What is Peyronie's disease and how is it treated?

Induratio penis plastica (Ipp) or La Peyronie's disease consists of an alteration of the corpora cavernosa of the penis leading to penile recurvatum (penile curvature). The appearance of plaque at the albuginea, the envelope that lines the organ, results in its actual deformation. 

Symptoms

"The tunica albuginea," the specialist explains, "is elastic structure made up of connective tissue that enables the maintenance of erection. Plaque formation or fibrotic lesions lead to penile deformity resulting in:

• erectile dysfunction;
• pain during erection and during sexual intercourse. 

It is a not-so-rare condition that can affect men of all ages. The consequences on the mental and physical well-being of those affected are quite significant, but if diagnosed in time, there is interesting scope for improvement for the patient." 

"The causes, unknown for many years," the specialist points out, "are currently traced to microtraumatisms, which result in the formation of scars on the tunica albuginea that lines the penis, among them: traumatisms resulting from sexual intercourse or from accidental blows, perhaps occurring during sports practice or through collisions."

Scarring leads to hyperproliferation of cells called fibroblasts, which in turn tend to transform into muscle cells, resulting in harder tissue (plaque) that deforms the penile surface. 

"The medical history is very important. - Dr. Barletta recalls. – The patient during the examination reports a formation at the genital level, the extent of which is appreciated by sight and touch. 

It then proceeds with: 

• objective examination to assess, through palpation of the penis, whether the plaque is at an early stage or is a more established formation;
• the Level II examination, which consists of a dynamic (with erection) ultrasound of the penis, with extension of the corpora cavernosa, to better study the plaque and the consequences it may bring on the vasculature.  

​ The inflammatory process of hypercicatrization is at first acute and sometimes becomes chronic. Hence the importance of early diagnosis from the onset of the first symptoms in order to have a broader, less invasive and more effective therapeutic path for the patient," Dr. Barletta emphasizes.

The Cura Città di Pavia Institute has excellent treatment options for Ipp (induratio penis plastica), depending on whether it is treated in the acute or chronic phase.

During the acute phase, treatment includes:

• infiltration of antioxidants and anti-inflammatories;
• therapy using a device that lengthens the corpora cavernosa and improves their structure; 
• regenerative therapy with Prp, Platelet Rich Plasma. This is an autologous blood draw that, once centrifuged, is injected into the plaque to reduce the inflammatory process;
• Iontophoresis and hydrophoresis that allow the passage of fibrinolytic drugs within the plaque; 
• infiltrative therapy with clostridium histolyticum collagenase, which has the function of dissolving the plaque, acting on the deformity and improving blood passage in the corpora cavernosa.

"These drug therapies," the specialist explains, "allow the patient's symptoms to be improved, with great advantages especially for those individuals who are not candidates for surgery. These are services that are performed on an outpatient basis, under local anesthesia and do not involve hospitalization. With timely drug therapy, it is therefore possible to avoid surgery and achieve good results."

During the chronic phase, induratio penis plastica can only be effectively treated with surgical therapy by straightening the penis through plastic. "During surgery under general anesthesia," Dr. Barletta explains, "the penis is reshaped to insert a penile prosthesis that will prevent the subject from suffering from erectile dysfunction and maintain a satisfying sex life.    

It should be remembered that induratio penis plastica is a chronic degenerative condition and therefore does not improve with the passage of time. "Returning to the state before the onset of the condition," Dr. Barletta explains, "is difficult, but through these therapies it is possible to aspire to a marked improvement in quality of life and sexual well-being. We are also able to support the patient during the course of treatment from a psychological point of view: our team employs specialists who can provide guidance and help to cope with the disease in the best possible way."