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).
• 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.
• Curvature can range from mild to severe and may preclude sexual intercourse and cause psychological distress.
• Synonyms: acquired penile curvature, penile induration

Epidemiology

• Between 3% and 9%
• Reported in up to 9% of men >40 years of age (1)
• Mean age of diagnosis: 53 years in white males

• Estimated prevalence: 3–20% of men of all ages
• Higher prevalence of up to 22.3% reported in patients with diabetes mellitus
• Reported prevalence of concomitant ED: 37–58%

Etiology and Pathophysiology

• Exact etiology unknown; generally thought to be secondary to trauma
• 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.
• Acute phase
  • 6–18 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 (1,2)
• Chronic phase
  • Stable plaque formation and angulation
  • Resolution of pain
• Complete spontaneous resolution of PD is uncommon.
• Most common presenting symptoms: penile pain, erection deformity, palpable plaque, ED

Risk Factors

• Genetic predisposition/HLA-B7
• Trauma

Commonly Associated Conditions

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