Men with Peyronie disease notice an angulation of the penis that slowly progresses over several years. However, in a minority of cases, the condition may resolve by itself or progression may stop [1]. The curvature is accompanied by pain, that becomes more severe during erection and palpable plaque at the site of angulation. The penile shaft presents an indentation. The abnormal form (curved up to 90° or hourglass) is more easily observable during the rigid phase, but may be sometimes noticed during the flaccid state. The sexual function becomes compromised over time, especially during the chronic phase, due to the angulation that makes intromission difficult and because of the insufficient distal rigidity. The pain more often characterizes the acute phase of the disease that lasts for 18 to 24 months, may precede the appearance of the angulation and is caused by inflammation and plaque formation. The length and stretch of the penis diminish at this stage and patients may experience numbness of the involved area.

• Pain

  Peyronie's disease [ pa-ron-ēz´ ] a self-limiting disease of the penis that causes hardening of the corpora cavernosa, resulting in painful chordee and penile curvature. [medical-dictionary.thefreedictionary.com]

  Mean preinjection and postinjection penile pain scores were 6.6 ± 2.1 and 0.5 ± 0.5, respectively. On average, patients were pain free at follow-up visits within 10.6 ± 7.6 weeks. The mean pain-free duration was 23.8 months (range, 3-52 months). [ncbi.nlm.nih.gov]

  Presentation A 40 year old man presents with painful erections and is referred for a penile ultrasound. [sonoworld.com]

  Such palpation may elicit pain if the disease is still in the inflammatory stage. [aafp.org]

• Inflammation

  Continuing inflammation produces profibrotic cytokines such as transforming growth factor beta and deposition of large amount of collagen fibers. The inflammation can also produce metalloproteinases that break the elastic fibers. [tau.amegroups.com]

  Inflammation inside the penis results in the formation of fibrous scar tissue that causes curvature in the erect penis, making penetration during sexual intercourse difficult or impossible. [merckmanuals.com]

  Pain is associated with the inflammation generated by the active phase of the healing process, and it typically disappears as the inflammation resolves. [aafp.org]

  Abnormal plaques and scar tissue create a chronic state of inflammation, causing increased curvature of the penis as well as erectile dysfunction. [ncbi.nlm.nih.gov]

• Weakness

  Various oral or injected treatments are used, though the evidence in support of them is weak, Dr. Carson said. [nytimes.com]

  By softening the plaque, the drug may cause a weakness in this casing. On erection a rupture may occur at the point of weakness. He says this occurs in less than 1 per cent of cases and may require a surgical repair. [afr.com]

  Some studies have found a weak association of Peyronie’s Disease with: Genital or lower body injuries Radical prostatectomy Paget’s disease Gout Lipomas Early studies suggested that many plaques resolved in about a year without treatment. [innovationsstemcellcenter.com]

  Symptoms of Peyronie's Disease Early stages of Peyronie's disease are characterized by painful and weak erections or difficult ejaculations caused by an inflammation which can develop into a hardened scar. [malefertility.md]

• Surgical Procedure

  Surgical Repair Surgical repair of Peyronie’s disease is very successful in treating curvature. Penile Plication Penile plication to correct curvature involves a minor outpatient surgical procedure. [medicine.yale.edu]

  Several types of reconstructive procedures have been developed and are tailored to the individual problem. The simplest surgical procedure is the corporeal plication. [malereproduction.com]

  Treatment Pain management, oral medications and vitamins, penile injections, and a number of surgical procedures are all viable options for curing Peyronie’s disease. The treatment will depend on the specific case. [uro.com]

  Here are a few of the procedures that can be performed: Nesbit Operation During this procedure the penis is Plicated. In other words, the penis is surgically shortened on the side that does not have scar tissue. [proextenderindia.com]

  Surgery There are several surgical procedures that can be used in the treatment of Peyronie’s disease. The type of surgery recommended will depend on your symptoms and the location of the penile plaque(s). [mydr.com.au]

• Disability

  The aim of this study was to examine the efficacy and safety of subcutaneous, nonintralesional steroid injections in patients with severe, disabling, and/or chronic penile pain associated with Peyronie disease. [ncbi.nlm.nih.gov]

  Please enable JS and disable any ad blocker [leplus.nouvelobs.com]

  Surgery for Peyronie's Disease Surgery is reserved for men with severe, disabling penile deformities that make it hard to have sex. [urologyhealth.org]

  Approximately one third of patients with end-stage disease have a disabling curvature that requires surgical correction. [aafp.org]

• Skin Plaque

  The main symptom of Peyronie’s disease is the formation of flat scar tissue called plaque. This scar tissue can generally be felt through the skin. Plaque normally forms on the upper side of the penis, but may also occur on the bottom or side. [healthline.com]

