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Peyronie's disease

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Peyronie's disease
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Peyronie's Disease (also known as "Induratio penis plastica",[1] or more recently Chronic Inflammation of the Tunica Albuginea (CITA), is a connective tissue disorder involving the growth of fibrous plaques[2] in the soft tissue of the penis affecting up to 10% of men. Specifically, scar tissue forms in the tunica albuginea, the thick sheath of tissue surrounding the corpora cavernosa causing pain, abnormal curvature, erectile dysfunction, indentation, loss of girth and shortening.[3][4][5][6] A variety of treatments have been used, but none have been especially effective.

Exception

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.

Human penis with Peyronie's disease

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 many men report satisfactory intercourse in spite of the disorder.[citation needed] Although it can affect men of any race and age, it is most commonly seen in Caucasian males above the age of 40[citation needed], especially those of blood type A+, but has been seen in men as young as 18.

The disorder is 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.[7]

Diagnosis

A urologist can diagnose the disease and suggest treatment, although it is easily diagnosed by general practitioners or family doctors.[citation needed] An ultrasound can provide conclusive evidence of Peyronie's disease, ruling out congenital curvature or other disorders.[8] [[File:Peyronie's Disease Ultrasound.jpg|thumb|This ultrasound depicts both normal and abnormal anatomy in a patient with Peyronie's Disease. The top image shows normal anatomy in cross section whereas the bottom image shows scar tissue on the tunica albuiginea. The scar tissue is localized and responsible for the hallmark deformities of Peyronie's disease (curvature and narrowing).

Causes

The underlying cause of Peyronie's Disease is not well understood, but is thought to be caused by trauma or injury to the penis usually through sexual activity although many patients often are unaware of any traumatic event or injury.[9]

There is also an association that a class of anti-hypertensive drugs known as calcium channel blockers may be a possible cause of or exacerbate the disease, although it has not been proven. However, all beta blocker drugs list Peyronie's disease as a possible side effect.[9]

Treatment

Without treatment, about 12-13% of patients will spontaneously improve over time, 40-50% will get worse and the rest will be relatively stable.[citation needed]

Medication and supplements

Many oral treatments have been studied, but results so far have been mixed.[10] Some consider the use of non-surgical approaches to be "controversial".[11]

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.[12] A combination of Vitamin E and colchicine has shown some promise in delaying progression of the condition.[13]

Some newer agents targeting the basic mechanisms of inflammation have been studied in larger clinical trials. These include potassium para-aminobenzoate (Potaba),[14] pentoxifylline (acting through TGFβ1 inhibition),[15] and Coenzyme Q10,.[16] Other newer agents of interest include acetyl L-carnitine, propionyl L-carnitine, L-arginine, and sildenafil (acting through phosphodiesterase-5 inhibition).

The efficacy of Interferon-alpha-2b in the early stages of the disease has been reported in recent publications but it was found to be less effective in cases where calcification of the plaque had occurred in common with many treatments.[17][18][19]

Formulations of superoxide dismutase are also reported to be effective in Peyronie's disease.[20]

Injections to plaques (scar tissue formed by the inflammation) with Verapamil may be effective in some patients, but a recent placebo controlled trial failed to show a significant improvement. Use of iontophoresis with Verapamil and Dexamethasone, applied to the affected areas has been studied[21] but the latest placebo controlled trial also failed to show a significant improvement. There are no clinical trials listed in the NIH trial registry. Topical Verapamil cream is also another option for patients who are unwilling to undergo penile injections.

Collagenase clostridium histolyticum (marketed as Xiaflex by Auxilium), a drug approved by the FDA to treat Dupuytren's contracture, has been reported to break down the excess collagen that causes Peyronie's disease. According to Auxilium, "the first phase II trials...showed promising results."[22] The drug has not been approved by the manufacturer or the FDA for the treatment of Peyronie's disease, and such treatments are currently considered off-label use, and are discouraged.[23]

Surgery

Surgery, such as the "Nesbit operation",[24] 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.[25] A European surgery called the Leriche technique, in which an 18 gauge needle is used to lacerate the plaque, has shown effectiveness at reducing curvature and returning sexual function.[26]

Physical therapy and devices

Self-administered manual stretching techniques, as well as a number of devices which exert gentle longitudinal forces on the plaque, are currently being studied in clinical trials. However, these penis extenders are controversial and most doctors recommend staying away from them due to their unknown and potentially harmful side-effects. But there are a controversial minority who have endorsed such products.

