From the Guidelines
Peyronie's disease is a condition characterized by the development of fibrous scar tissue inside the penis, causing curved, painful erections, and is typically treated with intralesional collagenase injections, which have been shown to reduce curvature by a mean of 17° in clinical trials 1. Peyronie's disease occurs when scar tissue, called plaque, forms in the tunica albuginea, the thick membrane that contains the erectile tissue, reducing flexibility and causing the penis to bend during erection, sometimes making sexual intercourse difficult or painful. The condition typically affects men over 40, though it can occur at any age. Symptoms include:
- Penile pain
- Palpable scar tissue or hard lumps
- Erectile dysfunction
- Penile shortening or deformity Treatment options range from watchful waiting for mild cases to medications like collagenase (Xiaflex) injections that break down scar tissue. Intralesional collagenase injections have been shown to be a effective treatment for Peyronie's disease, with a modest difference of 7.7° in curvature reduction compared to placebo 1. However, clinicians should counsel patients with Peyronie’s disease prior to beginning treatment with intralesional collagenase regarding potential occurrence of adverse events, including penile ecchymosis, swelling, pain, and corporal rupture 1. Intralesional interferon α‑2b may also be administered in patients with Peyronie’s disease, with studies showing statistically significant improvements in curvature reduction, plaque size reduction, and penile pain resolution 1. The exact cause of Peyronie's disease remains unclear, though trauma to the penis and genetic factors may contribute. Many men experience significant anxiety about this condition, so psychological support is often beneficial alongside physical treatment.
From the Research
Definition and Characteristics of Peyronie's Disease
- Peyronie's disease (PD) is a connective tissue disorder characterized by a fibrous plaque involving the tunica albuginea of the penis, leading to penile curvature 2.
- It is a benign condition with symptoms including curvature, penile pain, penile deformity, difficulty with coitus, shortening, hinging, narrowing, and erectile dysfunction 2, 3, 4.
- The disease can be divided into acute and chronic phases, with pain during erection or flaccid state being the hallmark of the acute phase 3.
Etiology and Pathogenesis
- The etiology of PD is not widely known, but it is believed to involve minor penile trauma with subsequent aberrant wound healing 2, 4.
- Penile micro-traumas during intercourse and subsequent activation of inflammatory processes constitute the pathogenetic basis of the disease 3.
- The process evolves as an inflammation with accumulation of inflammatory cells and production of reactive oxygen species (ROS), leading to the proliferation of fibroblasts and myo-fibroblasts and excessive production of collagen between the layers of the tunica albuginea 2.
Treatment Options
- Medical treatments can be systemic, intralesional, or topical, and include options such as vitamin-E, verapamil, para-aminobenzoate, propoleum, colchicine, carnitine, tamoxifen, interferons, collagenase, hyaluronidase, cortisone, pentoxifylline, superoxide dismutase, iontophoresis, radiation, extracorporeal shock wave therapy (ESWT), and the penile extender 2, 4, 5.
- Surgical therapy should be reserved for men who have failed conservative therapy and whose curvature, indentation, or erectile dysfunction precludes intercourse 4, 6.
- Intralesional treatments are growing in clinical popularity as a minimally invasive approach in the initial treatment of PD 6.