Peyronie’s disease: Contemporary evaluation and management

Abstract

Peyronie's disease is a common yet poorly understood condition characterized by penile pain, curvature, sexual dysfunction and psychological bother. Peyronie's disease represents a penile wound healing disorder, and is thought to arise from exuberant scarring in response to penile trauma in genetically predisposed men. In the absence of active treatment, the majority of men experience stable or worsening symptoms, with few reporting spontaneous resolution in penile curvature or other deformity. In contrast, penile pain improves or resolves in the majority of men. Treatment options vary based on symptom severity and stability. Several oral therapies are commonly prescribed, although to date there are no strong data to support any oral agents as monotherapy for Peyronie's disease. Other options including penile traction therapy and intralesional injections result in modest improvements for many patients, particularly when used early after symptom onset. Penile straightening through approaches, such as penile plication and plaque incision or partial excision and grafting, represent the most rapid and reliable approach to correct penile curvature once the symptoms have stabilized. Side-effects vary based on the type of surgery carried out, and include penile shortening, sensation changes and erectile dysfunction in the minority of men. In patients with drug refractory erectile dysfunction and Peyronie's disease, placement of a penile prosthesis will address both issues, and is associated with high levels of patient satisfaction. The current review provides a practical approach to the modern evaluation and management of patients presenting with Peyronie's disease.

The Natural History of Peyronie's Disease

“…The distinctive characteristic of the disease is the development of a fibrous scar at the level of the tunica albuginea ultimately leading to penile curvature and pain during erection. Erectile dysfunction (ED) is often an associated symptom secondary to pain discomfort during penetration, penile deformity and patient's emotional state [ 1 ].…”

Pathological Significance of Macrophages in Erectile Dysfunction Including Peyronie’s Disease

“…In addition to these disorders, ED is recognized as a major symptom of PD. Despite various PD treatments, such as pharmacological, conservative, and surgical therapy [ 118 , 119 , 120 ], many investigators suggest that more innovative treatment strategies are necessary. However, the etiology and pathophysiology of PD remain unclear [ 115 ].…”

Use of penile shear wave elastosonography for the diagnosis of Peyronie’s Disease: a prospective case–control study

“…PD is characterized by the formation of a fibrous scar in the tunica albuginea (TA) of the penis, resulting in penile curvature. This plaque is formed because of the altered production of the extracellular matrix caused by the upregulation of tissue inhibitors of matrix metalloproteinases and myofibroblast activity [ 2 , 3 ]. The cause of PD is unknown; however, it has been established that repeated episodes of trauma cause microvascular injuries and the deposition of inelastic fibrin, collagen types I and III, and calcium [ 4 ].…”