Generality
Peyronie's disease is a disease of the penis characterized by the abnormal formation of fibrous-scar tissue in correspondence of the corpora cavernosa. This negatively affects erectile function, resulting in a medical condition called a curved penis.
The diagnosis of Peyronie's disease is quite simple, because the curved penis presents itself with unmistakable signs.
The choice of the most appropriate therapeutic treatment depends on the severity of the disease: for less severe cases, pharmacological treatment is recommended; while, for the most serious cases, surgery is needed.
Anatomy of the Penis
For further information: Penis: Anatomy and Physiology
To better understand what happens in Peyronie's disease, it is advisable to do a brief review of the anatomy of the penis.
THE PENIS
The penis is the male reproductive organ. Located between pubis and perineum, it has a cylindrical shape and, didactically, can be divided into three parts: the body, the head and the foreskin.
The body is crossed by three tubular structures:
- two corpora cavernosa, located on the upper (or dorsal) side and crossed by the cavernous arteries;
- the corpus spongiosum, located on the lower (or ventral) side and crossed by the "urethra. At the" origin of the body c "is the scrotum, containing the testicles.
The head of the penis has a conical shape and corresponds to the glans; on the tip of the glans there is an opening, called the urinary meatus, through which urine and sperm come out. The glans is surrounded by a particular area, called the crown.
Finally, the foreskin is a layer of skin, which serves to cover the glans.
CAVERNOSIS BODIES AND ERECTION
The cavernous bodies are crossed by the so-called cavernous arteries and, on the outside, have an extremely elastic connective tissue, called tunica (or tunic) albuginea.
During an erection, the blood that passes through the cavernous arteries is able to widen the corpora cavernosa and straighten the penis, thanks to the presence of this elastic outer covering (tunica albuginea).
So is Peyronie's disease
Peyronie's disease, also called induratio penis Plastica (IPP), is an "anatomical anomaly of the penis, due to the formation of fibrous-scar tissue" inside the corpora cavernosa.
The disease is one of the main causes of a particular pathological condition, known as a curved penis. Its name is linked to the first surgeon who, in 1743, described its main characteristics, namely François Gigot de Peyronie.
DEFINITION OF CURVED PENIS
Doctors speak of a curved penis when, during an erection, the penis assumes an abnormal curvature and is painful.
As for the curvature, this can be in various directions: upwards, downwards, to the right or to the left. As for the pain, however, the sensations experienced can be so intense as to prevent normal sexual activity.
EPIDEMIOLOGY
Peyronie's disease affects adults, particularly elderly individuals.
In Italy, according to some statistical data, it affects 7% of the male population between 50 and 70 years old.
Causes
Peyronie's disease arises after a real lump of fibrous-scar tissue has formed inside the corpora cavernosa, which reduces the natural elasticity of the tunica albuginea.
In other words, Peyronie's disease is the result of a loss of elasticity by the penile structures (the corpora cavernosa) which normally, when reached by the blood, enlarge and allow an "erection".
But what determines the formation of the fibrous-scar tissue?
The answer to this question still has some open points, however it seems that Peyronie's disease has a "traumatic origin."
TRAUMATIC ORIGIN
Doctors and researchers believe that the formation of fibrous-scar tissue, inside a corpus cavernosum, is subsequent to one or more traumatic events affecting the penis; traumatic events that may have taken place during sexual intercourse or during sports accidents , road, workplace or fortuitous.
Therefore, according to the theory of traumatic origin, Peyronie's disease can be:
- The result of a trauma of such proportions as to cause, by itself, the formation of a fibrous-scarring nodule
Or
- The result of repetitive trauma to the penis, which gradually lead to the creation of a fibrous-scarring mass
NON-TRAUMATIC ORIGIN
Doubts about the traumatic theory of Peyronie's disease arise because some individuals develop a fibrous-scarring lump without having been involved in noteworthy traumatic events. In other words, some patients suffer from Peyronie's disease even though they have never experienced any trauma to the penis.
RISK FACTORS
According to some scientific and statistical studies, it seems that the formation of the fibrous-scarring nodule, in the corpora cavernosa, is favored by various factors, such as:
- Inheritance The recurrence of Peyronie's disease among male members of certain families has led researchers to believe that a certain genetic predisposition to the disorder is also necessary.
