Peyronie's disease

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Peyronie's disease
Other namesPeyronie disease, induratio penis plastica (IPP), [1] chronic inflammation of the tunica albuginea (CITA)
Peyronie disease.jpg
Man showing abnormal curvature of the penis associated with Peyronie's disease
Pronunciation
Specialty Urology
CausesUnknown [2]
Frequency~10% of men [2]
Named after François Gigot de la Peyronie

Peyronie's disease is a connective tissue disorder involving the growth of fibrous plaques in the soft tissue of the penis. Specifically, scar tissue forms in the tunica albuginea, the thick sheath of tissue surrounding the corpora cavernosa, causing pain, abnormal curvature, erectile dysfunction, indentation, loss of girth and shortening. [2] [3]

Contents

It is estimated to affect 1–20% of men. [2] The condition becomes more common with age. [2]

Signs and symptoms

Example of penis deformation from side Peyronie's disease.jpg
Example of penis deformation from side

A certain degree of curvature of the penis is considered normal, as many people are born with this benign condition, commonly referred to as congenital curvature. [4] 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). [5]

Although the popular conception of Peyronie's disease is that it always involves curvature of the penis, the scar tissue sometimes causes divots or indentations rather than curvature. The condition may also make sexual intercourse painful and/or difficult, though it is unclear whether some men report satisfactory or unsatisfactory intercourse in spite of the disorder.[ citation needed ] The disorder is confined to the penis, although a substantial number of men with Peyronie's exhibit concurrent connective tissue disorders in the hand, and to a lesser degree, in the feet. About 30 percent of men with Peyronie's disease develop fibrosis in other elastic tissues of the body, such as on the hand or foot, including Dupuytren's contracture of the hand. An increased incidence in genetically related males suggests a genetic component. [6] It can affect men of any race and age.

Psychosocial

Peyronie's disease can also have psychological effects. While most men will continue to be able to have sexual relations, they are likely to experience some degree of erectile dysfunction. It is not uncommon to exhibit depression or withdrawal from their sexual partners. [7]

Causes

The underlying cause of Peyronie's disease is unknown. Although, it is likely due to a buildup of plaque inside the penis due to repeated mild sexual trauma or injury during sexual intercourse or physical activity. [8]

Risk factors include diabetes mellitus, Dupuytren's contracture, plantar fibromatosis, penile trauma, smoking, excessive alcohol consumption, genetic predisposition, and European heritage. [9] [10] [11]

Diagnosis

This ultrasound depicts cross sections of the penis at different locations in a patient with Peyronie's disease. The top image shows normal anatomy whereas the bottom image shows scar tissue on the tunica albuginea (penis). The scar tissue is localized and responsible for the hallmark deformities of Peyronie's disease (curvature and narrowing). Peyronie's Disease Ultrasound.jpg
This ultrasound depicts cross sections of the penis at different locations in a patient with Peyronie's disease. The top image shows normal anatomy whereas the bottom image shows scar tissue on the tunica albuginea (penis). The scar tissue is localized and responsible for the hallmark deformities of Peyronie's disease (curvature and narrowing).

A urologist may be able to diagnose the disease and suggest treatment. An ultrasound can provide conclusive evidence of Peyronie's disease, ruling out congenital curvature or other disorders. [12]

Ultrasonography

On penile ultrasonography, the typical appearance is hyperechoic focal thickening of the tunica albuginea. Due to associated calcifications, the imaging of patients with Peyronie's disease shows acoustic shadowing, as illustrated in figures below. Less common findings, attributed to earlier stages of the disease (still mild fibrosis), are hypoechoic lesions with focal thickening of the paracavernous tissues, echoic focal thickening of the tunica without posterior acoustic shadowing, retractile isoechoic lesions with posterior attenuation of the beam, and focal loss of the continuity of the tunica albuginea.

In the Doppler study, increased flow around the plaques can suggest inflammatory activity and the absence of flow can suggest disease stability. Ultrasound is useful for the identification of lesions and to determine their relationship with the neurovascular bundle. Individuals with Peyronie's disease can present with erectile dysfunction, often related to venous leakage, due to insufficient drainage at the site of the plaque. Although plaques are more common on the dorsum of the penis, they can also be seen on the ventral face, lateral face, or septum. [13]

Treatment

Medication and supplements

Many oral treatments have been studied but results so far have been mixed. [14] Some consider the use of nonsurgical approaches to be controversial. [15]

Vitamin E supplementation has been studied for decades, and some success has been reported in older trials; those successes have not been reliably repeated in larger, newer studies. [16] The use of Interferon-alpha-2b in the early stages of the disease has been studied; as of 2007, its efficacy was questionable. [17]

