Page 89 - Remedial Andrology

8. PENILE CURVATURE

8.1 Congenital penile curvature
8.1.1 Epidemiology/aetiology/pathophysiology
Congenital penile curvature (CPC) is a rare condition, with a reported incidence of < 1% [947], although some
studies have reported higher prevalence rates of 4-10%, in the absence of hypospadias [948]. Congenital
penile curvature results from disproportionate development of the tunica albuginea of the corporal bodies and
is not associated with urethral malformation. In most cases, the curvature is ventral, but it can also be lateral
and, more rarely, dorsal [949].

8.1.2 Diagnostic evaluation
Taking a medical and sexual history is usually sufficient to establish a diagnosis of CPC. Patients usually
present after reaching puberty as the curvature becomes more apparent with erections, and more severe
curvatures can make intercourse difficult or impossible. Physical examination during erection (alternatively
photographic or preferably after intracavernous injection [ICI] of vasoactive drugs) is important to document the
curvature and exclude other pathologies [949].

8.1.3 Disease management
The definitive treatment for this disorder remains surgical and can be deferred until after puberty, although a
survey has suggested that men with probable untreated ventral penile curvature report more dissatisfaction
with penile appearance, increased difficulty with intercourse, and psychological problems; therefore, supporting
surgical correction of CPC in childhood [950]. Surgical treatments for CPC generally share the same principles
as in Peyronie’s disease. Plication techniques (Nesbit, 16-dot, Yachia, Essed-Schröeder, and others) with or
without neurovascular bundle elevation (medial/lateral) and with or without complete penile degloving, have
been described [951-960]. Other approaches are based on corporal body de-rotation proposed by Shaeer with
different technical refinements that enable correction of a ventral curvature, with reported minimal narrowing
and shortening [961-964]. There are no direct comparative studies therefore no single technique can be
advocated as superior in terms of surgical correction.

8.1.4 Summary of evidence for congenital penile curvature

Summary of evidence LE
Medical and sexual history are usually sufficient to establish a diagnosis of CPC. Physical examination 3
after intracavernosal injection or a photograph during erection is mandatory for documentation of the
curvature and exclusion of other pathologies.
There is no role for medical management of CPC. Surgery is the only treatment option, which can be 3
deferred until after puberty and can be performed at any time in adult life in individuals with significant
functional impairment during intercourse.

8.1.5 Recommendation for the treatment congenital penile curvature

Recommendation Strength rating
Use plication techniques with or without neurovascular bundle dissection (medial/lateral) for Strong
satisfactory curvature correction, although there is currently no optimum surgical technique.

8.2 Peyronie’s Disease
8.2.1 Epidemiology/aetiology/pathophysiology
8.2.1.1 Epidemiology
Epidemiological data on Peyronie’s disease (PD) are limited. Prevalence rates of 0.4-20.3% have been
published, with a higher prevalence in patients with ED and diabetes [965-975]. A recent survey has indicated
that the prevalence of definitive and probable cases of PD in the USA is 0.7% and 11%, respectively,
suggesting that PD is an under-diagnosed condition [976]. Peyronie’s disease often occurs in older men with
a typical age of onset of 50-60 years. However, PD also occurs in younger men (< 40 years), but at a lesser
prevalence than in older men (1.5-16.9%) [969, 977, 978].

8.2.1.2 Aetiology
The aetiology of PD is unknown. However, repetitive microvascular injury or trauma to the tunica albuginea

88 SEXUAL AND REPRODUCTIVE HEALTH - MARCH 2021