- Some connective tissue diseases. People with certain connective tissue abnormalities are more prone to Peyronie's disease. For example, men with Dupuytren's disease (or Dupuytren's contracture) also develop Peyronie's disease throughout their lives.
- Old age. In elderly men, the connective tissue of the cassock albuginea is more easily subject to changes and the formation, spontaneously or as a result of trauma to the penis, of agglomerates of fibrous-scar tissue.
- Cigarette smoke. It seems that smoking affects the onset of Peyronie's disease, however the scientific data on this are not yet exhaustive.
- Some prostate surgeries. As for cigarette smoking, for now it is more of a "hypothesis than a concrete fact."
Symptoms and Complications
For further information: Peyronie's Disease Symptoms
Peyronie's disease can appear suddenly or gradually.
Its onset determines different signs and symptoms: first of all, it forms a protuberance on the body of the penis perceptible to the touch, which is nothing more than the fibrous-scarring nodule; therefore, it causes the penis to be curved, painful and shorter in length during an erection than it would be during a normal erection.
PROTUBERANCE AND CURVED PENIS: THE CLASSIC SIGNS OF PEYRONIE'S DISEASE
The palpable protuberance is the fibrous-scarring nodule: touching it, it can appear as a sort of rigid plaque or as a real agglomerate of very hard consistency.
The curved penis, on the other hand, is a condition in which, during erection, the male reproductive organ assumes an abnormal curvature, which can be oriented upwards, downwards, to the right or to the left.
PAIN, ERECTION PROBLEMS AND DECREASE IN SIZE
Sometimes, the erections and daily life of people with Peyronie's disease are characterized by:
- Ache. Patients may experience an uncomfortable painful sensation, both when the penis is erect and in normal condition. The intensity of the disorder depends on the degree of severity of the lump and its location.
- Problems in maintaining an erection. Problems with erection are related to the patient's inability to maintain an erection constant. This makes it very difficult to successfully carry out sexual intercourse.
- Penis size reduction. The presence of fibrous-scar tissue alters the elasticity of the tunic albuginea and the blood supply of the corpora cavernosa. This prevents the penis, during an erection, from assuming the same size as it did before developing the pathological lump.
EVOLUTION OF SYMPTOMS
Penile curvature tends to worsen only in the initial phase of the disease; over time, in fact, the nodule stabilizes (in the sense that it remains as it is) and does not undergo further aggravation.
Furthermore, in many patients, the painful sensation subsides after about 12-24 months, although the fibrous-scarring lump remains and is noticeable as usual.
A spontaneous improvement (ie without any treatment) of the curved penis is a possible hypothesis, but very remote and which concerns very few individuals.
WHEN TO SEE THE DOCTOR?
It is good to contact your doctor if the curvature of the penis becomes evident or if it is associated with an unbearable painful sensation or problems with erectile dysfunction.
COMPLICATIONS
The curved penis and the associated erection difficulties can involve two kinds of complications: physical and psychological.
In fact, patients with Peyronie's disease, failing to maintain a normal erection and having children (physical complications), can develop a form of depression linked to unsatisfactory sex life, and a "performance anxiety (psychological complications).
Peyronie's disease complications picture
- Failure to erect or difficulty maintaining it throughout intercourse (erectile dysfunction)
- Total inability to have sexual intercourse
- Depression and sense of shame, related to the appearance of the penis erect
- Performance anxiety
- Difficulty in procreating (i.e. having children)
- Depression related to a sex life that is unsatisfactory for yourself and your partner
Diagnosis
Peyronie's disease determines unequivocal signs, therefore, to diagnose it, an objective examination (ie observation of the disorders manifested by the patient) is generally sufficient.
When an ultrasound of the penis is used, it is because the doctor wants to identify the exact position of the fibrous-scarring agglomerate and to know its most important characteristics.
Finally, to be able to understand how the curvature of the penis evolves, it is a good idea to photograph your reproductive organ (when it is erect) and measure its size. The photos and measurements are used by the andrologist (ie the doctor who specializes in dysfunctions of the reproductive and urogenital system), to determine when and if the time has come for surgery.
OBJECTIVE EXAMINATION
During the physical examination, the doctor (usually an andrologist) observes the signs reported by the patient and collects from the latter all the information regarding the symptoms experienced.
