What is Peyronie Disease?

Peyronie’s disease (PD) is a non-cancerous disorder in men that causes the penis to curve abnormally when it’s erect. This disease was named after François Gigot de la Peyronie, a French surgeon who co-founded the Académie Royale de Chirurgie in 1749, but it was actually first documented in 1561. The unusual curve happens because scar tissue forms in the erectile tissue of the penis, but the exact reason why this scar tissue forms is unknown.

Research shows that more than 1 in 10 men in the United States has PD. Like many sexual disorders, it can cause significant distress for individuals who have it. This distress comes not only from the physical changes to the penis and how it affects its function, but also because PD often coincides with erectile dysfunction — another condition that can be troubling for those affected by it. This topic seeks to explain why PD happens, how many people it affects, its historical background and symptoms, and common treatment methods that are backed by evidence.

What Causes Peyronie Disease?

To understand Peyronie’s disease, you should know about the anatomy of the penis. The penis is made up of two chambers known as the corpora cavernosa. When a man gets excited, these chambers fill with blood, making his penis stiff and larger. Each of these chambers is enclosed in a stretchy sheath known as the tunica albuginea, made mainly of a protein called type 1 collagen. Between each chamber, there’s a partition that’s attached to the top and bottom of the penis.

In Peyronie’s disease, a hard patch or “plaque” forms in the elastic sheath of the chambers that fill with blood. This inflexible patch alters the smooth upward curve of the erect penis, making it look more bent or kinked. It’s not yet certain how these plaques form but various theories are trying to explain it.

A widely accepted theory tells us that the plaque is due to an injury to the penis. If the penis is squeezed or bent unnaturally, it can stretch and damage the elastic sheath where the partition attaches. Blood leaks out from small damaged blood vessels, which triggers inflammation. This inflammation leads the type I collagen to change into another protein – type III collagen, and fibrin (a protein involved in blood clotting) gets deposited. Immune cells known as macrophages also enter the area and release a substance that breaks down the elastic fibers in the sheath. This reduces the stretchiness of the sheath.

This theory sheds some light on why Peyronie’s disease can happen after an injury to the penis. However, many patients don’t remember any noticeable injury. Other theories also exist, like damage to tiny blood vessels, chromosomal instability of the cells involved in plaque formation, variations with a natural chemical called nitric oxide, and differences in patients’ immune response.

We still can’t identify who will develop Peyronie’s disease but it’s more common in men who take part in vigorous sexual or non-sexual activities that can damage the penis.

Here are some of the risk factors, given the current evidence:

– Injury to the penis: A previous injury to the penis is a strong indicator of developing Peyronie’s disease. Injuries to the genitals or pelvis, medical procedures like catheterization, or cystoscopy, can all increase the risk.

– Disorders that affect your body’s connective tissue: Peyronie’s disease is often seen in patients with fibroproliferative diseases, like Dupuytren’s contracture and plantar fasciitis, suggesting a possible common cause. The prevalence of these conditions is higher among those with Peyronie’s disease.

– Family History: The genetic factors contributing to Peyronie’s disease are not well known. However, it is suggested that there is a genetic link, yet we do not know the exact mechanism or the genes responsible.

– Low testosterone: Having low testosterone levels could increase the likelihood of getting Peyronie’s disease and the severity of the condition. Testosterone plays a critical role in healing wounds by controlling how proteins help with wound healing. When testosterone levels are low, this normal healing process is disturbed, which increases the chances of getting Peyronie’s disease.

– Diabetes: Men with erectile dysfunction due to diabetes are more likely to get Peyronie’s disease compared to the general population.

– Smoking and Alcohol: Some studies suggest a correlation between smoking and Peyronie’s disease, although the relationship between the amount of smoking and risk is unclear.

– Age: Men in their 60s are most commonly affected by Peyronie’s disease, with an average age at diagnosis varying from 52 – 57 years old. However, cases can present at any age in adult life, with some reports of patients as young as 21 years old being affected.

Risk Factors and Frequency for Peyronie Disease

Peyronie’s disease (PD) prevalence ranges from 0.3% to 20.3%. It’s important to note that this number can vary based on the area, group of people, age, race or differences in research approaches. For example, different studies can use varied methods of diagnosis or information gathering, like whether it’s the patient or physician who reports the symptoms. This can cause a variation in the prevalence reported in different studies.

