Real and perceived magnitude of curvature among patients affected by penile curvature: acquired penile curvature (APC) vs congenital penile curvature (CPC) are there any differences?

INTRODUCTION AND OBJECTIVES: Acquired penile curvature (APC) and congenital penile curvature (CPC) are the most frequent causes of penile deformity. This can have psychological repercussions and effects on patient’s self-image (potentially resulting in depressive symptoms, relationship discord, self-esteem, confidence and social isolation). It has been demonstrated that only 20% of patients accurately report the degree of curvature and preoperative objective measures of erect deformity are necessary in order to accurately counsel patients. Aim: to evaluate the perceived magnitude of curvature among patients affected by penile curvature. METHODS: We recruited, from January 2013 to September 2014, patients with APC or CPC and invited them to: - assess their magnitude of curvature by drawing their own penis in erection on the orthogonal planes; - answer 2 questionnaires: International Index of Erectile Function (IIEF-5) and Beck Depression Inventory II (BDI-II); - undergo a physical examination and history; - have their erected penis photographed on the orthogonal planes Alprostadil was used to obtain an optimal rigidity. Drawing curvature angle and the photograph curvature angle were compared. RESULTS: The sample consisted of 86 men (67 APC and 19 CPC). Mean age was 55 (DS: 9.8) years old in APC group and a 34 years old in CPC group. In both groups had not been observed differences statistically significant regards IIEF-5 or BDI-II score, which otherwise correlate significantly with age. The real mean curvature, measured on the photograph, was 44.63 and 46.0 degrees for APC and CPC group, respectively. The mean curvature assessed by the patient, measured on the drawing, was 56.1 and 32.7 degrees for APC and CPC group, respectively. The mean difference between the 2 measurements were: þ12 degrees in APC group and -14 degrees in CPC group. This data was statistically significant (p<0.01). CONCLUSIONS: Penile curvature affects patient self- image. Patient affected by APC versus a patient with CPC, graphically overestimates the real magnitude of curvature. Best treatment option is very challenging in patients with penile curvature and frequently patients expectations cannot be satisfied by surgery. We believe that for every patients evaluated for penile curvature, the difference between the real magnitude and the perceived magnitude of curvature must be checked, in order to evaluate if patients really benefit from surgery or not