In addition, he feels the reproductive organ in normal conditions (that is, of non-erection), to understand the precise position of the fibrous-scarring nodule, and measures the size of the erect penis, asking the patient to do the same in the following months (perhaps taking photographs). This allows us to outline the evolution of the disease.
ULTRASOUND OF THE PENIS
Ultrasound of the penis is prescribed only to have a "clear" image of the fibrous-scarring agglomeration (exact position and size) and to see how much and how the flow of blood, passing through the corpora cavernosa, is interrupted.
Treatment
Before making any decision about the treatment to be adopted, the doctor evaluates:
- Whether the penis curvature is severe or not
- If the curvature is getting worse or is stable
- If the patient complains of pain during sexual intercourse
- If erections are painful
- If the patient manages to maintain an erection for the duration of sexual intercourse
Only once these considerations are over, do you decide what is best to do.
In general, when the curvature is moderate and does not prevent normal sexual intercourse, the doctor opts for a conservative, drug-based treatment.
When, on the other hand, the curvature is severe and uncomfortable, and impedes a normal sex life, she recommends surgery.
PHARMACOLOGICAL TREATMENT
When do you opt for pharmacological treatment?
The doctor opts for drug treatment when the curvature of the male reproductive organ is moderate and the symptoms of a curved penis are only slightly perceptible.
The drugs used in the treatment of Peyronie's disease are given by local injection, that is, injected directly into the penis.
They consist of:
- Verapamil. Used routinely for the treatment of hypertension, this drug stops the production of a protein called collagen, which plays a decisive role in the formation of fibrous-scar tissue.
- Interferon. According to some pharmacological studies, it seems that this protein is able to block the production of fibrous-scar tissue, thus avoiding a worsening of the curved penis.
- Collagenase of Clostridium histolyticum. Collagenase is the enzyme that breaks down collagen into small pieces Clostridium histolyticum appears to improve penile curvature and reduce the size of the scar-fibrous nodule.
Usually, local anesthesia is done before injecting these drugs, because the injection could be painful.
The duration of treatment is variable and depends on the results achieved with the therapy. Typically, injections are planned for several months.
SURGICAL TREATMENT
When do you opt for surgical treatment?
The doctor opts for surgical treatment when the curvature of the reproductive organ is severe and the symptoms of a curved penis prevent normal sexual activity (erectile dysfunction, inability to have children, etc.).
Possible surgical treatments for the curved penis, caused by Peyronie's disease, are:
- Nesbit surgery. To straighten the penis, the surgeon removes a small portion of healthy tissue, located on the opposite side of the fibrous-scarring nodule. This operation has two disadvantages: it shortens the length of the male reproductive organ and increases the risk of erectile dysfunction.
- The triple incision-excision-transplant surgery. In this case, the site of the incision-excision-transplant is the point where the fibrous-scarring nodule was formed. replacing the removed piece with a skin graft.
The skin tissue used for transplantation can be of human origin, animal origin or synthetic.
Since there is a high risk of affecting good erectile function, the triple incision-excision-transplant operation is practiced only in the case of very pronounced penile curvatures. - The implantation of a penile prosthesis. There are different types of penile prostheses; some are designed to swell with fluid (the so-called penile "hydraulic pumps"), others are composed of semi-rigid material, which, by replacing the soft tissue of the penis, prevent the penis to bend.
The choice of the type of intervention to be practiced depends on at least three factors: the site of the fibrous-scar tissue, the severity of the symptoms of the curved penis and the psychological state of the patient.
If the surgery is particularly invasive, a hospital stay of at least one night is required; otherwise, the patient is discharged on the day of the operation, after a short period of observation.
For any type of surgery, it is essential that the curvature of the penis has been stable for some time, therefore it is recommended to photograph the reproductive organ periodically and observe if there have been changes from one photo to another.
Before being able to resume normal sexual activity, patients with Peyronie's disease must wait 4 to 8 weeks.
Attention: if the patient to be operated on is not circumcised, he will undergo circumcision during the curved penis surgery.
OTHER PROCEDURES
Currently, doctors and scientists are investigating whether a cure based on iontophoresis and the administration of verapamil and steroids can provide benefits to those suffering from curved penis.
The results are still controversial, therefore it is necessary to continue with the research, to understand the true effects of this therapy.
