Peyronie's Disease

Abstract

Introduction Peyronie's disease is a sexual medicine condition that may adversely affect male sexual function. Aim To provide expert opinions/recommendations concerning state-of-the-art knowledge for the pathophysiology, diagnosis and treatment of Peyronie's disease. Methods An International Consultation in collaboration with the major urology and sexual medicine associations assembled over 200 multidisciplinary experts from 60 countries into 17 committees. Committee members established specific objectives and scopes for various male and female sexual medicine topics. The recommendations concerning state-of-the-art knowledge in the respective sexual medicine topic represent the opinion of experts from five continents developed in a scientific and debate process. Concerning the Peyronnie's disease committee, there were 10 experts from six countries. Main Outcome Measure Expert opinions/recommendations are based on grading of evidence-based medical literature, extensive internal committee discussion over 2 years, public presentation and deliberation. Results Peyronie's disease is characterized by an inflammatory response beneath the tunica albuginea with fibroblast proliferation forming a thickened fibrous plaque that may cause penile pain, penile curvature and erectile dysfunction. Medical treatments have been described but few prospective controlled trials have revealed significant clinical benefits. Surgical treatments (penile plication, Nesbit excision, plaque incision and grafting and penile prosthesis insertion) should be considered after Peyronie's disease has stabilized. Surgical outcome studies reveal that a stable deformity is best corrected with the least postoperative ED by a Nesbit procedure. Plaque incision and grafting should be reserved for men with good erectile function and marked penile shortening although there is a higher prevalence of postoperative ED. Implantation of a penile prosthesis is an excellent option for men with an accompanying erectile deficit. Conclusions Safe and effective treatments for Peyronie's disease examined by prospective, placebo-controlled, multi-institutional clinical trials are needed.

Penile size and penile enlargement surgery: a review

“…It is important to note that both the natural history of disease and the scarring process after surgical repair with incision/excision of plaque with graft or a penile plication procedure for surgical correction may cause a reduction in penile length. 19 When the disease is circumferential or bilateral, it prevents the tunica albuginea from expanding thereby causing penile shortening. 20 Surgical procedures for correction can result in fibrosis that can result in further reduction in length when compared to preoperative measurements.…”

PDE5 inhibitors beyond erectile dysfunction

“…The prevalence rate of PD is estimated to be between 0.4% and 9%, depending on the exact criteria used to define the condition. 119,120 The cause of fibrotic plaques in patients with PD is unknown, but it is hypothesized that trauma with excessive wound healing, infections and autoimmune disease may cause this local fibrosis within the penis. The molecular mechanisms underlying this condition are poorly understood.…”

Tratamiento conservador de la enfermedad de Peyronie: colchicina versus colchicina más vitamina E

“…Es una alteració n benigna que regularmente se caracteriza por la formació n de una placa fibrosa de tejido con o sin curvatura durante la erecció n. Puede asociarse a disfunció n eré ctil, dolor durante la erecció n e incluso puede haber dificultad en la penetració n como resultado de la curvatura 3 . La curvatura peneana, con o sin los demá s síntomas, puede resultar en problemas severos relacionados con la ejecució n del acto sexual así como en problemas psicoló gicos 4 .…”