Collagenase clostridium histolyticum is reported to help by breaking down the excess collagen in the penis. [18] [19] It was approved for treatment of Peyronie's disease by the FDA in 2013. [20]

The effects of tadalafil in treating the disease have also been studied. [21] [22]

Physical therapy and devices

There is moderate evidence that penile traction therapy is a well-tolerated, minimally invasive treatment; there is uncertainty about the optimal duration of stretching per day and per course of treatment, and the treatment course is difficult. [23]

Surgery

Surgery such as the "Nesbit operation", which is named after Reed M. Nesbit (1898–1979), an American urologist at University of Michigan), [8] is considered a last resort and should only be performed by highly skilled urological surgeons knowledgeable in specialized corrective surgical techniques. A penile implant may be appropriate in advanced cases. [24]

Epidemiology

It is estimated to affect 1–20% of men. [2] The condition becomes more common with age. [2] The mean age at onset of disease is 55–60 years although many cases have been recorded in adolescence and early 20's. [8] [25]

The overall prevalence of PD is about 1–20% in men. Rates range from 3.2 percent in a community-based survey of 4432 men (mean age of sample 57.4) to 16 percent among 488 men undergoing evaluation for erectile dysfunction (mean age 52.8). [26] [27] The prevalence of PD among the 4432 men in the community based study who responded by self report positively for palpable plaque, newly occurring angulation or curvature and painful erection was 1.5 percent between the ages of 30 and 39, 3 percent between 40 and 49, 3 percent between 50 and 59, 4 percent between 60 and 69, and 6.5 percent over 70.

In 534 men undergoing routine prostate screening for cancer detection (without a specific urologic complaint), the prevalence of PD was 8.9 percent. [26] In this study, the mean age of those with PD was 68.2 years compared with 61.8 years of those without PD.

History

The condition was first described in 1561 in correspondence between Andreas Vesalius and Gabriele Falloppio and separately by Gabriele Falloppio. [28] [29] The condition is named for François Gigot de la Peyronie, who described it in 1743. [30]

Related Research Articles

Erectile dysfunction (ED), also referred to as impotence, is a form of sexual dysfunction in males characterized by the persistent or recurring inability to achieve or maintain a penile erection with sufficient rigidity and duration for satisfactory sexual activity. It is the most common sexual problem in males and can cause psychological distress due to its impact on self-image and sexual relationships.

<span class="mw-page-title-main">Penis enlargement</span> Technique aimed to increase the size of a human penis

Penis enlargement, or male enhancement, is any technique aimed to increase the size of a human penis. Some methods aim to increase total length, others the shaft's girth, and yet others the glans size. Techniques include surgery, supplements, ointments, patches, and physical methods like pumping, jelqing, and traction.

<span class="mw-page-title-main">Tadalafil</span> Medication used to treat erectile dysfunction

Tadalafil, sold under the brand name Cialis among others, is a medication used to treat erectile dysfunction, benign prostatic hyperplasia, and pulmonary arterial hypertension. It is taken by mouth. Onset is typically within half an hour and the duration is up to 36 hours.

Sexual dysfunction is difficulty experienced by an individual or partners during any stage of normal sexual activity, including physical pleasure, desire, preference, arousal, or orgasm. The World Health Organization defines sexual dysfunction as a "person's inability to participate in a sexual relationship as they would wish". This definition is broad and is subject to many interpretations. A diagnosis of sexual dysfunction under the DSM-5 requires a person to feel extreme distress and interpersonal strain for a minimum of six months. Sexual dysfunction can have a profound impact on an individual's perceived quality of sexual life. The term sexual disorder may not only refer to physical sexual dysfunction, but to paraphilias as well; this is sometimes termed disorder of sexual preference.

<span class="mw-page-title-main">Penile fracture</span> Medical condition

Penile fracture is rupture of one or both of the tunica albuginea, the fibrous coverings that envelop the penis's corpora cavernosa. It is caused by rapid blunt force to an erect penis, usually during vaginal intercourse, or aggressive masturbation. It sometimes also involves partial or complete rupture of the urethra or injury to the dorsal nerves, veins and arteries.

<span class="mw-page-title-main">Vardenafil</span> Chemical compound

Vardenafil, sold under the brand name Levitra among others, is a medication that is used for treating erectile dysfunction. It is a PDE5 inhibitor. It is taken by mouth.

Nocturnal penile tumescence (NPT) is a spontaneous erection of the penis during sleep or when waking up. Along with nocturnal clitoral tumescence, it is also known as sleep-related erection. Men without physiological erectile dysfunction or severe depression experience nocturnal penile tumescence, usually three to five times during a period of sleep, typically during rapid eye movement sleep. Nocturnal penile tumescence is believed to contribute to penile health.

