(483) Predictors of Hinge Effect in Patients with Peyronie’s Disease

Abstract

Introduction Patients with Peyronie’s disease (PD) suffer from a variety of penile deformities including curvature, indentation, hourglass, penile shortening, as well as erectile dysfunction. The presence of a hinge effect can be appreciated at time of penile duplex evaluation as buckling or folding of the shaft when axial pressure is placed on the glans. Patients with hinge effect can experience bothersome buckling of the erection and instability during penetrative sex. The actual characteristics that cause this hinge effect and its clinical implications are not fully understood. Objective We aim to determine the PD factors that cause hinge effect. Furthermore, we seek to assess the role of hinge effect on subsequent surgical intervention. Methods Retrospective chart review was conducted on 1483 patients presenting with PD from 2016 to 2021. 1223 patients who had a complete penile duplex evaluation and hinge assessment were included for analysis. Baseline demographics, penile duplex assessment, and clinical outcomes were recorded. Univariate and multivariate analyses were performed to assess for predictors of hinge effect. Results Hinge effect was observed at the time of penile duplex evaluation in 33% of PD patients. The degree of indentation (1.82 OR, p < 0.001), rigidity of erections (0.82 OR, p=0.002), and degree of primary curvature (1.03 OR, p < 0.001) predicted presence of hinge effect. Furthermore, hinge effect greatly affected the type of surgical intervention required to correct PD deformity. Patients with presence of hinge effect were more likely to require plaque incision/excision and grafting as opposed to tunica albuginea plication in PD patients with good quality erections. When controlling for erectile rigidity, patients who underwent partial plaque excision and grafting were more likely to have hinge when measured girth discrepancy was >1 cm (p < 0.001). In patients requiring penile prosthesis, incision and grafting was more commonly required when hinge effect was present. Conclusions The presence of hinge effect can be extremely bothersome and cause instability of erections during penetrative sex. Multiple factors may predispose to a hinge effect, including quality of erection, severity of curvature. But when controlling for rigidity, a girth discrepancy of >1 cm did appear to pre-dispose to a hinge. Additionally, assessment of hinge effect pre-operatively was important in terms of determining the optimal surgical intervention to correct PD deformities. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific