Penile Autophotography Underestimates the Degree of Penile Curvature in Peyronie's Disease

Background: Penile curvature is the most debilitating symptom of Peyronie's disease (PD); the evaluation of the degree of angulation is essential for planning treatment strat-egy. However, the most used method of penile at-home autophotography (AHP) is asso-ciated with some potential pitfalls and discrepancies compared with different assessment methods.Objective: 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).Outcome measurements and statistical analysis: 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 degrees in curvature assessment between AHP and ICI.Results and limitations: Our study showed a significant (p < 0.001) difference in the degree of penile curvature between AHP (48 degrees [38 degrees; 55 degrees]) and ICI (50 degrees [40 degrees; 65 degrees]). 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 func-tion (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.Conclusions: AHP tends to underestimate the extent of penile curvature compared to ICI. Erectile dysfunction is an independent predictor of measurement differences of >10 degrees between AHP and ICI.Patient summary: 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.(c) 2022 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Automated summary

This study compared the differences in measuring penile curvature between at-home self-photography and in-office penile drug injection. It found that at-home self-photography underestimated the extent of penile curvature. The study also showed that men with erectile dysfunction have a larger difference in the measured degree of penile curvature between at-home self-photography and in-office penile drug injection.