Peyronie's disease

Peyronie's disease is a connective tissue disorder involving the

Peyronie's disease
growth of fibrous plaques in the soft tissue of the penis.
Specifically, scar tissue forms in the tunica albuginea, the thick Other names Peyronie disease, induratio
sheath of tissue surrounding the corpora cavernosa, causing pain, penis plastica (IPP),[1] chronic
abnormal curvature, erectile dysfunction, indentation, loss of girth inflammation of the tunica
and shortening.[2][3] A variety of treatments have been used, but albuginea (CITA)
few have been especially effective.

It is estimated to affect about 10% of men.[2] The condition

becomes more common with age.[2]

Contents
Signs and symptoms
Psychosocial
Causes
Diagnosis
Ultrasonography
Treatment
Medication and supplements
Person with Peyronie's disease
Physical therapy and devices
Surgery Pronunciation /peɪroʊˈniː/
Epidemiology Specialty Urology
History
Causes Unknown[2]
References
Frequency ~10% of men[2]
External links

Signs and symptoms

A certain degree of curvature of the penis is considered normal, as many men are
born with this benign condition, commonly referred to as congenital curvature.

The disease may cause pain; hardened, big, cord-like lesions (scar tissue known
as "plaques"); or abnormal curvature of the penis when erect due to chronic
inflammation of the tunica albuginea (CITA). Although the popular conception
of Peyronie's disease is that it always involves curvature of the penis, the scar
tissue sometimes causes divots or indentations rather than curvature. The
condition may also make sexual intercourse painful and/or difficult, though it is
unclear whether some men report satisfactory or unsatisfactory intercourse in Example of penis deformation from
spite of the disorder. It can affect men of any race and age. The disorder is side
confined to the penis, although a substantial number of men with Peyronie's
exhibit concurrent connective tissue disorders in the hand, and to a lesser degree,
in the feet. About 30 percent of men with Peyronie's disease develop fibrosis in other elastic tissues of the body, such as on the
hand or foot, including Dupuytren's contracture of the hand. An increased incidence in genetically related males suggests a
genetic component.[4]

Psychosocial
Peyronie's disease can also have psychological effects. While most men will continue to be able to have sexual relations, they are
likely to experience some degree of erectile dysfunction. It is not uncommon to exhibit depression or withdrawal from their
sexual partners.[5]

Causes
The underlying cause of Peyronie's disease is not well understood. The most common cause is a buildup of plaque inside the
penis. It could be by trauma or injury to the penis usually through sexual intercourse or physical activity, although many patients
are often unaware of any traumatic event or injury.

Diagnosis
A urologist may be able to diagnose the disease and suggest treatment. An
ultrasound can provide conclusive evidence of Peyronie's disease, ruling out
congenital curvature or other disorders.[6]

Ultrasonography
On Penile ultrasonography, the typical is hyperechoic focal thickening of the
tunica albuginea. Due to associated calcifications, the imaging of patients with
Peyronie's disease shows acoustic shadowing, as illustrated in figures below.
Less common findings, attributed to earlier stages of the disease (still mild
fibrosis), are hypoechoic lesions with focal thickening of the paracavernous This ultrasound depicts cross
tissues, echoic focal thickening of the tunica without posterior acoustic sections of the penis at different
locations in a patient with Peyronie's
shadowing, retractile isoechoic lesions with posterior attenuation of the beam,
disease. The top image shows
and focal loss of the continuity of the tunica albuginea.. In the Doppler study, normal anatomy whereas the bottom
increased flow around the plaques can suggest inflammatory activity and the image shows scar tissue on the
absence of flow can suggest disease stability. Ultrasound is useful not only for tunica albuginea (penis). The scar
the identification of lesions but also to determine their relationship with the tissue is localized and responsible for
neurovascular bundle. Individuals with Peyronie's disease can present with the hallmark deformities of
Peyronie's disease (curvature and
erectile dysfunction, often related to venous leakage, due to insufficient drainage
narrowing).
at the site of the plaque. Although plaques are more common on the dorsum of
the penis, they can also be seen on the ventral face, lateral face, or septum.[7]
 Transverse ultrasound of the penis, in a ventral view, in Projectional radiography ("X-ray"),
the middle portion of the penis. Note the echoic image penetrating the soft parts of the
with posterior acoustic shadowing, corresponding to penis, showing radiopaque images
calcification (arrow), in the left corpus cavernosum.[7] that correspond to calcifications in
the corpora cavernosa (arrows).

