SRS258 - Penile hypoxia, fibrosis, and calcification following radical prostatectomy: a pilot clinical study

Abstract Peyronie’s disease (PD) is a fibrotic disorder of the penis characterised by plaque formation and abnormal curvature. Evidence suggests that its incidence is higher in men after radical prostatectomy (RP). Postoperative hypoxia of the corpora cavernosa, secondary to nerve injury, has been implicated in the development of erectile dysfunction, and experimental studies demonstrate that hypoxia can promote fibrosis. We therefore hypothesised that penile hypoxia may underlie fibrotic changes and calcification observed after RP. In this pilot study, 24 men were assessed before and at 3 and 6 months after RP. Erectile function and PD-related symptoms were evaluated using the International Index of Erectile Function (IIEF), PD questionnaires, stretched penile length, and nocturnal penile tumescence. Fibrosis and calcification were assessed by ultrasonography, and penile tissue oxygenation was measured by oximetry. All patients developed fibrotic changes and calcifications detectable on ultrasonography, alongside a significant reduction in penile oxygen levels following RP. Erectile function scores declined significantly, although no participants reported curvature. Stretched penile length was reduced, and a significant correlation between oxygen levels and calcification was observed between 3 and 6 months. This study demonstrates for the first time a marked reduction in penile oxygenation after RP, accompanied by fibrosis and calcification. The correlation between hypoxia and calcification suggests that hypoxia-driven fibrosis may be a key mechanism in the progression of PD. Surgeons should consider informing patients that RP may predispose to penile fibrosis through hypoxia.