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Peyronie's disease is a connective tissue disorder involving the growth of fibrous plaques[3] in the soft tissue of the penis. Specifically, scar tissue forms in the tunica albuginea, the thick sheath of tissue surrounding the corpora cavernosa, causing pain, abnormal curvature, erectile dysfunction, indentation, loss of girth and shortening.[4][5][6][7] A variety of treatments have been used, but none have been especially effective.

Peyronie's disease
Synonyms Peyronie disease, induratio penis plastica (IPP),[1] chronic inflammation of the tunica albuginea (CITA)
Pronunciation
Specialty urology
Causes Unknown[2]
Frequency ~10% of men[2]

It is estimated to affect about 10% of men.[2] The condition becomes more common with age.[2]

Contents

Signs and symptomsEdit

 
Example of penis deformation from side.

A certain degree of curvature of the penis is considered normal, as many men are born with this benign condition, commonly referred to as congenital curvature.

The disease may cause pain; hardened, big, cord-like lesions (scar tissue known as "plaques"); or abnormal curvature of the penis when erect due to chronic inflammation of the tunica albuginea (CITA). Although the popular conception of Peyronie's disease is that it always involves curvature of the penis, the scar tissue sometimes causes divots or indentations rather than curvature. The condition may also make sexual intercourse painful and/or difficult, though it is unclear whether some men report satisfactory or unsatisfactory intercourse in spite of the disorder.[citation needed] It can affect men of any race and age. The disorder is confined to the penis, although a substantial number of men with Peyronie's exhibit concurrent connective tissue disorders in the hand, and to a lesser degree, in the feet. About 30 percent of men with Peyronie's disease develop fibrosis in other elastic tissues of the body, such as on the hand or foot, including Dupuytren's contracture of the hand. An increased incidence in genetically related males suggests a genetic component.[8]

CausesEdit

The underlying cause of Peyronie's disease is not well understood, but is thought to be caused by trauma or injury to the penis usually through sexual intercourse or physical activity, although many patients are often unaware of any traumatic event or injury.[9]

DiagnosisEdit

 
This ultrasound depicts cross sections of the penis at different locations in a patient with Peyronie's disease. The top image shows normal anatomy whereas the bottom image shows scar tissue on the tunica albuginea (penis). The scar tissue is localized and responsible for the hallmark deformities of Peyronie's disease (curvature and narrowing).

A urologist may be able to diagnose the disease and suggest treatment. An ultrasound can provide conclusive evidence of Peyronie's disease, ruling out congenital curvature or other disorders.[10]

TreatmentEdit

Without treatment, about 12–13% of patients will spontaneously improve over time, 40–50% will get worse and the rest will be relatively stable. This is based on a survey of 97 men and therefore based on the subjective impression of the patients. No objective long-term natural history via continual evaluation of patients has been recorded to date.[11]

Medication and supplementsEdit

Many oral treatments have been studied, but results so far have been mixed.[12] Some consider the use of nonsurgical approaches to be "controversial".[13]

Collagenase clostridium histolyticum (marketed as Xiaflex by [Auxilium]), a drug originally approved by the FDA to treat Dupuytren's contracture, is now an FDA-approved injectable drug for treatment of Peyronie's disease. The drug is reported to work by breaking down the excess collagen in the penis that causes Peyronie's disease.[14][15]

Vitamin E supplementation has been studied for decades, and some success has been reported in older trials, but those successes have not been reliably repeated in larger, newer studies.[16] A combination of Vitamin E and colchicine has shown some promise in delaying progression of the condition.[17]

Some newer agents targeting the basic mechanisms of inflammation have been studied in larger clinical trials. These include potassium para-aminobenzoate (Potaba),[18] pentoxifylline (acting through TGFβ1 inhibition),[19] and Coenzyme Q10.[20]

The efficacy of Interferon-alpha-2b in the early stages of the disease has been reported in recent publications, but it was found to be less effective in cases where calcification of the plaque had occurred in common with many treatments.[21][22][23]

SurgeryEdit

Surgery, such as the "Nesbit operation" (which is named after Reed M. Nesbit (1898–1979), an American urologist at University of Michigan),[24] is considered a last resort and should only be performed by highly skilled urological surgeons knowledgeable in specialized corrective surgical techniques. A penile prosthesis may be appropriate in advanced cases.[25]

Physical therapy and devicesEdit

There is moderately strong evidence that Penile Traction Therapy is a well–tolerated, minimally invasive treatment for Peyronie's disease, but there is uncertainty about the optimal duration of stretching per day and per course of treatment, and the treatment course is difficult.[26]

CounselingEdit

Peyronie's disease can be a physically and psychologically devastating disease. While most men will continue to be able to have sexual relations, they are likely to experience some degree of deformity and erectile dysfunction in the wake of the disease process. It is not uncommon for men afflicted with Peyronie's disease to exhibit depression or withdrawal from their sexual partners.[27]

