Table 3.
Criteria for Surgical Management Options of Stable Peyronie’s Disease
| AUA (2015) | CUA (2018) | EAU (2020) | ISSM (2016) | |
|---|---|---|---|---|
| Plication | -Stable PD -Adequate erectile rigidity with or without pharmacotherapy or VED (Grade C) |
-Stable PD -Adequate erections with or without pharmacotherapy -Adequate penile length -Curve that is “reasonably correctable with this approach” -Minimal/absent hourglass + hinge (Level 3; Grade C) |
-Stable PD -Adequate erections with or without pharmacotherapy -Adequate penile length -Absence of complex deformity (hourglass, hinge) -“Non-severe” curvature (Level 3; Weak) |
-Stable PD- -Adequate erections with or without pharmacotherapy -Adequate penile length -Minimal to moderate curvature -Absence of hourglass causing hinge (Level 3; Grade B) |
| Preferred plication technique | Not specifically addressed | Dependent on surgeon and patient factors | -Dependent on surgeon and patient preference -No procedure with proven superiority |
-No surgical procedure with proven superiority |
| Incision or excision and grafting | -Stable PD -Adequate erectile rigidity with or without pharmacotherapy or VED (Grade C) |
-Stable PD -Adequate erections with or without pharmacotherapy -Short penile length -Severe curvature > 60° -Large penile plaques -Complex indentation or hourglass (Level 3; Grade C) |
-Stable PD -Adequate erections with or without pharmacotherapy -Significant penile shortening -Severe penile curvature (>60°commonly cited but, per the guideline panel experts there is no unanimous consensus to support this threshold) -Complex deformities (hourglass, hinge) (Level 3; Weak) |
-Stable PD -“Good” erectile function -Significant curvature and/or Indentation/hourglass deformity (with or without -Concerns regarding further penile length loss (Level 3; Grade B) |
| Preferred graft material | Not addressed | -No preferred graft -Recommend against synthetic grafts (Level 3; Grade C) |
-No preferred graft material -Recommend against synthetic grafts (Strong) |
-No ideal/preferred graft -Synthetic grafts not recommended |
| Penile prosthesis with adjunctive procedures* | -Stable PD -ED and/or penile deformity that impairs coitus (despite pharmacotherapy or VED) (Grade C) |
-Stable PD -ED non-responsive to pharmacotherapy -Severe deformity refractory to non-surgical management -failed plication or grafting -Profound penile instability (buckling or hinge) (Level 3; Grade C) |
-Stable PD -ED unresponsive to pharmacotherapy (Level 2a; Strong) |
-Stable PD -ED with inadequate response to pharmacotherapy or VED -Complex deformity (Level 3; Grade B) |
| Preferred prosthesis | -Inflatable prosthesis is preferred (Expert opinion) |
-Inflatable prosthesis is preferred (Level 3; Grade C) |
-Inflatable prosthesis classically considered more effective -Malleable with similar satisfaction rates -Patient and surgeon preference should determine device type and model |
-Inflatable penile prosthesis associated with higher satisfaction and lower persistent curvature compared with malleable -Similar outcomes with commercially available inflatable prosthesis models |
*
Adjunctive procedures may include manual modeling, plication, incision, or grafting