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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