See alsoEdit

ReferencesEdit

  1. ^ Freedberg, Irwin M.; Fitzpatrick, Thomas B. (2003). Fitzpatrick's dermatology in general medicine (6th ed.). New York: McGraw-Hill, Medical Pub. Division. p. 990. ISBN 0-07-138076-0. 
  2. ^ a b c d "Penile Curvature (Peyronie's Disease)". National Institute of Diabetes and Digestive and Kidney Diseases. July 2014. Retrieved 25 October 2017. 
  3. ^ Levine LA, Estrada CR, Storm DW, Matkov TG (2003). "Peyronie disease in younger men: characteristics and treatment results". Journal of Andrology. 24 (1): 27–32. PMID 12514077. 
  4. ^ Levine, Laurence A (2010). "Peyronie's disease and erectile dysfunction: Current understanding and future direction". Indian Journal of Urology. 22 (3): 246–50. doi:10.4103/0970-1591.27633. 
  5. ^ Peyronie's disease at Who Named It?
  6. ^ "Peyronie's Disease". Retrieved 2007-12-03. 
  7. ^ "Peyronie's disease". Mayo Clinic. Retrieved 2007-12-03. 
  8. ^ Carrieri MP, Serraino D, Palmiotto F, Nucci G, Sasso F (June 1998). "A case-control study on risk factors for Peyronie's disease". Journal of Clinical Epidemiology. 51 (6): 511–5. doi:10.1016/S0895-4356(98)00015-8. PMID 9636000. 
  9. ^ "Peyronie's disease: Causes". Mayo Clinic. Retrieved 2010-03-18. 
  10. ^ Amin Z, Patel U, Friedman EP, Vale JA, Kirby R, Lees WR (May 1993). "Colour Doppler and duplex ultrasound assessment of Peyronie's disease in impotent men". The British Journal of Radiology. 66 (785): 398–402. doi:10.1259/0007-1285-66-785-398. PMID 8319059. 
  11. ^ Gelbard MK, Dorey F, James K (December 1990). "The natural history of Peyronie's disease". The Journal of Urology. 144 (6): 1376–9. PMID 2231932. 
  12. ^ Levine LA (October 2003). "Review of current nonsurgical management of Peyronie's disease". International Journal of Impotence Research. 15 Suppl 5: S113–20. doi:10.1038/sj.ijir.3901084. PMID 14551587. 
  13. ^ Hauck EW, Diemer T, Schmelz HU, Weidner W (June 2006). "A critical analysis of nonsurgical treatment of Peyronie's disease". European Urology. 49 (6): 987–97. doi:10.1016/j.eururo.2006.02.059. PMID 16698449. 
  14. ^ "FDA approves first drug treatment for Peyronie's disease". FDA NEWS RELEASE. U.S. Food and Drug Administration. 6 December 2013. Retrieved 6 December 2013. 
  15. ^ Pollack, Andrew (December 6, 2013). "Injections to Treat an Embarrassing Ailment Win U.S. Approval". New York Times. Retrieved December 7, 2013. 
  16. ^ Mynderse LA, Monga M (October 2002). "Oral therapy for Peyronie's disease". International Journal of Impotence Research. 14 (5): 340–4. doi:10.1038/sj.ijir.3900869. PMID 12454684. 
  17. ^ Prieto Castro RM, Leva Vallejo ME, Regueiro Lopez JC, Anglada Curado FJ, Alvarez Kindelan J, Requena Tapia MJ (April 2003). "Combined treatment with vitamin E and colchicine in the early stages of Peyronie's disease". BJU International. 91 (6): 522–4. doi:10.1046/j.1464-410X.2003.04134.x. PMID 12656907. 
  18. ^ Weidner W, Hauck EW, Schnitker J (April 2005). "Potassium paraaminobenzoate (POTABA) in the treatment of Peyronie's disease: a prospective, placebo-controlled, randomized study". European Urology. 47 (4): 530–5; discussion 535–6. doi:10.1016/j.eururo.2004.12.022. PMID 15774254. 
  19. ^ Safarinejad MR, Asgari MA, Hosseini SY, Dadkhah F (July 2010). "A double-blind placebo-controlled study of the efficacy and safety of pentoxifylline in early chronic Peyronie's disease". BJU International. 106 (2): 240–8. doi:10.1111/j.1464-410X.2009.09041.x. PMID 19863517. 
  20. ^ Safarinejad MR (2010). "Safety and efficacy of coenzyme Q10 supplementation in early chronic Peyronie's disease: a double-blind, placebo-controlled randomized study". International Journal of Impotence Research. 22 (5): 298–309. doi:10.1038/ijir.2010.20. PMID 20720560. 
  21. ^ Trost LW, Gur S, Hellstrom WJ (2007). "Pharmacological Management of Peyronie's Disease". Drugs. 67 (4): 527–45. doi:10.2165/00003495-200767040-00004. PMID 17352513. 
  22. ^ Dang G, Matern R, Bivalacqua TJ, Sikka S, Hellstrom WJ (January 2004). "Intralesional interferon-alpha-2B injections for the treatment of Peyronie's disease". Southern Medical Journal. 97 (1): 42–6. doi:10.1097/01.SMJ.0000056658.60032.D3. PMID 14746421. 
  23. ^ Hellstrom WJ, Kendirci M, Matern R, et al. (July 2006). "Single-blind, multicenter, placebo controlled, parallel study to assess the safety and efficacy of intralesional interferon alpha-2B for minimally invasive treatment for Peyronie's disease". The Journal of Urology. 176 (1): 394–8. doi:10.1016/S0022-5347(06)00517-9. PMID 16753449. 
  24. ^ Ralph DJ, Minhas S (January 2004). "The management of Peyronie's disease". BJU International. 93 (2): 208–15. doi:10.1111/j.1464-410X.2004.04587.x. PMID 14690485. 
  25. ^ Hellstrom WJ, Usta MF (October 2003). "Surgical approaches for advanced Peyronie's disease patients". International Journal of Impotence Research. 15 (Suppl 5): S121–4. doi:10.1038/sj.ijir.3901085. PMID 14551588. 
  26. ^ Eric C, Geralb B (February 2013). "Penile traction therapy and Peyronie's disease: a state of art review of the current literature". Ther Adv Urol. 5 (2): 59–65. doi:10.1177/1756287212454932. 
  27. ^ Nelson CJ, Mulhall JP (March 2013). "Psychological impact of Peyronie's disease: a review". The Journal of Sexual Medicine. 10 (3): 653–60. doi:10.1111/j.1743-6109.2012.02999.x. PMID 23153101. 

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