Peyronie Disease: Abnormal curvature of penis

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Peyronie’s disease (PD) is defined as an abnormal curvature in the erection of penis conditions. It is a non-malignant disorder of the penis, and it was being first described by Francois Gigot de la Peyronie, French MD in 1749. Underreported due to the embarrassment of this condition, Peyronie’s disease is thought to be affected more than 10% men in USA. PD can cause major distress to the patients and also associated with erectile dysfunction.

The abnormal curvature caused by anything that can form scar at the wall surface of penile erectile tissue called Tunica albuginea.

Peyronie’s disease risk factors are listed below.

Risk factors are listed below.

1. History of penile injury
   • Sexual-related penile injury, genital or perineal trauma.
   • Iatrogenic injury such as catheterization, cystoscopy or endoscopic surgery.
2. Connective tissue disorders
   • PD is strongly associated with Dupuytren’s contracture and plantar fasciitis by their nature, superficial scarring disorder diseases.
3. Family history of Peyronie’s disease
   • Genetic susceptibility can easily develop PD when penile trauma occurs.
4. Hypogonadism
   • Testosterones play essential role in normal wound healing at genital area.
   • Significant PD patients are reported in < 300 ng/dL testosterone level subgroup.
5. Diabetes mellitus (DM)
   • DM impairs healing process.
   • PD was reported 5 times more than normal populations.
6. Smoking and alcohol
   • There is some evidence suggest that smoking and alcohol is related to PD.
   • The correlation between the amounts of consumption still unclear.
7. Age
   • The most common affected patients’ subgroup is more than 60 years old.

Peyronie’s disease patient’s symptoms and signs must be divided into 2 phases

1. Acute phase – first 6 – 18 months of disease, pain during erection is a major complaint in this phase. Since the deformity of the penis is still progressing, so the specific treatment is not recommended in this phase, only pain-controlled and supplemented are the best modality.
2. Chronic phase – the degree of penile curvature will be stable in this phase. No pain: or minimal pains are complaint. The specific treatment for the disease is recommended in this phase.

Accurate physical examination during flaccid and erect state must be well-documented such as degree of penile curvature, painful during palpation, size and location of the PD plaque. Conventional ultrasound, penile doppler ultrasound or MRI penis are optional.

Treatment modalities can be categorized into 2 major options.

1. Nonsurgical management
   • Oral medications – based on American Urological Association guidelines, NSIAD, oral vitamin E and omega-3 are recommended
   • Intralesional injections – anti-plaque agents are reported in benefit for PD treatment
2. Surgical management
   • Surgical approach is recommended when fail or unsatisfied from nonsurgical treatment
   • Suitable period is 3 months after deformity-stable and pain-free PD has been observed
   • Several techniques with possible complications – erectile dysfunction, shortening of penis, unstable penis, persistent pain, recurrence of penile curvature.

Peyronie’s disease is a good prognosis disease, but patients must seek for medical advice as soon as possible. Any questions, you can discuss with your trusted Urologist or text me if you can. Take care!