Dr. Stacy McBroom
Dr. John Upshaw
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Peyronie's Disease

Overview

Peyronie’s disease is characterized by the formation of hardened tissue (fibrosis) in the penis that causes pain, curvature, and distortion, usually during erection. The penis (male organ for reproduction and urination) is composed of two columns of erectile tissue (corpora cavernosa); the corpus spongiosum, which contains the urethra (tube that carries urine and semen from the body); and the tunica albuginea (sheath that surrounds the erectile tissue). In Peyronie’s disease, dense, fibrous scar tissue (plaque) forms in the tunica albuginea.

Incidence and Prevalence
According to a report published in 1995 by the National Institutes of Health, Peyronie’s disease occurs in about 1% of men. It is most common between the ages of 45 and 60, but it also occurs in young and elderly men. Prevalence may be higher because of reluctance to seek medical attention for the condition and failure to report in cases with mild symptoms.

Causes and Risk Factors

The cause of Peyronie’s disease is unknown. Cases that develop suddenly are often caused by trauma to the penis (e.g., invasive penile procedure, injury, extremely vigorous sexual activity). Invasive penile procedures include urethral catheterization, cystoscopy, and transurethral prostatectomy.

Cases of Peyronie’s that develop over time may be caused by an inherited abnormality of human leukocyte antigen B7 (HLA-B7), suggesting a genetic link. Also, Peyronie’s occurs more frequently in men with family members who have the condition or a connective tissue disorder (e.g., systemic lupus erythematosus). About 30% of patients with Peyronie’s disease also develop hardened tissue in other parts of the body, such as the hand (e.g., Dupuytren’s contracture) or the foot.

Microscopic examination of hardened tissue in cases of Peyronie’s disease is consistent with cases of severe vasculitis (inflammation of blood vessels), suggesting the condition may have a vascular (i.e., pertaining to blood vessels) cause. Diabetes, which often leads to blood vessel disease, is also considered a risk factor.

The use of the antihypertension medication propranolol (Inderal®) has been found to cause the condition in rare cases. Peyronie’s disease has also been associated with vitamin E deficiency.

Signs and Symptoms

Peyronie’s disease may be mild or severe, and may develop rapidly or over time. Symptoms include the following:

  • Hardened tissue (plaque) in the penis
  • Pain during erection
  • Curve in the penis during erection
  • Distortion of the penis (indentation, shortening)

Plaque usually develops on the top of the shaft, causing the penis to bend upward during erection, but it may occur on the bottom, causing a downward bend. If plaque develops on the top and the bottom, indentations and shortening may occur. In about 13% of cases, plaque does not cause severe pain or curvature, and the condition resolves on its own.

In severe cases, pain and curvature result in erectile dysfunction (impotence). If there are several areas of plaque, incomplete erection may occur.