Peyronie Disease

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Basics

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

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Basics

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

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