Holler, Jordan T.

Abstract Background As perception of penile curvature varies widely, we sought to understand how adults perceive curvature and how these opinions compare with those of patients with curvature, specifically Peyronie’s disease (PD). Aim To investigate the perspectives of curvature correction from adults with and without PD, as well as differences within demographics. Methods A cross-sectional survey was administered to adult patients and nonpatient companions in general urology clinics at 3 institutions across the United States. Men, women, and nonbinary participants were recruited. Patients were grouped as having PD vs andrology conditions without PD vs general urology conditions plus companions. The survey consisted of unlabeled 2-dimensional images of penis models with varying degrees of curvature. Participants selected images that they would want surgically corrected for themselves and their children. Univariable and multivariable analyses were performed to identify demographic variables associated with willingness to correct. Outcomes Our main outcome was to detect differences in threshold to correct curvature between those with and without PD. Results Participants were grouped as follows: PD (n = 141), andrology (n = 132), and general (n = 302) . Respectively, 12.8%, 18.9%, and 19.9% chose not to surgically correct any degree of curvature (P = .17). For those who chose surgical correction, the mean threshold for correction was 49.7°, 51.0°, and 51.0° (P = .48); for their children, the decision not to correct any degree of curvature was 21.3%, 25.4%, and 29.3% (P = .34), which was significantly higher than correction for themselves (P < .001). The mean threshold for their children’s correction was 47.7°, 53.3°, and 49.4° for the PD, andrology, and general groups (P = .53), with thresholds no different vs themselves (P = .93). On multivariable analysis, no differences were seen in demographics within the PD and andrology groups. In the general group, participants aged 45 to 54 years and those who identified as LGBTQ (lesbian, gay, bisexual, transgender, queer) had a higher threshold for correction as compared with their counterparts when factoring other demographic variables (63.2° vs 48.8°, P = .001; 62.1° vs 50.4°, P = .05). Clinical Implications With changing times and viewpoints, this study stresses the importance of shared decision making and balancing risks and benefits to correction of penile curvature. Strengths and Limitations Strengths include the broad population surveyed. Limitations include the use of artificial models. Conclusion No significant differences were seen in the decision to surgically correct curvature between participants with and without PD, with participants being less likely to choose surgical correction for their children.

ABSTRACT Introduction Congenital penile curvature is common and presents with varying levels of severity. The curvature may present during infancy or post-pubertal. Historically, treatment has consisted of surgical correction, typically with penile plication or complex grafting procedures. Most pediatric urologists recommend surgical management for penile curvature (PC) based on curvature severity, with previous work identifying ≥ 30° as a common threshold to recommend correction. Objective To assess adult patients’ opinions on willingness to consider surgical correction for PC in order to determine if this aligns with pediatric urologists’ opinions. Methods In this cross-sectional study, a survey was administered to adult patients and their partners (> 18 years of age) in general adult urology clinics at 3 geographically separate institutions. The survey consisted of unlabeled images of penis models with varying degrees of PC (range 10-90°). Respondents were asked to select the images they would want surgically corrected for themselves or their partners. Univariable and multivariable analyses were performed to identify demographic variables associated with willingness to consider correction (p-values < .05 considered significant). Results Response rate was 77% (300/388). The majority (80%) of participants chose to surgically correct PC, however 20% chose to not surgically correct any degree of PC. Most participants were male (70%), married (62%), heterosexual (92%), and did not work in healthcare (80%) (Table 1). Among those who endorsed willingness to surgically correct PC, the average threshold for correction was 40.5° (SD 25.3). On univariable analysis, there was a significant difference in willingness to undergo PC correction based on gender, age groups, sexual orientation, and region (Table 1). Male patients were more likely to consider surgery at a lower degree of PC compared to females (36.6° vs 50.6°, p<.001). Those who identified as heterosexual also had a lower threshold for correction compared to those identifying as LGBTQ (39.6° vs 56.4°, p=.015). Midwestern residents endorsed an average threshold for correction of 21.5° compared to other regions varying between 40° to 60° (p<.001). Regionality differences remained true on multivariable analysis when accounting for all demographic features (p<.001). Conclusions In surveying adult patients, we identified an average PC threshold of 40° beyond which surgical correction was desired. Females and LGBTQ+ participants had a higher threshold for surgical correction, but when accounting for all demographic factors, only residence in the Midwest US was associated with a lower threshold for correction. Disclosure No