EAU guidelines on penile curvature

Konstantinos Hatzimouratidis, Ian Eardley, François Giuliano, Dimitrios Hatzichristou, Ignacio Moncada, Andrea Salonia, Yoram Vardi, Eric Wespes

Research output: Contribution to journalArticle

Abstract

Context: Penile curvature can be congenital or acquired. Acquired curvature is secondary due to La Peyronie (Peyronie's) disease. Objective: To provide clinical guidelines on the diagnosis and treatment of penile curvature. Evidence acquisition: A systematic literature search on the epidemiology, diagnosis, and treatment of penile curvature was performed. Articles with the highest evidence available were selected and formed the basis for assigning levels of evidence and grades of recommendations. Evidence synthesis: The pathogenesis of congenital penile curvature is unknown. Peyronie's disease is a poorly understood connective tissue disorder most commonly attributed to repetitive microvascular injury or trauma during intercourse. Diagnosis is based on medical and sexual histories, which are sufficient to establish the diagnosis. Physical examination includes assessment of palpable nodules and penile length. Curvature is best documented by a self-photograph or pharmacologically induced erection. The only treatment option for congenital penile curvature is surgery based on plication techniques. Conservative treatment for Peyronie's disease is associated with poor outcomes. Pharmacotherapy includes oral potassium para-aminobenzoate, intralesional treatment with verapamil, clostridial collagenase or interferon, topical verapamil gel, and iontophoresis with verapamil and dexamethasone. They can be efficacious in some patients, but none of these options carry a grade A recommendation. Steroids, vitamin E, and tamoxifen cannot be recommended. Extracorporeal shock wave treatment and penile traction devices may only be used to treat penile pain and reduce penile deformity, respectively. Surgery is indicated when Peyronie's disease is stable for at least 3 mo. Tunical shortening procedures, especially plication techniques, are the first treatment options. Tunical lengthening procedures are preferred in more severe curvatures or in complex deformities. Penile prosthesis implantation is recommended in patients with erectile dysfunction not responding to pharmacotherapy. Conclusions: These European Association of Urology (EAU) guidelines summarise the present information on penile curvature. The extended version of the guidelines is available on the EAU Web site (www.uroweb.org/guidelines/).

Original languageEnglish
Pages (from-to)543-552
Number of pages10
JournalEuropean Urology
Volume62
Issue number3
DOIs
Publication statusPublished - Sep 2012

Fingerprint

Urology
Penile Induration
Guidelines
Verapamil
Penile Implantation
Therapeutics
para-Aminobenzoates
4-Aminobenzoic Acid
Drug Therapy
Iontophoresis
Wounds and Injuries
Traction
Collagenases
Erectile Dysfunction
Tamoxifen
Vitamin E
Connective Tissue
Interferons
Dexamethasone
Physical Examination

Keywords

  • Acquired
  • Congenital
  • EAU guidelines
  • Medical management
  • Penile abnormalities
  • Penile curvature
  • Peyronie's disease
  • Pharmacotherapy
  • Surgical management

ASJC Scopus subject areas

  • Urology

Cite this

Hatzimouratidis, K., Eardley, I., Giuliano, F., Hatzichristou, D., Moncada, I., Salonia, A., ... Wespes, E. (2012). EAU guidelines on penile curvature. European Urology, 62(3), 543-552. https://doi.org/10.1016/j.eururo.2012.05.040

EAU guidelines on penile curvature. / Hatzimouratidis, Konstantinos; Eardley, Ian; Giuliano, François; Hatzichristou, Dimitrios; Moncada, Ignacio; Salonia, Andrea; Vardi, Yoram; Wespes, Eric.

In: European Urology, Vol. 62, No. 3, 09.2012, p. 543-552.

