Saturday, June 14, 2014

Peyronie’s Disease : Causes, Treatment : Information




 Peyronie’s Disease  In Peyronie's Disease, hard nodules, called plaques, form in the sheath surrounding the vascular erectile tissue within the penile shaft. The plaques, which are not cancerous, cause the penis to bend toward the affected side. This can interfere with erection and penetration and reduce penile length, causing much distress for the man and his partner.  The causes of PD are not altogether clear. Fortunately, however, as research into the disease continues, new medical therapies are emerging and surgical techniques are being refined.  In this article, we’ll discuss what is known about PD—possible causes, typical signs and symptoms, frequency, and risk. We’ll explore some of the myths surrounding the disease, describe the treatments currently in use or under investigation, and discuss which patients are most likely to benefit from the various treatments.  Conditions - Peyronie’s Disease  Much is still unknown about the causes of PD, but research suggests it is a disorder of wound healing. The PD plaques are actually hardened scar tissue. It’s widely believed that the disease is triggered by an injury to the erect penis—often one that goes unnoticed by the man. What is unclear is why a relatively minor injury would lead to such excessive scarring.   Normally, wounds heal in three phases: First, enzymes clean the wound of dead or damaged tissue. Second, the body repairs the wound by forming a scar that strengthens the injured tissue. Finally, the collagen fibers that make up the scar are broken down and realigned leaving a smaller “remodeled” scar. In PD, not only is scar formation extreme, but scar remodeling either fails to occur or is insufficient.   The abnormal scarring of PD is believed to be related to the actions of fibrin and cytokines, which stimulate the formation of scar tissue in the second phase of wound healing. It seems that, in PD, these substances allow excessive amounts of collagen to collect. The enzymes protease and collagenase, which are responsible for remodeling scar tissue in the third phase of wound healing, also may play a role. Patients with PD may produce too few of these enzymes or the enzymes they produce may not function properly to remodel the scar.   Some investigators believe that the tendency to develop PD may be inherited. There is a reported association between PD and a genetic disorder called Dupuytren’s contracture, in which scar tissue forms along the sheath surrounding tendons in the palm of the hand, causing the ring finger to contract inward.   Diagnosing Peyronie’s Disease  The plaques of PD develop in the tunica albuginea—the fibrous tissue that covers the penile erection chambers, known as the corpus cavernosa. The plaques restrict penile expansion during erection and cause the erect penis to bend in the direction of the plaques, which are usually on the upper (or “dorsal”) surface but may be on the underside (the “ventral” surface) or on either side (“lateral” plaques). Some plaques are so small that they cause only a slight indentation. Others go all the way around the penis, causing the penis to take on an hourglass shape. Generally, the greater the curvature of the penis, the more difficult it is to penetrate during sexual intercourse. Hourglass and indentation deformities can cause sexual difficulty too, sometimes causing the penis to buckle during penetration attempts.   Peyronie’s disease may be associated with pain, especially in the initial stages, and with penile shortening. Many men with PD have erectile dysfunction (ED), which means they find it difficult to have an erection or to maintain one long enough to have satisfactory sex.   Contrary to popular belief, in most cases, PD does not get better without treatment. Spontaneous improvement or resolution has been said to occur in anywhere from 3% to 15% of all cases.   How common is PD and who gets it?  In the late 1990s, PD was thought to be relatively uncommon, with many researchers reporting a prevalence of only 1%. Recent studies, however, suggest that the condition is far more widespread. A 2004 survey of 534 men undergoing urologic examination at prostate cancer screening centers revealed that nearly 9% had signs of PD.   Typically, PD is diagnosed in middle-aged men, though it can occur in men of any age, from adolescence onward. Although it tends to occur most frequently in Caucasians, men of any ethnic group may develop PD.   Treatment for  Peyronie’s Disease  Medicines  for PD  Intraregional injection therapy  Topical gel therapy  Electroshock wave therapy  Surgery



