What Is Peyronie's Disease?


Myth: Peyronie's disease is very rare. Fact: In a recent strudy of 534 men, 8.9% had palpable penile plaque*.

 

Peyronie's disease was written about as early as 1678 but was first described in 1743 by Francois Gigot de la Peyronie, a surgeon to Louis XIV of France. Peyronie's disease is a fibrotic tissue disorder or wound healing disorder, which is non-cancerous and is characterized by the presence of excess collagen, which is often called fibrotic tissue or plaque. The most common symptoms caused by the plaque are curvature of the penis and painful erections. It was thought that Peyronie's disease was very rare; however, the rate of reported cases of Peyronie's disease referred to in literature is commonly 3-6%. A recent questionnaire of 8,000 men found the prevalence of the condition to be 1.5% for men age 30-39, 3.0% for men age 40-59, 4.0% for men age 60-69, and 6.5% for men age 70 and older*. The condition has also been diagnosed in patients both younger and older, especially if they are sexually active. The prevalence of Peyronie's disease is likely higher than reported due to patients not seeking diagnosis and treatment. One published study found 22 of 100 autopsied patients to have some degree of the disease process**.

*Subjective and objective analysis of the prevalence of Peyronie’s disease in a population of men presenting for prostate cancer screening: Mulhall JP, Creech SD, Boorjian SA, Ghaly S, Kim ED, Moty A, Davis R, Hellstrom W. The Journal of Urology- 2004 06 (Vol. 171, Issue 6 (Part 1))
**Gelbard MK, Dorey F, James K. The natural history of Peyronie's disease. J Urol. 1990;144:1376. MEDLINE

Symptoms

Illustration of Peyronie's disease

Since Peyronie's disease is a wound healing disorder, there are constant changes that take place at the onset of the condition. These changes are classified into two categories:

  1. The acute inflammatory phase which occurs during the first six to eighteen months in which pain is common.
  2. The chronic or stable phase where the symptoms reach their most severe state.

The plaque forms in a part of the penis called the tunica albuginia and can usually be felt just under the skin in the shaft of the penis. The plaque reduces the elasticity of the tunica albuginia, which can result in symptoms such as penile curvature, painful erections, constrictions or indentations along the shaft, loss of length and/or girth, and erectile dysfunction. In addition to the physical symptoms, Peyronie's disease can also have a significant emotional impact on patients. A questionnaire used in a study of Peyronie's disease patients found that 77% suffered from psychological effects of the condition and 65% of those patients stated that the problem concerned them frequently*.

*Gelbard MK, Dorey F, James K. The natural history of Peyronie's disease. J Urol. 1990;144:1376. MEDLINE

Causes of Peyronie's Disease

The exact cause of Peyronie's disease is not well understood; however, there are a few potential causes that most Urologist agree likely play a role in the condition.

Trauma

Trauma to the penis is one of the most common causes of Peyronie’s disease. When the penis bends or is struck severely, the penile tissue can tear and lead to an overproduction of collagen during the wound healing process. This excess collagen can reduce normal tissue elasticity and cause painful erections, curvature, and penile deformities.

Genetics

Many patients have a genetic predisposition to Peyronie’s disease and other related fibrotic tissue disorders. A parent or other close relative may have had one or more of these conditions. In some cases, patients with Peyronie’s disease may also develop Dupuytren’s disease (a buildup of plaque in the palm of the hand causing pain and palmar contracture) or plantar fibromatosis (a buildup of plaque in the foot causing pain and difficulty walking).

Medications/ Vitamins/ Supplements

Medications often used for treating high blood pressure that belong to the drug class known as beta adrenergic blocking agents (beta-blockers) have been reported to cause fibrotic tissue disorders. Anti-seizure medications such as phenytoin and certain supplements such as glucosamine/chondroitin and large doses of supplemental vitamin C may also promote the production of excess collagen.

Other Conditions

Peyronie's disease has been associated with a number of conditions including diabetes, gout, and heart disease. Some research suggest that Peyronie's disease may be an autoimmune disorder. It has been theorized that repeated minor trauma to the tissue in penis might trigger the immune system to respond to heal the injury; however, the body is improperly responds and produces excess fibrotic tissue or fibrotic plaque.

 

Treatment Options

Myth: Peyronie's disease resolves in 30% to 50% of patients without treatment. Fact: In the largest published study following patients with no treatment, only 12% had improvement (not cure) in curvature and 48% worsened*.

Doctors have tried many different treatments for Peyronie's disease since it was first described in 1678. The most common treatments can be divided into two basic categories, invasive and non-invasive.

Invasive treatments include:

  • Injections of verapamil, interferon, or purified clostridial collagenase into the plaque
  • Various stretching devices
  • Surgery- usually performed as a last resort due to potential unfavorable outcomes such as impotence and loss of penile length. Penile prosthesis is an option if the patient has severe erectile dysfunction.

Non-invasive options include:

  • Transdermal Verapamil 15% Gel
  • Iontophoresis of different drugs
  • ESWT- Extracorporeal Shock Wave Therapy
  • Oral Medications such as vitamin E, colchicine, paraaminobenzoate (Potaba®), tamoxifen, and acetyl-L carnitine

Most doctors agree that a conservative approach to treating Peyronie's disease is preferred. As a result, the least invasive options are typically tried first before moving to invasive procedures or surgery in patients suffering from the most significant cases of Peyronie's disease.

*An Analysis of the Natural History of Peyronie's Disease Mulhall JP, Schiff J, Guhring P The Journal of Urology- 2006 06 (Vol. 175, Issue 6)