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Modeling Intensity Predicts Timing of Resolution in Penile Curvature Management
Benjamin H. Rosenfeld, MD1, Britney L. Atwater, MD2, Muhammed A. Hammad, MBBCh3, Martin S. Gross, MD1.
1Dartmouth Health, Lebanon, NH, USA, 2University of South Florida, Tampa, FL, USA, 3University of California, Irvine, Irvine, CA, USA.
Background: During inflatable penile prosthesis (IPP) implantation, adjunctive maneuvers, such as manual modeling, can be utilized to further correct penile curvature. While modeling can be a useful technique, the relationship between the number of modeling rounds and the timing of resolution remains unclear.
Methods: We retrospectively analyzed patients with documented resolution of penile curvature by 6 months post-intervention. Resolution was defined as residual curvature ≤10° and classified as early (by 6 weeks) or delayed (by 6 months). The number of modeling rounds was compared between these groups using a Mann-Whitney U test. To assess independent predictors of early resolution, we performed logistic regression adjusting for preoperative curve severity.
Results: Among 84 patients who achieved resolution, 67 (80%) resolved early and 17 (20%) resolved by 6 months. Patients who resolved early underwent fewer modeling rounds (mean 1.34) compared to those who required delayed resolution (mean 2.24;
p=0.00015). Early resolvers clustered tightly around a single round of modeling, while delayed cases demonstrated a broader distribution, with some requiring up to four rounds. In multivariable logistic regression, each additional modeling round was associated with an 80% reduction in the odds of early resolution (OR 0.20, 95%CI 0.08-0.46,
p<0.001). This association remained significant after adjusting for preoperative severity, which itself was not significantly associated with early resolution.
Conclusions: Higher modeling intensity is strongly associated with delayed resolution, even among patients who ultimately achieve successful outcomes. These findings suggest that early responders tend to require minimal intervention, whereas delayed responders may benefit from additional modeling rounds. Modeling frequency may serve as a useful clinical indicator for plaque complexity, tailoring expectations, monitoring response, and planning follow-up in penile curvature management.
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