Venous leak, also called venogenic erectile dysfunction and penile venous insufficiency, is one category of vasculogenic impotence — a cause of erectile dysfunction in males. It affects all ages, being particularly awkward in young men. Much about venous leaks has not reached a consensus among the medical community, and many aspects of the condition, particularly its treatment strategies, are controversial. The prevalence of the condition is still unknown, although some sources claim it to be a common cause of erectile dysfunction.

<span class="mw-page-title-main">Penile implant</span> Medical device

A penile implant is an implanted device intended for the treatment of erectile dysfunction, Peyronie's disease, ischemic priapism, deformity and any traumatic injury of the penis, and for phalloplasty or metoidioplasty, including in gender-affirming surgery. Men also opt for penile implants for aesthetic purposes. Men's satisfaction and sexual function is influenced by discomfort over genital size which leads to seek surgical and non-surgical solutions for penis alteration. Although there are many distinct types of implants, most fall into one of two categories: malleable and inflatable transplants.

<span class="mw-page-title-main">Human penis</span> Human male external reproductive organ

In human anatomy, the penis is an external male sex organ that additionally serves as the urinary duct. The main parts are the root, body, the epithelium of the penis including the shaft skin, and the foreskin covering the glans. The body of the penis is made up of three columns of tissue: two corpora cavernosa on the dorsal side and corpus spongiosum between them on the ventral side. The human male urethra passes through the prostate gland, where it is joined by the ejaculatory duct, and then through the penis. The urethra traverses the corpus spongiosum, and its opening, the meatus, lies on the tip of the glans. It is a passage both for urination and ejaculation of semen.

<span class="mw-page-title-main">Erection</span> Physiological phenomenon involving the hardening and enlargement of the penis

An erection is a physiological phenomenon in which the penis becomes firm, engorged, and enlarged. Penile erection is the result of a complex interaction of psychological, neural, vascular, and endocrine factors, and is often associated with sexual arousal, sexual attraction or libido, although erections can also be spontaneous. The shape, angle, and direction of an erection vary considerably between humans.

<span class="mw-page-title-main">Human penis size</span> Measurement of the human penis

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A male genital disease is a condition that affects the male reproductive system. The human male genitals consist of testicles and epididymides, ductus deferentes, seminal vesicles and ejaculatory ducts, prostate, bulbourethral glands, and penis.

<span class="mw-page-title-main">Clitoral erection</span> Physiological phenomenon involving the engorgement of the clitoris

Clitoral erection is a physiological phenomenon where the clitoris becomes enlarged and firm.

Male genital examination is a physical examination of the genital in males to detect ailments and to assess sexual development, and is normally a component of an annual physical examination. The examination includes checking the penis, scrotum, and urethral meatus. A comprehensive assessment of the male genitals assesses the pubic hair based on Sexual Maturity Rating and the size of the testicles and penis. The exam can also be conducted to verify a person's age and biological sex. The genitourinary system can also be assessed as part of the male genital examination. During a genital examination, the doctor can detect any of the following: structural abnormalities, urethral opening abnormalities, problems related to not being circumcised, lumps, tumors, redness, excoriation, edema, lesions, swelling, cancer, hair-related issues, and many others. In some instances where a physical examination of the male genitals is not sufficient to diagnose an individual, then an internal genital examination using imaging or ultrasounds will be needed for further evaluation.

A penile injury is a medical emergency that afflicts the penis. Common injuries include fracture, avulsion injury, strangulation, entrapment, and amputation.

Penile ulltrasonography is medical ultrasonography of the penis. Ultrasound is an excellent method for the study of the penis, such as indicated in trauma, priapism, erectile dysfunction or suspected Peyronie's disease.

Culley Clyde Carson III is an American retired urologist who specializes in Peyronie's disease, penile implants and erectile dysfunction. After serving two years as a flight surgeon with the United States Air Force, he took on a urology residency at the Mayo Clinic and then taught at the Duke University Medical Center as an assistant professor, subsequently gaining full professorship.

A penis extender is an external medical device with tentative evidence as of 2019 for Peyronie's disease. It acts as a mechanical, traction device that stretches the human penis in the flaccid state to make it longer.

