A NEW classification system for Peyronie’s disease (PD), has been introduced in a recent study aiming to better define the subtypes and stages of this condition. PD is a chronic disorder that leads to penile scarring, curvature, and, in some cases, pain. While the disease has long been recognised, progress in developing categories beyond basic criteria has been limited. Currently, many cases of penile curvature or pain are often grouped under the broad diagnosis of PD, however, the diverse presentations of the disease suggest that distinct subtypes exist.
To develop categories for the disease, researchers conducted a retrospective analysis of 1,098 male patients who were diagnosed with penile deformity between 2020 and 2023. These participants completed comprehensive questionnaires detailing their disease history and current symptoms. Additionally, a second group of 719 participants was studied to examine a specific relapsing, or remitting, subtype of the disease.
The study identified four distinct subtypes of PD, the first, classical and nonclassical PD, includes cases that align with traditional descriptions of the disease. The second subtype, calcifying PD, is characterised by moderate to severe calcification while the third, progressive PD, is marked by worsening symptoms after the initial disease onset. The fourth, and final, subtype was labelled relapsing/remitting PD and was defined by periods of stability followed by reactivation after at least six months.
In addition to these PD subtypes, the researchers identified three categories of non-PD penile curvatures: congenital, which is present since birth; maturational, which develops around puberty; and trauma-induced, resulting from injury. The study also found that penile pain is not a reliable indicator of disease progression or stability, challenging a common assumption in diagnosing and managing PD.
To standardise the classification and communication of PD, the researchers proposed a new staging system known as PTNM. This system classifies the disease based on four key factors: P, the PD component, T, whether trauma is present, N, the non-PD curvature, and M, the mode of the disease defined as a stable or active phase. The researchers hope this PTNM system will improve the accuracy of prognosis, enhance patient counselling, and aid in treatment decisions, while also facilitating further research into PD.
Katie Wright, EMJ
Reference
Trost L et al. Creation of a novel classification system (PTNM) for Peyronie’s disease and penile curvature using evidence-based criteria. J Urol. 2024;212(3):470-82.
