Peyronie’s disease: Diagnosis & Treatments

The most common area for the plaque is on the top or bottom of the penis.

The plaque seen in Peyronie’s disease is benign, noncancerous, and not contagious or caused by any known transmittable disease.
The disease was named after the French surgeon François Gigot de la Peyronie who described it in 1743.

Usually men with Peyronie’s disease are referred to a urologist—a doctor who specializes in sexual and urinary problems.

Swelling inside the penis will block blood flow through the layers of tissue inside the penis. When the blood can’t flow normally, clots can form and trap immune system cells. As the injury heals, the immune system cells may release substances that lead to the formation of too much scar tissue. The scar tissue builds up and forms a plaque inside the penis. The plaque reduces the elasticity of tissues and flexibility of the penis during erection, leading to curvature. The plaque may further harden because of calcification––the process in which calcium builds up in body tissue.
 

Who gets Peyronie's disease?

The actual occurrence of Peyronie’s disease may be higher due to men’s embarrassment and health care providers’ limited reporting. The disease is rare in young men, although it has been reported in men in their 30s. The chance of developing Peyronie’s disease increases with age. This condition is most commonly acquired at about age 55.
A man can be born with a curved penis, but this is not Peyronies disease but usually a penile curvature. 

Who is more likely to develop Peyronie’s disease? 

The following factors may increase a man’s chance of developing Peyronie’s disease:
 

• vigorous sexual or nonsexual activities that cause microscopic injury to the penis,
• certain connective tissue and autoimmune disorders,
• a family history of Peyronie’s disease,

• aging,
• connective tissue and autoimmune disorders.

Men who have certain connective tissue and autoimmune disorders may have a higher chance of developing Peyronie’s disease. A common example is a condition known as Dupuytren’s disease, an abnormal cordlike thickening across the palm of the hand. Dupuytren’s disease is also known as Dupuytren’s contracture. Although Dupuytren’s disease is fairly common in older men, only about 15 percent of men with Peyronie’s disease will also have Dupuytren’s disease. Other connective tissue disorders associated with Peyronie’s disease include:
 

• Plantar fasciitis - inflammation of the plantar fascia, thick tissue on the bottom of the foot that connects the heel bone to the toes and creates the arch of the foot.
 

• Scleroderma - abnormal growth of connective tissue, causing it to get thick and hard; scleroderma can cause swelling or pain in muscles and joints.

Autoimmune disorders associated with Peyronie’s disease include:

• systemic lupus erythematosus - inflammation and damage to various body tissues, including the joints, skin, kidneys, heart, lungs, blood vessels, and brain.
• Sjögren’s syndrome - inflammation and damage to the glands that make tears and saliva.

• Behcet’s syndrome - inflammation of the blood vessels

Family History of Peyronie’s Disease

Medical experts believe that Peyronie’s disease may run in some families. For example, a man whose father or brother has Peyronie’s disease may have an increased chance of getting the disease.

Aging

The chance of getting Peyronie’s disease increases with age. Age-related changes in the elasticity of tissues in the penis may cause it to be more easily injured and develop the disease. 

The signs and symptoms of Peyronie’s disease may include:
 

• hard lumps on one or more sides of the penis
• pain without erection or during sexual intercourse or during an erection
• a curve in the penis either with or without an erection

In addition to producing a curved penis, Peyronies disease may change the shape of the erection in other ways: indentation, diameter reduction, or loss of length.

Erectile Dysfunction

Symptoms of Peyronie’s disease range from mild to severe. Symptoms may develop slowly or appear quickly. In many cases, the pain decreases over time, although the curve in the penis may remain. In milder cases, symptoms may go away without causing a permanent curve.

What are the consequences and evolutivity of Peyronie’s disease?

Complications of Peyronie’s disease may include:

• the inability to have sexual intercourse,

• Erectile Dysfunction (The cause for the erectile dysfunction of Peyronie’s disease could be a “venous leakage » , or psychogenic),

• Strong psychological impact – especially in single men and young men who are not in a well-established relationship, with a lack of self-esteem and a refusal for sexual intercourse.

Evolutivity of the painful period (not always) with erection usually lasts 6-8 months and is known as the inflammatory phase. This is followed by a fibrotic stage in which the pain settles but scarring continues to develop and the distortion of the penis continues. About half the men who get Peyronie's disease develop depression. Some cases are mild, healing without treatment within a year of onset. Most cases produce at least some degree of persistent curvature. 

Surgical treatments

A urologist may recommend surgery to remove plaque or help straighten the penis during an erection. Medical experts recommend surgery for long-term cases when:

• symptoms have not improved,
• the curve or bend in the penis does not allow the man to have sexual intercourse.
 

Some surgical methods can cause shortening of the penis. Medical experts suggest waiting 1 year or more from the onset of symptoms and 3 months witout any evolutivity before having surgery because the course of Peyronie’s disease is different in each man.
 

A urologist may recommend the following surgeries:
• Incision-Excision-Grafting: These procedures involve the replacement or expansion of scarred tunica albuginea with grafts of healthy tissue from another site. More recently, surgeons have been using grafts to expand the contracted scars (or plaque) without excising them. Though some calcified plaques still require removal, this non-excisional approach seems less disturbing to erectile function, and less likely to cause post-operative impotence. A urologist will cut or remove the plaque and attach a patch of a vein, or biomaterial. This procedure may straighten the penis and restore some lost length from Peyronie’s disease. However, some men may experience numbness of the

penis and erectile dysfunction after the procedure.

• Plications: This operation, or its various modifications, corrects bending by plicating the convex or outer side of the bend. Counteracting the relative shortage of tunica albuginea on the concave side straightens the penis, though length is reduced slightly as a consequence. Still, this procedure is less likely to cause numbness and erectile dysfunction than tissue grafting, and remains the first choice for moderate bends without associated diameter reduction.

• Penile implantation: A urologist implants a device into the penis that can cause an erection and help straighten it during an erection. Penile implants may be considered if a man has both Peyronie’s disease and erectile dysfunction. In some cases, an implant alone will straighten the penis adequately. If the implant alone does not straighten the penis, a urologist may combine implantation with one of the other two surgeries. Once a man has an implant, he must use the device to have an erection. 

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