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Peyronie's disease

Peyronie's disease is characterised by the formation of abnormal, fibrous lumps (plaques) within the erectile tissue of the penis. Over time, these plaques can grow and deform the erect penis by causing it to curve. The upper side of the penis is usually affected, but Peyronie's disease may sometimes target the lower side or both sides. Infection or injury to the penis can lead to Peyronie's disease, but the cause remains unknown in the majority of cases. The condition is more common in middle aged and older men. There is no cure, and Peyronie's disease is difficult to treat. The most successful form of treatment is surgery to remove the plaques, and replacement of erectile tissue with an inflatable bladder.

Symptoms
Peyronie's disease can be mild, moderate or severe. It may appear suddenly, or progress slowly over a matter of weeks or months. The progression of symptoms may include:

• The person experiences a small, localised ache or discomfort in the penis.
• A lump forms at the site of the aching.
• The lump may be painless.
• The plaque contracts as it spreads, bending or kinking the erect penis towards the affected side.
• Erections become uncomfortable or painful.
• The erections are softer than usual.
• There may be one or several plaques.

The structure of the penis
The erectile tissue of the penis - called corpora cavernosa - looks like two rods running the length of penis. Blood vessels are contained in the corpora cavernosa. These blood vessels lie closely side by side when the penis is flaccid. During sexual arousal, the nerves that supply the penis allow these relatively empty blood vessels to open and fill with blood, causing the erection. Veins permit only the bare minimum of blood to return to the heart, just enough to maintain circulation.

Peyronie's disease tends to start in the fibrous tissue (fascia) that lies between the skin and the corpora cavernosa, and can progress to invade the erectile tissue. The contraction of the plaques causes the penis to bend, and the invasion of the corpora cavernosa interferes with blood flow, compromising the firmness of erections.

Deformed erections
The plaque most often develops on the topside of the penis, causing it to curve upwards. Sometimes, the plaque develops on the underside, which means the penis curves downwards. In a small percentage of cases, plaques grow on both the upper and lower sides, which shortens and distorts the penis.

The link to Dupuytren's contracture
Around one third of men with Peyronie's disease develop other forms of fibrosis, or plaques. A common example is Dupuytren's contracture, which is the shortening of the connective tissue of the palm and the resulting closure of the fingers.

A range of causes
In most cases, the cause of Peyronie's disease is unknown. Some of the known causes and risk factors include:

• Injury to the penis, such as bending it severely enough to rupture blood vessels.
• Family history (suggesting a genetic susceptibility).
• Infection of the penis.
• Problems with the nerves that supply the penis.
• Narrowed blood vessels within the penis (associated with poorly managed diabetes or high blood cholesterol levels).
• Certain drugs including blood pressure medications (beta blockers), interferon and anti-seizure drugs.

Diagnosis methods
Peyronie's disease is diagnosed using a number of tests, including:

• Medical history
• Physical examination
• Ultrasound scan of the penis.

Treatment methods
Treatment options include:

• 'Wait-and-see' approach - in some cases, Peyronie's disease can resolve by itself with no medical intervention at all. The reasons for this are unknown.
• Medications - including anti-inflammatory drugs, vitamin E and potassium para-aminobenzoate. If symptoms haven't eased within one year of treatment, it is assumed that medications won't fix the condition.
• Steroid injections - steroids are injected into the plaques. However, this form of treatment runs the risk of damaging erectile tissue.
• Enzyme injections - a relatively new form of treatment that shows promise, which involves the injection of an enzyme called collagenase directly into the plaques.
• Radiotherapy - the plaques are targeted by precise doses of radiation.
• Surgery - in severe cases, where sexual function is affected, surgery to remove the plaque or plaques may be the only answer. However, this can impact on the quality of the man's erections. A prosthetic bladder may need to be surgically implanted. This bladder is inflated manually to allow an erection firm enough for successful sexual intercourse. Surgery is the option of last resort, and most doctors prefer to try other treatment methods for one or two years.

Where to get help

• Your doctor
• Urologist
• Family Planning Victoria Tel. (03) 9257 0100

Things to remember

• Peyronie's disease is characterised by the formation of abnormal, fibrous lumps (plaques) within the erectile tissue of the penis.
• Over time, these plaques can grow and deform the erect penis by causing it to curve.
• There is no cure, and Peyronie's disease is difficult to treat.
• The most successful form of treatment is surgery to remove the plaques, and replacement of erectile tissue with an inflatable bladder.
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Article publication date: 16/01/2002
Last reviewed: 30/06/2004

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