Peyronie’s disease is a condition of uncertain cause that 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.
A French surgeon, Francois 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. Although Peyronie’s disease can be associated with impotence, it is a factor that is not always present.
Peyronie’s disease is benign, or noncancerous. A plaque on the top of the shaft (most common) causes the penis 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.
Many researchers believe the plaque 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.
There may be pain and the penis may have scarring, plaques, and be bent.
Diagnosis is made by physical examination.
Because the plaque of Peyronie’s disease often shrinks or disappears without treatment, medical experts suggest waiting 1 to 2 years before attempting to correct it surgically.
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. 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.
What is the probable cause?
Will this resolve itself over time?
What are treatment options?
Are injections such as steroids or collagenase effective?
Will surgery be required to correct the problem?
While awaiting surgery, 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 has also been used. Like some of the chemical treatments, radiation appears to reduce pain, yet it has no effect on the plaque itself and can produce unwelcome side effects.