| Abstract: |
Purpose: Our goal was to identify new Peyronie’s disease (PD) subtypes, non-PD penile curvature classifications, and define active (acute) vs stable (chronic) phases of disease using evidence-based analyses. Materials and Methods: A retrospective review was performed of 1098 men who presented with penile deformity, including subjective standardized and nonstandardized questionnaires and objective measures. A second cohort of 719 men who were sent a mailed survey was also utilized for the relapsing/remitting subtype. Statistical analyses were performed to identify clusters of disease characteristics representative of distinct PD and non-PD categorizations, including sensitivity/specificity analyses and subtype comparisons. Results: Comparative analyses identified 4 distinct subtypes of PD: (1) classical and nonclassical, (2) calcifyingdmoderate/severe calcification, (3) progressivedsubjective worsening following disease onset, and (4) relapsing/remittingdreactivation following ≥ 6 months of stability. Additional, non-PD categorizations included congenital (lifelong), maturational (developed around puberty), and trauma induced. Statistical analyses demonstrated unique profiles among each category. Penile pain was not found to be a reliable predictor for disease progression or stability. Stable phase disease (historically “chronic”) was variably defined by subtype: classical (≥3 months); progressive, calcifying, or trauma induced (≥12 months D ≥3 months stable OR ≥6 months stable). Similarly, PD subtypes may be assigned at ≥ 3 months following disease onset. A PTNM staging system is proposed to help communicate disease states, in which P [ PD component (Cadcalcifying, Cldclassical, Pdprogressive, Rdrelapsing/remitting, Udundifferentiated), T [ trauma component (0dabsent, 1dpresent), N [ non-PD component (Cdcongenital, Mdmaturational, Udundifferentiated), and M [ mode (0dstable, 1dactive); for example, PClT1N0M0 [ stable classical PD with prior trauma. Conclusions: The current study provides an evidence-based proposal for the establishment of new PD subtypes and non-PD curvature categorizations as well as a standardized definition for active vs stable phases of disease. © 2024 by AMERICAN UROLOGICAL ASSOCIATION EDUCATION AND RESEARCH, INC. |
