eu/en/search?search_api_fulltext=IntronA.

  11. Gelbard M, Goldstein I, Hellstrom WJ, McMahon CG, Smith T, Tursi J, et al. Clinical efficacy, safety and tolerability of collagenase clostridium histolyticum for the treatment of peyronie disease in 2 large double-blind, randomized, placebo controlled phase 3 studies. J Urol. 2013;190:199–207.

    Article  CAS  PubMed  Google Scholar 

  12. Cocci A, Russo GI, Salamanca JIM, Ralph D, Palmieri A, Mondaini N. The end of an era: withdrawal of Xiapex (clostridium histolyticum collagenase) from the European market. Eur Urol. 2020;77:660–1.

    Article  PubMed  Google Scholar 

  13. Public statement on Xiapex: withdrawal of the marketing authorisation in the European Union, Reference Number: EMA/95504/2020. 2020. https://www.ema.europa.eu/en/search?search_api_fulltext=xiapex.

  14. Loftus CJ, Rajanahally S, Holt SK, Raheem OA, Ostrowski KA, Walsh TJ. Treatment trends and cost associated with Peyronie’s disease. Sex Med. 2020;8:673–8.

    Article  PubMed  PubMed Central  Google Scholar 

  15. García-Gómez B, Aversa A, Alonso-Isa M, Parnham A, Serefoglu EC, Corona G, et al. The use of penile traction devices for Peyronie’s disease: position statements from the European Society for Sexual Medicine. Sex Med. 2021;9:100387.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Hellstrom WJ, Usta MF. Surgical approaches for advanced Peyronie’s disease patients. Int J Impot Res. 2003;15:S121–4.

    Article  PubMed  Google Scholar 

  17. Mobley EM, Fuchs ME, Myers JB, Brant WO. Update on plication procedures for Peyronie’s disease and other penile deformities. Ther Adv Urol. 2012;4:335–46.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Osmonov D, Ragheb A, Ward S, Blecher G, Falcone M, Soave A, et al. ESSM position statement on surgical treatment of Peyronie’s disease. Sex Med. 2022;10:100459.

    Article  PubMed  Google Scholar 

  19. Mulhall J, Anderson M, Parker M. A surgical algorithm for men with combined Peyronie’s disease and erectile dysfunction: functional and satisfaction outcomes. J Sex Med. 2005;2:132–8.

    Article  PubMed  Google Scholar 

  20. Kurtzman JT, Sukumar S, Pijush DB, Brandes SB. The rising incidence of penile prosthesis surgery as the first line surgical treatment for Peyronie’s disease. Urol Pract. 2021;8:503–9.

    Article  PubMed  Google Scholar 

  21. Moncada I, Zaccaro C. Re: the rising incidence of penile prosthesis surgery as the first line surgical treatment for Peyronie’s disease. Eur Urol. 2022;81:120.

    Article  PubMed  Google Scholar 

  22. Chung PH, Siegel JA, Tausch TJ, Klein AK, Scott JM, Morey AF. Inflatable penile prosthesis as tissue expander: what is the evidence? Int Braz J Urol. 2017;43:911–6.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Moncada I, Krishnappa P, Ascencios J, Lopez I, Martinez-Salamanca JI. Home modeling after penile prosthesis implantation in the management of residual curvature in Peyronie’s disease. Int J Impot Res. 2021;33:616–9.

    Article  PubMed  Google Scholar 

  24. Wilson SK, Delk JR 2nd. A new treatment for Peyronie’s disease: modeling the penis over an inflatable penile prosthesis. J Urol. 1994;152:1121–3.

    Article  CAS  PubMed  Google Scholar 

  25. Sánchez-Sánchez F, Ferrer-Casanova C, Ponce-Buj B, Sipán-Sarrión Y, Jurado-López AR, San Martin-Blanco C, et al. Diseño y validación del Cuestionario de Función Sexual del Hombre, FSH [Design and validation of a Male Sexual Function Questionnaire]. Semergen. 2020;46:441–7.

    Article  PubMed  Google Scholar 

  26. Habous M, Tal R, Tealab A, Aziz M, Sherif H, Mahmoud S, et al. Predictors of satisfaction in men after penile implant surgery. J Sex Med. 2018;15:1180–6.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Capoccia E, Ziegelmann M, Emmerson J, Lankford J, Ofori-Marfoh C, Levine L. Long-term patient-reported outcomes in men with Peyronie’s disease undergoing nonsurgical and nonintralesional injection management. Int J Impot Res. 2021;33:75–81.