• Painful Erection

  The symptom is bending of an erect penis, sometimes with pain. It often interferes with sexual intercourse. Erectile failure associated with the angulation often precedes it. [medical-dictionary.thefreedictionary.com]

  Presentation A 40 year old man presents with painful erections and is referred for a penile ultrasound. [sonoworld.com]

  The contracture usually results in deviation of the erect penis to the involved side, occasionally causes painful erections, and may prevent penetration. Fibrosis may extend into the corpus cavernosum, compromising tumescence distally. [merckmanuals.com]

• Penile Pain

  However, use of steroid injections in managing penile pain has been poorly investigated. [ncbi.nlm.nih.gov]

  Penile pain was reported to be diminished or absent in 83% of men, and 23% reported decreased penile deformity. [emedicine.medscape.com]

  The early phase of the disease is believed to be inflammatory and is often associated with penile pain. The inflammatory phase usually resolves in around 18 months. Over 90% of men also see resolution of pain by about 18 months. [innovationsstemcellcenter.com]

• Chordee

  Peyronie's disease [ pa-ron-ēz´ ] a self-limiting disease of the penis that causes hardening of the corpora cavernosa, resulting in painful chordee and penile curvature. [medical-dictionary.thefreedictionary.com]

  This may be part of an abnormality called chordee, which is different from Peyronie disease. You or your health care provider may notice an abnormal hardening of the tissue below the skin, in one area along the shaft of the penis. [nlm.nih.gov]

  Background Curvature of the penis is known as chordee. Some curvature of the penis is normal and many men are born with a slight curvature - usually the bend is downward. This is known as congenital chordee. [metrovanurology.com]

The physical examination is the main diagnosis tool in Peyronie disease, as the clinical aspect is pathognomonic. The physician should also inquire about previous penis trauma and systemic vascular disease, as well as psychological factors that may further worsen the sexual dysfunction. For instance, the patient may perceive the deformity to be more severe than it really is [2]. The blood panel is usually noncontributory. Palpation reveals an endured area both when the penis is tumescent and flaccid. Imaging methods are necessary in order to identify the state of the plaque. Calcification signifies plaque maturity and disease stability. Calcium deposits can be identified using plain radiographs or ultrasonography. This latter method may also describe the dimensions of the plaque. Moreover, better estimations can be obtained when performing duplex ultrasonography with intracavernous alprostadil, phentolamine or papaverine injection [3]. The same information can be gathered using magnetic resonance imaging and corpus cavernosography, but this method of diagnosis offers further data regarding compression of the cavernosal space and other causes of erectile impairment, such as veno-occlusive or arteriogenic dysfunction. Magnetic resonance imaging highlights the presence of hypointense areas, with contrast enhancement not always present in the inflammatory phase [4]. However, the most important issue is with respect to disease evolution. To this end, technetium 99m human immunoglobulin G scintigraphy may be used [5]. This substance was proven to be more often found in unstable lesions, that require medical treatment, than stable ones that are best treated surgically. Penis sensitivity can be evaluated by biothesiometry if the patient complains about numbness.

The histological aspect of Peyronie disease consists of an abnormal pattern of elastic fibers, surrounded by an excessive amount of collagen and fibrin [6], leading to the loss of stretchability in the affected area and curvature, caused by the normal function of the tissue found on the opposite side of the penis.

• HLA-B27

  An association between these conditions and the HLA-B27 histocompatibility antigen has been discovered and points toward a genetic or autoimmune process. [malereproduction.com]

  When hereditary trend for PD has been observed for a long time, the relation of HLA-B27 and HLA-B7 is still debatable ( 41 ). [ncbi.nlm.nih.gov]

Up to eight injections (four treatment cycles) may be administered in the course of treatment. After each treatment cycle, a penile modeling procedure is recommended to disrupt the plaque. [renalandurologynews.com]

Minimally Invasive Treatment Minimally invasive treatment is personalized to the degree of curvature, the degree of bother, and any other associated sexual dysfunctions. [medicine.yale.edu]

Figure 1 Ultrasound findings before and after 8 months of treatment with pentoxifylline. The calcification was no longer detectable on follow up. A. pre-treatment; B.post-treatment (8 months pentoxifylline). [tau.amegroups.com]

Abstract The current nonsurgical treatment options for men with Peyronie's disease is reviewed. The treatments currently employed and published in the English literature are discussed. [doi.org]

The current nonsurgical treatment options for men with Peyronie's disease is reviewed. The treatments currently employed and published in the English literature are discussed. [ncbi.nlm.nih.gov]

Prognosis Sometimes the condition disappears spontaneously. A careful look for other causes of impotence should be done before surgery. Resources Books Jordan, Gerald H., et al. "Surgery of the Penis and Urethra." [medical-dictionary.thefreedictionary.com]