Treatment

Medication and supplements

Many oral treatments have been studied, but results so far have been mixed.[8] Some consider the use of nonsurgical approaches
to be "controversial".[9]

Vitamin E supplementation has been studied for decades, and some success has been reported in older trials, but those successes
have not been reliably repeated in larger, newer studies.[10]

The use of Interferon-alpha-2b in the early stages of the disease has been studied, but as of 2007 its efficacy was questionable.[11]

Collagenase clostridium histolyticum (Auxilium) is reported to help by breaking down the excess collagen in the penis that
causes Peyronie's disease.[12][13]

Physical therapy and devices

There is moderate evidence that penile traction therapy is a well-tolerated, minimally invasive treatment, but there is uncertainty
about the optimal duration of stretching per day and per course of treatment, and the treatment course is difficult.[14]

Surgery
Surgery, such as the "Nesbit operation" (which is named after Reed M. Nesbit (1898–1979), an American urologist at University
of Michigan),[15] is considered a last resort and should only be performed by highly skilled urological surgeons knowledgeable in
specialized corrective surgical techniques. A penile prosthesis may be appropriate in advanced cases.[16]

Epidemiology
It is estimated to affect about 10% of men.[2] The condition becomes more common with age.[2]

History
The condition is named for François Gigot de la Peyronie, who described it in 1743; however, the condition may have been
described around 100 years before that.[17]

