Peyronie's disease (also known as "Induratio penis plastica"[1]) is a connective tissue disorder involving the growth of fibrous plaques[2] in the soft tissue of the penis affecting as many as 1-4% of men. Specifically the fibrosing process occurs in the tunica albuginea, a fibrous envelope surrounding the penile corpora cavernosa causing an abnormal curvature of the penis.
Peyronie's Disease is also formally known as "penile induration" or "Induratio Penis Plastica (IPP)" and colloquially as "bent nail syndrome". A French surgeon, François Gigot de la Peyronie, first described the disease in 1743. [3][4][5]
Exception
A certain degree of curvature of the penis is considered normal, as many men are born with this benign condition, commonly referred to as congenital curvature.
The disease may cause pain; hardened, cord-like lesions (scar tissue known as "plaques"); or abnormal curvature of the penis when erect. Although the popular conception of Peyronie's disease is that it always involves curvature of the penis, the scar tissue sometimes causes divots or indentations rather than curvature. The condition may also make sexual intercourse painful and/or difficult, though many men report satisfactory intercourse in spite of the disease. Although it can affect men of any race and age, it is most commonly seen in Caucasian males above the age of 40. Peyronie's Disease is not contagious, nor is it related in any way to cancer. The disease only affects men and is confined to the penis, although a substantial number of men with Peyronie's exhibit concurrent connective tissue disorders in the hand, and to a lesser degree, in the feet. About 30 percent of men with Peyronie's disease develop fibrosis in other elastic tissues of the body, such as on the hand or foot, including Dupuytren's contracture of the hand. An increased incidence in genetically related males suggests a genetic component.[citation needed]
Diagnosis
A urologist can diagnose the disease and suggest treatment, and it is best to seek out a urologist who specializes in Peyronie's Disease, as the disease and its current treatments are not well understood by general practitioners or family doctors.
Causes
The underlying cause of Peyronie's Disease is not well understood, but is thought to be caused by trauma or injury to the penis usually through sexual activity and the patient is often unaware of any traumatic event or injury.[6]
There is also an association that a class of anti-hypertensive drugs known as calcium channel blockers may be a possible cause of or exacerbate the disease, although it has not been proven. However, all beta blocker drugs list Peyronie's disease as a possible side effect.[6]
Treatment
Without treatment, about 12-13% of patients will spontaneously improve over time, 40-50% will get worse and the rest will be relatively stable.[citation needed]
Medication and supplements
Many oral treatments have been studied, but results so far have been mixed.[7] Some consider the use of non-surgical approaches to be "controversial".[8]
Vitamin E supplementation has been studied for decades, and some success has been reported in older trials, but those successes have not been reliably repeated in larger, newer studies.[9] A combination of Vitamin E and colchicine has shown some promise in delaying progression of the condition.[10]
Newer agents targeting the basic mechanisms of inflammation have not yet been studied in larger clinical trials. Such medications include potassium para-aminobenzoate (Potaba),[11] acetyl L-carnitine, propionyl L-carnitine, L-arginine, sildenafil (acting through phosphodiesterase-5 inhibition) and pentoxifylline (acting through TGFβ1 inhibition).
Interferon-alpha-2b has been proposed in recent publications.[12]
Formulations of superoxide dismutase are also reported to be effective in Pey[1].
Injections to plaques (scar tissue formed by the disease) with Verapamil may be effective in some patients. Use of iontophoresis with Verapamil and Dexamethasone, applied to the affected areas has been studied[13] but a recent placebo controlled trial failed to show a significant improvement. There are no clinical trials listed in the NIH trial registry.
Surgery
Surgery, such as the "Nesbit cock operation",[14] is considered a last resort and should only be performed by highly skilled urological surgeons knowledgeable in specialized corrective surgical techniques. A penile prosthesis may be appropriate in advanced cases.[15] A European surgery called the Leriche technique, in which an 18 gauge needle is used to lacerate the plaque, has shown effectiveness at reducing curvature and returning sexual function.[16]
Physical therapy and devices
Self-administered manual stretching techniques, as well as a number of devices which exert gentle longitudinal forces on the plaque, are currently being studied in clinical trials. Vacuum therapy devices (or penis pumps), which have traditionally been used to treat erectile dysfunction, are currently being prescribed to help correct the curvature of the penis associated with Peyronie's.[citation needed]
Doctors are starting to look into less intrusive forms of therapy as an alternative to surgery, which is becoming increasingly unpopular amongst both doctors and patients. Due to the very intrusive nature of penile curvature correction surgery, and the arguably scarce results that it provides at a very high economical, emotional, and physical cost, patient insatisfaction post surgery is very high. Most patients were unhappy with the results of the intervention due mostly to the penile shortening that happens after the surgery. As the scar retracts, the penis is pulled deeper into the body, eventually resulting in penile shortening. This was recorded in nearly 100% of the cases studied.[17]
Although there is no cure for Peyronie's Disease, several clinical studies such as the one mentioned above point to penis extenders as the best treatment to correct curvature, or at the very least to impede the curvature from getting worse. According to Doctor Gontero, the leading Doctor of the above mentioned study which was published in the Journal of Sexual Medicine in 2009, "Overall results were self-reported as "acceptable", making this minimally invasive treatment modality a potential new treatment option in selected Peyronie's disease patients."