Treatment and prognosis Indications for surgical correction include severe bending or shortening of the penis causing sexual difficulty. [radiopaedia.org]

What is the prognosis for Peyronie's disease? Can it be cured? The prognosis (outcome) of this disease is variable, from good to poor, depending on the response to treatment and the patient's emotional response to the symptoms and treatments. [medicinenet.com]

Because evidence of the effectiveness of treatments from large-scale trials is lacking, the effect of the various therapies on prognosis is unknown. [patient.info]

Prognosis Peyronie's disease runs a very variable course. [netdoctor.co.uk]

Four patients complained of erectile dysfunction despite medication, even though no objective vascular etiology was shown on postoperative penile Doppler ultrasound. Overall, 82,2% of patients reported high levels of satisfaction. [ncbi.nlm.nih.gov]

Discussion Peyronie’s disease is an acquired disease of unknown etiology, affecting middle aged men with formation of fibrous plaques in the penile erectile tissue, resulting in scar tissue. [sonoworld.com]

Etiology Although microtraumatic events are implicated in the current theory of the pathogenesis of Peyronie disease, no etiology is proven. No risk factors are known, but associations do exist. [emedicine.medscape.com]

Epidemiology and etiology Controversy exists regarding the presentation age of PD. [ncbi.nlm.nih.gov]

Louis, MO, USA Epidemiology of Peyronie's disease F Sommer1, U Schwarzer1, G Wassmer2, W Bloch3, M Braun1, T Klotz1 and U Engelmann1 International Journal of Impotence Research (2002) 14, 379-383. doi:10.1038/sj.ijir.3900863 Weidner W, Schroeder-Printzen [quickextenderpro.com]

Seftel, Peyronie’s disease: epidemiology, diagnosis, and management, Current Medical Research and Opinion, 30, 1, (113), (2014). [doi.org]

Genetic susceptibility is thought to play a role. [ 1 ] Studies suggest a link with low testosterone levels. [ 2 ] A congenital form has also been described. [ 3 ] Epidemiology Exact figures for prevalence and incidence are hard to come by as, due to [patient.info]

Epidemiology Frequency United States The rate for Peyronie disease is 0.3-4% among white men. International Peyronie disease is less common in men of African or Asian heritage. Race Peyronie disease is well documented in whites. [emedicine.medscape.com]

Despite the prevalence of the disease and natural history studies that suggest progression, men might not seek therapeutic intervention due to a lack of general knowledge about the disease, its pathophysiology, and treatments aimed at ameliorating its [ncbi.nlm.nih.gov]

Basically, the aim of this treatment is to fracture the calcified plaques, although the exact effect on the disease pathophysiology is not clear. [news-medical.net]

However, the pathophysiology remains unclear. [ 3 ] Presentation [ 3 ] When Peyronie's disease (PD) first presents, it tends to be with penile pain during erections, penile angulation (this can be seen in some cases in a flaccid penis), palpable fibrous [patient.info]

Research over the past decade has been directed towards a better understanding of the pathophysiology of this disease as well as determining the demographics and its natural history. [doi.org]

Ultrasound treatments can stimulate blood flow, which may prevent further scarring. Radiation therapy may decrease pain; however, radiation often worsens tissue damage. [merckmanuals.com]

This can prevent you from having sex or might make it difficult to get or maintain an erection (erectile dysfunction). For many men, Peyronie's disease also causes stress and anxiety. Peyronie's disease sometimes goes away on its own. [mayoclinic.org]

While the application of vitamin E at this time is not substantiated in scientific journals, the vitamin E won't hurt you and may, in fact, help prevent heart disease. [malehealthcenter.com]

1. Gelbard M, Dorey F, James K. The natural history of Peyronie's disease. J Urol. 1990;144(6):1376-1379.
2. Bacal V, Rumohr J, Sturm R, et al. Correlation of degree of penile curvature between patient estimates and objective measures among men with Peyronie's disease. J Sex Med. 2009;6(3):862-865.
3. Shenoy-Bhangle A, Perez-Johnston R, Singh A. Penile imaging. Radiol Clin North Am. 2012;50(6):1167-1181.
4. Bertolotto M, Pavlica P, Serafini G, et al. Painful penile induration: imaging findings and management. Radiographics. 2009;29(2):477-493.
5. Erdogru T, Boz A, Koksal T, et al. Penile scintigraphy with 99mTc-human immunoglobulin G: a novel method for distinguishing the unstable and stable phases of Peyronie's disease. BJU Int. 2002;90(7):703-706.
6. Devine C, Somers K, Ladaga L. Peyronie's disease: pathophysiology. Prog Clin Biol Res. 1991;370:355-358.