Peyronie Disease

Snapshot

• A 30-year-old gentleman presents complaining of an abnormal curvature in his penis particularly when he has an erection.  He denies symptoms of dyuria and is otherwise in good health.  He states that engaging in intercourse has been painful for his wife.

Introduction

• Peyronie’s Disease
  • curvature of the penis secondary to acquired fibrosis of the tunica albuginea (which surrounds the corpora cavernosa) 
  • patients can also present with divots or other anatomical abnormalities of the penis
  • there is a genetic component to this disease and there could be other systemic findings
    • Duptuyren’s contracture
    • connective tissue disorders of the feet
• other systemic connective tissue disorders possible

Presentation

• Symptoms
  • infertility
  • pain
  • unpleasant intercourse with partner
  • sexual withdrawal from partner
• depression

Studies

• Diagnosis
  • clinically by a urologist
• the most accurate test is an ultrasound

Treatment

• Medical – low success rate
  • collagenase
    • breaks down excess collagen in the tunica albuginea
    • also used in Duptruyen’s contracture
  • colchicine + vitamin E
    • can slow disease progress (weak evidence)
  • interferon-α 
    • some evidence that it is helpful in the early stage of the disease
  • physical therapy
    • manual stretching and traction devices
• Surgical
  • Nesbit operation
    • very difficult procedure
    • used in extreme/refractory cases