Peyronie's disease in Spain: a prospective study.

Background: Peyronie's disease (PD) research has limitations due to heterogeneity in time of presentation, severity, deformity characteristics, and associated conditions. Aim: To provide further insight into clinical characteristics of patients, PD treatments and patient perceptions of outcomes in clinical practice in Spain. Methods: A total of 601 men from 15 Spanish andrology centers were included in this observational, prospective multicenter cohort study. Enrolled patients (aged ≥18 years with confirmed PD diagnosis, naïve to specific therapy and without congenital penile curvature) were evaluated by detailed medical history and physical examination including plaque characteristics and curvature. Sexual function was assessed by the International Index of Erectile Function-5 and the Peyronie's Disease Questionnaire. The characteristics of treatment used for PD as well as patient subjective outcomes were analyzed in cases involving curvature assessments. Outcomes: The primary outcome was demographic and clinical characterization of PD patients; secondary outcomes included PD treatment used in clinical practice and patient satisfaction. Results: The median age (interquartile range, IQR) was 57 (49.0-63.0) years with a median duration of PD of 12 (6.0-18.0) months. There were 246 (41.6%) patients in the acute phase of the disease. The most common nonsurgical treatments were traction therapy (36.0%), collagenase injections (29.3%), and daily tadalafil (22.7%). The most frequently used surgical technique was penile plication (62.3%) followed by grafting and plaque incision (34.0%). The median Peyronie's Disease Questionnaire and International Index of Erectile Function-5 scores were 19.0 (12.0-28.0) and 18.0 (13.0-22.5), respectively. Curvature assessment was performed in 331 patients, using the Kelami test in 316 (96.0%) or intracavernous injection of a vasoactive agent in 143 (45.5%). Clinical implications: Many patients are misdiagnosed, and treatment may take a long time; understanding the profile of PD, as well as satisfaction with real-life treatment outcomes, can aid clinicians in selecting more appropriate treatments. Strengths and Limitations: As a free collaborative registry, not all patient data were collected, and therefore not all data were available throughout the study, and a longer follow-up period would have given us more information to compare the pretreatment and post-treatment situations. However, this study provides a description of clinical characteristics of a large real-world cohort of men with PD from a considerable number of sites nationwide. Conclusions: We found a wide variety of treatments used in clinical practice, including those with poor evidence of efficacy, which suggests the need for a better understanding of PD for developing the most effective treatment protocol.