  • One study conducted in the USA found a prevalence rate of 0.39% for PD.
  • Another survey done in France, involving a questionnaire mailed to 8000 men, reported a 3.2% prevalence.
  • A large-scale, three-part study involving 11,420 males in the US found PD prevalence rates as high as 13%.

Estimating the actual prevalence of PD in any population can be challenging, primarily due to the embarrassment associated with the condition. It’s likely that the real occurrence is towards the higher end of the reported range.

Signs and Symptoms of Peyronie Disease

Peyronie’s disease (PD) is a condition that was first described more than 250 years ago, but we’ve only recent found out how it develops over time. Early studies suggested that symptoms of PD often disappear on their own, but we now know this to be inaccurate. In fact, research has shown that most people’s symptoms don’t improve without treatment, and many actually get worse over time.

The development of PD is usually split into two phases: the acute and the chronic phase. The acute phase, which lasts 6-18 months, is characterized by a worsening of the penile deformity, and it’s often painful whether the penis is erect or flacid. It is not advised to start treatment during this period. Once the symptoms stop getting worse for about 3-6 months, the disease has entered the chronic phase. At this point, the deformity doesn’t change, and any pain should diminish or disappear altogether. Treatment is typically started during the chronic phase. The presence or absence of pain is a clear indicator of which phase the patient is in.

When diagnosing a patient with PD, a thorough account of the patient’s history is necessary. This should include things like:

  • When the symptoms started and how they’ve progressed
  • A description of the deformity
  • How the patient’s erections are affected
  • If there’s any pain and when it occurs
  • Any past instances of trauma, surgeries, or urologic procedures performed on the penis
  • Family history of PD or related conditions
  • Medical history, specifically relating to diabetes, hypertension, and heart disease
  • Social history, specifically relating to sexual habits, smoking, or drug use
  • The patient’s mental state and how their relationships and self-esteem might have been affected

An examination of the penis is also important for determining a baseline before beginning treatment. This should include inspection of the penis while it is erect and flacid. In order to get an accurate image of the deformity, the doctor can either inject a substance into the penis to cause an erection or use a vacuum erection device. Ultrasounds in this state can give an accurate representation of plaque size and location and any calcification that may have occurred, which will help guide treatment.

Finally, while PD is mostly diagnosed through an examination and a patient’s medical history, lab tests can still be useful when low testosterone is suspected as a cause. Furthermore, with the strong connection between PD and other similar diseases, any diagnostic workup should include screening for conditions like diabetes, heart disease, and other fibroproliferative conditions.

Testing for Peyronie Disease

The most crucial part of diagnosing Peyronie’s disease, which is a condition that causes curved erections and can be painful, relies heavily on the doctor’s examination and the patient’s description of their symptoms. There’s no compulsory need for lab tests or detailed imaging scans to determine this condition.

To provide a more detailed understanding of the condition, the American Urological Association (AUA) advises conducting an in-office test to induce an erection, either with or without a specific ultrasound test known as Penile Doppler Duplex Ultrasound (PDUS). This ultrasound technique helps to identify any hardened lumps (calcifications), assess blood flow in the penis, and evaluate the quality of the erection post-induction. Plus, it can help discover areas of plaque (scar tissue that causes the penis to curve) that may not be easily felt during a physical exam. It can also identify if these plaques have calcifications.

Recent studies introduced a way of grading calcifications. They discovered that patients with extensive calcifications were more likely to opt for surgery, especially if they still had satisfactory sexual function. Those with minor calcifications or none at all didn’t show any increased tendency to undergo surgery.

Magnetic Resonance Imaging (MRI), particularly high-resolution T2 MRI, has also proven effective in identifying issues related to Peyronie’s disease. In this imaging procedure, plaques appear as areas of low signal intensity on the tunica albuginea, which is the tissue that covers the penis. However, this technique may not always detect calcifications. Since MRIs are expensive and not widely available, their use in routinely diagnosing Peyronie’s disease is still debatable.

Treatment Options for Peyronie Disease

Peyronie’s disease is a condition that causes unusual curvature in a man’s penis due to a build-up of scar tissue. It is advised that the patient must be treated by a physician who is experienced and equipped to diagnose, provide guidance, and treat thecondition. The suitable treatment depends on the patient’s level of distress and willingness to try different types of treatments.

