Peyronie’s Disease: A Review of Etiology, Diagnosis, and Management

Abstract

Peyronie’s Disease (PD) is a superficial fibrosing disorder of the penis resulting in plaque formation and penile deformity. Once considered rare, PD has more recently been found in up to 13% of men, and can negatively affect sexual and psychosocial function of both patients and their partners. While the etiology of PD is unclear, it is thought to result from an inciting traumatic event followed by aberrant fibrosis or dysregulated wound healing. The evaluation of men presenting with PD includes a detailed history and physical exam, focusing on the penis in both the flaccid and erect states. PD is often associated with erectile dysfunction (ED), as well as several other comorbidities. Laboratory testing is not needed to diagnose PD, although given the associations between PD and systemic diseases including hypogonadism, diabetes, and cardiovascular disease, screening and work-up for these conditions in men with PD may be warranted. Treatment modalities for PD are diverse and include oral, topical, intralesional, mechanical, and surgical therapies. Oral, topical, and mechanical therapies generally have little evidence supporting their efficacy. Several intralesional therapies, including interferon α2b and collagenase Clostridium hystiolyticum have demonstrated efficacy in the treatment of PD. Surgical treatment, indicated in men with significant, stable deformity, includes plication of the tunica albuginea, plaque incision/excision and grafting, and placement of inflatable penile prosthesis (IPP) with or without additional maneuvers to achieve desired results, and has high success rates.

Role of interleukin‐6 and pentraxin 3 as an early marker in Peyronie's disease

“…In their study, the mean follow‐up was 18 months and 89% of patients were pain free at the last follow‐up. The late or chronic phase of PD is defined by improvement in or resolution of pain and stability of penile deformity [2]. In our study, we found a significant positive correlation between PTX3 and the painful erections in patients with PD, which confirms that PTX3 is associated with the amplified inflammatory response that can sustain the pain for up to 18 months.…”

“…Owing to the risk of progression following surgery, surgical intervention should be postponed for at least 3–6 months after penile deformity and ED become stable. Penile pain should ideally be resolved before surgical treatment, as pain may be an indicator of active phase and persistent inflammation [2].…”

“…Peyronie's disease (PD) is a connecting tissue disorder of the penis affecting up to 13% of men, which may disrupt the sexual and psychosocial well‐being mainly due to the curvature it causes on the penis, penile pain, and frequently accompanying erectile dysfunction (ED) [1]. Although the exact etiology of PD is not known, repetitive microtrauma to the penis followed by fibrosis or impaired wound‐healing process of the connective tissue affecting the tunica albuginea of the corpora covarnosa is implicated in the development of plaques and curvature [2]. The abundant collagen fibers in the erectile tissue of PD patients may be the result of an immune‐mediated fibroblast proliferation or a reaction to an infectious agent [3].…”

The role of inflammatory parameters (neutrophil‐to‐lymphocyte ratio, platelet‐to‐lymphocyte ratio, and monocyte‐to‐eosinophil ratio) in patients with Peyronie's disease

“…Surgical intervention should be performed following the acute phase of the disease (Alenda et al ., ; Atar et al ., ). As pain may be an indicator of the acute phase and persistent inflammation, therefore, it should be resolved before surgery (Bilgutay & Pastuszak, ; Atar et al ., ). Our findings suggest that NLR could be helpful to differentiate the chronic phase from the acute phase in patients with PD.…”

Predictors of treatment success after collagenase Clostridium histolyticum injection for Peyronie's disease: development of a nomogram from a multicentre single‐arm, non‐placebo controlled clinical study

“…During the initial acute inflammatory phase, plaque starts to form and curvature becomes evident, often accompanied by pain, particularly during erection [2]. These deformities include penile curvature (PC), penile length loss, narrowing and sometimes a variable degree of erectile dysfunction [3,4]. PD can be associated with significant psychological distress and bother, including emotional strain and negative effects on relationship with the partner [5,6].…”