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 based on history and physical examination. 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.
General reference
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
Surgical excision of fibrosis with patch grafting
Local injection of verapamil, high-potency glucocorticoids, or Local injection of verapamil, high-potency glucocorticoids, orcollagenase
Ultrasound or radiation therapy
Repeated use of external traction devices (to straighten the penis)
Treatment results are unpredictable, and oral therapies (eg, vitamin E or potassium para-aminobenzoate) have not been proven to be effective (Treatment results are unpredictable, and oral therapies (eg, vitamin E or potassium para-aminobenzoate) have not been proven to be effective (1).
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.
A series of local injections of verapamil or high-potency glucocorticoids into the plaque may be effective, but oral glucocorticoids are not. For a penile curvature of > 30° accompanied by a palpable plaque, 1 to 4 cycles of injections of A series of local injections of verapamil or high-potency glucocorticoids into the plaque may be effective, but oral glucocorticoids are not. For a penile curvature of > 30° accompanied by a palpable plaque, 1 to 4 cycles of injections ofcollagenase clostridium histolyticum (collagenase) into the plaque has been effective (clostridium histolyticum (collagenase) into the plaque has been effective (2). Cycles are performed about 6 weeks apart; each cycle involves 2 injections, followed by at-home manual penile remodeling exercises (penile stretching and straightening).
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.
Treatment references
1. Yousif A, Natale C, Hellstrom WJG. Conservative Therapy for Peyronie's Disease: a Contemporary Review of the Literature. Curr Urol Rep. 2021;22(2):6. doi:10.1007/s11934-020-01024-8
2. Peak TC, Mitchell GC, Yafi FA, Hellstrom WJ. Role of collagenase clostridium histolyticum in Peyronie's disease. Biologics. 2015;9:107-116. doi:10.2147/BTT.S65619
Drugs Mentioned In This Article
