Peyronie Disease

Description

• Peyronie disease (PD) is a progressive connective tissue disorder affecting the tunica albuginea.
• Results in aberrant fibrosis and inelastic scar (plaque) formation due to abnormal wound healing
• Formation of plaque results in penile deformities: curvature, indentation, shortening, hourglass configuration, and/or painful erections.
• PD is often accompanied with erectile dysfunction (ED) (1)[C].
• Named after 18th-century French physician Francois de la Peyronie
• The most common plaque location is on the dorsal aspect of the penis followed by lateral then ventral (1)[C].
• Curvature can range from mild to severe and may preclude sexual intercourse and cause psychological distress.
• Synonyms: acquired penile curvature, penile induration

Epidemiology

Incidence

• Between 2% and 9% (1)
• Reported in up to 9% of men >40 years of age (1,2)
• May have significant effects of quality of life (1)
• Associated with high rates of depression, relationship stressors, low self-esteem (1)

Prevalence

• Estimated prevalence 3–20% of men of all ages (1)
• Higher prevalence of up to 22.3% reported in patients with diabetes mellitus (1)
• Reported prevalence of concomitant ED 37–58% (1)
• Up to 39% of men with PD may be affected with Dupuytren contracture (1).

Etiology and Pathophysiology

• Exact etiology unknown; generally thought to be secondary to trauma (1)[C]
• Theory: Microtrauma in men with genetic predisposition leads to inflammation of the tunica albuginea, then collagen deposition, and eventually fibrosis in the form of a plaque (1)[C].
• Acute phase
  • 6 to 18 months of acute inflammation eventually leading to fibrosis and plaque formation
  • Painful erections that resolve spontaneously
  • Angulation in flux: 12% improve, 40% remain stable, 48% worsen (1)[B],(2)[C].
• Chronic phase
  • Stable plaque formation and angulation (1,2)[C]
  • Resolution of pain
• Complete spontaneous resolution of PD is uncommon (1,2)[C].
• Most common presenting symptoms: penile pain, erection deformity, palpable plaque, ED (1)[C]

Risk Factors

• Genetic predisposition/HLA-B7
• Trauma (1)[C]

Commonly Associated Conditions

• Dupuytren contracture
• Ledderhose disease of plantar fascia
• Tympanosclerosis of eardrum
• ED