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Peyronie Disease

Cavernitides Fibrous

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.


Presentation

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.

Collapse
  • […] neutrophils. 34, 35 Intracellular collagen exists as fibrous-long spacing collagen (FLS) within the RER in fibromatoses including Peyronie's disease, Dupuytren's contracture and musculoaponeurotic desmoid fibro-matosis. 31 Colchicine has been shown to cause collapse[doi.org]
Venous Insufficiency
  • Persistent venous insufficiency was noted in 3 patients (8.6%); we observed arterial insufficiency during dynamic evaluation of blood flow in 2 (5.8%); and in 2 cases, a low peak systolic velocity was accompanied by an abnormal cavernous artery structure[ncbi.nlm.nih.gov]
Social Isolation
  • The challenges imposed by PD include alterations in sexual relationships, restrictions on intimacy, social isolation, and stigmatization, all of which are linked and reinforce each other.[ncbi.nlm.nih.gov]
Painful Erection
  • One manifestation of Peyronie disease is painful erection. In patients with persistent erectile pain, we found circumferential inelastic scarring of the tunica albuginea.[ncbi.nlm.nih.gov]
  • CONSUMERS: Click here for the Consumer Version Peyronie disease is fibrosis of the cavernous sheaths leading to contracture of the investing fascia of the corpora, resulting in a deviated and sometimes painful erection.[merckmanuals.com]
  • Presentation A 40 year old man presents with painful erections and is referred for a penile ultrasound.[sonoworld.com]
  • Peyronie’s disease is a condition which affects the penis, usually causing painful erections, lumps in the penis and a bend in the erection. Although it can be progressive, it is not a malignant (cancerous) condition and it is not life-threatening.[birminghamprostateclinic.co.uk]
  • The chief symptom of Peyronie's disease is painful erection. Palliative treatment includes radiation therapy and intralesional corticosteroid injections. There is no known cure.[medical-dictionary.thefreedictionary.com]
Penile Pain
  • However, use of steroid injections in managing penile pain has been poorly investigated.[ncbi.nlm.nih.gov]
  • OBJECTIVE: Our purpose was to describe sonographic findings in patients with Peyronie disease that may explain persistent penile pain in these patients.[ncbi.nlm.nih.gov]
  • Interferon-alpha-2b, in particular, has been documented in a large, multicentre, placebo-controlled study to be significantly more effective than placebo in decreasing penile curvature, plaque size, penile pain and plaque density.[ncbi.nlm.nih.gov]
  • 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]
  • If patients have no penile pain or other complications, they can resume sexual intercourse in six to eight weeks.[memphisurology.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]
  • 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]
  • 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]

Workup

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.

Treatment

  • 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]
  • […] and its treatment remains frustrating to the practicing urologist.[nature.com]
  • […] satisfaction (assessed by Erectile Dysfunction Inventory of Treatment Satisfaction questionnaire), and side‐effects.[doi.org]
  • Thus, intralesional verapamil treatment should be considered a first-line treatment in the great majority of patients presenting with PD. References 1. de La Peyronie F .[nature.com]
  • PURPOSE: Collagenase Clostridium histolyticum is an investigational nonsurgical treatment for Peyronie disease.[ncbi.nlm.nih.gov]

Prognosis

  • 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]
  • Treatment and prognosis Indications for surgical correction include severe bending or shortening of the penis causing sexual difficulty.[radiopaedia.org]
  • 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 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]
  • Prognosis Peyronie's disease runs a very variable course.[netdoctor.co.uk]

Etiology

  • 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]
  • 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.com]
  • etiology with or without venous insufficiency.[doi.org]

Epidemiology

  • Epidemiology and etiology Controversy exists regarding the presentation age of PD.[ncbi.nlm.nih.gov]
  • 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]
  • 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]
  • 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.com]
Sex distribution
Age distribution

Pathophysiology

  • 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]
  • This literature review outlines the prevalence, genetics, pathophysiology, diagnostic methods, and work-up of PD.[ncbi.nlm.nih.gov]
  • 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]

Prevention

  • CONCLUSION: Corporoplasty with buccal mucosa graft is easy to perform and represents a good treatment choice for most forms of Peyronie disease with curvature preventing penetration and sexual intercourse. Copyright 2015 Elsevier Inc.[ncbi.nlm.nih.gov]
  • 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]

References

Article

  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.

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Last updated: 2019-06-28 12:09