Similarly, after conducting two case studies, Urologist Wendy Hum of the British Royal Infirmary, came to the conclusion, "As patient and doctor discuss the possible treatment options, it is extremely important to exhaustively inform the patient that the treatment with the Andropenis (a brand of penile extender) has to be considered an overall effective and viable treatment." [18] Several other studies exist reaffirming these types of results.[19][20][21]
Counseling
Peyronie's Disease can be a physically and psychologically devastating disease. While most men will continue to be able to have sexual relations, they are likely to experience some degree of deformity and erectile dysfunction in the wake of the disease process. It is not uncommon for men afflicted with Peyronie's Disease to exhibit depression or withdrawal from their sexual partners.
See also
References
- ^ Freedberg, et al. (2003). Fitzpatrick's Dermatology in General Medicine. (6th ed.). Page 990. McGraw-Hill. ISBN 0071380760.
- ^ Levine LA, Estrada CR, Storm DW, Matkov TG (2003). "Peyronie disease in younger men: characteristics and treatment results". J. Androl. 24 (1): 27–32. PMID 12514077.
- ^ Peyronie's disease at Who Named It?
- ^ "Peyronie’s Disease". http://kidney.niddk.nih.gov/kudiseases/pubs/peyronie/index.htm. Retrieved 2007-12-03.
- ^ "Peyronie's disease - MayoClinic.com". http://www.mayoclinic.com/health/peyronies-disease/DS00427. Retrieved 2007-12-03.
- ^ a b http://www.mayoclinic.com/health/peyronies-disease/DS00427/DSECTION=causes
- ^ Levine LA (2003). "Review of current nonsurgical management of Peyronie's disease". Int. J. Impot. Res. 15 Suppl 5: S113–20. doi:10.1038/sj.ijir.3901084. PMID 14551587.
- ^ Hauck EW, Diemer T, Schmelz HU, Weidner W (2006). "A critical analysis of nonsurgical treatment of Peyronie's disease". Eur. Urol. 49 (6): 987–97. doi:10.1016/j.eururo.2006.02.059. PMID 16698449. http://linkinghub.elsevier.com/retrieve/pii/S0302-2838(06)00304-6.
- ^ Mynderse LA, Monga M (2002). "Oral therapy for Peyronie's disease". Int. J. Impot. Res. 14 (5): 340–4. doi:10.1038/sj.ijir.3900869. PMID 12454684. http://www.nature.com/ijir/journal/v14/n5/full/3900869a.html.
- ^ Prieto Castro RM, Leva Vallejo ME, Regueiro Lopez JC, Anglada Curado FJ, Alvarez Kindelan J, Requena Tapia MJ (2003). "Combined treatment with vitamin E and colchicine in the early stages of Peyronie's disease". BJU Int. 91 (6): 522–4. doi:10.1046/j.1464-410X.2003.04134.x. PMID 12656907. http://www.blackwell-synergy.com/openurl?genre=article&sid=nlm:pubmed&issn=1464-4096&date=2003&volume=91&issue=6&spage=522.
- ^ Carson CC (1997). "Potassium para-aminobenzoate for the treatment of Peyronie's disease: is it effective?". Tech Urol 3 (3): 135–9. PMID 9422444.
- ^ Trost LW, Gur S, Hellstrom WJ (2007). "Pharmacological Management of Peyronie's Disease". Drugs 67 (4): 527–45. doi:10.2165/00003495-200767040-00004. PMID 17352513.
- ^ Riedl CR, Plas E, Engelhardt P, Daha K, Pflüger H (2000). "Iontophoresis for treatment of Peyronie's disease". J. Urol. 163 (1): 95–9. doi:10.1016/S0022-5347(05)67981-5. PMID 10604323. http://linkinghub.elsevier.com/retrieve/pii/S0022-5347(05)67981-5.
- ^ Ralph DJ, Minhas S (2004). "The management of Peyronie's disease". BJU Int. 93 (2): 208–15. doi:10.1111/j.1464-410X.2004.04587.x. PMID 14690485. http://www.blackwell-synergy.com/openurl?genre=article&sid=nlm:pubmed&issn=1464-4096&date=2004&volume=93&issue=2&spage=208.
- ^ Hellstrom WJ, Usta MF (2003). "Surgical approaches for advanced Peyronie's disease patients". Int. J. Impot. Res. 15 Suppl 5: S121–4. doi:10.1038/sj.ijir.3901085. PMID 14551588.
- ^ Khouaja K., Delmas V. and Boccon-Gibod L. (Sep. 2004), "Leriche technique for the treatment of La Peyronie's disease" (in French), Prog Urol. (Urology Clinic Hospital Bichat, Paris) (4), archived from the original on 11-02-2005, http://www.peyroniesforum.net/index.php?topic=119.0, retrieved 2009-06-26
- ^ Use of Penile Extender Device in the Treatment of Penile Curvature as a Result of Peyronie’s Disease. Results of a Phase II Prospective Study http://www.andromedical.com/pdf/en/study_penile_extender_device_treatment_penile_curvature.pdf
- ^ Peyronie´s disease - latest treatment options http://www.andropenis.com/pdf/en/study_treatment_options_for%20peyronie_disease.pdf
- ^ Can an External Penis Stretcher Reduce Peyronie's Penile Curvature? Oct. 2001 http://www.nature.com/ijir/journal/v13/n4s/pdf/3900746a.pdf
- ^ 5th Congress of the European Society for Sexual and Impotence Research (ESSIR). Hamburg, Germany. December 1-4, 2002. http://www.andromedical.com/pdf/en/study_penis_stretching_effective_for_peyronie_disease.pdf
- ^ Conservative treatment in a case of induratio penis plastica XXI National Congress of the SIA Regional Sections (Italian Andrology Society) Trieste, Italy, September 23rd-26th, 2004.
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