ⓘ Peyronies disease is a connective tissue disorder involving the growth of fibrous plaques in the soft tissue of the penis. Specifically, scar tissue forms in th ..

                                     

ⓘ Peyronies disease

Peyronies disease is a connective tissue disorder involving the growth of fibrous plaques in the soft tissue of the penis. Specifically, scar tissue forms in the tunica albuginea, the thick sheath of tissue surrounding the corpora cavernosa, causing pain, abnormal curvature, erectile dysfunction, indentation, loss of girth and shortening.

It is estimated to affect about 10% of men. The condition becomes more common with age.

                                     

1. Signs and symptoms

A certain degree of curvature of the penis is considered normal, as many men are born with this benign condition, commonly referred to as congenital curvature. The disease may cause pain; hardened, big, cord-like lesions scar tissue known as "plaques"; or abnormal curvature of the penis when erect due to chronic inflammation of the tunica albuginea CITA.

Although the popular conception of Peyronies disease is that it always involves curvature of the penis, the scar tissue sometimes causes divots or indentations rather than curvature. The condition may also make sexual intercourse painful and/or difficult, though it is unclear whether some men report satisfactory or unsatisfactory intercourse in spite of the disorder. It can affect men of any race and age. The disorder is confined to the penis, although a substantial number of men with Peyronies exhibit concurrent connective tissue disorders in the hand, and to a lesser degree, in the feet. About 30 percent of men with Peyronies disease develop fibrosis in other elastic tissues of the body, such as on the hand or foot, including Dupuytrens contracture of the hand. An increased incidence in genetically related males suggests a genetic component.

                                     

1.1. Signs and symptoms Psychosocial

Peyronies disease can also have psychological effects. While most men will continue to be able to have sexual relations, they are likely to experience some degree of erectile dysfunction. It is not uncommon to exhibit depression or withdrawal from their sexual partners.

                                     

2. Causes

The underlying cause of Peyronies disease is unknown. Although, it is likely due to a buildup of plaque inside the penis due to repeated mild sexual trauma or injury during sexual intercourse or physical activity.

Risk factors include diabetes mellitus, Dupuytrens contracture, plantar fibromatosis, penile trauma, smoking, excessive alcohol consumption, genetic predisposition, and European heritage.

                                     

3. Diagnosis

A urologist may be able to diagnose the disease and suggest treatment. An ultrasound can provide conclusive evidence of Peyronies disease, ruling out congenital curvature or other disorders.

                                     

3.1. Diagnosis Ultrasonography

On Penile ultrasonography, the typical is hyperechoic focal thickening of the tunica albuginea. Due to associated calcifications, the imaging of patients with Peyronies disease shows acoustic shadowing, as illustrated in figures below. Less common findings, attributed to earlier stages of the disease still mild fibrosis, are hypoechoic lesions with focal thickening of the paracavernous tissues, echoic focal thickening of the tunica without posterior acoustic shadowing, retractile isoechoic lesions with posterior attenuation of the beam, and focal loss of the continuity of the tunica albuginea. In the Doppler study, increased flow around the plaques can suggest inflammatory activity and the absence of flow can suggest disease stability. Ultrasound is useful for the identification of lesions and to determine their relationship with the neurovascular bundle. Individuals with Peyronies disease can present with erectile dysfunction, often related to venous leakage, due to insufficient drainage at the site of the plaque. Although plaques are more common on the dorsum of the penis, they can also be seen on the ventral face, lateral face, or septum.



                                     

4.1. Treatment Medication and supplements

Many oral treatments have been studied but results so far have been mixed. Some consider the use of nonsurgical approaches to be "controversial".

Vitamin E supplementation has been studied for decades, and some success has been reported in older trials but those successes have not been reliably repeated in larger, newer studies.

The use of Interferon-alpha-2b in the early stages of the disease has been studied but as of 2007 its efficacy was questionable.

Collagenase clostridium histolyticum Auxilium is reported to help by breaking down the excess collagen in the penis that causes Peyronies disease. It was approved for treatment of Peyronies disease by the FDA in 2013.



                                     

4.2. Treatment Physical therapy and devices

There is moderate evidence that penile traction therapy is a well-tolerated, minimally invasive treatment, but there is uncertainty about the optimal duration of stretching per day and per course of treatment, and the treatment course is difficult.

                                     

4.3. Treatment Surgery

Surgery, such as the "Nesbit operation" which is named after Reed M. Nesbit 1898–1979, an American urologist at University of Michigan), is considered a last resort and should only be performed by highly skilled urological surgeons knowledgeable in specialized corrective surgical techniques. A penile prosthesis may be appropriate in advanced cases.

                                     

5. History

The condition was first described in 1561 in correspondence between Andreas Vesalius and Gabriele Falloppio and separately by Gabriele Falloppio. The condition is named for François Gigot de la Peyronie, who described it in 1743.

                                     
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