Presentation Authors: Shyam Sukumar*, Debduth Pijush, Stanley Desire, Steven Brandes, New York, NY
Introduction: Numerous surgical options exist for the treatment of Peyronie&[prime]s disease (PD). The majority of prior reports on the surgical management of PD are from high volume centers or single surgeon series. There is a paucity of population-based data on the surgical management of PD.
Methods: The New York Statewide Planning and Research Cooperative System database-a large statewide database that captures comprehensive all-payer data on patients across all outpatient and inpatient settings-was reviewed to identify patients with PD undergoing surgery from 2003-2016. Descriptive statistics and multinomial regression modeling was used.
Results: 1399 patients underwent surgical treatment for PD. Median age was 60 years, 52% of patients were Caucasian, and 45.9% had concurrent erectile dysfunction (ED). The most commonly performed procedures were penile prosthesis (PP) alone or as a combination procedure (CP; defined as a PP with concurrent modeling, tunical plication-TP- or plaque incision/excision with grafting-PEG). Of all patients without ED, the most commonly performed procedure was still PP (alone or as CP; 34.6%); rates of TP and PEG were 34.5% and 30.8%, respectively.The annual rates of these procedures is shown in Figure 1. Over the course of the study period, relative rates of TP were stable, but there was a significant increase in the use of CP (p=0.009) and a decrease in the use of PEG (p=0.006)Factors predicting use of PP include age (OR=1.03, p=0.027), Black race (OR=3.31, p=0.032), Hispanic ethnicity (OR=2.70, p=0.004), higher socioeconomic status (OR= 2.62, p=0.0005), and presenting to a high volume practitioner (OR=2.96, p=0.0003). Factors predicting use of PEG were Hispanic ethnicity (OR=2.45, p=0.016) and low socioeconomic status (OR=3.48, p=0.002).
Conclusions: Penile prosthesis is by far the most commonly performed primary procedure for PD in New York State, even in patients without ED. The high volume of PP use, along with its use in 35% of patients with normal erectile function suggests over utilization of PP. Plaque incision and grafting is indicated for significant deformity and normal rigidity, yet utilization was lowest of the treatments and decreasing,even in patients without ED. This suggests possible under use of plaque incision and grafting.