Peyronie's diseasePeyronie's disease is a condition that affects the penis. It presents as a plaque or hard lump in the layers of erectile tissue that occurs more often on the upper than lower side of the penis. The condition has differing degrees of severity. Mild cases may just appear as redness and swelling (inflammation), whilst in more severe cases hardened plaques force the penis to
bend during erection, which may be painful.
The cause of Peyronie's disease is unclear. Many researchers believe the plaque of Peyronie's disease can develop following trauma (hitting or bending) that causes localized bleeding inside the penis. Other cases, which develop over time, may be genetically linked or inherited (passed on from parents to children through genes). In addition, a number of medications list Peyronie's disease as a possible side effect. Most are a type of drug called beta-blockers that are often prescribed for people with heart conditions or high blood pressure. Other drugs that may cause Peyronie's disease are interferon, which is used to treat multiple sclerosis, and Dilantin, an anti-seizure medicine. However, the chance of developing Peyronie's disease from any of these medicines is very low and there is no evidence that Peyronie's disease is related to taking these drugs.
Cases of Peyronie’s that develop over time may be caused by an inherited abnormality of human leukocyte antigen B7 (HLA-B7), suggesting a genetic link. Also, Peyronie’s occurs more frequently in men with family members who have the condition or a connective tissue disorder (e.g., systemic lupus erythematosus). About 30% of patients with Peyronie’s disease also develop hardened tissue in other parts of the body, such as the hand (e.g., Dupuytren’s contracture) or the foot. Microscopic examination of hardened tissue in cases of Peyronie’s disease is consistent with cases of severe inflammation of blood vessels (vasculitis), suggesting the condition may have a vascular (i.e., pertaining to blood vessels) cause. Diabetes, which often leads to blood vessel disease, is also considered a risk factor. The use of the antihypertension medication proprano's disease has also been associated with vitamin E deficiency.
Peyronie's disease can be mild, moderate or severe. It may appear suddenly, or progress slowly over a matter of weeks or months. The progression of symptoms may include:
- The person experiences a small, localised ache or discomfort in the penis.
- A lump forms at the site of the aching.
- The lump may be painless.
- The plaque contracts as it spreads, bending or kinking the erect penis towards the affected side.
- Erections become uncomfortable or painful.
- The erections are softer than usual.
- There may be one or several plaques.
In many men Peyronie's disease is mild and resolves within a year or two so treatment may be unnecessary. In more severe cases, the hardened lump and deformity persist and may get worse.
Medical therapy with various agents may relieve the discomfort e.g. Vitamin E, intralesional steroids or ultrasonic therapy but these seldom help long-term. Intralesional collagenase is sometimes helpful. Surgery is probably the best treatment but is usually only done after waiting for 1-2 years to allow the plaque to stabilise or disappear. There is less chance of recurrence post surgery if the inflammatory phase of Peyronie's disease has settled and the degree of bending has reached its peak. A semi-rigid prosthesis may be inserted.