Peyronie’s disease – plastic sclerosis of the penis. Causes, symptoms, diagnosis

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Peyronie’s disease, or sclerosis of the penis, is manifested by its curvature and reduced ability to have a healthy erection. Men between the ages of 40 and 60 suffer from the disease, but there are very few of them. The disease may appear, inter alia, in following injuries or atherosclerotic changes.

Peyronie’s disease – definition

Peyronie’s disease is a condition that affects the male sex organs. It consists in penis curvature and erection problems resulting from the low hardness of the penis and frequent pain during erection. It happens that the disease ends in impotence.

The name of the disease comes from the French physician Francis de la Pyronie, who was the first to describe a malady in men, consisting in the formation of plaques in the area of ​​the corpus cavernosum leading to its curvature during erection, he discovered it in 1743. Peyronie’s disease is most common in men between 40-60 years of age, although it can also appear at a much younger age.

The course of Peyronie’s disease

At the beginning of Peyronie’s disease, acute inflammation occurs, the multiplication of fibroblasts and the remodeling of the albuminous tissue (it becomes hard). An erection causes the whitish membrane to extend beyond the plate, which leads to a curvature of the penis in the direction of the plate. The plaques calcify over time.

In some cases, the curvature of the penis may resolve spontaneously in the early stages of the disease. Pain occurs in up to 40% of menand it disappears about a year after the diagnosis of the disease. In some men, Peyronie’s disease can even lead to depression.

How is the penis built?

The penis consists of two cavernous bodies that are located on the dorsal side and one spongy body that is located ventrally or runs through the urethra. In addition, there are thick connective tissue sheaths around the corpus cavernosum. At the time of erection, the male cavernous bodies fill with blood, which leads to their enlargement and stiffening.

The thickness of the whitish penile membrane at rest is 2 mm, while during erection, the membrane stretches and its thickness will decrease to ¼ mm. It is in the whitish membrane that plaques are formed during Peyronie’s disease.

Peyronie’s disease – causes

The causes of the disease are not fully known. The formation of scar tissue around the whitish sheath of the shaft of the penis may be caused by microtrauma to the whitish membrane that occurs during sexual intercourse. In addition, other causes of Peyronie’s disease may be inheritance (not confirmed conclusively) or atherosclerotic lesions.

The resulting scarring causes limited blood supply and the formation of lumps, which lead to the curvature of the penis at the place of the scar. In addition, the penis may change its diameter and length, and may appear bulging. This leads to pain, and when the curvature is very severe, sexual intercourse becomes impossible.

Other factors influencing the development of Peyronie’s disease

Peyronie’s disease can coexist with other conditions, including:

1. arterial hypertension;
2. cardiomyopathy;
3. diabetes;
4. heavy smoking;
5. excessive consumption of alcohol;
6. erectile dysfunction.

Peyronie’s disease – symptoms

The first symptoms of Peyronie’s disease are seen on the back of the penis – they are cartilaginous nodules. Patients also complain of penile curvature, as well as the associated pain during erection. In the later stages, the curvature may be so great that it is completely impossible to have sexual intercourse.

Peyronie’s symptoms can therefore be divided into two stages:

1. Stage 1 is the inflammatory phase, in which the painful erection occurs, the plaque becomes soft at the site of pain;
2. Stage 2 is the stabilization phase, during which the pain subsides, the plaque calcifies and the penis curves during erection.

Peyronie’s disease – diagnosis

The diagnosis of Peyronie’s disease is largely based on a physical examination and medical history. During the conversation, the doctor asks questions about the occurrence and duration of symptoms to determine what stage of the disease the patient is at. Conservative treatment may be used in the inflammatory phase of Peyronie’s disease. In addition to the interview, the patient is asked to fill in a special questionnaire that includes information about erectile dysfunction.

As for the physical examination, the doctor examines the corpus cavernosum and checks for fibrous indurations on the albuminous membrane. If they are detected, it evaluates their size and their cohesiveness. It is not necessary to perform an ultrasound to confirm the diagnosis. It happens that the doctor asks the patient to take a photo of the penis during erection (if there is a curvature), thanks to which it is possible to accurately analyze the degree of curvature.

How to Treat Peyronie’s Disease?

Often times, Peyronie’s disease will disappear on its own. Conservatively, vitamin E, steroids and colchicines are administered. These preparations are supposed to have an anti-inflammatory effect and reduce penile deformation. However, there is no drug that is highly effective and one that would be recommended for Peyronie’s disease. Invasive treatment involves the excision of scar plaques within the penile sheaths.

Potassium para-aminobenzoate has been approved by the US Food and Drug Administration as an effective treatment for Peyronie’s disease. However, in Poland it did not receive a positive opinion from the Agency for Health Technology Assessment.

Another method of treatment is topical application of verapamil gel to the penis twice a day. To alleviate pain, it is worth using the ESWL lithotripter used in urolithiasis.

Steroids, collagenosis and interferon are applied directly to the plate by injection, which allows for greater treatment effectiveness. It is worth knowing that steroids can cause skin thinning and atrophy. By injecting drugs, the penis curvature angle and plaque size are reduced. In addition, pain is relieved.

In Peyronie’s disease, the most important thing is self-control during daily ablution, during which you should check for hard, moderately tender plaque within the penis.

Peyronie’s disease and surgical treatment

Surgical treatment is to eliminate penile curvature so that the man can enjoy sexual activity. The procedure is performed on patients who have been in a stable phase of Peyronie’s disease for at least 3 months (without pain and with plaque calcification). As before any operation, the patient is informed about the possible consequences, such as:

1. problems with an erection,
2. penis reduction,
3. the risk of relapse,
4. palpable thickening of penile tissues after the procedure.

Surgical treatment to eliminate penile curvature is carried out using two methods: lengthening or shortening. Shortening is performed on patients who have a suitable penis length and a curvature below 60 degrees. The doctor cuts a portion of the whitish membrane on the healthy side, which causes the penis to straighten. In about 80% of patients it is possible to completely straighten the penis.

The shortening of the penis as a complication after the surgery is small (about 1,5 cm). Penile lengthening is performed in men who have a short penis and its significant curvature (over 60 degrees). Then the diseased (concave) side is operated on, the doctor removes the plate and places a graft in its place. Penile lengthening surgery may result in erectile dysfunction, as removing the plaque causes vascular disorders.