Peyronie's disease

Editor-in-Chief: Joel Gelman, M.D. [mailto:jgelman@uci.edu], Director of the Center for Reconstructive Urology and Associate   Clinical Professor in the Department of Urology at the University of   California, Irvine

Synonyms and keywords: Curved penis, penile curvature

Peyronie's disease is a connective tissue disorder involving the growth of fibrous plaques in the soft tissue of the penis affecting as many as 1-4% of men. Specifically the fibrosing process occurs in the tunica albuginea, a fibrous envelop surrounding the penile corpora cavernosa.

Peyronies disease is also formally known as "penile induration" or "Induratio Penis Plastica (IPP)" and colloquially as "bent nail syndrome". A French surgeon, François de la Peyronie, first described the disease in 1743.

Variation
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. This causes the penis to point in a direction other than directly forward, while still having a relatively straight shaft. Such curvature is not caused by Peyronie's Disease.

Symptoms
The disease may cause pain, hardened, cord-like lesions (scar tissue known as "plaques"), or abnormal curvature of the penis when erect. In addition, narrowing and or shortening of the penis may occur. Pain felt in the early stages of the disease often resolves in twelve to eighteen months. Erectile dysfunction, in varying degrees, often accompanies these symptoms in the later stages of the disease process. The condition may also make sexual intercourse painful and/or difficult, though many men report satisfactory intercourse in spite of the disease. Although it can affect men of any race and age, it is most commonly seen in caucasian males above the age of 40. Peyronie's Disease is not contagious, nor is it related in any way to cancer. The disease only affects men and 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.

Diagnosis
A diagnosis of Peyronie's disease usually can be made by a detailed medical history and conducting a thorough physical examination.

In rare conditions where a diagnosis of Peyronie's disease cannot be made through a physical examination, a biopsy may be recommended. During a biopsy, a small amount of plaque cells are removed from the penis and then examined under a microscope to help diagnose the condition and rule out other diseases, such as cancer.

Treatment
Without treatment, about 12-13% of patients will spontaneously improve over time, 40-50% will get worse and the rest will be relatively stable. Always consult a qualified physician before starting any treatment regimen.

Medication and supplements
Many oral treatments have been studied, but results so far have been mixed. Some consider the use of non-surgical approaches to be "controversial".

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. A combination of Vitamin E and colchicine has shown some promise in delaying progression of the condition.

Newer agents targeting the basic mechanisms of inflammation have not yet been studied in larger clinical trials. Such medications include potassium para-aminobenzoate (Potaba), acetyl L-carnitine, propionyl L-carnitine, L-arginine, sildenafil (acting through phosphodiesterase-5 inhibition) and pentoxifylline (acting through TGFβ1 inhibition).

Interferon-alpha-2b has been proposed in recent publications.

Formulations of superoxide dismutase are also reported to be effective in Pey.

Injections to plaques (scar tissue formed by the disease) with Verapamil may be effective in some patients. Use of iontophoresis with Verapamil and Dexamethasone, applied to the affected areas has been studied but a recent placebo controlled trial failed to show a significant improvement. There are no clinical trials listed in the NIH trial registry.

Surgery
Surgery, such as the "Nesbit operation", 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.

Physical therapy and devices
Self-administered manual stretching techniques, as well as a number of devices which exert gentle longitudinal forces on the plaque are currently being studied in clinical trials.

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, withdrawal from their sexual partners, and an unwillingness to talk openly about their concerns with their partner and or their physician. Accordingly, seeking out a mental health professional is often recommended as an adjunct to medical treatment.