Peyronie's disease

Peyronie's disease
Other names	Peyronie disease, induratio penis plastica (IPP), chronic inflammation of the tunica albuginea (CITA)
Pronunciation	/peɪroʊˈniː/
Specialty	Urology
Causes	Unknown
Frequency	~10% of men

Peyronie's disease is a connective tissue disorder involving the growth of fibrous plaques in the soft tissue of the penis. 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. A variety of treatments have been used, but few have been especially effective.

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

Signs and symptoms

Example of penis deformation from side.

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 spite of the disorder. It can affect men of any race and age. 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.

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

This ultrasound depicts cross sections of the penis at different locations in a patient with Peyronie's disease. The top image shows normal anatomy whereas the bottom image shows scar tissue on the tunica albuginea (penis). The scar tissue is localized and responsible for the hallmark deformities of Peyronie's disease (curvature and narrowing).

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.

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 tissues, echoic focal thickening of the tunica without posterior acoustic shadowing, retractile isoechoic lesions with posterior attenuation of the beam, and focal loss of the continuity of the tunica albuginea.. In the Doppler study, increased flow around the plaques can suggest inflammatory activity and the absence of flow can suggest disease stability. Ultrasound is useful not only for the identification of lesions but also to determine their relationship with the neurovascular bundle. Individuals with Peyronie's disease can present with erectile dysfunction, often related to venous leakage, due to insufficient drainage 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.

• 
  Transverse ultrasound of the penis, in a ventral view, in the middle portion of the penis. Note the echoic image with posterior acoustic shadowing, corresponding to calcification (arrow), in the left corpus cavernosum.
• 
  Projectional radiography ("X-ray"), penetrating the soft parts of the penis, showing radiopaque images that correspond to calcifications in the corpora cavernosa (arrows).

Treatment

Medication and supplements

Collagenase clostridium histolyticum (Auxilium), a drug originally approved by the FDA to treat Dupuytren's contracture, is now an FDA-approved injectable drug for treatment of Peyronie's disease. The drug is reported to work by breaking down the excess collagen in the penis that causes Peyronie's disease.

Surgery

Surgery, such as the "Nesbit operation" (which is named after Reed M. Nesbit (1898–1979), an American urologist at University of Michigan), 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.

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.

Methods with very limited evidence

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.

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

Psychosocial effects

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.

History

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

In 2013, the US FDA approved the first drug specifically for Peyronie's; the drug was collagenase clostridium histolyticum (Auxilium).

See also

• Chordee
• Hypospadias

External links

• Medscape Urology overview of Peyronie's disease