What is Peyronie's disease (Penile Fibrosis)?

From the Guidelines

Peyronie's disease is a condition characterized by the formation of fibrous scar tissue inside the penis, causing curved, painful erections, and is defined as an acquired penile abnormality characterized by fibrosis of the tunica albuginea, which may be accompanied by pain, deformity, erectile dysfunction, and/or distress 1.

Definition and Symptoms

Peyronie's disease occurs when scar tissue, called plaque, develops on the tunica albuginea, the thick membrane that contains the erectile tissue, preventing normal expansion during erection, resulting in curvature and sometimes pain. The disease typically affects men over 40, though it can occur at any age. Symptoms include penile pain, curved erections, erectile dysfunction, shortening of the penis, and the presence of hard lumps under the skin.

Treatment Options

Treatment options vary based on severity and may include oral medications, injectable treatments such as collagenase (Xiaflex), or surgical procedures for severe cases. Many mild cases resolve without treatment within 12-18 months.

• Clinicians may offer intralesional collagenase clostridium histolyticum in combination with modeling by the clinician and by the patient for the reduction of penile curvature in patients with stable Peyronie’s disease, penile curvature 1.
• Clinicians may administer intralesional interferon α‑2b in patients with Peyronie’s disease 1.
• Clinicians may offer tunical plication surgery to patients whose rigidity is adequate for coitus to improve penile curvature 1.

Important Considerations

The exact cause remains unclear, but factors like repeated penile trauma during sex or athletic activities, genetic predisposition, and certain autoimmune disorders may contribute to its development. Men experiencing symptoms should consult a urologist for proper diagnosis and treatment planning.

• Clinicians should discuss with patients the available treatment options and the known benefits and risks/burdens associated with each treatment 1.
• 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.

From the FDA Drug Label

The FDA drug label does not answer the question.

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 an acquired benign condition without known systemic sequelae, presenting symptoms that include the presence of a plaque or induration of the penile shaft, penile curvature or deformity during erection, penile pain, and erectile dysfunction 3.
• PD is a superficial fibrosing disorder of the penis resulting in plaque formation and penile deformity, which can negatively affect sexual and psychosocial function of both patients and their partners 4.

Etiology and Pathophysiology

• The etiology of PD is unclear, but it is thought to result from an inciting traumatic event followed by aberrant fibrosis or dysregulated wound healing 4.
• The penile trauma results in a delamination of the tunica albuginea with a consequent small hematoma, then the process evolves as an inflammation with accumulation of inflammatory cells and production of reactive oxygen species (ROS) 2.
• The activation of nuclear factor kappa-B induces the production of inducible nitric oxide synthase (iNOS), with an increase of nitric oxide, leading to increased production of peroxynitrite anion, resulting in the proliferation of fibroblasts and myo-fibroblasts and excessive production of collagen between the layers of the tunica albuginea (penile plaque) 2.

Symptoms and Clinical Course

• Signs of PD include curvature, penile pain, penile deformity, difficulty with coitus, shortening, hinging, narrowing, and erectile dysfunction 2.
• The natural history of PD and the clinical course can develop from spontaneous resolution of symptoms to progressive penile deformity and impotence 2.
• PD is often associated with erectile dysfunction (ED), as well as several other comorbidities, such as hypogonadism, diabetes, and cardiovascular disease 4.

Treatment Options

• Medical treatments can be systemic (colchicine, potassium aminobenzoate, vitamin E), intralesional (steroids, verapamil, collagenase, interferons), or topical 3.
• Surgical therapy for PD should be reserved for the man who has failed conservative therapy and whose curvature, indentation, or erectile dysfunction precludes intercourse 3.
• Combination therapy of verapamil and pentoxifylline may improve results and should be considered as a choice in treatment of PD 5.