The Rising Incidence of Penile Prosthesis Surgery as the First Line Surgical Treatment for Peyronie's Disease

Peyronie's disease is a potentially debilitating connective tissue disorder of the penis that at times requires surgical intervention. There is a dearth of multi-center or community-level data regarding management trends. The aim of this study was to perform the first population-based assessment of surgical practice patterns in the treatment of Peyronie's disease among New York State urologists.

We used the New York Statewide Planning and Research Cooperative System (SPARCS) database to identify all patients who underwent surgical treatment for Peyronie's disease between 2003 and 2016. We used descriptive statistics and multinomial regression modeling to assess predictors of treatment choice.

Among 1,733 patients who underwent surgical treatment for Peyronie's disease, 30% underwent insertion of a penile prosthesis alone and 40% underwent insertion of a penile prosthesis with concurrent auxiliary procedures. Penile prosthesis (alone or in combination) was the first line surgical treatment in 21% of patients without documented erectile dysfunction. Relative rates of performing tunical plication and penile grafting decreased over time (both p <0.05), while insertion of a penile prosthesis/insertion of penile prosthesis with concurrent auxiliary procedures rates correspondingly increased (p=0.012).

Insertion of penile prosthesis is by far the most commonly performed primary procedure for Peyronie's disease in New York State, with 1 in 5 patients without erectile dysfunction receiving an implant. While this trend cannot be explained by an administrative data set alone, it does warrant further exploration, as the declining utilization of alternate surgical treatments could compromise surgeon comfort in performing penile grafting and/or tunical plication in the future and may exacerbate disparities in treatment over time.