Peyronie's disease

What is it?

Peyronie's disease is an acquired condition of the penis characterized by the formation of fibrosis or plaque in the tunica albuginea of the corpora cavernosa.

This fibrosis can alter the elasticity of the penis during erection.

How can it present?

• acquired penile curvature;
• palpable plaque;
• pain during erection;
• shortening;
• deformities;
• difficulty with penetration;
• erectile dysfunction.

Something important to ask

Not every penile curvature is Peyronie's.

A curvature present since early in life may correspond to congenital curvature.

In Peyronie's, the deformity is typically acquired.

Outcome

Conceptually, two stages can be recognized.

There may be:

• pain;
• onset or progression of the curvature;
• changes in the deformity.

The deformity stops showing significant changes over a given period, and pain usually disappears or decreases.

This distinction is important because it influences the treatment options.

Evaluation

The following should be determined:

• onset and course;
• pain;
• direction and degree of curvature;
• presence of a plaque;
• erectile function;
• ability to achieve penetration;
• impact on sexual activity.

Photographs of the erect penis can be useful for documenting the deformity.

In selected patients, penile ultrasound can be used.

Treatment

It depends on:

• phase of the disease;
• degree and type of deformity;
• pain;
• erectile function;
• difficulty maintaining sexual intercourse;
• patient expectations.

In certain patients, observation or conservative treatment may be appropriate.

Stable deformities that make intercourse difficult may require surgical treatment.

Surgical strategies include:

• plication techniques;
• incision/partial excision of the plaque with grafting in selected patients;
• penile prosthesis when there is significant associated erectile dysfunction.