Introduction: The actual aetiology of Peyronie’s Disease (PD) is still unknown. Although several associated risk factors have been identified (e.g., penile trauma, hypertension, diabetes mellitus, smoking, etc.) some patients develop PDdespite the absence of commonly recognised risk factors. We aimed to investigate the rate of and the clinical characteristics of men with PD and no risk factors versus patients with PD and at least 1 risk factor.
Methods: Complete demographic, clinical and laboratory data from 566 patients seeking first medical help for PDbetween 2015-2021 at a single tertiary-referral center were analysed. Every patient completed the IIEF-15 and PDQ questionnaires. Descriptive statistics was used to compare categorical and continuous variables, between the entire cohort segregated according to the presence of known risk factors, such as: diabetes, dyslipidemias, hypertension, ischemic cardiopathy, autoimmune diseases (e.g., Dupuytren’s disease or other connective tissue diseases), previous pelvic surgery (e.g., radical prostatectomy), smoking, alcohol consumption (>1L/week), erectile disfunction (ED), and low testosterone levels ( < 3 ng/mL). Health-significant comorbidities were scored with the Charlson Comorbidity Index (CCI). In order to better measure the degree of curvature after intra cavernous injection (ICI) and evaluate the penile haemodynamic (peak systolic velocity (PSV) < 35 cm/s and/or resistance index (RI) = 0.80 at 20 minutes after ICI), dynamic penile color doppler duplex ultrasound (CDDU) was suggested to all patients.
Results: Of 566, 96 (17%) patients did not report any associated comorbidity or risk factor, and none had a positive clinical history for penile trauma. No differences were found between groups in terms of PDQ scores in each PDQ subscale (i.e., Pain, Bother and Symptoms) and serum hormones. Patients with no risk factors had lower age (median (IQR) 48 (34, 56) vs. 58 (48, 64) yrs; p<0.001), BMI (23.7 (22.0, 26,2) vs. 25.4 (23.7, 27.8) kg/m^2; p<0.001) and CCI (CCI=1 in 3 (3%) vs. 47 (10%) patients; p=0.04). IIEF-EF was lower in patients with known risk factors (median (IQR) IIEF-EF score 20 (9, 27) vs. 26 (16.50, 28.50); p=0,03). At CDDU, patients with no risk factors for PD had worse degree of curvature (70 (52.5, 90.0) vs. 50 (30, 80) degrees; p=0.02), better PSV values (44.6 (41.7, 53.2) vs. 37.9 (30.9, 42.1) cm/s; p=0,01) and comparable RI values.
Conclusions: Approximately one out of five men presenting for PD had no risk factors or known associated comorbidity. To our knowledge, this is the first study highlighting the clinical characteristics of this subgroup of patients.
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