Peyronie's Disease - NIH Report

Dr.Joe's Data Base

WellnessWeb
The Patient's Network

Dr. Chris Steidle - Northeast Indiana Urology

Peyronie's Disease

Overview
Course of the Disease
Treatment
Sources of More Information

Overview

Peyronie's disease, a condition of uncertain cause, is characterized
by a plaque, or hard lump, that forms on the penis. The plaque
develops on the upper or lower side of the penis in layers containing
erectile tissue. It begins as a localized inflammation and can
develop into a hardened scar.

Peyronie's disease often occurs in a mild form that heals without
treatment in 6 to 15 months. But in severe cases, the hardened
plaque reduces flexibility, causing pain and forcing the penis to
bend or arc during erection.

The plaque itself is benign, or noncancerous. A plaque on the top of
the shaft (most common) causes the penis to bend upward; a plaque on
the underside causes it to bend downward. In some cases, the plaque
develops on both top and bottom, leading to indentation and
shortening of the penis. At times, pain, bending, and emotional
distress prohibit sexual intercourse.

One study found Peyronie's disease occurring in 1 percent of men.
Although the disease occurs mostly in middle-aged men, younger and
older men can acquire it. About 30 percent of people with Peyronie's
disease develop fibrosis (hardened cells) in other elastic tissues of
the body, such as on the hand or foot. A common example is a
condition known as Dupuytren's contracture of the hand. In some
cases, men who are related by blood tend to develop Peyronie's
disease, which suggests that familial factors might make a man
vulnerable to the disease.

Men with Peyronie's disease usually seek medical attention because of
painful erections and difficulty with intercourse. Since the cause
of the disease and its development are not well understood, doctors
treat the disease empirically; that is, they prescribe and continue
methods that seem to help. The goal of therapy is to keep the
Peyronie's patient sexually active. Providing education about the
disease and its course often is all that is required. No strong
evidence shows that any treatment other than surgery is effective.
Experts usually recommend surgery only in long-term cases in which
the disease is stabilized and the deformity prevents intercourse.

A French surgeon, François de la Peyronie, first described
Peyronie's disease in 1743. The problem was noted in print as early
as 1687. Early writers classified it as a form of impotence.
Peyronie's disease can be associated with impotence; however, experts
now recognize impotence as one factor associated with the disease-a
factor that is not always present.

Course of the Disease

Many researchers believe the plaque of Peyronie's disease develops
following trauma (hitting or bending) that causes localized bleeding
inside the penis. A chamber (actually two chambers known as the
corpora cavernosa) runs the length of the penis. The inner-surface
membrane of the chamber is a sheath of elastic fibers. A connecting
tissue, called a septum, runs along the center of the chamber and
attaches at the top and bottom.

If the penis is abnormally bumped or bent, an area where the septum
attaches to the elastic fibers may stretch beyond a limit, injuring
the lining of the erectile chamber and, for example, rupturing small
blood vessels. As a result of aging, diminished elasticity near the
point of attachment of the septum might increase the chances of
injury.

The damaged area might heal slowly or abnormally for two reasons:
repeated trauma and a minimal amount of blood-flow in the sheath-like
fibers. In cases that heal within about a year, the plaque does not
advance beyond an initial inflammatory phase. In cases that persist
for years, the plaque undergoes fibrosis, or formation of tough
fibrous tissue, and even calcification, or formation of calcium
deposits.

While trauma might explain acute cases of Peyronie's disease, it does
not explain why most cases develop slowly and with no apparent
traumatic event. It also does not explain why some cases disappear
quickly, and why similar conditions such as Dupuytren's contracture
do not seem to result from severe trauma.

Treatment

Because the plaque of Peyronie's disease often shrinks or disappears
without treatment, medical experts suggest waiting 1 to 2 years or
longer before attempting to correct it surgically. During that wait,
patients often are willing to undergo treatments that have unproven
effectiveness.

Some researchers have given men with Peyronie's disease vitamin E
orally in small-scale studies and have reported improvements. Yet,
no controlled studies have established the effectiveness of vitamin E
therapy. Similar inconclusive success has been attributed to oral
application of para-aminobenzoate, a substance belonging to the
family of B-complex molecules.

Researchers have injected chemical agents such as collagenase,
dimethyl sulfoxide, steroids, and calcium channel blockers directly
into the plaques. None of these has produced convincing results.
Steroids, such as cortisone, have produced unwanted side effects,
such as atrophy, or death of healthy tissues. Perhaps the most
promising directly injected agent is collagenase, an enzyme that
attacks collagen, the major component of Peyronie's plaques.

Radiation therapy, in which high-energy rays are aimed at the plaque,
also has been used. Like some of the chemical treatments, radiation
appears to reduce pain, yet it has no effect on the plaque itself and
can cause unwelcome side effects. Currently, none of the treatments
mentioned here has equalled the body's natural ability to eliminate
Peyronie's disease. The variety of agents and methods used points to
the lack of a proven, effective treatment.

Peyronie's disease has been treated with some success by surgery.
The two most common surgical methods are: removal or expansion of
the plaque followed by placement of a patch of skin or artificial
material, and removal or pinching of tissue from the side of the
penis opposite the plaque, which cancels out the bending effect. The
first method can involve partial loss of erectile function,
especially rigidity. The second method, known as the Nesbit
procedure, causes a shortening of the erect penis.

Some men choose to receive an implanted device that increases
rigidity of the penis. In some cases, an implant alone will
straighten the penis adequately. In other cases, implantation is
combined with a technique of incisions and grafting or plication
(pinching or folding the skin) if the implant alone does not
straighten the penis.

Most types of surgery produce positive results. But because
complications can occur, and because many of the phenomena associated
with Peyronie's disease (for example, shortening of the penis) are
not corrected by surgery, most doctors prefer to perform surgery only
on the small number of men with curvature so severe that it prevents
sexual intercourse.

Sources of More Information

American Foundation for Urologic Disease
300 West Pratt Street
Suite 401
Baltimore, MD 21201

National Organization for Rare Disorders
P.O. Box 8923
New Fairfield, CT 06812-1783
Tel: (800) 999-6673

National Kidney and Urologic Diseases Information Clearinghouse
3 Information Way
Bethesda, MD 20892-3580

The National Kidney and Urologic Diseases Information Clearinghouse
is a service of the National Institute of Diabetes and Digestive and
Kidney Diseases, part of the National Institutes of Health, under the
U.S. Public Health Service. Authorized in 1987, the clearinghouse
provides information about diseases of the kidneys and urologic
system to people with such afflictions and to their families, health
care professionals, and the public. The clearinghouse answers
inquiries; develops, reviews, and distributes publications; and works
closely with professional and patient organizations and government
agencies to coordinate resources about kidney and urologic diseases.

Publications produced by the clearinghouse are reviewed carefully for
scientific accuracy, content, and readability. Publications produced
by outside sources are also reviewed carefully before being used to
supplement clearinghouse materials when responding to inquiries.

NIH Publication No. 95-3902