What is Peyronie's disease?

From the Guidelines

Peyronie's disease is a condition characterized by the formation of fibrous scar tissue inside the penis, causing curved, painful erections, typically presenting in men in their mid-50s with recent onset of penile curvature and mild to moderate penile pain. The condition results from abnormal wound healing following penile trauma, with excessive collagen deposition creating the characteristic plaque. According to the American Urological Association (AUA) guideline 1, the most common presentation is a male in his mid-50s who presents with recent onset of penile curvature accompanied by mild to moderate penile pain.

Symptoms and Diagnosis

• The patient usually doesn’t recall a specific sexual or non-sexual event that preceded symptom onset.
• Generally, his erection is still firm enough for intercourse, but the penile curvature may preclude intercourse or make it difficult for the patient and/or his partner.
• The patient and clinician usually cannot palpate any abnormalities on the penile shaft in the non-erect state.
• Penile curvature and varying degrees of penile pain may be considered diagnostic, although rare pathologies (e.g., penile tumors) must be excluded 1.

Treatment Options

• For mild cases or early stages, a watchful waiting approach may be appropriate as some cases resolve spontaneously.
• Medical treatments include oral medications such as pentoxifylline or collagenase clostridium histolyticum (Xiaflex) injections directly into the plaque to break down the scar tissue.
• Traction therapy using penile stretching devices for several hours daily over months may help straighten the penis.
• For severe cases with significant curvature or erectile dysfunction, surgical options include plication procedures to straighten the penis, plaque incision/excision with grafting, or penile implants 1.
• Intralesional collagenase clostridium histolyticum in combination with modeling by the clinician and by the patient is a recommended treatment for the reduction of penile curvature in patients with stable Peyronie’s disease 1.

Surgical Options

• Tunical plication surgery, plaque incision or excision and/or grafting, and penile prosthesis surgery are options for patients with adequate rigidity for coitus and significant penile deformity 1.
• Inflatable penile prosthesis is recommended for patients undergoing penile prosthetic surgery for the treatment of Peyronie’s disease 1.

Quality of Life

• Psychological support is important as the condition can cause significant distress, affecting sexual function and self-image.
• Pain typically resolves within 12-18 months of onset, but curvature may persist.

From the Research

Definition and Characteristics of Peyronie's Disease

• Peyronie's disease (PD) is a condition characterized by the formation of a fibrotic plaque in the tunica albuginea layer of the penis 2, 3, 4, 5, 6.
• This plaque can cause penile pain, angulation, and erectile dysfunction 2, 3, 4, 5, 6.
• The disease is thought to result from a predisposing genetic susceptibility combined with an inciting event, such as microtrauma during intercourse 3, 4, 5, 6.

Prevalence and Natural History

• Peyronie's disease has a prevalence of 3-9% in adult men 2, 3, 4.
• The condition may progress, stabilize, or regress during the initial acute phase (6-18 months) 2, 3, 4.
• In some cases, the disease may resolve spontaneously, while in others, it may lead to progressive penile deformity and impotence 5.

Symptoms and Clinical Presentation

• Common symptoms of Peyronie's disease include penile curvature, penile pain, penile deformity, difficulty with coitus, shortening, hinging, narrowing, and erectile dysfunction 2, 3, 4, 5, 6.
• The disease can cause significant distress and impairment in sexual function 2, 3, 4, 5, 6.

Treatment Options

• Conservative treatment approaches, including oral and intralesional pharmacotherapy, are often recommended as a first-line treatment 2, 3, 4.
• Oral therapies, such as vitamin E and para-aminobenzoate, have been used, but their effectiveness is limited 2, 3, 4.
• Intralesional injection therapies, including interferon alpha-2B and verapamil, have shown some benefit in reducing penile pain and curvature 2, 3, 4.
• Surgical treatment, including plication, grafting, and penile prosthesis implantation, may be considered in cases where conservative treatment fails 2, 3, 4, 6.