<span class="mw-page-title-main">Hard flaccid syndrome</span> Medical condition

Hard flaccid syndrome (HFS), also known as hard flaccid (HF), is a chronic painful condition characterized by a semi-rigid penis at the flaccid state, a soft glans at the erect state (cold glans syndrome), pelvic pain, low libido, erectile dysfunction, erectile pain, pain on ejaculation, penile sensory changes (numbness or coldness), lower urinary tract symptoms, contraction of the pelvic floor muscles, and psychological distress. Other complaints include rectal and perineal discomfort, cold hands and feet, and a hollow or detached feeling inside the penile shaft. The majority of HFS patients are in their 20s–30s and symptoms significantly affect one's quality of life.

References

  1. ↑ Freedberg, Irwin M.; Fitzpatrick, Thomas B. (2003). Fitzpatrick's dermatology in general medicine (6th ed.). New York: McGraw-Hill, Medical Pub. Division. p. 990. ISBN   978-0-07-138076-8.
  2. 1 2 3 4 5 6 7 "Penile Curvature (Peyronie's Disease)". National Institute of Diabetes and Digestive and Kidney Diseases. July 2014. Retrieved 25 October 2017.
  3. ↑ Levine, Laurence A (2010). "Peyronie's disease and erectile dysfunction: Current understanding and future direction". Indian Journal of Urology. 22 (3): 246–50. doi: 10.4103/0970-1591.27633 .
  4. ↑ Davis, Timothy; McCammon, Kurt A. (2010). "81. Congenital Curvature". In Graham, Sam D.; Keane, Thomas E.; Glenn, James Francis (eds.). Glenn's Urologic Surgery. Lippincott Williams & Wilkins. p. 533. ISBN   9780781791410.
  5. ↑ Kumar, Anand; Sharma, Mona (2017). "15. Male Sexual Function". In Kumar, Anand; Sharma, Mona (eds.). Basics of Human Andrology: A Textbook. New Delhi: Springer. p. 268. ISBN   978-981-10-3694-1.
  6. ↑ Carrieri MP, Serraino D, Palmiotto F, Nucci G, Sasso F (June 1998). "A case-control study on risk factors for Peyronie's disease". Journal of Clinical Epidemiology. 51 (6): 511–5. doi:10.1016/S0895-4356(98)00015-8. PMID   9636000.
  7. ↑ Nelson CJ, Mulhall JP (March 2013). "Psychological impact of Peyronie's disease: a review". The Journal of Sexual Medicine . 10 (3): 653–60. doi:10.1111/j.1743-6109.2012.02999.x. PMID   23153101.
  8. 1 2 3 Ralph, D. J.; Minhas, S. (January 2004). "The management of Peyronie's disease". British Journal of Urology International . 93 (2): 208–15. doi: 10.1111/j.1464-410X.2004.04587.x . PMID   14690485. S2CID   38211880.
  9. ↑ Tobias S. Köhler, Kevin T. McVary (2016). Contemporary Treatment of Erectile Dysfunction: A Clinical Guide. Springer. ISBN   9783319315874 . Retrieved 2020-01-17.
  10. ↑ Hatzimouratidisa, Konstantinos; Eardley, Ian; Giuliano, François; Hatzichristou, Dimitrios; Moncada, Ignacio; Salonia, Andrea; Vardi, Yoram; Wespes, Eric (2012). "EAU guidelines on penile curvature". European Urology. 62 (3): 543–552. doi:10.1016/j.eururo.2012.05.040. PMID   22658761 . Retrieved 21 January 2020.
  11. ↑ Abern, Michael R.; Levine, Laurence A. (2009). "Peyronie's disease: evaluation and review of nonsurgical therapy". The Scientific World Journal. 27 (9): 665–675. doi: 10.1100/tsw.2009.92 . PMC   5823162 . PMID   19649505.
  12. ↑ Amin Z, Patel U, Friedman EP, Vale JA, Kirby R, Lees WR (May 1993). "Colour Doppler and duplex ultrasound assessment of Peyronie's disease in impotent men". The British Journal of Radiology. 66 (785): 398–402. doi:10.1259/0007-1285-66-785-398. PMID   8319059.
  13. 1 2 Originally copied from:
    Fernandes, Maitê Aline Vieira; Souza, Luis Ronan Marquez Ferreira de; Cartafina, Luciano Pousa (2018). "Ultrasound evaluation of the penis". Radiologia Brasileira. 51 (4): 257–261. doi:10.1590/0100-3984.2016.0152. ISSN   1678-7099. PMC   6124582 . PMID   30202130.
    CC-BY license