    Article  PubMed  Google Scholar 

  28. Low P, Wang L, Li KD, Shibley WP, Cedars BE, Holler JT, et al. Thematic analysis of the psycho-sexual symptoms in patients with Peyronie’s disease present on online forums. Int J Impot Res. 2023;35:533–8.

    Article  PubMed  Google Scholar 

  29. Porst H, Burri A, European Society for Sexual Medicine (ESSM) Educational Committee. Current strategies in the management of Peyronie’s disease (PD)-results of a survey of 401 sexual medicine experts across Europe. J Sex Med. 2019;16:901–8.

    Article  PubMed  Google Scholar 

  30. Walton EL, Quinn TP, Mulloy E, Patil D, Mehta A. Cost of intralesional collagenase clostridium histiolyticum therapy versus surgery for the management of Peyronie’s disease: a claims-based analysis (2009-2019). Sex Med. 2022;10:100517. https://doi.org/10.1016/j.esxm.2022.100517.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Tsambarlis PN, Yong R, Levine LA. Limited success with clostridium collagenase histolyticum following FDA approval for the treatment of Peyronie’s disease. Int J Impot Res. 2019;31:15–19.

    Article  PubMed  Google Scholar 

  32. Bella AJ, Lee JC, Grober ED, Carrier S, Benard F, Brock GB. 2018 Canadian Urological Association guideline for Peyronie’s disease and congenital penile curvature. Can Urol Assoc J. 2018;12:E197–209.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Chung E, Clendinning E, Lessard L, Brock G. Five-year follow-up of Peyronie’s graft surgery: outcomes and patient satisfaction. J Sex Med. 2011;8:594–600.

    Article  PubMed  Google Scholar 

  34. Montague DK. The rising incidence of penile prosthesis surgery as the first line surgical treatment for Peyronie’s disease. Letter. Urol Pract. 2022;9:16.

    Article  PubMed  Google Scholar 

  35. Bivalacqua TJ, Allen BK, Brock GB, Broderick GA, Chou R, Kohler TS, et al. The diagnosis and management of recurrent ischemic priapism, priapism in sickle cell patients, and non-ischemic priapism: an AUA/SMSNA guideline. J Urol. 2022;208:43–52.

    Article  PubMed  Google Scholar 

  36. Dunsch F, Evans DK, Macis M, Wang Q. Bias in patient satisfaction surveys: a threat to measuring healthcare quality. BMJ Glob Health. 2018;3:e000694. https://doi.org/10.1136/bmjgh-2017-000694.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Joseph J, Ziegelmann MJ, Alom M, Savage J, Köhler TS, Trost L. Outcomes of RestoreX penile traction therapy in men with Peyronie’s disease: results from open label and follow-up phases. J Sex Med. 2020;17:2462–71.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Contributions

Ignacio Moncada had full access to all the data in the study and took responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: Moncada. Acquisition of data: Moncada, Krishnappa, Zaccaro, Fraile, Romero-Otero, Martinez-Salamanca, and Lledó-Garcia. Analysis and interpretation of data: Moncada, Krishnappa, and Zaccaro. Drafting of the manuscript: Krishnappa and Moncada. Critical revision of the manuscript for important intellectual content: Moncada, Krishnappa, Zaccaro, Fraile, Romero-Otero, Martinez-Salamanca, and Lledó-Garcia. Statistical analysis: Krishnappa and Moncada. Approval of final version: Moncada, Krishnappa, Zaccaro, Fraile, Romero-Otero, Martinez-Salamanca, and Lledó-Garcia.

Corresponding author

Correspondence to Pramod Krishnappa.

Ethics declarations

Competing interests

The authors declare no competing interests.

Ethical approval

Institutional Ethics Board approval was obtained.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Moncada, I., Krishnappa, P., Zaccaro, C. et al. Penile prosthesis implantation is safe and effective in Peyronie’s disease patients with and without erectile dysfunction. Int J Impot Res (2024). https://doi.org/10.1038/s41443-024-00938-y

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1038/s41443-024-00938-y

Search

Quick links