Congenital penile curvature as a possible risk factor for the onset of Peyronie's disease, and psychological consequences of penile curvature

Abstract

Objective: To investigate a possible relationship between a history of congenital penile curvature (CPC) and Peyronie's disease (PD), and to characterize the psychological profile of patients suffering from PD, with or without concomitant CPC. Methods: We included 519 patients with Peyronie's disease (PD), of which 73 were found to have underlaying CPC. As a comparator population, we selected 2166 patients without PD, referring to our tertiary care clinic. In this population we detected 15 subjects with CPC. All patients completed the GAD-7 (Generalized-Anxiety-Disorder - 7 questions) and the PHQ-9 (Patient-Health-Questionnaire - 9 questions) questionnaires. Results: The overall prevalence of CPC in PD-patients was 14.07%, compared to a prevalence of 0.69% in the non-PD control population (p < 0.00001). Moderate-to-severe anxiety was found to be present in 89.4% of all PD-patients.Significantly higher proportions of patients with CPC associated with PD showed severe anxiety, compared to patients with PD alone (57.5% vs. 36.7%, respectively, p = 0.0008). Moderate- severe depression was found to be present in 57.8% of all PD- patients. Significantly higher proportions of PD patients with a history of CPC showed severe depression, compared to patients with PD alone (13.6% vs. 3.36%, respectively, p < 0.0002). GAD-7 median scores were significantly higher in patients with more severe penile curvatures (> 45°; p = 0.029). We did not detect a statistically significant difference between PHQ-9 medi- an scores based on the severity of PD (p = 0.53). Analysis of PHQ-9 and GAD-7 median scores showed significantly worse depressive and anxious symptoms in younger patients(p < 0.001 and p = 0.0013, respectively). Conclusions: The presence of congenital-penile-curvature may represent a risk factor for the subsequent onset of Peyronie's disease. Moderate/severe anxiety and moderate/severe depression were reported in a high fraction of cases. Anxiety was significantly higher in patients with more severe penile-curvatures, and depression was present independently of the degree of penile curvature. Depression and anxiety were found to be more severe in younger subjects.

Molecular Mechanisms and Risk Factors Related to the Pathogenesis of Peyronie’s Disease

“…Although no genome-wide association study (GWAS) studies to date have specifically examined genetic susceptibility to PD, other reported findings provide several possibly associated candidate genes. Other known intrinsic risk factors include aging and low testosterone level, while associations of the ABO blood group with congenital penile curvature (CPC) and PD have also been reported [ 177 , 184 ].…”

“…Thus, CPC is considered to have a completely different pathology from PD, an acquired condition that causes obvious pathological changes in the TA. Recently, Paulis et al conducted a retrospective analysis of a clinical database from a single andrology clinic and found a history of CPC in 73 of 519 patients with PD (14.1%), whereas only 15 (0.7%) of 2166 in a comparator population without PD had such results [ 184 ]. These authors speculated that the presence of CPC is a risk factor for the subsequent development of PD, although the mechanisms underlying the association between the two diseases remain unclear.…”

Chronic prostatitis as possible risk factor for Peyronie's disease: Psychological, sexual and prostatitis-like symptoms in patients with PD

“…Although there is no specific incidence of anxiety symptoms in PD in the literature, some studies report the presence of "emotional difficulties" and "distress" in about 80-81% of cases (34,35). In our recent study, we found that moderate-to-severe anxiety was present in 89.4% of PD patients (36).…”

“…The scientific literature is rich in studies that have demonstrated the presence of numerous risk factors able to favor the onset of PD. These studies include the following risk factors: penile trauma, erectile dysfunction, congenital penile curvature, Dupuytren's disease, diabetes mellitus, dyslipidemia, obesity, hypertension, smoking, alcohol consumption, rheumatoid arthritis, psoriasis, and psoriatic arthritis (36,(53)(54)(55)(56)(57)(58). This is the first study that specifically investigates the association between PD and CP.…”