TZPSS Articles | Health | Peyronie's Disease

Health

TZPSS
science

Topics Front Page

Knowledge has power.

Peyronie's Disease

Peyronie's disease, a condition of uncertain cause, is
characterized by a plaque, or hard lump, that forms on the
penis. The plaque develops on the upper or lower side of the
penis in layers containing erectile tissue. It begins as a localized
inflammation and can develop into a hardened scar.

Cases of Peyronie's disease range from mild to severe.
Symptoms may develop slowly or appear overnight. In severe
cases, the hardened plaque reduces flexibility, causing pain and
forcing the penis to bend or arc during erection. In many cases,
the pain decreases over time, but the bend in the penis may
remain a problem, making sexual intercourse difficult. The
sexual problems that result can disrupt a couple's physical and
emotional relationship and lead to lowered self-esteem in the
man. In a small percentage of patients with the milder form of
the disease, inflammation may resolve without causing
significant pain or permanent bending.

The plaque itself is benign, or noncancerous. A plaque on the
top of the shaft (most common) causes the penis to bend
upward; a plaque on the underside causes it to bend
downward. In some cases, the plaque develops on both top
and bottom, leading to indentation and shortening of the penis.
At times, pain, bending, and emotional distress prohibit sexual
intercourse.

One study found Peyronie's disease in 1 percent of men.
Although the disease occurs mostly in middle age, younger and
older men can develop it. About 30 percent of men with
Peyronie's disease develop fibrosis (hardened cells) in other
elastic tissues of the body, such as on the hand or foot. A
common example is a condition known as Dupuytren's
contracture of the hand. In some cases, men who are related
by blood tend to develop Peyronie's disease, which suggests
that genetic factors might make a man vulnerable to the
disease.

Men with Peyronie's disease usually seek medical attention
because of painful erections and difficulty with intercourse.
Since the cause of the disease and its development are not well
understood, doctors treat the disease empirically; that is, they
prescribe and continue methods that seem to help. The goal of
therapy is to keep the Peyronie's patient sexually active.
Providing education about the disease and its course often is all
that is required. No strong evidence shows that any treatment
other than surgery is effective. Experts usually recommend
surgery only in long-term cases in which the disease is
stabilized and the deformity prevents intercourse.

A French surgeon, François de la Peyronie, first described
Peyronie's disease in 1743. The problem was noted in print as
early as 1687. Early writers classified it as a form of impotence,
now called erectile dysfunction (ED). Peyronie's disease can be
associated with ED; however, experts now recognize ED as
only one factor associated with the disease—a factor that is not
always present.

The internal cavity of the penis that runs the length of the
penis and is divided into two chambers (corpora cavernosa) by
a vertical connecting tissue known as a septum. It is believed
that, during trauma such as bending, bleeding might occur at a
point of attachment of the septum to tissue lining the chamber
wall (center). The bleeding results in a hard scar, which is
characteristic of Peyronie's disease. The scar reduces flexiblility
on one side of the penis during erection, leading to curvative.

Course of the Disease
Many researchers believe the plaque of Peyronie's disease
develops following trauma (hitting or bending) that causes
localized bleeding inside the penis. Two chambers known as the
corpora cavernosa run the length of the penis. The inner-
surface membrane of the chambers is a sheath of elastic fibers.
A connecting tissue, called a septum, runs between the two
chambers and attaches at the top and bottom.

If the penis is abnormally bumped or bent, an area where the
septum attaches to the elastic fibers may stretch beyond a
limit, injuring the lining of the erectile chamber and, for
example, rupturing small blood vessels. As a result of aging,
diminished elasticity near the point of attachment of the
septum might increase the chances of injury.

The damaged area might heal slowly or abnormally for two
reasons: repeated trauma and a minimal amount of blood flow
in the sheath-like fibers. In cases that heal within about a year,
the plaque does not advance beyond an initial inflammatory
phase. In cases that persist for years, the plaque undergoes
fibrosis, or formation of tough fibrous tissue, and even
calcification, or formation of calcium deposits.

While trauma might explain acute cases of Peyronie's disease, it
does not explain why most cases develop slowly and with no
apparent traumatic event. It also does not explain why some
cases disappear quickly or why similar conditions such as
Dupuytren's contracture do not seem to result from severe
trauma.

Some researchers theorize that Peyronie's disease may be an
autoimmune disorder.

Diagnosis and Evaluation
Doctors can usually diagnose Peyronie's disease based on a
physical examination. The plaque is visible and palpable whether
the penis is flaccid or erect. Full evaluation, however, may
require examination during erection to determine the severity of
the curvature. The erection may be induced by injecting
medicine into the penis or through self-stimulation. Some
patients may eliminate the need to induce an erection in the
doctor's office by taking a digital or Polaroid picture in the
home. The examination may include an ultrasound scan of the
penis to pinpoint the location and extent of the plaque and
evaluate blood flow throughout the penis.

Treatment
Because the course of Peyronie's disease is different in each
patient and because some patients experience improvement
without treatment, medical experts suggest waiting 1 to 2
years or longer before attempting to correct it surgically.
During that wait, patients often are willing to undergo
treatments whose effectiveness has not been proven.

Experimental Treatments
Some researchers have given vitamin E orally to men with
Peyronie's disease in small-scale studies and have reported
improvements. Yet, no controlled studies have established the
effectiveness of vitamin E therapy. Similar inconclusive success
has been attributed to oral application of para-aminobenzoate,
a substance belonging to the family of B-complex molecules.

Researchers have injected chemical agents such as verapamil,
collagenase, steroids, calcium channel blockers, and interferon
alpha-2b directly into the plaques. These interventions are still
considered unproven because studies included small numbers
of patients and lacked adequate control groups. Steroids, such
as cortisone, have produced unwanted side effects, such as the
atrophy or death of healthy tissues. Another intervention
involves iontophoresis, the use of a painless current of
electricity to deliver verapamil or some other agent under the
skin into the plaque.

Radiation therapy, in which high-energy rays are aimed at the
plaque, has also been used. Like some of the chemical
treatments, radiation appears to reduce pain, but it has no
effect at all on the plaque itself and can cause unwelcome side
effects. Although the variety of agents and methods used
points to the lack of a proven treatment, new insights into the
wound healing process may one day yield more effective
therapies.

Surgery
Peyronie's disease has been treated surgically with some
success. The two most common surgical procedures are
removal or expansion of the plaque followed by placement of a
patch of skin or artificial material, and removal or pinching of
tissue from the side of the penis opposite the plaque, which
cancels out the bending effect. The first method can involve
partial loss of erectile function, especially rigidity. The second
method, known as the Nesbit procedure, causes a shortening
of the erect penis.

Some men choose to receive an implanted device that increases
rigidity of the penis. In some cases, an implant alone will
straighten the penis adequately. In other cases, implantation is
combined with a technique of incisions and grafting or plication
(pinching or folding the skin) if the implant alone does not
straighten the penis.

Most types of surgery produce positive results. But because
complications can occur, and because many of the phenomena
associated with Peyronie's disease (for example, shortening of
the penis) are not corrected by surgery, most doctors prefer to
perform surgery only on the small number of men with
curvature so severe that it prevents sexual intercourse.

Content Source NKUDIC

MEDICAL NOTES