Peyronie’s disease: treating this deformity of the penis

Peyronie’s disease remains little known even though it is actually relatively common in men. “It is estimated that it affects between 3 and 9% of the adult male populationmainly between 45 and 65 years old with a peak observed at 53 years old, indicates Dr Ludovic Ferretti, urological surgeon. 20% of men with Dupuytren’s disease can develop Peyronie’s disease“. This disease is characterized by penile deformity associated with pain and discomfort during erection. How treat her?

Definition: what is Peyronie’s disease?

There Peyronie’s disease (or La Peyronie) is acquired fibrosis affecting the envelope of the corpora cavernosa: the albuginea. Often following repeated microtrauma during intercourse and in a predisposing genetic context, the quantity of fibrous tissue increases abnormally between the corpora cavernosa of the penis (central part contributing to erectile function) and the albuginea (membrane surrounding the corpora cavernous). We aknowledge the formation of plaques composed of collagen disorganized and fragmented elastic fibrils, which causes a curvature of the penis and theappearance of pain during erection (during the initial phase), which can lead to erectile dysfunction when the fibrosis is very extensive.

What are the symptoms of Peyronie’s disease?

► The first symptom of Peyronie’s disease is usually the appearance pain in the penis during erection. In some cases, this pain persists when the penis is not erect. Pain marks the inflammatory phase of the disease. They tend to fade as fibrosis developsuntil it disappears after 6 to 18 months.

► The development of fibrosis causes a loss of elasticity in certain areas of the penis, which leads to a deformation of the penis. The deviation is most often dorsal: the erect penis curves towards the stomach. “Althoughthey remain rare, lateral and ventral deviations of the penis are also possible. Other deformations were also observed, including one penis shortening and constriction with an hourglass shape“, specifies Dr Ludovic Ferretti. Peyronie’s disease progresses through attacks (usually only one) before stabilizing after 6 to 18 months. At this stage, the deformation of the penis stabilizes.

► Peyronie’s disease has an impact on sex life. It constitutes discomfort during sexual intercourse and can be the cause of erectile dysfunction.

What are the causes of Peyronie’s disease?

Peyronie’s disease is said to be acquired, that is to say neither congenital (present at birth) nor hereditary (transmitted by heredity). It appears over the course of life, generally gradually but sometimes suddenly. However, its origin remains poorly understood to this day. It seems like microtrauma occurring during sexual intercourse or other activities may be a trigger for fibrosis. Other hypotheses have also been put forward. In particular, it is assumed that Peyronie’s disease may have an autoimmune origin (linked to the immune system), or even ischemic (decreased arterial blood supply). Certain studies and observations also suggest that this fibrosis in the penis may be caused by disorders at other levels of the body. Peyronie’s disease is particularly associated with:

• diabetes
• Dupuytren’s disease which corresponds to palmar fibromatosis with the development of tumors in the hand
• Ledderhose disease which corresponds to plantar fibromatosis

The diagnosis of Peyronie’s disease is essentially clinical, including palpation of the plaques and one examination of the erect penis using a photograph. In the most complex cases, the diagnosis can be based on additional examinations such asan MRI (magnetic resonance imaging), even if the clinical examination remains the reference. You can talk to your general practitioner who can refer you to a urologist or andrologist. Some specialize in diseases of the penis.

There are today several therapeutic options for the management of Peyronie’s disease. The choice of treatment depends on the progression of the disease and the condition of the person concerned. It should be noted thatspontaneous remission occurs in 30% of cases, especially in young people with small plaques.

► The treatment of Peyronie’s disease can be based on different medications. “Vitamin Eanti oxidant is commonly prescribed, but its effect remains very limited or even zero, continues the specialist. Of the arterial vasodilators can also be used to improve blood circulation without evidence of its effectiveness on deformity“.

► In the acute phase, traction treatment is generally offered usinga vacuum or a penis extender to guide healing.

When the disease has completed its progression (18 months to 2 years) and the deformation is fixed, surgery may be necessary. Different interventions exist depending on the type of deformity and the associated symptoms. Currently, collagenase injections are proposed for small, bothersome back curves with moderate effectiveness, but this treatment remains expensive and not reimbursed. “In the most complex cases, surgery remains the standard treatment, with results depending on the experience and knowledge of the operator on this very particular condition. concludes the doctor.

Thanks to Dr Ludovic Ferretti, member of the andrology and sexual medicine committee of the AFU (French Urology Association)