BOSTON -- Many men with untreated Peyronie's disease eventually experienced curvature improvement or stability, and resolution of pain, according to researchers here.
Out of more than 700 patients, 162 (23%) responded to a mail-in survey and, among them, the median duration of disease was 8.4 years at the time of the survey completion. When asked to evaluate how their disease had progressed since diagnosis, 38% of patients said it was somewhat or much better, 36% reported no change, and 26% said it was worse, according to Matthew Ziegelmann, MD, of the Mayo Clinic in Rochester, Minn., and colleagues.
Action Points
- Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
Of those who responded, 86% reported they had penile curvature at the time they presented with their disease. Curvature either resolved or improved in 43% of patients, remained stable in 37%, and worsened in 20%, they said in a presentation at the American Urological Association annual meeting.
These findings are contrary to those in some previous reports on the natural history of the disease, according to the investigators.
Peyronie's disease is a disorder in which plaque forms inside the tissues of the tunica albuginea. As this tissue builds up, it causes the penis to curve or bend, making sexual intercourse painful, and in some cases, impossible.
While Peyronie's disease was initially described in the literature in the 18th century, limited data exists on the natural history of the disorder. Ziegelmann noted that the first report on the natural history of the wasn't published until 1970, when researchers reported spontaneous symptom resolution in 50% of patients in a small cohort.
A later included 97 patients early in the course of Peyronie's disease and the researchers found that 13% of patients reported that the disease gradually resolved, while the vast majority reported that the disease had stabilized or had progressed.
A followed a group of 246 patients early in their disease, and found that, over the course of 12 months after the onset of Peyronie's, 48% of the patients had curvature that had worsened.
"Given the few studies that have been reported to date, we sought to characterize long-term, conservatively managed Peyronie's disease, particularly from the patient's perspective," Ziegelmann said.
His group identified all patients who were evaluated for Peyronie's disease at their institution from 1990 to 2012. Of those patients, 719 were randomly selected to receive a questionnaire, with questions relating to the natural history of the disorder, such as change in curvature, pain, and shortening of the penis over time.
"Interestingly, 12% of patients developed a new penile curvature at a median of 17 months after initial presentation, and these patients were significantly more likely to report worsening of their initial penile curvature," the authors stated.
Penile pain was reported in 60% of patients, who further noted that their pain either improved (18%) or resolved (60%) at a median of 12 months. In addition, 65% of patients reported penile shortening at the time of disease presentation, with 50% reporting that shortening had stabilized and 30% reporting that it had worsened over time.
"As a side note, those patients with penile shortening were more likely to have lower median IIEF [International Index of Erectile Function] scores, or more likely to reported decreased intercourse frequency and an impact on their self esteem," Ziegelmann said.
The researchers also pointed out that patients with less than 5 years of disease duration were more likely to report that their condition had worsened over time compared with those with longer disease duration.
Ziegelmann said that among patients who said that their disease process had improved, "not surprisingly" reported that their curve had stabilized or improved, and their shortening had stabilized.
His group concluded that, contrary to earlier reports, the majority of men with Peyronie's disease experienced curvature stability or improvement, resolution of pain, and progressive penile shortening over time.
"Overall, the information from this survey helps us without our understanding when we are counseling patients with a new diagnosis of Peyronie's disease," the authors stated.
Disclosures
Ziegelmann and co-authors disclosed no relevant relationships with industry.
Primary Source
American Urological Association
M Ziegelmann, et al "The natural history of untreated Peyronie's Disease: Curvature, length, and pain" AUA 2017; Abstract PD31-01.