Department of Urology, Faculty of Medicine, Medical Center, University of Freiburg, Freiburg, Germany.
Department of Urology, Faculty of Medicine, Medical Center, University of Freiburg, Freiburg, Germany; Department of Urology, Alexianer Hospital, Krefeld, Germany.
Eur Urol Focus. 2023 Jan;9(1):64-68. doi: 10.1016/j.euf.2022.10.009. Epub 2022 Nov 2.
Penile curvature is the most debilitating symptom of Peyronie's disease (PD); the evaluation of the degree of angulation is essential for planning treatment strategy. However, the most used method of penile at-home autophotography (AHP) is associated with some potential pitfalls and discrepancies compared with different assessment methods.
To compare the degree of penile curvature quantified by AHP and in-office intracavernosal alprostadil injection (ICI) prior to therapy.
DESIGN, SETTING, AND PARTICIPANTS: Data from 55 PD patients of a single tertiary referral center were analyzed. All patients provided standardized AHP of the erect phallus. Clinic-based assessment included ICI with curvature measurement and completion of the International Index of Erectile Function (IIEF-15).
The Wilcoxon and/or chi-square test was used to compare the degree of curvature obtained using AHP and ICI, and to evaluate whether erectile dysfunction was a predictor of a relevant difference of >10° in curvature assessment between AHP and ICI.
Our study showed a significant (p < 0.001) difference in the degree of penile curvature between AHP (48° [38°; 55°]) and ICI (50° [40°; 65°]). Patients suffering from erectile dysfunction tend to have a higher difference in the degree of penile curvature between AHP and ICI than patients with good erectile function (p < 0.001). Our study is not devoid of limitations. First, we did not use Peyronie's Disease Questionnaire, as suggested by the European Association of Urology guidelines. Second, we did not evaluate inter- and intraobserver variations in the measurements.
AHP tends to underestimate the extent of penile curvature compared to ICI. Erectile dysfunction is an independent predictor of measurement differences of >10° between AHP and ICI.
It is necessary to evaluate the degree of penile curvature in Peyronie's disease prior to therapy decision. The at-home self-photography underestimates the real degree of penile curvature compared with an erection by in-office penile drug injection. Especially men suffering from erectile dysfunction carry the risk of a high difference in the measured degree of penile curvature, with a potential impact on the further treatment.
阴茎弯曲是 Peyronie 病（PD）最具致残性的症状；评估弯曲角度对于规划治疗策略至关重要。然而，与不同的评估方法相比，最常用的阴茎家庭自摄影（AHP）方法存在一些潜在的陷阱和差异。
比较治疗前 AHP 和诊室海绵体内前列腺素 E1 注射（ICI）定量评估的阴茎弯曲程度。
设计、设置和参与者：分析了来自单一三级转诊中心的 55 例 PD 患者的数据。所有患者均提供勃起阴茎的标准化 AHP。临床评估包括 ICI 和曲率测量，并完成国际勃起功能指数（IIEF-15）。
使用 Wilcoxon 和/或卡方检验比较 AHP 和 ICI 获得的弯曲程度，并评估勃起功能障碍是否是 AHP 和 ICI 评估的曲率差异>10°的相关预测因素。
我们的研究表明，AHP（48°[38°;55°]）和 ICI（50°[40°;65°]）测量的阴茎弯曲程度有显著差异（p<0.001）。与勃起功能良好的患者相比，患有勃起功能障碍的患者 AHP 和 ICI 测量的阴茎弯曲程度差异更大（p<0.001）。我们的研究并非没有局限性。首先，我们没有按照欧洲泌尿外科学会指南的建议使用 Peyronie 病问卷。其次，我们没有评估测量的观察者内和观察者间变异。
与 ICI 相比，AHP 往往低估阴茎弯曲的程度。勃起功能障碍是 AHP 和 ICI 测量差异>10°的独立预测因素。
在决定治疗方案之前，有必要评估 Peyronie 病患者的阴茎弯曲程度。与诊室阴茎药物注射引起的勃起相比，家庭自摄影法会低估阴茎的真实弯曲程度。特别是患有勃起功能障碍的男性，其阴茎弯曲程度的测量差异存在较高风险，这可能对进一步的治疗产生影响。
