Peyronie’s disease is a connective tissue disorder affecting the penis. It mainly affects the fibrous sheath covering the penis, namely the tunica albuginea. Sometimes it can affect the vascular cylinders which carry the blood, the septum of the corpora cavernosa.
The cause of Peyronies’s disease still remains unclear despite heavy research. Invariably there is a history of penile trauma which can happen in the riding position or entering from behind. Following this there is impaired wound healing that results in fibrosis and plaque formation. Other comorbid conditions would involve smoking, diabetes and hypertension and Dupuytren’s contracture ( which is a fibrotic condition of the hand).Sometimes certain conditions of the immune systems can also affect and cause a problem.
Incidence of Peyronie’s disease is about 10% in the general population.These men present commonly with deformity, pain and erectile dysfunction. Evaluation is usually clinical, though sometimes ultrasound can be used. The identification of the plaque by ultrasound helps us confirm.
Various medications have been tried with different success rates. Vitamin E, Tamoxifen, Pentoxifylline, L arginine and PDE5 inhibitors. Collagenase injections and Interferon alpha have been tried with some success in Peyronie’s disease. Extracoporeal shock wave lithotripsy has been tried but the results have not been great. Tadalafil which is a PDE5 inhibitor has been used with some success in early stages to halt progression of disease.
Finally, surgery is indicated in disease more than 6 months with stable deformity, inabitlity to engage in intercourse, extensive plaque calcification and failed conservative treatment.