Peyronie's disease

Peyronie's disease (plastic induration of the penis) is characterized by fibrosis within the penis that may cause pain and deformity. It may affect up to roughly 10% of men. Although many people associate Peyronie solely with curvature, scarring may instead produce indentations or divots. Progression can lead to penile shortening, erectile dysfunction (ED), and difficulty or pain with intercourse.

The exact cause is unknown; minor repetitive trauma with aberrant wound healing is a widely discussed factor. Plaque may form in the tunica albuginea, with dense fibrosis and sometimes calcification, producing deformity. Because the tunica is central to erection rigidity, multifocal tunica disease may contribute to erectile dysfunction.

Early on, patients may report pain and altered sensation (e.g. paresthesia), followed by palpable plaque, then deformity (often curvature), penile retraction, and ED. Common themes include painful erection; visible deformity or shortening in erection; a firm plaque along a corpus; and erectile dysfunction.

Examination can often identify a hard plaque. Pharmacologic erection (e.g. with prostaglandin E1) may be used to document deformity accurately when planning treatment.

Conservative treatment

Oral agents, topical therapy, and intralesional injections help some patients but are often limited in efficacy, especially when deformity is severe.

Surgical treatment

Surgery is required in many cases. Preoperative assessment of penile vasculature and erectile function is essential. Broadly, three approaches exist:

1. Tunical lengthening - incising the concave corporal side and grafting the defect to straighten the penis.
2. Plaque excision with penile prosthesis - with or without additional grafting.
3. Tunical shortening (plication-type techniques) - though some surgeons avoid standard plication when further shortening is undesirable.

Strategy depends on erectile status and severity of disease. We generally avoid plication techniques when they would meaningfully shorten an already compromised length. When erections are preserved, our preference is often a grafting-based lengthening approach using precise geometry to size the graft so that straightening and length are optimized. Men with advanced ED not responsive to conservative therapy may be best served by penile prosthesis, sometimes combined with plaque or graft steps as indicated.

Postoperative vacuum therapy is an important part of rehabilitation. When rigidity is insufficient despite other measures, simultaneous prosthesis implantation may be planned to restore suitable erections.