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Peyronie’s disease (pay-row-NEEZ), a condition of unknown cause. It is characterized by a hard plaque or lump that forms on the penis. The plaque develops on the top or bottom of the penis in layers that contain erectile tissue. It begins as a localized inflammation and can develop into a hardened scar.
François de la Peyronie, a French surgeon, first described Peyronie’s disease in 1743. Early writers classified it as a form of impotence, now called erectile dysfunction. Peyronie’s disease may be associated with ED; however, experts now recognize that erectile dysfunction is only one factor associated with the disease, a factor that is not always present.
Cases of Peyronie’s disease range from mild to severe. Symptoms can develop slowly or come on suddenly, even overnight. In severe cases, the hardened plate reduces flexibility, causing pain and forcing the penis to bend or arch during an erection. In many cases, the pain subsides over time, but the curvature of the penis can still be a problem, making sexual intercourse difficult. With the milder form of the disease, the inflammation may resolve without causing significant pain or permanent flexing. The plaque itself is not cancerous. A plate at the top of the shaft (most common) causes the penis to bend upwards. One at the bottom makes it fold down. Sometimes the plaque develops on both the top and bottom, causing clefting and shortening of the penis. Sometimes pain, bending, and emotional distress prevent sexual intercourse.
One study found Peyronie’s disease in one percent of men. Although the disease mostly occurs in middle age, young and older men can also develop it. Genetic factors can make a man vulnerable to the disease Men with Peyronie’s disease often seek medical attention because of painful erections and difficulty having sexual intercourse. Since the cause of the disease and its course 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 is often all that is required. There is no strong evidence to show that any treatment other than surgery is effective. Experts usually recommend surgery only in long-term cases where the disease is stabilized and the deformity prevents intercourse.
disease course
Many researchers believe that Peyronie’s disease plaque develops after trauma (blow or bending) that causes localized bleeding within the penis. Two chambers known as the corpora cavernosa run the length of the penis. The membrane on the inner surface of the chambers is a sheath of elastic fibers. A connective tissue, called a septum, runs along the center of each chamber and joins at the top and bottom. If the penis is abnormally bumped or bent, an area where the septum attaches to elastic fibers can be stretched beyond a limit, injuring the lining of the erectile chamber and, for example, rupturing small blood vessels. As a result of aging, decreased elasticity near the septal attachment point can increase the chances of injury. The damaged area may 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 in about a year, the plaque does not progress beyond an initial inflammatory phase.
In cases that persist for years, the plaque undergoes fibrosis, or the formation of tough fibrous tissue, and even calcification, or the formation of calcium deposits. While trauma may explain acute cases of Peyronie’s disease, it does not explain why most cases develop slowly and without an apparent traumatic event. Nor does it explain why some cases disappear quickly. Some researchers theorize that Peyronie’s disease may even be an autoimmune disorder.
Treatment
The course of Peyronie’s disease is different for each patient. Some patients experience improvement without treatment, medical experts suggest waiting a year or two or more before trying to correct it surgically. During that wait, patients are often willing to undergo treatments whose effectiveness has not been proven. Some researchers have given men with Peyronie’s disease oral vitamin E in small-scale studies and have reported improvements. However, no controlled studies have established the effectiveness of vitamin E therapy. Steroids, such as cortisone, have produced unwanted side effects, such as atrophy or death of healthy tissue.
Radiation therapy, in which high-energy rays are directed at the plaque, has also been used. Like some of the chemical treatments, radiation seems to reduce pain, but it has no effect on the plaque itself and can cause unwanted side effects. Although the variety of agents and methods used points to the lack of proven treatment, new insights into the wound healing process may one day lead to more effective therapies.
Peyronie’s disease has been treated surgically with some success. The two most common surgical procedures are removal or expansion of the plate 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 plate, thereby negating the flexing effect. The first method may 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 the rigidity of the penis. In some cases, an implant alone will straighten the penis adequately. In other cases, the implantation is combined with a technique of incisions and grafts or plications (pinching or folding of 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 a small number of men with a curvature so severe that it prevents sexual intercourse.
See a qualified urologist if you think you have this disorder.