Thursday, 3 November 2016

What is Peyronie's Disease?

Peyronie's Disease, also known as Induratio Penis Plastica was initially described by the French Surgeon Francois Gigot de La Peyronie in 1743.

It represents a disorder of the tunica albuginea of the penis, which is the connective layer surrounding the erectile tissue of the corpora cavernosa. 
Peyronie's Disease is characterized by the formation of a scar, commonly known as "plaque", which can be appreciated during examination of the penis. Since scar tissue is inelastic and does not stretch as the surrounding tunica albuginea, during erections it will cause a traction of the corpora cavernosa, bending them in the direction of the plaque. The degree of deformity varies according to the size, shape and texture of the plaque and in many cases can be so severe to interfere with penetrative sexual intercourse. 
Cardiovascular risk factors are often present in patients with Peyronie's Disease and erectile dysfunction is therefore not uncommon. Alternatively, erectile dysfunction can be caused by Peyronie's Disease itself, especially when the plaque produces a hourglass deformity or when it directly infiltrates the cavernosal arteries. It has also been suggested that the plaque can cause venous leak and ultimately erectile dysfunction as it disrupts the normal interface between cavernosal smooth muscle and tunica albuginea.
Peyronie's Disease is a relatively common condition, with a prevalence of around 10% in men of 50-70 years of age. Although the onset of this condition is typically in the fifth decade of life, cases of Peyronie's Disease have been described in all age groups. Typically Peyronie's Disease tends to be more aggressive in the younger patient.
Although the real cause of Peyronie's Disease is still not completely clear, it is believed that this condition represents a wound healing disorder and that plaque formation is consequence of penile trauma in the genetically susceptible patient.
Peyronie's Disease is typically characterized by two separate phases. The first phase, also known as inflammatory phase, due to the presence of a local inflammatory process that will lead to the formation of the plaque, usually lasts around 6-9 months. During this phase many patients complain of pain during erections, when the plaque is under tension, while penile deformity worsens with the increase in size of the plaque. At the end of this phase the inflammation settles and the plaque stabilizes. Once the inflammation disappears, the pain during erections progressively settles and the deformity stabilizes. This represents the chronic phase of Peyronie's Disease.
Diagnosis of Peyronie's Disease relies mainly on history taking and physical examination. An adequate assessment of the quality of the erections and of the degree of deformity and shortening of the penis once the disease has stabilized is necessary in order to formulate the most appropriate treatment plan.  

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