Non-surgical treatments include oral and injectable therapies, which have mixed evidence supporting their effectiveness. The symptoms during the active phase of the disease, which usually include pain, can be managed with the use of nonsteroidal anti-inflammatory drugs. Other recommended therapies include oral treatments like vitamin E, tamoxifen, procarbazine, omega-3 fatty acids, or a combination of vitamin E with L-carnitine. Some patients are managed with injections into the troublesome areas with solutions of collagenase Clostridium hystolyticum, interferon-a-2b, or verapamil. This type of treatment is usually mixed with a process known as ‘modeling’, which is a process carried out by the doctor to reduce the curvature of the penis.

In cases where non-surgical treatments fail, surgical treatment may be considered. There are several surgical options available, which include:

– Penile plication: In this surgery, permanent stitches are placed in the layer that covers the erectile tissue of penis to straighten it. The surgeon would usually decide what type of this procedure to do based on your individual circumstance. Patients can expect to recover and resume sexual activities after 4 to 6 weeks of rest.

– Plaque Incision or Excision and Grafting: This involves creating an incision in the scar tissue causing the curve or removing some of it, and then covering the area with grafts of tissue taken from another part of the body or from a donor. Grafts not only cover the incision but also help in lengthening the short side of the penis. Graft sources could be from your own body, a deceased donor, or from domesticated animals.

– Penile prosthesis: This involves the insertion of a device into the penis to help with erections and can also help correct the curvature. This technique is best suited for men with severe deformities or erectile dysfunction along with Peyronie’s disease, where non-surgical treatments have failed.

It is essential to discuss with the doctor about the technique most suitable for you, your preferences, the nature and location of your penile deformity, the doctor’s surgical experience, as well as the potential risks and complications of each procedure.

Balanitis is a condition that causes inflammation in the head of the penis (glans penis). It appears in around 11% of adult men and 3% of boys who visit urology clinics. In boys, it is usually due to bacteria invading the soft tissue, while in adults, it is commonly due to poor personal hygiene, skin irritation, cuts or abrasions, and bacteria or yeast overgrowth. The treatment consists of maintaining better hygiene, avoiding any irritants, and controlling blood sugar levels for diabetic patients.

Chordee causes abnormal curvature in the penis and can exist with or without another condition called hypospadias. It is considered a disruption during the penis’ normal development while the baby is still in the womb. If a patient has Chordee, doctors usually operate after the baby is six months old. During surgery, the surgeon would identify the area of maximum curvature and correct it. If hypospadias is also present, it would be corrected in the same surgery.

Penile fracture is a severe injury that usually occurs during sexual intercourse. The person often hears a “pop” sound, followed by severe pain and the penis becoming soft. On physical exam, the penis usually has swelling, bruising, and possibly, a noticeable defect in the corpora cavernosa. Doctors can diagnose this condition through physical examination, patient history, and MRI testing, which is highly effective for diagnosing penile fractures. Treatment usually involves surgery to explore and repair the injury with absorbable stitches. If there is any suspicion of a urethral injury, it should be checked with a cystoscopy, and any found injuries should be repaired in the same surgery.

Penile pain syndrome is a condition where a person experiences recurring pain in the penis. This can be due to local conditions such as skin irritation, infection, or lack of blood flow. It can also be referred pain from the bladder, prostate, lower back, or hips. In some cases, the pain could be nerve-related due to injury to the dorsal nerve, pudendal nerve, or cauda equina. Mental health conditions could also be a reason. Treatment for persistent penile pain involves diagnosing and treating the underlying cause.

What to expect with Peyronie Disease

The overall outlook for people with Peyronie’s disease is positive because there are many different treatment options available.

Possible Complications When Diagnosed with Peyronie Disease

There are certain complications linked with the methods used to treat medical conditions, including injections into the plaque, a firm, thickened patch on your body (in this context, the penis). These complications may involve bruising on your penis, swelling, pain, the risk of rupturing the sheath of erectile tissue in your penis or failing to correct its curvature.

Surgical options can also lead to complications, including infection risks, injury to the tube that carries urine from your bladder out of your body, shortening of the penis, persistent pain, a build-up of thick sticky blood or swelling (otherwise known as a hematoma), a loss of penile sensation and the curvature returning.

