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Peyronie disease: Causes and Symptoms

• Peyronie disease: Epidemiology and causes
• Peyronie disease: Diagnosis and treatment

Definition of Peyronie disease

Peyronie disease (PD) is an acquired fibrosis of the tunica albuginea, which may be accompanied by pain, penile deviation or deformity, erectile dysfunction and distress. PD is also called Induratio penis plastica.

Epidemiology of Peyronie disease

An increasing prevalence rate with age is reported: 30–39 years (1.5%), 40–59 years (3%), 60–69 years (4%) and over 70 years (6.5%). The symptomatic prevalence is approximately 1% for all age groups. The prevalence of Peyronie disease at autopsy is much higher, with up to 20% penile indurations.

Causes (Etiology) of Peyronie disease

Microtrauma and Peyronie disease

Trauma (Bending) of the penis is a risk factor for Peyronie disease. More frequent and vigorous sexual intercourse is a risk factor, and sexual intercourse in positions which are potentially traumatic to the penis. The manifestation of Peyronie 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 by releasing growth factors (e.g., TGF-β). The fibrotic inflammatory response can maintain itself and lead to the formation of a penile deviation with fibrotic plaques.

Etiology of Peyronie disease: the tunica albuginea of the corpora cavernosa consists of two layers (A). Microtrauma (e.g., bending) leads to the separation of the layers, bleeding, and a fibrotic inflammatory response (B).

Associated Diseases and Conditions

The following diseases or conditions are associated with Peyronie disease: Dupuytren disease (30–40%), Ledderhose disease (plantar form of Dupuytren disease), liver cirrhosis, rheumatic diseases, tympanosclerosis, penile or urethral trauma, urethral instrumentation, urethritis, diabetes mellitus, Paget disease, treatment with β-blocker (weak evidence).

Erectile Dysfunction and Peyronie 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 disease

The deposition of fibrin is typical in penile plaques due to Peyronie disease. Fibrin usually is absent in scar tissue of the tunica albuginea. Furthermore, the plaques consist of dense connective tissue with collagens, and the elastin is fragmented and diminished. The expression of TGF-β is increased. Neighboring vessels show infiltrates with lymphocytes. In 30%, dystrophic calcifications of the plaques are found.

Signs and Symptoms of Peyronie disease

Peyronie disease often shows two stages:

• Inflammatory stage: palpable induration, painful erection and increasing deviation. The pain usually improves within six months.
• Stable disease: static deviation and often erectile dysfunction.

Penile Deviation

The penile deviation may show a dorsal, lateral or ventral curvature. A pronounced deviation prevents sexual intercourse. The curvature is often associated with penile shortening.

Penile Plaques

The penile plaques are palpable on the concave side of the deviation in the tunica albuginea of the corpora cavernosa.

Natural History of Peyronie disease

In up to 15%, Peyronie 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 duration over two years, plaque calcification, or concurrent Dupuytren disease.

References

A. Nehra et al. “AUA Guideline: Peyronie’s Disease,” 2015. [Online]. Available: https://www.auanet.org/guidelines-and-quality/guidelines/peyronies-disease-guideline.

EAU-Guidelines: Sexual and Reproductive Health

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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169 (2003), Nr. 4, S. 1234–41

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.: Congenital Curvature of the Phallus: Report of Three Cases with Description of Corrective Operation.
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Tunuguntla 2001 TUNUGUNTLA, H. S.: Management of Peyronie’s disease-a review.
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Yachia 1990 YACHIA, D.: Modified corporoplasty for the treatment of penile curvature.
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  Deutsche Version: Ursachen der Induratio penis plastica (Morbus Peyronie)