Effects of patients' understanding and choice of surgical types on postoperative outcomes of Peyronie's disease: a single-center retrospective study of 108 patients

Clinical Presentation of Peyronie's Disease: A Retrospective Study of 564 Cases

Peyronie's disease (PD) affects the penile albuginea, resulting in penile deformity, pain, erectile dysfunction (ED), and an anxious-depressive state. PD diagnosis involves a thorough medical history, penile palpation, documentation of the penile deformation, a dynamic penile echo color Doppler ultrasound (PCDU), and the completion of questionnaires for the evaluation of pain, ED, and psychometric tests. The aim of this study was to evaluate the symptoms of PD and their prevalence in PD patients in the active phase who had access to our andrology clinic. Inclusion criteria: availability of data on patients diagnosed with PD, including detailed medical history, blood tests, penile palpation, photographic documentation of penile deformity, and penile PCDU. Exclusion criteria: PD patients in the stable phase or those without the specified tests and data mentioned above. Our study found a higher prevalence of PD in younger patients (24.2%), a higher coexistence of PD with chronic prostatitis (35.6%), a higher percentage of cases of association between penile deformity and penile curvature (84.4%), a higher prevalence of "significant anxiety" (88.4%), a higher presence of plaque calcification (35.6%), and the detection of a longer duration of the first phase of PD (>18 months). The most frequently observed type of penile curvature was dorsal, followed by left lateral, right lateral, and, less commonly, ventral. We observed a significant statistical correlation between patient age and IIEF score, indicating that patients over the age of 40 years are at a higher risk of experiencing ED. We found a strong statistical relationship between VAS score and age. As age increases, the VAS score decreases, suggesting that younger patients reported more penile pain compared to those who were older than 40 years. Furthermore, we found that penile pain has a significant impact on the psychological state of PD patients. We also found that 38.8% of PD patients suffered from severe anxiety. In relation to this, psychotherapy should be integrated into PD treatment to improve the quality of life and treatment adherence.

What do patients with Peyronie's disease expect from therapy? A prospective multi-center study

BACKGROUND

Little is known about patients' pre-treatment expectations in Peyronie's disease (PD).

OBJECTIVE

To evaluate in detail patients' expectations of conservative therapy and surgery.

PATIENTS AND METHODS

This multi-center study prospectively enrolled 317 PD patients, who were scheduled to receive conservative therapy or surgery between 2019 and 2022 at the Department of Urology of the University Medical Center Hamburg-Eppendorf, and the Center of Reproductive Medicine and Andrology, University Medical Center Muenster, both Germany. The primary end-point was patients' pre-treatment expectations of conservative therapy and surgery, measured with the Stanford Expectations of Treatment Scale (SETS). Secondary end-points included patient-reported psychological and physical symptoms, penile pain, symptom bother and erectile function, measured with the Peyronie's disease questionnaire (PDQ) and International Index of Erectile Function Erectile Function Domain (IIEF-EF).

RESULTS

In total, 239 (75%) and 78 (25%) patients were scheduled for the conservative therapy and surgery, respectively. Patients undergoing surgery had higher positive and negative mean SETS expectations scores (14 vs. 11, p < 0.001; 9.6 vs. 6.0, p < 0.001). In multivariable analysis, surgery was an independent predictor of positive and negative patients' pre-treatment expectations (all p ≤ 0.001). In thematic analysis, patients undergoing surgery emphasized distinct themes of pre-treatment expectations. Patients undergoing surgery had higher mean PDQ symptom bother as well as higher psychological and physical symptom scores (14 vs. 10, p < 0.001; 9.2 vs. 7.1, p = 0.001). There were significant positive correlations between SETS negative expectation score and PDQ symptom bother (|ρ| = 0.25; p < 0.001) as well as PDQ psychological and physical symptoms score, respectively (|ρ| = 0.21; p = 0.001).

CONCLUSION

PD patients expect both more benefit and more harm from surgery. In addition, patients undergoing surgery have more psychological and physical symptoms and more symptom bother. To set realistic expectations, it is of pivotal importance to assess patients' expectations before starting treatment.

Testicular salvage: using machine learning algorithm to develop a predictive model in testicular torsion

PURPOSE

To compare the models developed with a classical statistics method and a machine learning model to predict the possibility of orchiectomy using preoperative parameters in patients who were admitted with testicular torsion.

MATERIALS AND METHODS

Patients who underwent scrotal exploration due to testicular torsion between the years 2000 and 2020 were retrospectively reviewed. Demographic data, features of admission time, and other preoperative clinical findings were recorded. Cox Regression Analysis as a classical statistics method and Random Forest as a Machine Learning algorithm was used to create a prediction model.

RESULTS

Among patients, 215 (71.6%) were performed orchidopexy and 85 (28.3%) were performed orchiectomy. The multivariate analysis revealed that monocyte count, symptom duration, and the number of previous Doppler ultrasonography were predictive of orchiectomy. Classical Cox regression analysis had an area under the curve (AUC) 0.937 with a sensitivity and specificity of 88 and 87%. The AUC for the Random Forest model was 0.95 with a sensitivity and specificity of 92 and 89%.

CONCLUSION

The ML model outperformed the conventional statistical regression model in the prediction of orchiectomy. The ML methods are cheap, and their powers increase with increasing data input; we believe that their clinical use will increase over time.