References
1. Freedberg, Irwin M.; Fitzpatrick, Thomas B. (2003). Fitzpatrick's dermatology in general medicine (6th ed.). New
York: McGraw-Hill, Medical Pub. Division. p. 990. ISBN 978-0-07-138076-8.
2. "Penile Curvature (Peyronie's Disease)" (https://www.niddk.nih.gov/health-information/urologic-diseases/penile-c
urvature-peyronies-disease). National Institute of Diabetes and Digestive and Kidney Diseases. July 2014.
Retrieved 25 October 2017.
3. Levine, Laurence A (2010). "Peyronie's disease and erectile dysfunction: Current understanding and future
direction". Indian Journal of Urology. 22 (3): 246–50. doi:10.4103/0970-1591.27633 (https://doi.org/10.4103%2F0
970-1591.27633).
4. Carrieri MP, Serraino D, Palmiotto F, Nucci G, Sasso F (June 1998). "A case-control study on risk factors for
Peyronie's disease". Journal of Clinical Epidemiology. 51 (6): 511–5. doi:10.1016/S0895-4356(98)00015-8 (http
s://doi.org/10.1016%2FS0895-4356%2898%2900015-8). PMID 9636000 (https://www.ncbi.nlm.nih.gov/pubmed/9
636000).
5. Nelson CJ, Mulhall JP (March 2013). "Psychological impact of Peyronie's disease: a review". The Journal of
Sexual Medicine. 10 (3): 653–60. doi:10.1111/j.1743-6109.2012.02999.x (https://doi.org/10.1111%2Fj.1743-610
9.2012.02999.x). PMID 23153101 (https://www.ncbi.nlm.nih.gov/pubmed/23153101).
6. Amin Z, Patel U, Friedman EP, Vale JA, Kirby R, Lees WR (May 1993). "Colour Doppler and duplex ultrasound
assessment of Peyronie's disease in impotent men". The British Journal of Radiology. 66 (785): 398–402.
doi:10.1259/0007-1285-66-785-398 (https://doi.org/10.1259%2F0007-1285-66-785-398). PMID 8319059 (https://
www.ncbi.nlm.nih.gov/pubmed/8319059).
7. Originally copied from:
Fernandes, Maitê Aline Vieira; Souza, Luis Ronan Marquez Ferreira de; Cartafina, Luciano Pousa (2018).
"Ultrasound evaluation of the penis" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6124582). Radiologia
Brasileira. 51 (4): 257–261. doi:10.1590/0100-3984.2016.0152 (https://doi.org/10.1590%2F0100-3984.2016.015
2). ISSN 1678-7099 (https://www.worldcat.org/issn/1678-7099). PMC 6124582 (https://www.ncbi.nlm.nih.gov/pm
c/articles/PMC6124582). PMID 30202130 (https://www.ncbi.nlm.nih.gov/pubmed/30202130).
CC-BY license
8. Levine LA (October 2003). "Review of current nonsurgical management of Peyronie's disease". International
Journal of Impotence Research. 15 Suppl 5: S113–20. doi:10.1038/sj.ijir.3901084 (https://doi.org/10.1038%2Fsj.ij
ir.3901084). PMID 14551587 (https://www.ncbi.nlm.nih.gov/pubmed/14551587).
9. Hauck EW, Diemer T, Schmelz HU, Weidner W (June 2006). "A critical analysis of nonsurgical treatment of
Peyronie's disease". European Urology. 49 (6): 987–97. doi:10.1016/j.eururo.2006.02.059 (https://doi.org/10.101
6%2Fj.eururo.2006.02.059). PMID 16698449 (https://www.ncbi.nlm.nih.gov/pubmed/16698449).
10. Mynderse LA, Monga M (October 2002). "Oral therapy for Peyronie's disease". International Journal of
Impotence Research. 14 (5): 340–4. doi:10.1038/sj.ijir.3900869 (https://doi.org/10.1038%2Fsj.ijir.3900869).
PMID 12454684 (https://www.ncbi.nlm.nih.gov/pubmed/12454684).
11. Trost LW, Gur S, Hellstrom WJ (2007). "Pharmacological Management of Peyronie's Disease". Drugs. 67 (4):
527–45. doi:10.2165/00003495-200767040-00004 (https://doi.org/10.2165%2F00003495-200767040-00004).
PMID 17352513 (https://www.ncbi.nlm.nih.gov/pubmed/17352513).
12. "FDA approves first drug treatment for Peyronie's disease" (http://www.fda.gov/newsevents/newsroom/pressanno
uncements/ucm377849.htm). FDA NEWS RELEASE. U.S. Food and Drug Administration. 6 December 2013.
Retrieved 6 December 2013.
13. Pollack, Andrew (December 6, 2013). "Injections to Treat an Embarrassing Ailment Win U.S. Approval" (https://w
ww.nytimes.com/2013/12/07/business/fda-approves-treatment-for-curved-penis.html). New York Times.
Retrieved December 7, 2013.
14. Eric C, Geralb B (February 2013). "Penile traction therapy and Peyronie's disease: a state of art review of the
current literature" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3547530). Ther Adv Urol. 5 (2): 59–65.
doi:10.1177/1756287212454932 (https://doi.org/10.1177%2F1756287212454932). PMC 3547530 (https://www.n
cbi.nlm.nih.gov/pmc/articles/PMC3547530). PMID 23372611 (https://www.ncbi.nlm.nih.gov/pubmed/23372611).
15. Ralph DJ, Minhas S (January 2004). "The management of Peyronie's disease". BJU International. 93 (2): 208–
15. doi:10.1111/j.1464-410X.2004.04587.x (https://doi.org/10.1111%2Fj.1464-410X.2004.04587.x).
PMID 14690485 (https://www.ncbi.nlm.nih.gov/pubmed/14690485).
16. Hellstrom WJ, Usta MF (October 2003). "Surgical approaches for advanced Peyronie's disease patients".
International Journal of Impotence Research. 15 (Suppl 5): S121–4. doi:10.1038/sj.ijir.3901085 (https://doi.org/1
0.1038%2Fsj.ijir.3901085). PMID 14551588 (https://www.ncbi.nlm.nih.gov/pubmed/14551588).
17. Peyronie's disease (http://www.whonamedit.com/synd.cfm/3345.html) at Who Named It?

External links
Medscape Urology overview of Peyronie's disease (http://emedicine.m
Classification ICD-10: N48.6 (htt D
edscape.com/article/456574-overview)
p://apps.who.int/cla
ssifications/icd10/br
owse/2016/en#/N4
8.6) · ICD-9-CM:
607.85 (http://www.i
cd9data.com/getIC
D9Code.ashx?icd9
=607.85) · OMIM:
171000 (https://omi
m.org/entry/17100
0) · MeSH:
D010411 (https://w
ww.nlm.nih.gov/cgi/
mesh/2015/MB_cg
i?field=uid&term=D
010411) ·
DiseasesDB:
29308 (http://www.d
iseasesdatabase.co
m/ddb29308.htm)
External MedlinePlus:
resources 001278 (https://ww
w.nlm.nih.gov/medli
neplus/ency/article/
001278.htm) ·
eMedicine:
derm/851 (http://ww
w.emedicine.com/d
erm/topic851.htm)

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