Peyronie's Disease: Overview
Peyronie’s disease (PD) presents a physically and psychologically devastating problem to the affected man. It is manifest by a fibrous inelastic scar involving the tunica albuginea, which in the flaccid condition results in a palpable scar causing penile deformity in the erect state, including bending, narrowing, hinging, and oftentimes the most devastating consequence, shortening of the penis. There may also be painful erections in the early, acute stage of this disease, but pain may persist as a result of strong erections, causing a torque effect on the deformed penis. All of these manifestations can result in difficulty with sexual intercourse. In spite of the multiple treatment options, which have been available since the time of de la Peyronie, it remains a therapeutic dilemma to the practicing physician. Unfortunately there are only few high level evidence based medicine treatment studies available. This review will briefly outline what is known about the etiopathology, prevalence, natural history, evaluation and treatment options for PD.
A historical survey of Peyronie’s disease revealed that it was de la Peyronie who was in fact the first to describe and treat this problem, although Guilielmus of Saliceto in the thirteenth century was likely to first describe a case of Peyronie’s disease. François Gigot de la Peyronie was the first surgeon to King Louis XV and founded the Académie Royale de Chirurgie in 1731. He described two cases of Peyronie’s disease in his classic paper of 1743, as likely the scarred remains of venereal disease. Peyronie’s disease can present with a variety of deformities, including dorsal, lateral, or ventral curve, as well as varying degrees of shaft indentation and hourglass deformities, which can cause a reduction of the ability of the penis to withstand axial forces, resulting in what is known as a hinge effect.
The prevalence of Peyronie’s disease has been examined in a variety of studies and ranges from 2% to as high as 8.9%. The discrepancy here may be due to the way the study was conducted. When men are simply asked the question “Do you have a deformed in penis in the erect state?,” this may result in different outcomes as compared to when a trained specialist examines the penis for a palpable scar. Regardless, what is important is that Peyronie’s disease is not a rare disorder as previously thought, and it appears to increase in prevalence with aging. The natural history of Peyronie’s disease has been researched in several recent studies, suggesting that pain will tend to resolve in 89-100% of patients with time, ranging from weeks to months. Penile deformity may get worse in the first 12-18 months after onset of the condition in 42-48% of men, and will remain stable in 40-45%, but will have some spontaneous improvement in only 12-13%. Therefore, any spontaneous deformity resolution is not common and it is extremely rare to have complete resolution.
The following caveats provide useful information to gain a better understanding of Peyronie’s disease:
First, that it is not a rare disorder and it does not tend to resolve spontaneously as previously thought. Peyronie’s disease is frequently associated with erectile dysfunction. In fact 50% of men will have ED before developing PD, and the other 50% will develop ED subsequently. This may be due to vascular changes, but may also be contributed to by psychogenic inhibition. There is no reliable non-surgical cure currently for Peyronie’s disease, but current treatments have been shown to stabilize the deformity, and may reduce the deformity and improve sexual function. Should non-surgical treatments be used, it should be recognized that treatment-related change occurs at “glacial speed.” Surgery is the most rapid and reliable treatment, and diagnosis is easy, but treatment remains a challenge.
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