Peyronie’s Disease
Everything you need to know about the causes, symptoms, and different treatments for the fibrosis that causes excessive penile curvature.
Symptoms and Causes
Peyronie’s disease is a condition in which scar tissue forms in the penis. This plaque accumulates in the tunica albuginea, a membrane located beneath the skin that helps maintain erections. Because the plaque tightens the tissues, the penis bends instead of remaining straight.
This condition consists of two distinct phases:
- Acute phase: Inflammation occurs, promoting the formation of scar tissue. This phase lasts between six and twelve months. It is an active phase during which symptoms progressively develop.
- Chronic phase: Begins once the plaque has formed and symptoms stabilize.
Although treatment was traditionally not initiated until the chronic phase, it has now been demonstrated that outcomes are better when therapy begins during the acute phase. Therefore, to improve prognosis, it is recommended to consult a specialist at the first sign of pain or penile curvature.
Symptoms
The symptoms of Peyronie’s disease appear progressively as the condition advances. Each phase presents specific signs:
- Acute phase:
- Penis curved upward, downward, or to one side.
- Pain at rest.
- Pain during erections.
- Chronic phase:
- Curvature stabilizes and does not worsen.
- Less intense pain than during the acute phase.
- Erectile dysfunction when the plaque extends into the corpus cavernosum.
- Penile shortening.
Causes
The causes of Peyronie’s disease are not fully understood, although some patients show a genetic predisposition or have previously sustained an injury, either during sexual intercourse or in an accidental event.
Risk Factors
Some factors that may increase the risk of developing Peyronie’s disease include:
- Age: most commonly occurs between 45 and 70 years of age.
- Family history of the disease.
- Connective tissue disorders, such as Ehlers-Danlos syndrome, osteogenesis imperfecta, Marfan syndrome, or lupus.
Complications
Peyronie’s disease may lead to one of the following complications:
- Erectile dysfunction: inability to achieve or maintain an erection sufficient for satisfactory sexual intercourse.
- Penile shortening.
- Chronic pain.
- Anxiety.
- Depression.
- Relationship problems.
Prevention
Peyronie’s disease cannot be prevented.
Which specialist treats Peyronie’s disease?
Peyronie’s disease is treated within the specialty of Urology.
Diagnosis
The diagnosis of Peyronie’s disease follows this procedure:
- Medical history: The patient’s medical and family history, as well as lifestyle factors, are assessed.
- Physical examination: The flaccid penis is palpated to determine the location and extent of the plaque. In some cases, images of the erect penis taken by the patient at home are reviewed.
- Doppler ultrasound and dynamic vascular assessment: Ultrasound is used to evaluate the condition of the tunica albuginea, measure the size of the fibrotic plaque, identify calcifications, and determine how deeply the plaque extends into the cavernous tissue. To assess penile function, a vasoactive agent is injected to induce an erection while blood flow is evaluated.
Treatment
Treatment for Peyronie’s disease is individualized according to the results obtained from diagnostic tests. The therapeutic goal differs depending on the phase of the disease:
- During the acute phase, the objective is to stabilize the plaque and prevent further damage.
- Oral medication: Drugs are administered to reduce fibrosis, relieve pain, improve curvature, or treat erectile dysfunction.
- Intralesional injections: Medications that break down the collagen within the scar tissue are injected directly into the plaque. This softens the fibrosis and reduces penile curvature.
- Shock wave therapy: Low-intensity acoustic waves are applied through the skin to break down the tissue forming the plaque. This therapy helps reduce pain, decrease penile curvature, and improve erectile function.
- Traction devices: Mechanical devices that exert a constant, controlled force on the flaccid penis are used to remodel the scar tissue and consequently stretch the penis.
- Vacuum erection devices: By placing a vacuum device around the penis, blood is drawn into the organ, producing an erection. When used in a controlled manner, these devices help correct curvature, improve blood flow, condition penile tissues, and restore penile length.
- During the chronic phase, treatment focuses on correcting the shape of the penis.
- Plication surgery: A section of the tunica albuginea on the side opposite the curvature is folded to counteract the bend. Outcomes are generally satisfactory, although penile length is reduced.
- Grafting surgery: A graft is placed on the concave side of the penis to correct curvature without shortening penile length. These grafts may be made of collagen or tissue harvested from the patient’s oral mucosa.
- Penile prosthesis: This option is used when penile deformities are severe or when erectile function is significantly impaired.
- Malleable prosthesis: Cylinders are inserted into the cavernous tissue through an incision in the scrotum or pubic area. The penis remains permanently rigid, although it can be manually positioned as needed.
- Inflatable prosthesis: The cylinders used allow the penis to remain flaccid most of the time. In addition, a reservoir is placed in the scrotum, functioning as a pump system that enables an erection to be achieved whenever desired.
