Penile Autophotography Underestimates the Degree of Penile Curvature in Peyronie's Disease

Background: Penile curvature is the most debilitating symptom of Peyronie's disease (PD); the evaluation of the degree of angulation is essential for planning treatment strat-egy. However, the most used method of penile at-home autophotography (AHP) is asso-ciated with some potential pitfalls and discrepancies compared with different assessment methods.Objective: To compare the degree of penile curvature quantified by AHP and in-office intracavernosal alprostadil injection (ICI) prior to therapy.Design, setting, and participants: Data from 55 PD patients of a single tertiary referral center were analyzed. All patients provided standardized AHP of the erect phallus. Clinic-based assessment included ICI with curvature measurement and completion of the International Index of Erectile Function (IIEF-15).Outcome measurements and statistical analysis: The Wilcoxon and/or chi-square test was used to compare the degree of curvature obtained using AHP and ICI, and to evaluate whether erectile dysfunction was a predictor of a relevant difference of >10 degrees in curvature assessment between AHP and ICI.Results and limitations: Our study showed a significant (p < 0.001) difference in the degree of penile curvature between AHP (48 degrees [38 degrees; 55 degrees]) and ICI (50 degrees [40 degrees; 65 degrees]). Patients suffering from erectile dysfunction tend to have a higher difference in the degree of penile curvature between AHP and ICI than patients with good erectile func-tion (p < 0.001). Our study is not devoid of limitations. First, we did not use Peyronie's Disease Questionnaire, as suggested by the European Association of Urology guidelines. Second, we did not evaluate inter-and intraobserver variations in the measurements.Conclusions: AHP tends to underestimate the extent of penile curvature compared to ICI. Erectile dysfunction is an independent predictor of measurement differences of >10 degrees between AHP and ICI.Patient summary: It is necessary to evaluate the degree of penile curvature in Peyronie's disease prior to therapy decision. The at-home self-photography underestimates the real degree of penile curvature compared with an erection by in-office penile drug injection. Especially men suffering from erectile dysfunction carry the risk of a high difference in the measured degree of penile curvature, with a potential impact on the further treatment.(c) 2022 European Association of Urology. Published by Elsevier B.V. All rights reserved.