Peyronie disease is fibrosis of the cavernous sheaths leading to contracture of the investing fascia of the corpora, resulting in a deviated and sometimes painful erection.
Peyronie disease occurs in adults. The cause is unknown but appears to be similar to that of Dupuytren contracture and may be related to past trauma, possibly during intercourse (1). The contracture usually results in deviation of the erect penis to the involved side, occasionally causes painful erections, and may prevent penetration. Fibrosis may extend into the corpus cavernosum, compromising tumescence distally.
Diagnosis is made clinically. Ultrasound or other examination of the erect penis may be used to document the fibrosis.
Resolution may occur spontaneously over many months. Mild Peyronie disease that does not cause sexual dysfunction does not need treatment.
Довідковий матеріал загального характеру
1. Nehra A, Alterowitz R, Culkin DJ, et al: Peyronie's disease. American Urological Association clinical guideline. J Urol 194(3):745-753, 2015. doi: 10.1016/j.juro.2015.05.098
Treatment of Peyronie Disease
Oral vitamin E and potassium para-aminobenzoate
Surgical replacement of fibrosis with patch graft
Local injections of verapamil, high-potency corticosteroids, or collagenase Clostridium histolyticum (collagenase)
Ultrasound or radiation therapy
Repeated use of external traction devices (to straighten the penis)
Treatment results are unpredictable. Oral vitamin E and potassium para-aminobenzoate have had varied success.
Surgical removal of the fibrosis and replacement with a patch graft may be successful or may result in further scarring and exaggeration of the defect. Graft patches may be created using autografts (dermis, tunica vaginalis, or buccal mucosa), allografts (usually cadaveric pericardium), xenografts (bovine pericardium or intestinal submucosa), and synthetic grafts (Dacron and Gore-Tex).
A series of local injections of verapamil or high-potency corticosteroids into the plaque may be effective, but oral corticosteroids are not. For a penile curvature of > 30° accompanied by a palpable plaque, 1 to 4 treatment cycles (performed about 6 weeks apart) of injections of collagenase clostridium histolyticum (collagenase) into the plaque followed by at-home manual penile remodeling may be used. Repeated injection of collagenase with manipulation is provided by penile stretching and straightening exercises to break up the plaque.
Ultrasound treatments can stimulate blood flow, which may prevent further scarring. Radiation therapy may decrease pain; however, radiation often worsens tissue damage. To assist penetration, a penile prosthesis may be implanted but may require a patch procedure to straighten the penis.
Penile external traction to straighten the penis is often done in conjunction with medical therapies.
Surgical penile plication may be used to treat Peyronie disease by using sutures to shorten the side opposite the plaque. It is generally successful at straightening the penis but usually results in mild shortening of the penis.