Doctors are starting to look into less intrusive forms of therapy as an alternative to surgery because many patients were unhappy with the results of the intervention due mostly to the penile shortening that happens after the surgery.[27] Although there is no cure for Peyronie's Disease or fibrotic disorders that are localized in different areas of the body (Fibrosis), several clinical studies such as the one mentioned above point to penis extenders as a possible treatment to correct curvature, or at the very least to impede the curvature from getting worse. According to Doctor Gontero, the leading Doctor of the above mentioned study which was published in the Journal of Sexual Medicine in 2009, "Overall treatment results were subjectively scored as acceptable in spite of curvature improvements, which varied from “no change” to “mild improvement.”" The study concluded that penile extender devices provided only minimal improvements in penile curvature but patients were generally satisfied likely from increased penile length. Several other studies exist which exhibit minor to moderate improvements in curvature, length and thickness but no cases of complete reversal of the Peyronies curvature.[28][29][30]

In 2009 Dr. Timothy Abreu of the Gush Institute and Dr. Keith Kwon Nguyen of the Eastern Australian Men's Health and Fitness Association debuted a new suction-based treatment that showed promise in reducing the severity and discomfort of Peyronie's disease. Unfortunately the clinical trials were cut short after over 30 cases of necrosis.

Counseling

Peyronie's Disease can be a physically and psychologically devastating disease. While most men will continue to be able to have sexual relations, they are likely to experience some degree of deformity and erectile dysfunction in the wake of the disease process. It is not uncommon for men afflicted with Peyronie's Disease to exhibit depression or withdrawal from their sexual partners.

