Peyronie's disease

Peyronie's disease
Synonyms Peyronie disease, induratio penis plastica (IPP),[1] chronic inflammation of the tunica albuginea (CITA)
Pronunciation
  • /peɪroʊˈniː/
Specialty Urology Edit this on Wikidata
Causes Unknown[2]
Frequency ~10% of men[2]

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] A variety of treatments have been used, but few have been especially effective.

It is estimated to affect about 10% of men.[2] The condition becomes more common with age.[2]

Signs and symptoms

Example of penis deformation from side.

A certain degree of curvature of the penis is considered normal, as many men are born with this benign condition, commonly referred to as congenital curvature.

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). 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. It can affect men of any race and age. 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.[4]

Causes

The underlying cause of Peyronie's disease is not well understood, but is thought to be caused by trauma or injury to the penis usually through sexual intercourse or physical activity, although many patients are often unaware of any traumatic event or injury.

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).

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.[5]

Treatment

Medication and supplements

Collagenase clostridium histolyticum (Auxilium), a drug originally approved by the FDA to treat Dupuytren's contracture, is now an FDA-approved injectable drug for treatment of Peyronie's disease. The drug is reported to work by breaking down the excess collagen in the penis that causes Peyronie's disease.

Surgery

Surgery, such as the "Nesbit operation" (which is named after Reed M. Nesbit (1898–1979), an American urologist at University of Michigan),[6] is considered a last resort and should only be performed by highly skilled urological surgeons knowledgeable in specialized corrective surgical techniques. A penile prosthesis may be appropriate in advanced cases.[7]

Physical therapy and devices

There is moderate evidence that penile traction therapy is a well-tolerated, minimally invasive treatment, but there is uncertainty about the optimal duration of stretching per day and per course of treatment, and the treatment course is difficult.[8]

Counseling

Peyronie's disease can be a physically and psychologically devastating disease. While most men will continue to be able to have sexual relations, they are likely to experience some degree of deformity and erectile dysfunction in the wake of the disease process. It is not uncommon for men afflicted with Peyronie's disease to exhibit depression or withdrawal from their sexual partners.[9]

History

The condition is named for François Gigot de La Peyronie, who described it in 1743; the condition may have been described around 100 years before that.[10]

In 2013, the US FDA approved the first drug specifically for Peyronie's; the drug was collagenase clostridium histolyticum (Auxilium).[11][12]

Research

Vitamin E supplementation has been studied for decades, and some success has been reported in older trials, but those successes have not been reliably repeated in larger, newer studies.[13]

The use of Interferon-alpha-2b in the early stages of the disease has been studied, but as of 2007 its efficacy was questionable.[14]

See also

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 0-07-138076-0.
  2. 1 2 3 4 5 "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. ↑ 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.
  5. ↑ 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.
  6. ↑ Ralph DJ, Minhas S (January 2004). "The management of Peyronie's disease". BJU International. 93 (2): 208–15. doi:10.1111/j.1464-410X.2004.04587.x. PMID 14690485.
  7. ↑ 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.
  8. ↑ 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.
  9. ↑ 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.
  10. ↑ Peyronie's disease at Who Named It?
  11. ↑ "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.
  12. ↑ Pollack, Andrew (December 6, 2013). "Injections to Treat an Embarrassing Ailment Win U.S. Approval". New York Times. Retrieved December 7, 2013.
  13. ↑ 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.
  14. ↑ 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.
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