Peyronie’s disease

• What is Peyronie’s Disease
• Statistics on Peyronie’s Disease
• Risk Factors for Peyronie’s Disease
• Progression of Peyronie’s Disease
• Symptoms of Peyronie’s Disease
• Clinical Examination of Peyronie’s Disease
• How is Peyronie’s Disease Diagnosed?
• Prognosis of Peyronie’s Disease
• How is Peyronie’s Disease Treated?
• Peyronie’s Disease References

What is Peyronie’s Disease

Peyronie’s Disease is a curvature of the penis of an unknown cause. The primary abnormality of this condition is the accumulation of fibrous tissue within the tunica albuginea (the whitish membrane, composed of collagen and elastic fibres, within the penis that surrounds the spongy chambers) of the penis. This causes a progressive penile deformity and varying degrees of erectile dysfunction. During erection the penile scar tissue shortens and may cause bending of the penis. Occassionally the shaft of the penis is narrowed causing a flail segment at the site of constriction, firmness proximally and a soft penis distally (due to impaired venous engorgement).

Statistics on Peyronie’s Disease

The incidence of Peyronie’s disease is estimated to be between 1-3%. Most penile deformity patients present between the ages of 40 and 60 years. The youngest recorded age is 18 and the oldest reported case was aged 80 years of age. The actual incidence of Peyronie’s Disease may be higher than estimated due to reluctance of men to seek medical advice for the penile condition.

Risk Factors for Peyronie’s Disease

Doctors are not entirely sure of the causes of Peyronie’s disease but several factors have been associated with the condition:

1. Age- Most penile deformity patients are between 45 and 65 years of age, when the elasticity of tissues within the penis is reduced.
2. Sexual trauma- Many patients recall an episode of penile injury such as an invasive procedure of the penis, blunt trauma or injury during intercourse. Damage whilst the penis is erect can cause bleeding and eventual scarring.
3. Family History.
4. Diabetes Mellitus.
5. Patients with a genetic predisposition to poor wound healing – e.g. Negroes.
6. Connective tissue disorders – e.g. systemic lupus erythematosus and scleroderma. Up to 47% of patients have another cause of loss of elasticity such as Dupuytren’s contracture or Ledderhose’s disease (thickening of the fascia on the palms and soles respectively).
7. Autoimmune disorders.
8. Arterial disease.
9. Frequent sexual intercourse.
10. Some medications such as beta-blockers list the condition as a possible side-effect.

Progression of Peyronie’s Disease

Peyronie’s disease usually begins between the ages of 40 and 60 years old, being first noticed as an area of firmness on the topside of the penis. This area of firmness is usually associated with the development of penis pain. This area then increases in size over months to years, causing the penis to bend towards this area of firmness. The penis deformity may increase over time, and can make sexual intercourse difficult. The pain will usually spontaneously resolve after six months, as the inflammation subsides. It is common for the peyronie’s disease patient to develop performance anxiety about sexual intercourse as a result of their deformity and the varying degree of impotence that accompanies peyronie’s disease.

Symptoms of Peyronie’s Disease

Peyronie’s disease may present with the following complaints:

1. Presence of an area of hardness (induration) on the penis.
2. Increasing curvature to their penis, or shortening when their penis is erect.
3. Flacidity of the end of the penis.
4. Penile pain – During the period of inflammation.
5. Erectile dysfunction – occurs in 41-55% of patients with Peyronie’s disease.
6. Your partner may complain of discomfort during sexual intercourse due to the abnormal penile curvature.

Your doctor will ask specific questions to determine whether the inflammation of the penis is still active, as medical therapy is still beneficial in these cases. The presence of pain, recent penile deformity and short disease duration are all markers of early disease progression.

Clinical Examination of Peyronie’s Disease

The doctor will carefully examine the penis to feel for areas of thickening and scarring. This may be painful if the peyronie’s disease is still within its active phase. Visit our information on the Male urogenital system.

How is Peyronie’s Disease Diagnosed?

There are no general investigations for peyronie’s disease. If the patient is suspected of a predisposing condition, investigations may be carried out to investigate their presence. This will usually involve a series of blood tests. Imaging including plain x-ray, ultrasound and MRI of the penis may be performed to determine the prescence of calcifications in advanced peyronie’s disease.

Prognosis of Peyronie’s Disease

Peyronie’s disease has a variable prognosis, depending on the severity of peyronie’s disease and response to treatment. If the condition is left without penile treatment, the pain will eventually subside but the patient may be left with a permanent deformity of their penis. The prognosis is brightened if peyronie’s disease is diagnosed and treated early, as medications may be given to reduce the severity of the abnormality in its early stages. Many patients are able to tolerate the resulting penile deformity, and only few require surgical correction.

How is Peyronie’s Disease Treated?

There are a large number of treatments available for peyronie’s disease, involving medications, physical therapy or surgery of the penis.

1. Medications: These are only useful in the early stages of peyronie’s disease, when the inflammation of the penis remains active. A number of different penile treatments have been proven effective in reducing the severity of inflammation, resulting in a less severe deformity of the penis. Proven medications include Vitamin E, Potassium Para-Aminobenzoate, Tamoxifen, colchicine, verapamil and interferon.
2. Physical therapy: The use of ultrasound in a procedure called extracorporeal shockwave therapy has been proven effective in reducing penile curvature and pain. There are no long-term studies, however, to support the effectiveness of this procedure. Low-dose radiotherapy is also used for long-term painful peyronie’s disease with good results, however, the risks of exposure to radiation must be considered when using this form of penile treatment.
3. Surgery: Surgery is required when the condition is no longer active, and medication can no longer provide any benefit. A number of procedures can be performed to straighten the penis, ranging from penile plastic surgery to correct its shape, to penile prostheses in the more severe and resistant cases.

Peyronie’s Disease References

1. Fitkin J, Ho G, Peyronie’s Disease: Current Management, American Family Physician 1999; 60(2).
2. Longmore M, Wilkinson I, Torok E. Oxford Handbook of Clinical Medicine. Oxford Universtiy Press. 2001.
3. Ralph DJ, and Minhas S. The management of Peyronie’s disease. BJU International 2004 93:208-215.
4. Wagner G, Tejada I, Update on male erectile dysfunction, BMJ 1998;316:678-682.