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Response to comment on: penile prosthesis implantation is safe and effective in Peyronie’s disease patients with and without erectile dysfunction

International Journal of Impotence Research volume 37, pages 103–104 (2025)Cite this article

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The mechanisms leading to Erectile dysfunction (ED) in Peyronie’s disease (PD) are still debatable [1,2,3]. One plausible mechanism is the lack of activation of the veno-occlusive mechanism due to the plaque in PD [1] and some authors highlight the psychological burden and pain being the factors for poor erections in PD [2]. According to the theory proposed by Goldstein and Udelson [1], the inelasticity of the plaque causes an inadequate stretching of the sub-tunical venules leading to a lack of activation of the veno-occlusive mechanism and subsequent venous leakage. It is very common that the rigidity of the erection is normal in the base of the penis but is less firm distally from the point of plaque. This also may explain the de novo ED that some patients experience after grafting in PD due to a lack of tunica expansion and venous leakage. Geometrical alterations of the penile anatomy may also cause a lack of rigidity, a bent penis has less axial rigidity than a straight penis based on the geometrical properties of a column-like erect penis.

The traditional concept in the management of PD has been to do penile prosthesis (PP) implantation when there is refractory ED [4]. However, there has been an evolving trend where some men with PD having normal erections have undergone PP during surgical correction of bothersome curvature [5, 6]. Recently, Moncada et al. reported that 19.6% (n = 33/135) of PD patients without ED opted for PP when curvature correction surgery was planned [5]. Another study by Kurtzman et al. analysed the New York State PP Registry which revealed that 1 in 5 PD patients without ED had received a PP between 2003 and 2016 [6]. Intraoperative manual modelling [7] and post-operative home modelling [8] over inflatable PP in PD can help in the correction of primary or residual curvature respectively. Hence adjunct procedures such as plication or grafting can be avoided, which otherwise may lead to post-operative poor patient satisfaction.

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Authors and Affiliations

  1. Dept of Urology & Robotic Surgery, Hospital Universitario Sanitas la Zarzuela, Madrid, 28023, Spain

    Ignacio Moncada

  2. Andrology Division, Department of Urology, Orchidz Health, AndroNeo, NU Hospitals, Bangalore, 560010, India

    Pramod Krishnappa

Authors
  1. Ignacio Moncada
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  2. Pramod Krishnappa
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Contributions

Ignacio Moncada had full access to all the data in the study and took responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: Moncada. Analysis and interpretation of data: Moncada, Krishnappa. Draughting of the manuscript: Krishnappa, Moncada. Critical revision of the manuscript for important intellectual content: Moncada, Krishnappa, Approval of final version: Moncada, Krishnappa.

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Correspondence to Pramod Krishnappa.

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Moncada, I., Krishnappa, P. Response to comment on: penile prosthesis implantation is safe and effective in Peyronie’s disease patients with and without erectile dysfunction. Int J Impot Res 37, 103–104 (2025). https://doi.org/10.1038/s41443-024-00984-6

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