Erectile Dysfunction is a Risk Factor for Subsequent Peyronie’s Disease
Peyronie's Disease (PD) is characterized by accumulation of scar tissue in the tunica albuginea of the corpora cavernosa that leads to penile deformity and sexual disability. Prevalence of PD increases with age, similar to trends in erectile dysfunction (ED); however, the association between ED and PD is poorly understood. We hypothesized that men with ED would be more likely to subsequently develop PD and that ED treatment would attenuate this association.
The Truven Marketscan® database was queried from 2007-2015 for men in three groups: 1) Untreated ED; 2) ED treated with oral agents (sildenafil, tadalafil, or vardenafil); and, 3) Age-matched controls. ED claims were identified by ICD-9 code and/or receipt of oral agent. Subjects were required to have prescription coverage data, no PD in year prior to first ED claim (or matched date in controls), and at least one-year follow-up. Time zero was defined as the first ED claim or January 1 of the matched year in controls. To capture incident cases of PD after ED diagnosis, a minimum of 30 days was required between diagnoses. Multivariate proportional hazards models were adjusted for age, year, region, and insurance status.
A total of 254,513 men with untreated ED were identified in comparison to 459,758 men with treated ED and 714,271 controls. Median follow up was 3.0 years (range 1.0- 7.0). The hazard ratio (HR) for development of PD with any ED claim was 2.72 (95% CI 2.57-2.89) in comparison to controls. For those with ED treated with oral therapy, HR for PD development was 2.35 (95% CI 2.19-2.52) in comparison to HR of 3.49 (95% CI 3.17-3.89) with untreated ED. Finally, the HR for PD development in individuals treated with oral agents versus individuals with untreated ED was 0.66 (95% CI 0.62-0.70). Figure 1 demonstrates the Kaplan-Meier cumulative risk curve for PD development.
ED may be a risk factor for subsequent development of PD. Treatment of ED with oral agents may be protective against PD development. The risk of PD in men with ED, and the ability of ED treatment to decrease this risk, can only be fully assessed through prospective, long-term studies of at-risk men.