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.
Entire Body System
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]
Such palpation may elicit pain if the disease is still in the inflammatory stage. [aafp.org]
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). [en.wikipedia.org]
- 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]
In 82 patients, 44 with painful erections and 78 with curvature, 36 had calcific plaque and fibrotic. The pain disappears in 70% post-treatment, 41% had reduction in the echogenicity while 39% were unchanged or larger. [bumc.bu.edu]
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]
Penile pain was reported to be diminished or absent in 83% of men, and 23% reported decreased penile deformity. [emedicine.medscape.com]
If patients have no penile pain or other complications, they can resume sexual intercourse in six to eight weeks. [memphisurology.com]
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]
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.
Both HLA-DR3 and HLA-DRw2 are typically associated with organospecific autoimmune disorders, suggesting possible auto-immunological factors in PD ( 22 ). [ncbi.nlm.nih.gov]
Another investigation on HLA class II antigens has shown the association of HLA-DR3 and HLA-DQw2 with PD. The antigen HLA-DR3 was detected in 33.3% patients and HLA-DQw2 was found in 58.8% of patients. [ncbi.nlm.nih.gov]
- Gelbard M, Dorey F, James K. The natural history of Peyronie's disease. J Urol. 1990;144(6):1376-1379.
- 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.
- Shenoy-Bhangle A, Perez-Johnston R, Singh A. Penile imaging. Radiol Clin North Am. 2012;50(6):1167-1181.
- Bertolotto M, Pavlica P, Serafini G, et al. Painful penile induration: imaging findings and management. Radiographics. 2009;29(2):477-493.
- 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.
- Devine C, Somers K, Ladaga L. Peyronie's disease: pathophysiology. Prog Clin Biol Res. 1991;370:355-358.