Penile curvature (Peyronie's disease)
What is it?
La Peyronie's disease or Induratio Penis Plastica is a benign pathology characterized by the acute onset of an abnormal curvature of the penile shaft during erection, which can differ in direction and degree in different patients. Acquired penile curvature may also be associated with a reduction in penile length. This condition is generally an important psychological disturbance for the patient who suffers from it and can be associated with a variable degree of erectile deficit; in the most severe cases it can make penetration during intercourse geometrically impossible, significantly affecting the sexual life of the couple. The onset of penile curvature is linked to the sudden formation of a fibrotic plaque of hard consistency and diameter ranging from a few millimeters to several centimeters at the level of the tunica albuginea of the penis (the outer covering of the corpora cavernosa of the penis). This plaque determines a scar retraction of the penile tissues that results in the onset of pathological curvature. The biological causes underlying the development of this plaque remain, even today, not completely known. Among the main risk factors identified, an important role in the etiopathogenesis of this pathology is played by penile trauma during sexual intercourse, individual genetic predisposition, cigarette smoking and immune disorders such as autoimmune diseases.
La Peyronie's disease usually goes through two clinical phases:
- first phase, defined as "active" or "acute", characterizes the first months after the onset of the pathology, and is often accompanied by pain in erection. In this phase, there is a progressive worsening of the curvature.
- second phase, called "stable" or "chronic", in which there is an absence of pain, and changes in shape are rare.
Which are the symptoms?
The clinical picture of a patient with this disease is characterized by the presence of significant penile cruvature, which may or may not be associated with penile pain during erection. Generally, it is possible to clinically appreciate the presence of a hardened area on the penile lining tissues. Erectile deficit varies depending on the clinical picture.
- Penile curvature during erection
- Penile pain
- Presence of a penile plaque
- Erectile dysfunction
How is it diagnosed?
The diagnosis of this pathology is purely clinical. Through penile palpation it is possible to locate the penile plate(s) responsible for the curvature. The evaluation of the degree of curvature is performed with the penis erect and usually grounded by iconographic documentation provided by the patient himself, or during immediate examination in the clinic with drug-induced erection. It is also necessary to perform an ultrasound of the penis with dynamic Doppler (EcoColorDoppler dynamic penile) for precise location of the plaque, the study of its ultrasound characteristics and the evaluation of proper vascularization and hemodynamics of the penis during erection.
How is it treated?
Therapy of La Peyronie's disease is related to the stage of the disease. During the acute phase, conservative medical treatments are suggested, mainly aimed at controlling pain and possibly preventing worsening of the degree of curvature. Low intensity shock wave treatment (LISWT) has proved to be particularly effective at this stage. Once the pathology has reached the chronic phase, with the stabilization of the curvature, the patient can be directed to other types of treatment. Conservative management may involve the use of Vacuum devices during surgical treatment. The surgical procedure is called "penile corporoplasty" and may in some cases involve the application of synthetic tissue patches. In patients with severe form of erectile deficit not responsive to drug therapy, the proposed surgical intervention involves the implantation of a penile prosthesis. The surgical treatment is not free from possible complications and therefore is usually reserved for cases in which the curvature exceeds 30 degrees, and only when it is actually a cause of discomfort for the patient and limitation to his sex life. More recently, patients in chronic phase of the disease, with a curvature of at least 30 degrees, have been given a chance to get treatment based on the injection of collagenase of Clostridium Histolyticum (Xiapex®) inside the penile plate responsible for the curvature with the aim of making this plate less retracting the surrounding tissues and therefore reduce the curvature.
Where do we treat it?
Are you interested in receiving the treatment?