Peyronie's disease is a condition in which a hard lump called plaque forms on the penis, most often on the upper side in the layers that contain erectile tissue. Sometimes it occurs on the lower side. The plaque often begins as an area of irritation with inflammation and swelling which evolves into a hardened scar. The scarring reduces elasticity and flexibility in that part of the penis.
It's painful and causes the penis to bend or curve in erect state. It also can cause emotional distress, and affect a man's desire and ability to function during sex.
The cause of Peyronies is of unknown origins. There are various theories but there is no sure, 100% proof of the etiology. No one is certain of the causes or origin of Peyronies disease nor the factors which produce it nor what may predispose a man toward the disorder. Some theories propose it's caused by genetic factors. Others suggest it's the result of immune system malfunctions.
The predominant theory about the cause of Peyronies is micro-trauma of the tunica albuginea during rough sexual intercourse, causing micro-breaks of the penis and bleeding in the albuginea which surrounds the spongy corpora cavernosa chambers of the penis. The corpora cavernosa trap blood in the penis, enabling erection.
In the past, Peyronies disease was found primarily in men in their 50s and 60s. Now it is becoming more common in men in their thirties and even in their twenties.
There are two layers of tunica albuginea — longitudinal and circular. When the longitudinal layer of fibers are affected by Peyronies disease, the resulting penile curvature depends on which side is scarred. If the dorsal side of the albuginea is affected then the curvature will be dorsal. If damage is on the ventral side, the penis curvature will be ventral. It can also be lateral (bending toward either side) and in an increasing number of cases a combination, such as ventral-lateral or dorsal-lateral penis curvature or even spiral curvature. The dorsal side of the penis is the back (upper, posterior) side and the ventral side is the front (lower, bottom, anterior) surface.
If the inner, circular tunica albuginea is affected by Peyronie's disease it will cause narrowing or shrinkage. The surgeons of the Sava Perovic Foundation find that slightly more than 30% of Peyronies patients have both penis curvature and narrowing. In a few patients, they discover only narrowing. In some rare cases, patients have symmetrical involvement of the tunica albuginea and as a result there is no curvature and no narrowing or shrinkage but penile shortening instead.
Diagnosis of Peyronies is best done by a physician inducing an artificial erection by chemical injection plus palpation to determine the location of the affected tunica albuginea, degree of damage, and extent of Peyronies disease.
Conservative treatment is more or less unsuccessful. In the early stages, mechanical force applied by a penis stretcher or vacuum device might be effective to some degree. However, in the later stages of Peyronies disease those methods can help very little if at all.
There is no specific preparations patients must do before surgery. However, in Dr Djinovic's experience, Peyronies disease impacts on the erections of 15-20% of sufferers. If they had erectile dysfunction before surgery, there is a good chance they will also have ED after surgery.
Before surgery, the likeliness of erectile dysfunction continuing after surgical treatment of Peyronies should be estimated and the patient warned of this possible result after treatment of the disease.
Patients must be warned that about 10-15% of patients with no erectile dysfunction before surgery lose their ability to have an erection after grafting. They MUST be aware of this risk.
In those cases where patients experience ED because of Peyronies disease or because of the surgical correction of the bent penis, implantation of a penile prosthesis is absolutely indicated and the only proper solution.
The USA National Institute of Health reports that approximately 30% of Peyronie's disease patients also develop connective tissue disorders in their hands and feet.
