UroToday - Peyronie's disease (PD) occurs more frequently following radical prostatectomy (RP) than it does among men in the general population, according to a report by Dr. Raanan Tal and colleagues in the Journal of Sexual Medicine.

In the general population, the incidence of PD is reported to be 3.2-8.9%. To determine the incidence among men treated with RP for prostate cancer (CaP), the investigators studied men attending a sexual medicine clinic at Memorial Sloan-Kettering Cancer Center between 2002 and 2008.

In addition to having undergone RP, they had to have, in the database, notation of a penile exam for plaques prior to surgery and have been seen in the sexual medicine clinic within 3 years of RP. The degree of nerve-sparing at RP was noted in the records and analyzed. Patients could not have had other salvage therapies for their CaP.

Patients had erectile function measured by a penile rigidity scale of 0 to 10 with 0 denoting no engorgement, 6 the minimal engorgement for penetration and 10 a fully rigid erection. The diagnosis of PD was based upon finding a plaque on physical examination. Intracavernosal injections were used and a goniometer measured the degree of curvature.

A total of 1,011 patients fulfilled the inclusion criteria and median time from RP to first sexual medicine evaluation was 5.8 months. The overall incidence of PD was 15.9%, with 77 men developing PD within one year of RP, 139 within 2 years and 161 men within three years.

Mean time to develop PD after RP was 13.9 months and mean degree of curvature was 31 degrees.

Predictors of developing PD after RP were evaluated. In multivariate analysis, younger age and white race were independent predictors of PD occurrence after RP. Cardiovascular disease was not more common in men who developed PD vs. those who did not develop PD.

Nerve sparing was not an independent predictor in multivariate analysis. Whether RP is associated with a fibrotic reaction in the penis after surgery is not known as a causative etiology.

As the men in this study were presenting to the sexual medicine clinic for initial evaluation after RP, it is not reported to what degree the incidence of PD impaired sexual function.

Tal R, Heck M, Teloken P, Siegrist T, Nelson CJ, Mulhall JP
J Sex Med. 2010 Mar;7(3):1254-61.
doi: 10.1111/j.1743-6109.2009.01655.x

UroToday Contributing Editor Christopher P. Evans, MD, FACS

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