Peyronie's Disease (Penile Curvature)
What Is Peyronie's Disease?
Peyronie's disease is a condition in which certain areas of the penis's inner lining—which normally stretches and expands during an erection—lose their elasticity. It is also known as penile calcification.
What Are the Causes of Peyronie's Disease?
The tissue of the penile sheath begins to weaken with age. As a result of repeated minor trauma to the penis, small, microscopic bleeds occur within the sheath covering the penis, and as these heal—much like a wound—they leave behind permanent scars and scar tissue. These scars and wounds disrupt the structure of the penis; since the penis has lost its elasticity, it bends in that direction during an erection.
Trauma resulting from forced sexual intercourse, vitamin E deficiency, and smoking are among the causes of the condition. In addition, its association with conditions such as infection, genetic predisposition, diabetes, hypertension, gout, and Paget’s disease has been investigated. While some researchers suggest that these conditions influence Peyronie’s disease, others state that there is no connection between them.
What Is the Prevalence of Peyronie's Disease?
The prevalence of Peyronie's disease increases with age and is observed in 7% of men aged 50–69.
At What Ages Does Peyronie's Disease Occur?
Peyronie's disease is most commonly seen in men over the age of 50, and the initial symptom is pain during an erection. Usually, after about a year, plaques become palpable, and eventually, a curvature of the penis develops in the direction of the plaques, often accompanied by pain.
The plaques are located on 70% of the penis’s upper surface, and the curvature is upward. In men of this age group, Peyronie’s disease is frequently accompanied by diabetes, hypertension, and erectile dysfunction.
In the acute phase, symptoms of the disease are unlikely to resolve on their own. However, in a large proportion of patients, the disease progresses and the curvature of the penis continues to worsen. In some patients, the penis may even gradually take on an hourglass shape.
How Is Peyronie's Disease Diagnosed?
The diagnosis is made using cavernosography, which is performed to determine the location and size of the fibrous plaque.
What Are the Treatment Options for Peyronie's Disease?
Certain medications—such as Potaba (vitamin E), colchicine, tamoxifen, corticosteroids, procarbazine, orgatein, NSAIDs, Seldane, and Allegra—may lead to an improvement of about 30–40% in the early stages of the disease.
Topical treatments—such as corticosteroids, verapamil cream, and beta-aminopropionitrile—may be used. However, the effectiveness of these treatments is debatable.
Intralesional injections of verapamil, interferon, collagenase, cortisone, parathyroid hormone, and prostacyclin may be administered.
ESWL (extracorporeal shock wave therapy): Although the exact mechanism of action is not fully understood, it causes direct damage to the plaque, leading to resorption through vascularization and cavitation. The most common side effects include hematomas and hemorrhage in the skin, as well as bleeding from the urinary tract. Surgical treatment should be preferred in cases where penile curvature exceeds 40 degrees, there is extensive calcification in the plaque, or the patient desires rapid and effective treatment.
If the penis does not become sufficiently erect and there is difficulty penetrating the vagina, the condition should be corrected surgically. If these issues are normal, surgery is not performed.
In cases where the curvature is mild and there are no erectile dysfunction issues, Nesbit or plication surgery should be performed. In cases where the curvature is severe and there are no erectile dysfunction issues, the patch method is used. In cases where the curvature is severe and there are also erectile dysfunction issues, penile prosthesis surgery is performed.
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