Peyronie disease represents a common cause of male sexual dysfunction in which tunica albuginea of the penis becomes affected by plaque and fibrosis, usually in the shaft region, leading to painful and insufficient erection and curvature of the penis. The area that is located distal to the fibrotic process receives insufficient blood supply during erection.
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 . 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.
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 . 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 . 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 . However, the most important issue is with respect to disease evolution. To this end, technetium 99m human immunoglobulin G scintigraphy may be used . 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 , 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.