Common Complications:

  • Bruising on your penis
  • Swelling
  • Pain
  • Risk of rupturing the erectile tissue in your penis
  • Inability to fix the penis’s curved shape
  • Risk of infection
  • Injury to the tube that carries urine from your bladder
  • Shortening of the penis
  • Persistent penile pain
  • Build-up of blood or swelling, also known as a hematoma
  • Loss of sensation in the penis
  • Return of the penis’s curvature

Preventing Peyronie Disease

Peyronie’s disease can sometimes be a tough issue to tackle. This is often due to the fact that many people feel embarrassed about the condition and hesitate to seek medical assistance. It’s important for patients to realize that this condition is probably more common than they think and that numerous treatments offer excellent outcomes. So, don’t be afraid to reach out for medical help.

Frequently asked questions

The prognosis for Peyronie's Disease is positive because there are many different treatment options available.

Peyronie's disease can be caused by factors such as injury to the penis, disorders that affect the body's connective tissue, family history, low testosterone levels, diabetes, smoking and alcohol use, and age.

The signs and symptoms of Peyronie's Disease (PD) include: - Penile deformity: PD causes a curvature or bending of the penis, which can be upward, downward, or to the side. This deformity can make sexual intercourse difficult or painful. - Pain: During the acute phase of PD, there is often pain associated with the penile deformity. This pain can occur both when the penis is erect or flaccid. However, as the disease progresses into the chronic phase, the pain should diminish or disappear altogether. - Erectile dysfunction: PD can affect the ability to achieve or maintain an erection. The curvature or plaque formation in the penis can interfere with blood flow, leading to difficulties in achieving or maintaining an erection. - Changes in sexual habits: PD can impact a person's sexual habits and relationships. The deformity and pain associated with PD may lead to decreased sexual desire, anxiety, and relationship problems. - Plaque formation: PD is characterized by the formation of fibrous plaques or scar tissue in the penis. These plaques can be felt as hard lumps or bands under the skin of the penis. - Progression of symptoms: Without treatment, PD symptoms typically worsen over time. The penile deformity may become more pronounced, and the pain may increase during the acute phase. It is important to note that the presence or absence of pain is a clear indicator of which phase of PD the patient is in. During the acute phase, the symptoms worsen and are often painful, while the chronic phase is characterized by stable symptoms and diminished or no pain.

The types of tests that may be ordered to diagnose Peyronie's disease include: 1. In-office test to induce an erection, with or without Penile Doppler Duplex Ultrasound (PDUS) to assess blood flow, identify hardened lumps (calcifications), and evaluate the quality of the erection. 2. Magnetic Resonance Imaging (MRI), particularly high-resolution T2 MRI, to identify issues related to Peyronie's disease, such as areas of low signal intensity on the tunica albuginea (the tissue that covers the penis). It is important to note that lab tests or detailed imaging scans are not compulsory for diagnosing Peyronie's disease, and the doctor's examination and the patient's description of symptoms are crucial for diagnosis.

A doctor needs to rule out the following conditions when diagnosing Peyronie's Disease: 1. Erectile dysfunction 2. Balanitis 3. Chordee 4. Penile fracture 5. Penile pain syndrome

The side effects when treating Peyronie's Disease can include: - Bruising on the penis - Swelling - Pain - Risk of rupturing the erectile tissue in the penis - Inability to fix the penis's curved shape - Risk of infection - Injury to the tube that carries urine from the bladder - Shortening of the penis - Persistent penile pain - Build-up of blood or swelling, also known as a hematoma - Loss of sensation in the penis - Return of the penis's curvature

A urologist.

Peyronie's disease prevalence ranges from 0.3% to 20.3%.

Peyronie's disease can be treated through both non-surgical and surgical methods. Non-surgical treatments include oral and injectable therapies, such as nonsteroidal anti-inflammatory drugs, vitamin E, tamoxifen, procarbazine, omega-3 fatty acids, or injections of collagenase Clostridium hystolyticum, interferon-a-2b, or verapamil. These treatments are often combined with a process called 'modeling' to reduce the curvature of the penis. If non-surgical treatments fail, surgical options may be considered, including penile plication, plaque incision or excision and grafting, and penile prosthesis insertion. The choice of treatment depends on the patient's level of distress and willingness to try different options, as well as the nature and location of the penile deformity and the doctor's surgical experience.

Peyronie's disease is a non-cancerous disorder in men that causes the penis to curve abnormally when it's erect.

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