Peyronie's Disease is common in poorly controlled diabetics but is not associated with the metabolic syndrome
Habous, M1; Malkawi, I2; Han, E3; Nassar, M1; Abdelrahman, Z1; Binsaleh, S4; Bettocchi, C5; Ralph, D6; Santucci, R7
1: Elaj Medical Centers, Saudi Arabia; 2: DMC Department of Urology,USA; 3: DMC Department of urology,USA; 4: King Saud university,Riyadh,Saudi Arabia; 5: Bari university,Italy; 6: St Peters institute,UCLH,London,UK; 7: DMC Department of urology ,Detroit,USA
Purpose: The root cause of Peyronie's disease (PD) is unknown. Many theories have been advocated for its etiology, but the most widely accepted is trauma to the tunica albuginea. Because prevalence varies widely the potential for contributory cofactors/comorbidities has been proposed. We hypothesized that metabolic syndrome and other systemic comorbidities may be found at higher rates in the PD population, and endeavored the largest descriptive study ever to test this hypothesis.
Materials and Methods: A retrospective chart review of 1833 patients presenting to a men's health clinic with a variety of complaints: erectile dysfunction (ED), premature ejaculation (PE), premarital checkup, small penis, decreased libido, lower urinary tract symptoms (LUTS) and PD were screened for PD. Variables collected: presence/absence of diabetes mellitus (DM), hypertension (HTN), dyslipidemia (DL), body mass index (BMI), total testosterone (T), penile peak systolic velocity (PSV), end diastolic velocity (EDV) in patients with ED and/or PD, smoking, glycosylated hemoglobin level (HbA1c) in patients with diabetes, and the presence of metabolic syndrome. Patients with PD were compared to patients without PD.
Results: A total of 1622 patients, with a mean age of 41 years (range 19-82) were analyzed. PD prevalence ranged widely depending on presenting diagnosis, from 7-51%, with an average of 20%. Metabolic syndrome, hypertension, BMI, T level, total number of comorbidities, low PSV, abnormal EDV, and mean HbA1c were not associated with a higher prevalence of PD. Diabetes and a HbA1c level >8.5 were associated with PD; DM patients had a 7% higher chance of having PD than non-DM patients (p=0.005). Patients with HbA1c levels >8.5 had were 1.6 times more likely to have PD (CI 1.061-2.459, p=0.025). Increased age was correlated with PD (p=0.025); for each year of life, the likelihood increases by an OR of 1.019 (~2% per year) (p=0.001, CI 1.004-1.027). Interestingly, dyslipidemia (p=0.006) and smoking (p=0.041) were associated with 5-7% lower prevalence of PD.
Conclusion: In a large population of patients visiting a men’s health clinic for a variety of other complaints, PD was found in 20% upon screening. While metabolic syndrome was not associated with PD, diabetes and particularly poorly controlled diabetes was associated with an increased rate. A decreased prevalence of PD in smokers and patients with dyslipidemia was seen and does not necessarily reflect a protective role. Further research into the interaction of PD and metabolic disease is warranted. Furthermore, screening younger populations for PD maybe necessary.
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