Peyronie's Disease

Peyronie's disease is a connective tissue disorder characterised by the formation of fibrous plaques within the soft tissue of the penis. Specifically, these plaques form in the tunica albuginea, the thick sheath surrounding the corpora cavernosa. This condition can result in pain, abnormal curvature, erectile dysfunction, indentation, loss of girth, and shortening of the penis. The prevalence of Peyronie's disease ranges from 1–20% and tends to increase with age.

Signs and Symptoms

A certain degree of penile curvature is normal, often referred to as congenital curvature. However, Peyronie's disease can lead to significant symptoms such as pain, hardened lesions (plaques), and abnormal curvature during erection due to chronic inflammation of the tunica albuginea (CITA). The condition can also present with divots or indentations rather than curvature. Sexual intercourse can become painful or difficult, and men with Peyronie's disease are more likely to experience erectile dysfunction. Additionally, about 30% of men with this condition may develop fibrosis in other elastic tissues such as the hand or foot, including Dupuytren's contracture.

Psychosocial Impact

Peyronie's disease can have significant psychological effects, including depression and withdrawal from sexual partners. Despite these impacts, many men continue to engage in sexual relations.

Causes

The exact cause of Peyronie's disease remains unknown, but it is believed to result from the buildup of plaque due to repeated mild trauma or injury during sexual intercourse or physical activity. Risk factors include diabetes mellitus, Dupuytren's contracture, plantar fibromatosis, penile trauma, smoking, excessive alcohol consumption, genetic predisposition, and European heritage.

Diagnosis

A urologist typically diagnoses the condition, often using ultrasound to provide conclusive evidence and rule out other disorders.

Ultrasonography

Penile ultrasonography typically shows hyperechoic focal thickening of the tunica albuginea, often with associated calcifications leading to acoustic shadowing. Doppler studies can indicate inflammatory activity or disease stability by showing altered blood flow around the plaques. Erectile dysfunction related to venous leakage is common due to insufficient drainage at the plaque site.

Treatment

Medication and Supplements

Oral treatments have shown mixed results, and their use remains controversial. Vitamin E supplementation has had some reported success, but newer studies have failed to replicate these findings consistently. Interferon-alpha-2b and collagenase clostridium histolyticum have also been studied, with the latter receiving FDA approval for Peyronie's disease treatment in 2013. Tadalafil's effects have also been looked at.

Physical Therapy and Devices

Penile traction therapy has shown moderate evidence as a well-tolerated, minimally invasive treatment, though optimal treatment duration remains uncertain.

Surgery

Surgery, such as the "Nesbit operation," is considered a last resort and should be performed by highly skilled urological surgeons. Penile implants may be suitable for advanced cases.

Epidemiology

Peyronie's disease affects 1–20% of men, with increasing prevalence with age. The mean age of onset is 55–60 years, though cases have been recorded in younger individuals. Various studies have reported prevalence rates ranging from 3.2% to 16%, with higher rates observed in men undergoing evaluation for erectile dysfunction and those undergoing routine prostate screening.

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Self-assessment MCQs (single best answer)

What is Peyronie's disease primarily characterised by?

Which part of the penis is primarily affected in Peyronie's disease?

What percentage of men with Peyronie's disease may also develop fibrosis in other elastic tissues?

Which of the following is NOT a common symptom of Peyronie's disease?

Which of the following is a significant psychological impact of Peyronie's disease?

What is a commonly believed cause of Peyronie's disease?

Which diagnostic tool is commonly used to confirm Peyronie's disease?

Which medication received FDA approval for the treatment of Peyronie's disease in 2013?

What is a non-surgical treatment option with moderate evidence for Peyronie's disease?

What is the typical age range for the onset of Peyronie's disease?