Peyronie’s Disease
v  In Peyronie's Disease, hard nodules, called plaques, form in the sheath surrounding the vascular erectile tissue within the penile shaft. The plaques, which are not cancerous, cause the penis to bend toward the affected side. This can interfere with erection and penetration and reduce penile length, causing much distress for the man and his partner.
v  The causes of PD are not altogether clear. Fortunately, however, as research into the disease continues, new medical therapies are emerging and surgical techniques are being refined.
v  In this article, we’ll discuss what is known about PD—possible causes, typical signs and symptoms, frequency, and risk. We’ll explore some of the myths surrounding the disease, describe the treatments currently in use or under investigation, and discuss which patients are most likely to benefit from the various treatments.

Conditions - Peyronie’s Disease
¬  Much is still unknown about the causes of PD, but research suggests it is a disorder of wound healing. The PD plaques are actually hardened scar tissue. It’s widely believed that the disease is triggered by an injury to the erect penis—often one that goes unnoticed by the man. What is unclear is why a relatively minor injury would lead to such excessive scarring.

¬  Normally, wounds heal in three phases: First, enzymes clean the wound of dead or damaged tissue. Second, the body repairs the wound by forming a scar that strengthens the injured tissue. Finally, the collagen fibers that make up the scar are broken down and realigned leaving a smaller “remodeled” scar. In PD, not only is scar formation extreme, but scar remodeling either fails to occur or is insufficient.

¬  The abnormal scarring of PD is believed to be related to the actions of fibrin and cytokines, which stimulate the formation of scar tissue in the second phase of wound healing. It seems that, in PD, these substances allow excessive amounts of collagen to collect. The enzymes protease and collagenase, which are responsible for remodeling scar tissue in the third phase of wound healing, also may play a role. Patients with PD may produce too few of these enzymes or the enzymes they produce may not function properly to remodel the scar.

¬  Some investigators believe that the tendency to develop PD may be inherited. There is a reported association between PD and a genetic disorder called Dupuytren’s contracture, in which scar tissue forms along the sheath surrounding tendons in the palm of the hand, causing the ring finger to contract inward.


Diagnosing Peyronie’s Disease
Ø  The plaques of PD develop in the tunica albuginea—the fibrous tissue that covers the penile erection chambers, known as the corpus cavernosa. The plaques restrict penile expansion during erection and cause the erect penis to bend in the direction of the plaques, which are usually on the upper (or “dorsal”) surface but may be on the underside (the “ventral” surface) or on either side (“lateral” plaques). Some plaques are so small that they cause only a slight indentation. Others go all the way around the penis, causing the penis to take on an hourglass shape. Generally, the greater the curvature of the penis, the more difficult it is to penetrate during sexual intercourse. Hourglass and indentation deformities can cause sexual difficulty too, sometimes causing the penis to buckle during penetration attempts.

Ø  Peyronie’s disease may be associated with pain, especially in the initial stages, and with penile shortening. Many men with PD have erectile dysfunction (ED), which means they find it difficult to have an erection or to maintain one long enough to have satisfactory sex.

Ø  Contrary to popular belief, in most cases, PD does not get better without treatment. Spontaneous improvement or resolution has been said to occur in anywhere from 3% to 15% of all cases.

How common is PD and who gets it?
ü  In the late 1990s, PD was thought to be relatively uncommon, with many researchers reporting a prevalence of only 1%. Recent studies, however, suggest that the condition is far more widespread. A 2004 survey of 534 men undergoing urologic examination at prostate cancer screening centers revealed that nearly 9% had signs of PD.

ü  Typically, PD is diagnosed in middle-aged men, though it can occur in men of any age, from adolescence onward. Although it tends to occur most frequently in Caucasians, men of any ethnic group may develop PD.


Treatment for  Peyronie’s Disease
Ø  Medicines  for PD
Ø  Intra regional injection therapy
Ø  Topical gel therapy
Ø  Electroshock wave therapy
Ø  Surgery









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