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Weill Medical College

Cornell Institute for Reproductive Medicine

Center for Male Reproductive Medicine and Microsurgery

"State-of-the-Art Compassionate Care for the Infertile Couple"

PEYRONIE’S DISEASE

Peyronie's disease is a medical condition characterized by the development of a lump on the shaft of the penis. This lump is a scar (plaque) that forms on the lining (tunica) of the erectile body (corpus cavernosum) and is believed to be the result of injury to the penis during sexual relations. Early on following the trauma, an inflammatory reaction occurs, often bringing a man's attention to the problem because of pain associated with erection. With time, the inflammation progresses and a scar develops. The time to develop this scar and the degree to which it occurs varies from patient to patient. Often the process heals itself over the first 12 months after the scar forms. In some cases, however, the scar formation is severe. In these cases, the scar becomes progressively harder and more obvious, causing the penis to curve during erection. While the scar is benign (non-cancerous), the resulting curvature may lead to the inability to have sexual intercourse.

The incidence of Peyronie's disease is estimated to be approximately 1-3%, although this figure is most probably an underestimate. Recent research lead by Dr. Mulhall, suggests that the incidence is far higher at approximately 8.9%. In this research study one third of patients did not know that they had the condition. Peyronie’s disease occurs most often in middle-aged men but can occur in men from 20-70 years of age. Peyronie's disease is characterized by a localized scarring of the tunica albuginea of the penis. The inelasticity of the plaque in the normally stretchy tunica albuginea results in restricted expansion of the affected corporal body during erection resulting in curvature or incomplete rigidity of the erect penis. The consequent erectile deformity frequently results in the inability of the male to participate in satisfactory coitus. The condition is associated with other conditions, including Dupuytren's contracture of the hand.

The cause of Peyronie's disease appears to be multi-factorial and has not been fully explained. As bending of the penis occurs in all men during penetrative sexual relations, one of the questions concerning Peyronie's disease is, why is it that only a small percentage of men manifest plaque formation? While trauma is believed to be the initial event, many theories have been proposed for the pathogenesis of Peyronie's disease, including, auto-immune factors (Peyronie’s disease appears to be more common in certain ethnic groups, particularly northern European Caucasians; it is uncommon in African-American men and rare in Asian men), excess production of chemicals (known as cytokines) in the tunical tissue of the penis, and abnormalities of tunical cell behavior.

Men with Peyronie's disease typically present to a physician in a number of ways, including painful erections, penile curvature or erectile dysfunction (ED). It is estimated that approximately 20% of men who have Peyronie’s disease will have improvement or complete correction of their penile curvature within the first 12 months of their condition. Thus, as the plaque in Peyronie's disease may shrink or disappear without treatment, medical experts suggest waiting a full year before attempting to correct it surgically. During that period, patients are often willing to undergo treatments, none of which have been scientifically proven to be of significant benefit (see section on Medical Treatment Of Peyronie’s Disease).

Suggested Reading

1. Schwarzer U et al. Prevalence of Peyronie's disease: results of an 8,000 man survey. Journal of Urology. 163: 167, 2000.
2. Jordan G: Peyronie's disease, in Walsh PC et al: Campbell's Urology. Philadelphia, WB Saunders, 1992, pp 2204-22.
3. Gelbard MK, et al. The natural history of Peyronie's disease. Journal of Urology. 144: 1376, 1990.
4. Devine CJ, et al. Peyronie's disease : Pathophysiology. Progress in Clinical Biological Research. 370: 355-358, 1991.
5. Chilton CP, Castle, W.M., Westwood, C.A., Pryor, J.P.: Factors associated in the etiology of Peyronie's disease. British Journal of Urology. 54: 748, 1982.
6. Weidner W, Schroeder-Printzen, I., Weiske, W., Vosshenrich, R.: Sexual Dysfunction in Peyronie's disease : An analysis of 222 patients without previous local plaque therapy. Journal of Urology 157: 325-328, 1997.
7. Mulhall JP, et al. Subjective and objective analysis of the prevalence of Peyronie’s disease in a population of men presenting for prostate cancer screening. Journal of Urology 167(4):821A, 2002.



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