Peyronie's disease: Causes and Symptoms
Review literature: (Gholami et al, 2003) (Hauck et al, 2006) (Tunuguntla, 2001).
Definition of Peyronie's Disease
Peyronie's disease is an acquired penile deviation with formation of palpable plaques in the tunica albuginea of the penis. Peyronie's disease is also called Induratio penis plastica.
Epidemiology of Peyronie's Disease
An increasing prevalence rate
with age is reported: 30–39 years (1.5%), 40–59 years (3%), 60–69 years (4%) and more than 70 years (6.5%). The symptomatic prevalence is approximately 1% for all age groups. The prevalence of Peyronie's disease at autopsy is much higher, with up to 20% penile indurations.
Causes (Etiology) of Peyronie's Disease
Microtrauma and Peyronie's Disease
Trauma (Bending) of the penis is a risk factor for peyronie's disease. A more frequent and vigorous sexual intercourse is a risk factor, as well sexual intercourse in positions, which are potentially traumatic to the penis. The manifestation of peyronie's disease represents a pathological form of wound healing of the tunica albuginea.
The tunica albuginea of the corpora cavernosa consists of two layers (outer longitudinal and inner circular layer). Due to traumatic events (see above), these two layers are separated, most likely at the septal insertions. The delamination of the tunica albuginea leads to bleeding and clot formation. Macrophage invasion creates a fibrotic inflammatory response with release of growth factors (e.g. TGF-β). The fibrotic inflammatory response can maintain itself and leads to the formation of a penile deviation with fibrotic plaques.
Associated Diseases and Conditions
The following diseases or conditions are associated with Peyronie's disease: Dupuytren's disease (30–40%), Ledderhose's disease (plantar form of Dupuytren's disease), liver cirrhosis, rheumatic diseases, tympanosclerosis, penile or urethral trauma, urethral instrumentation, urethritis, diabetes mellitus, Paget's disease, treatment with β-blocker (weak evidence).
Erectile Dysfunction and Peyronie's Disease
Penile plaques destroy the elasticity of the tunica albuginea and thus lead to erectile dysfunction due to venous insufficiency. A pronounced penile deviation is a mechanical handicap for vaginal penetration and causes psychological frustration. Circular plaques can cause instability of the penis.
Pathology of Peyronie's Disease
The deposition of fibrin is typical in penile plaques due to Peyronie's disease. Fibrin is normally absent in scar tissue of the tunica albuginea. Furthermore, the plaques consist of dense connective tissue with collagens, the elastin is fragmented and diminished. The expression of TGF-β is increased. Neighboring vessels show infiltrates with lymphocytes. In 30%, dystrophic calcification of the plaques is found.
Signs and Symptoms of Peyronie's Disease
Peyronie's disease often shows two stages:
- Inflammatory stage: palpable induration, painful erection and increasing deviation. Pain shows of a spontaneous improvement within 6 months.
- Stable disease: static deviation and often erectile dysfunction
Penile deviation may show a dorsal, lateral or ventral curvature. A pronounced deviation prevents sexual intercourse. The curvature is often associated with penile shortening.
The penile plaques are palpable on the concave side of the deviation in the tunica albuginea of the corpora cavernosa.
Natural History of Peyronie's Disease
In up to 15%, peyronie's disease shows a spontaneous regression. In 40%, the disease remains stable. The following factors make a spontaneous regression unlikely: penile deviation over 45 degrees, disease progression over two years, plaque calcification, or Dupuytren's disease.
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Gholami u.a. 2003 GHOLAMI, S. S. ;
GONZALEZ-CADAVID, N. F. ; LIN, C. S. ; RAJFER,
J. ; LUE, T. F.:
- Peyronie’s disease: a review.
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Hauck, E. W. u. a. (2006). A critical analysis of nonsurgical treatment of Peyronie’s disease. In: Eur Urol 49, S. 987–997.
Nesbit 1965 NESBIT, R. M.:
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Description of Corrective Operation.
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Tunuguntla 2001 TUNUGUNTLA, H. S.:
- Management of Peyronie’s disease-a review.
In: World J Urol
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Yachia 1990 YACHIA, D.:
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