  14. ↑ Levine LA (October 2003). "Review of current nonsurgical management of Peyronie's disease". International Journal of Impotence Research. 15 (Suppl 5): S113–20. doi: 10.1038/sj.ijir.3901084 . PMID   14551587.
  15. ↑ Hauck EW, Diemer T, Schmelz HU, Weidner W (June 2006). "A critical analysis of nonsurgical treatment of Peyronie's disease". European Urology. 49 (6): 987–97. doi:10.1016/j.eururo.2006.02.059. PMID   16698449.
  16. ↑ Mynderse LA, Monga M (October 2002). "Oral therapy for Peyronie's disease". International Journal of Impotence Research. 14 (5): 340–4. doi: 10.1038/sj.ijir.3900869 . PMID   12454684.
  17. ↑ Trost LW, Gur S, Hellstrom WJ (2007). "Pharmacological Management of Peyronie's Disease". Drugs. 67 (4): 527–45. doi:10.2165/00003495-200767040-00004. PMID   17352513. S2CID   10578409.
  18. ↑ "FDA approves first drug treatment for Peyronie's disease". FDA NEWS RELEASE. U.S. Food and Drug Administration. 6 December 2013. Retrieved 6 December 2013.
  19. ↑ Pollack, Andrew (December 6, 2013). "Injections to Treat an Embarrassing Ailment Win U.S. Approval". New York Times. Retrieved December 7, 2013.
  20. ↑ Giorgio Pajardi, Marie A. Badalamente, Lawrence C. Hurst (2018). Collagenase in Dupuytren Disease. Springer. ISBN   9783319658223 . Retrieved 2020-01-17.{{cite book}}: CS1 maint: multiple names: authors list (link)
  21. ↑ Spirito, Lorenzo; Manfredi, Celeste; La Rocca, Roberto; Napolitano, Luigi; Di Girolamo, Antonio; Capece, Marco; Trama, Francesco; Sciorio, Carmine; Sokolakis, Ioannis; Creta, Massimiliano; Arcaniolo, Davide (2022). "Daily low-dose tadalafil may reduce the penile curvature progression rate in patients with acute Peyronie's disease: a retrospective comparative analysis". International Journal of Impotence Research. doi:10.1038/s41443-022-00651-8. PMID   36513814. S2CID   254674530.
  22. ↑ Park*, Hyun Jun; Park, Sung Woo; Kim, Tae Nam (2019). "Pd21-09 Daily Tadalafil Therapy: A New Treatment Option for Peyronie's Disease?". Journal of Urology. 201 (Supplement 4). doi: 10.1097/01.JU.0000555753.36349.5d .
  23. ↑ Eric C, Geralb B (February 2013). "Penile traction therapy and Peyronie's disease: a state of art review of the current literature". Ther Adv Urol. 5 (2): 59–65. doi:10.1177/1756287212454932. PMC   3547530 . PMID   23372611.
  24. ↑ Hellstrom WJ, Usta MF (October 2003). "Surgical approaches for advanced Peyronie's disease patients". International Journal of Impotence Research. 15 (Suppl 5): S121–4. doi: 10.1038/sj.ijir.3901085 . PMID   14551588.
  25. ↑ Tal, Raanan; Hall, Matthew S.; Alex, Byron; Choi, Judy; Mulhall, John P. (2012-01-01). "Peyronie's Disease in Teenagers". The Journal of Sexual Medicine. 9 (1): 302–308. doi:10.1111/j.1743-6109.2011.02502.x. ISSN   1743-6095. PMID   21981606.
  26. 1 2 Mulhall JP, Creech SD, Boorjian SA, Ghaly S, Kim ED, Moty A, Davis R, Hellstrom W. Subjective and objective analysis of the prevalence of Peyronie's disease in a population of men presenting for prostate cancer screening. J Urol. 2004 Jun;171(6 Pt 1):2350-3. doi: 10.1097/01.ju.0000127744.18878.f1. PMID 15126819.
  27. ↑ Kadioglu A, Oktar T, Kandirali E, Kendirci M, Sanli O, Ozsoy C. Incidentally diagnosed Peyronie's disease in men presenting with erectile dysfunction. Int J Impot Res. 2004 Dec;16(6):540-3. doi: 10.1038/sj.ijir.3901247. PMID 15116064.
  28. ↑ Dunsmuir WD, Kirby RS (October 1996). "Francois de LaPeyronie (1978-1747): the man and the disease he described". Br J Urol. 78 (4): 613–22. doi:10.1046/j.1464-410x.1996.14120.x. PMID   8944520.
  29. ↑ Falloppio, Gabriele (1561). Gabrielis Falloppii medici Mutinensis Observationes anatomicae ad Petrum Mannam medicum Cremonensem . U.S. National Library of Medicine. Venetiis : Apud Marcum Antonium Vlmum.
  30. ↑ Peyronie's disease at Who Named It?
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