See also

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 0-07-138076-0.{{cite book}}: CS1 maint: multiple names: authors list (link)
  2. ^ Levine LA, Estrada CR, Storm DW, Matkov TG (2003). "Peyronie disease in younger men: characteristics and treatment results". Journal of Andrology. 24 (1): 27–32. PMID 12514077.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  3. ^ Levine, L. (2010) Peyronie's disease and erectile dysfunction: Current understanding and future direction. Indian Journal of Urology http://www.indianjurol.com/article.asp?issn=0970-1591;year=2006;volume=22;issue=3;spage=246;epage=250;aulast=Levine
  4. ^ Peyronie's disease at Who Named It?
  5. ^ "Peyronie's Disease". Retrieved 2007-12-03.
  6. ^ "Peyronie's disease - MayoClinic.com". Retrieved 2007-12-03.
  7. ^ http://www.ncbi.nlm.nih.gov/pubmed?term=9636000
  8. ^ Amin, Z., Patel, U., Friedman, E. P., Vale, J. A., Kirby, R., & Lees, W. R. (1993). Colour Doppler and duplex ultrasound assessment of Peyronie's disease in impotent men. British journal of radiology, 66(785), 398-402.
  9. ^ a b "Peyronie's disease: Causes". MayoClinic.com. Retrieved 2010-03-18.
  10. ^ Levine LA (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. PMID 14551587. {{cite journal}}: Unknown parameter |month= ignored (help)
  11. ^ Hauck EW, Diemer T, Schmelz HU, Weidner W (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. PMID 16698449. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  12. ^ Mynderse LA, Monga M (2002). "Oral therapy for Peyronie's disease". International Journal of Impotence Research. 14 (5): 340–4. doi:10.1038/sj.ijir.3900869. PMID 12454684. {{cite journal}}: Unknown parameter |month= ignored (help)
  13. ^ Prieto Castro RM, Leva Vallejo ME, Regueiro Lopez JC, Anglada Curado FJ, Alvarez Kindelan J, Requena Tapia MJ (2003). "Combined treatment with vitamin E and colchicine in the early stages of Peyronie's disease". BJU International. 91 (6): 522–4. doi:10.1046/j.1464-410X.2003.04134.x. PMID 12656907. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  14. ^ Weidner W; et al. (2005). "Potassium Paraaminobenzoate (POTABA) in the Treatment of Peyronie's Disease: A Prospective, Placebo-Controlled, Randomized Study". European Urology. 47: 530–6. PMID 15774254. {{cite journal}}: Explicit use of et al. in: |author= (help)
  15. ^ Safarinejad MR; et al. (2009). "A double-blind placebo-controlled study of the efficacy and safety of pentoxifylline in early chronic Peyronie's disease". British Journal of Urology International. 106: 240–8. PMID 19863517. {{cite journal}}: Explicit use of et al. in: |author= (help); line feed character in |title= at position 47 (help)
  16. ^ Safarinejad MR (2010). "Safety and efficacy of coenzyme Q10 supplementation in early chronic Peyronie's disease: a double-blind, placebo-controlled randomized study". International Journal of Impotence Research. 22: 298–309. PMID 20720560.
  17. ^ Trost LW, Gur S, Hellstrom WJ (2007). "Pharmacological Management of Peyronie's Disease". Drugs. 67 (4): 527–45. doi:10.2165/00003495-200767040-00004. PMID 17352513.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  18. ^ Dang G, Matern R, Bivalacqua TJ, Sikka S, Hellstrom WJ (2004). "Intralesional interferon-alpha-2B injections for the treatment of Peyronie's disease". South. Med. J. 97 (1): 42–6. doi:10.1097/01.SMJ.0000056658.60032.D3. ISSN 0038-4348. PMID 14746421. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  19. ^ Hellstrom WJ, Kendirci M, Matem R. et al. (July 2006) "Single-blind, multicenter, placebo controlled, parallel study to assess the safety and efficacy of intralesional interferon alpha-2B for minimally invasive treatment for Peyronie's disease", Journal of Urology 176 (1): 394-8
  20. ^ Riedl CR, Sternig P, Gallé G; et al. (2005). "Liposomal recombinant human superoxide dismutase for the treatment of Peyronie's disease: a randomized placebo-controlled double-blind prospective clinical study". European Urology. 48 (4): 656–61. doi:10.1016/j.eururo.2005.04.011. PMID 15982798. {{cite journal}}: Explicit use of et al. in: |author= (help); Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  21. ^ Riedl CR, Plas E, Engelhardt P, Daha K, Pflüger H (2000). "Iontophoresis for treatment of Peyronie's disease". The Journal of Urology. 163 (1): 95–9. doi:10.1016/S0022-5347(05)67981-5. PMID 10604323. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  22. ^ "Auxilium Product Pipeline: Peyronie's Disease". Retrieved 2011-07-15.
  23. ^ Hutchison, Courtney. "Penis-Straightening Drug Xiaflex May Provide Relief for Peyronie's". ABC News Medical Unit.
  24. ^ Ralph DJ, Minhas S (2004). "The management of Peyronie's disease". BJU International. 93 (2): 208–15. doi:10.1111/j.1464-410X.2004.04587.x. PMID 14690485. {{cite journal}}: Unknown parameter |month= ignored (help)
  25. ^ Hellstrom WJ, Usta MF (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. PMID 14551588. {{cite journal}}: Unknown parameter |month= ignored (help)
  26. ^ Khouaja K, Delmas V, Boccon-Gibod L (2004). "[Leriche technique for the treatment of La Peyronie's disease]". Progrès En Urologie (in French). 14 (4): 586–9, discussion 588–9. PMID 15776920. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  27. ^ Use of Penile Extender Device in the Treatment of Penile Curvature as a Result of Peyronie's Disease. Results of a Phase II Prospective Study http://www.andromedical.com/pdf/en/study_penile_extender_device_treatment_penile_curvature.pdf
  28. ^ Can an External Penis Stretcher Reduce Peyronie's Penile Curvature? Oct. 2001 http://www.nature.com/ijir/journal/v13/n4s/pdf/3900746a.pdf
  29. ^ 5th Congress of the European Society for Sexual and Impotence Research (ESSIR). Hamburg, Germany. December 1–4, 2002. http://www.andromedical.com/pdf/en/study_penis_stretching_effective_for_peyronie_disease.pdf
  30. ^ Conservative treatment in a case of induratio penis plastica XXI National Congress of the SIA Regional Sections (Italian Andrology Society) Trieste, Italy, September 23rd-26th, 2004.
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