Penile Modeling in Peyronie?s Disease: A Systematic Review of the Literature

Introduction: Penile modeling to correct the penile curvature in Peyronie's disease (PD) may be achieved manually (intra-operatively or post-injection) or by using assisted devices (penile traction, vacuum device, or penile prosthesis). Objectives: To evaluate the efficacy, safety, and satisfaction associated with penile modeling in patients with PD. Methods: A PROSPERO registered (CRD42021241729) systematic search in MEDLINE and Cochrane Library was done following PRISMA. PICO: Studies were deemed eligible if they assessed patients with PD (P) undergoing modeling procedures (I) with or without a comparative group(C) evaluating the efficacy, safety, or patient satisfaction (O). Retrospective and prospective primary studies were included. The primary outcome measure is the change in penile curvature after modeling. The secondary outcome measures are the change in stretched penile length, adverse events, and patient satisfaction after modeling. Results: A total of 23 studies, involving 1,238 patients were included. Most studies (13, 56.5%) evaluated penile traction therapy. The studies were of low and intermediate quality (mean Newcastle-Ottawa Scale score of 5.7 and mean Jadad score of 3.3) with a mean level of evidence of 3.4. The mean penile curvature at baseline was between 31 and 80.8 degrees. Nine (39.1%) studies found a significant improvement (P < .05) of penile curvature after penile modeling, ranging between 11.7, and 37.2 degrees. An increase in mean stretched penile length was reported in 7 (30.4%) articles, varying between 0.4, and 1.8 cm. Serious complications such as penile prosthesis malfunctions (3.3-11.1%) and urethral injuries (2.9%) were only reported for intra-operative manual modeling. Conclusion: Although individual studies have noted improvement in penile curvature and stretched penile length, specific recommendations regarding penile modeling in PD cannot be provided due to limited evidence available. Further RCTs with adequate sample size, validated assessment tools, and longer follow-up are needed. Copyright (C) 2022, International Society of Sexual Medicine. Published by Elsevier Inc. All rights reserved.