Peyronie's disease

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**Peyronie's disease**
*Classification & external resources*
ICD-10	N 48.6
ICD-9	607.85
OMIM	171000
DiseasesDB	29308
MedlinePlus	001278
eMedicine	derm/851
MeSH	D010411

Peyronie's disease is a rare connective tissue disorder involving the growth of fibrous plaques in the soft tissue of the penis affecting as many as 1% of men. A French surgeon, François de la Peyronie, first described the disease in 1743. ^[1]^[2]^[3]

This may be associated with Dupuytren's contracture.

1 Causes
2 Variation
3 Symptoms
4 Diagnosis and treatment
5 See also
6 References
7 External links

[edit] Causes

The exact cause is not known, although it is thought to be caused by injury to the internal cavity of the penis, which results in bleeding at the site of the injury, triggering an over production of scar tissue formation in the tunica albuginea of the corpora cavernosa.

When an injury to the penis precedes the onset of abnormal curvature, most commonly reported are sudden injuries occurring during strenuous intercourse, especially when the receptive partner is on top of the penetrative partner, followed by injuries to the penis sustained while participating in sports activities where an accidental impact occurred. Notably, Peyronie's Disease is also reported in men who deny any sexual activity or physical injury. It is thought that Peyronie's Disease may be hereditary.

Some medical scientists consider Peyronie's Disease to be a wound healing disorder. Unlike the normally elastic tissues of the penis which allow for expansion and contraction during erection, scar tissue is hard and inelastic. Over time, continued scar tissue production begins to pull or contract the penis, causing hard lumps or a curvature deformity.

[edit] Variation

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. This causes the penis to point in a direction other than directly forward, while still having a relatively straight shaft. Such curvature is not caused by Peyronie's Disease.

[edit] Symptoms

The disease may cause pain, hardened, cord-like lesions (scar tissue known as "plaques"), or abnormal curvature of the penis when erect. In addition, narrowing and or shortening of the penis may occur. Pain felt in the early stages of the disease often resolves in twelve to eighteen months. Erectile dysfunction, in varying degrees, often accompanies these symptoms in the later stages of the disease process. The condition may also make sexual intercourse painful and/or difficult, though many men report satisfactory intercourse in spite of the disease. Although it can affect men of any race and age, it is most commonly seen in caucasian males above the age of 40. Peyronie's Disease is not contagious, nor is it related in any way to cancer. The disease only affects men and is confined to the penis, although a substantial number of men with Peyronie's exhibit concurrent connective tissue disorders in the hand, and to a lesser degree, in the feet.

[edit] Diagnosis and treatment

A urologist can diagnose the disease and suggest treatment, and it is best to seek out a urologist who specializes in Peyronie's Disease, as the disease and its current treatments are not well understood by most urologists in general practice. Commonly prescribed oral treatments, such as Vitamin E and potassium aminobenzoate (Potaba), are of limited value. Newer agents targeting the basic mechanisms of inflammation show promise, but have not yet been studied in larger clinical trials. Such medications include acetyl L-carnitine, propionyl L-carnitine, L-arginine, sildenafil (acting through phosphodiesterase-5 inhibition) and pentoxifylline (acting through TGFß1 inhibition). Leading medical researchers believe that early treatment yields the best outcomes. Surgery is considered a last resort and should only be performed by highly skilled urological surgeons knowledgeable in specialized corrective surgical techniques. Injections to plaques (scar tissue formed by the disease) with Verapamil has shown promise and is effective in some patients. Use of Iontophoresis with Verapamil and Dexamethasone, applied to the affected areas, has also been shown to be effective in some cases. Other treatments exist, and investigational medical trials are ongoing. Always consult a qualified physician before starting any treatment regimen. Anecdotal evidence supports use of a vacuum erection device to exert gentle longitudinal forces on the plaque, and to lead to remodeling; this too is now being studied in a clinical trial. Never attempt to bend or force the erect penis back to its former alignment as this could cause serious injury and significantly worsen the condition.

Peyronie's Disease can be a physically and psychologically devastating disease. While most men will continue to be able to have sexual relations, they are likely to experience some degree of deformity and erectile dysfunction in the wake of the disease process. It is not uncommon for men afflicted with Peyronie's Disease to exhibit depression, withdrawal from their sexual partners, and an unwillingness to talk openly about their concerns with their partner and or their physician. Accordingly, seeking out a mental health professional is often recommended as an adjunct to medical treatment.