Research output: Contribution to journalArticle

Hatzimouratidis, K, Eardley, I, Giuliano, F, Hatzichristou, D, Moncada, I, Salonia, A, Vardi, Y & Wespes, E 2012, 'EAU guidelines on penile curvature', European Urology, vol. 62, no. 3, pp. 543-552. https://doi.org/10.1016/j.eururo.2012.05.040
Hatzimouratidis K, Eardley I, Giuliano F, Hatzichristou D, Moncada I, Salonia A et al. EAU guidelines on penile curvature. European Urology. 2012 Sep;62(3):543-552. https://doi.org/10.1016/j.eururo.2012.05.040
Hatzimouratidis, Konstantinos ; Eardley, Ian ; Giuliano, François ; Hatzichristou, Dimitrios ; Moncada, Ignacio ; Salonia, Andrea ; Vardi, Yoram ; Wespes, Eric. / EAU guidelines on penile curvature. In: European Urology. 2012 ; Vol. 62, No. 3. pp. 543-552.
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abstract = "Context: Penile curvature can be congenital or acquired. Acquired curvature is secondary due to La Peyronie (Peyronie's) disease. Objective: To provide clinical guidelines on the diagnosis and treatment of penile curvature. Evidence acquisition: A systematic literature search on the epidemiology, diagnosis, and treatment of penile curvature was performed. Articles with the highest evidence available were selected and formed the basis for assigning levels of evidence and grades of recommendations. Evidence synthesis: The pathogenesis of congenital penile curvature is unknown. Peyronie's disease is a poorly understood connective tissue disorder most commonly attributed to repetitive microvascular injury or trauma during intercourse. Diagnosis is based on medical and sexual histories, which are sufficient to establish the diagnosis. Physical examination includes assessment of palpable nodules and penile length. Curvature is best documented by a self-photograph or pharmacologically induced erection. The only treatment option for congenital penile curvature is surgery based on plication techniques. Conservative treatment for Peyronie's disease is associated with poor outcomes. Pharmacotherapy includes oral potassium para-aminobenzoate, intralesional treatment with verapamil, clostridial collagenase or interferon, topical verapamil gel, and iontophoresis with verapamil and dexamethasone. They can be efficacious in some patients, but none of these options carry a grade A recommendation. Steroids, vitamin E, and tamoxifen cannot be recommended. Extracorporeal shock wave treatment and penile traction devices may only be used to treat penile pain and reduce penile deformity, respectively. Surgery is indicated when Peyronie's disease is stable for at least 3 mo. Tunical shortening procedures, especially plication techniques, are the first treatment options. Tunical lengthening procedures are preferred in more severe curvatures or in complex deformities. Penile prosthesis implantation is recommended in patients with erectile dysfunction not responding to pharmacotherapy. Conclusions: These European Association of Urology (EAU) guidelines summarise the present information on penile curvature. The extended version of the guidelines is available on the EAU Web site (www.uroweb.org/guidelines/).",
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AB - Context: Penile curvature can be congenital or acquired. Acquired curvature is secondary due to La Peyronie (Peyronie's) disease. Objective: To provide clinical guidelines on the diagnosis and treatment of penile curvature. Evidence acquisition: A systematic literature search on the epidemiology, diagnosis, and treatment of penile curvature was performed. Articles with the highest evidence available were selected and formed the basis for assigning levels of evidence and grades of recommendations. Evidence synthesis: The pathogenesis of congenital penile curvature is unknown. Peyronie's disease is a poorly understood connective tissue disorder most commonly attributed to repetitive microvascular injury or trauma during intercourse. Diagnosis is based on medical and sexual histories, which are sufficient to establish the diagnosis. Physical examination includes assessment of palpable nodules and penile length. Curvature is best documented by a self-photograph or pharmacologically induced erection. The only treatment option for congenital penile curvature is surgery based on plication techniques. Conservative treatment for Peyronie's disease is associated with poor outcomes. Pharmacotherapy includes oral potassium para-aminobenzoate, intralesional treatment with verapamil, clostridial collagenase or interferon, topical verapamil gel, and iontophoresis with verapamil and dexamethasone. They can be efficacious in some patients, but none of these options carry a grade A recommendation. Steroids, vitamin E, and tamoxifen cannot be recommended. Extracorporeal shock wave treatment and penile traction devices may only be used to treat penile pain and reduce penile deformity, respectively. Surgery is indicated when Peyronie's disease is stable for at least 3 mo. Tunical shortening procedures, especially plication techniques, are the first treatment options. Tunical lengthening procedures are preferred in more severe curvatures or in complex deformities. Penile prosthesis implantation is recommended in patients with erectile dysfunction not responding to pharmacotherapy. Conclusions: These European Association of Urology (EAU) guidelines summarise the present information on penile curvature. The extended version of the guidelines is available on the EAU Web site (www.uroweb.org/guidelines/).

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