Peyronie's disease
Encyclopedia
Peyronie's Disease
Peyronie's Disease (also known as "Induratio penis plastica", or more recently Chronic Inflammation of the Tunica Albuginea
(CITA), is a connective tissue
disorder involving the growth of fibrous plaques in the soft tissue
of the penis
affecting up to 10% of men. Specifically, scar tissue forms in the tunica albuginea
, the thick sheath of tissue surrounding the corpora cavernosa causing pain, abnormal curvature, erectile dysfunction, indentation, loss of girth and shortening. A variety of treatments have been used, but none have been especially effective. The most respected medical authority on Peyronie's Disease, Dr. Tom Lue of UCSF Medical Center
, recommends only 400mg Pentoxifylline daily until injectible Collagenase becomes available.
The disease may cause pain; hardened, big, cord-like lesion
s (scar tissue known as "plaques"); or abnormal curvature of the penis when erect due to chronic inflammation of the tunica albuginea (CITA). Although the popular conception of Peyronie's Disease is that it always involves curvature of the penis, the scar tissue sometimes causes divots or indentations rather than curvature. The condition may also make sexual intercourse
painful and/or difficult, though many men report satisfactory intercourse in spite of the disorder. Although it can affect men of any race and age, it is most commonly seen in Caucasian
males above the age of 40, especially those of blood type
A+, but has been seen in men as young as 18.
The disorder is confined to the penis, although a substantial number of men with Peyronie's exhibit concurrent connective tissue disorders in the hand, and to a lesser degree, in the feet. About 30 percent of men with Peyronie's Disease develop fibrosis
in other elastic tissues of the body, such as on the hand or foot, including Dupuytren's contracture
of the hand. An increased incidence in genetically related males suggests a genetic component.
s or family doctors. W.B..
There is also an association that a class of anti-hypertensive drugs
known as calcium channel blockers may be a possible cause of or exacerbate the disease, although it has not been proven. However, all beta blocker
drugs list Peyronie's disease as a possible side effect.
Vitamin E
supplementation has been studied for decades, and some success has been reported in older trials, but those successes have not been reliably repeated in larger, newer studies. A combination of Vitamin E and colchicine
has shown some promise in delaying progression of the condition.
Some newer agents targeting the basic mechanisms of inflammation have been studied in larger clinical trials. These include potassium para-aminobenzoate (Potaba),, pentoxifylline (acting through TGFβ1 inhibition), , and Coenzyme Q10,. Other newer agents of interest include acetyl L-carnitine, propionyl L-carnitine, L-arginine, and sildenafil
(acting through phosphodiesterase-5 inhibition).
Interferon-alpha-2b has been proposed in recent publications.
Formulations of superoxide dismutase
are also reported to be effective in Peyronie's disease.
Injection
s to plaques (scar tissue formed by the inflammation) with Verapamil
may be effective in some patients, but a recent placebo controlled trial failed to show a significant improvement. Use of iontophoresis
with Verapamil and Dexamethasone
, applied to the affected areas has been studied but the latest placebo controlled trial also failed to show a significant improvement. There are no clinical trials listed in the NIH trial registry.
Collagenase clostridium histolyticum (marketed as Xiaflex by Auxilium), a drug approved by the FDA to treat Dupuytren's contracture
, has been reported to break down the excess collagen that causes Peyronie's disease. According to Auxilium, "the first phase II trials...showed promising results." The drug has not been approved by the manufacturer or the FDA for the treatment of Peyronie's disease, and such treatments are currently considered off-label use
, and are discouraged.
may be appropriate in advanced cases.
A European surgery called the Leriche technique, in which an 18 gauge needle is used to lacerate the plaque, has shown effectiveness at reducing curvature and returning sexual function.
Doctors are starting to look into less intrusive forms of therapy as an alternative to surgery, which is becoming increasingly unpopular amongst both doctors and patients. Due to the very intrusive nature of penile curvature correction surgery, and the arguably scarce results that it provides at a very high economical, emotional, and physical cost, patient insatisfaction post surgery is very high. Most patients were unhappy with the results of the intervention due mostly to the penile shortening that happens after the surgery. As the scar retracts, the penis is pulled deeper into the body, eventually resulting in penile shortening. This was recorded in nearly 100% of the cases studied.
Although there is no cure for Peyronie's Disease or fibrotic disorders that are localized in different areas of the body (Fibrosis
), several clinical studies such as the one mentioned above point to penis extenders as the best treatment to correct curvature, or at the very least to impede the curvature from getting worse. According to Doctor Gontero, the leading Doctor of the above mentioned study which was published in the Journal of Sexual Medicine in 2009, "Overall results were self-reported as "acceptable", making this minimally invasive treatment modality a potential new treatment option in selected Peyronie's Disease patients." Several other studies exist reaffirming these types of results.
In 2009 Dr. Timothy Abreu of the Gush Institute and Dr. Keith Kwon Nguyen of the Eastern Australian Men's Health and Fitness Association debuted a new suction based treatment that shows promise in reducing the severity and discomfort of Peyronie's disease. Unfortunately the clinical trials were cut short after over 30 cases of necrosis, however Abreu and Nguyen hold several patents and are rumored to be working on a
in the wake of the disease process. It is not uncommon for men afflicted with Peyronie's Disease to exhibit depression or withdrawal from their sexual partners.
Peyronie's Disease (also known as "Induratio penis plastica", or more recently Chronic Inflammation of the Tunica Albuginea
Tunica albuginea (penis)
The tunica albuginea is the fibrous envelope of the corpora cavernosa penis. It consists of approximately 5% elastin, an extensible tissue that is primarily made up of the amino acids glycine, valine, alanine, and proline...
(CITA), is a connective tissue
Connective tissue
"Connective tissue" is a fibrous tissue. It is one of the four traditional classes of tissues . Connective Tissue is found throughout the body.In fact the whole framework of the skeleton and the different specialized connective tissues from the crown of the head to the toes determine the form of...
disorder involving the growth of fibrous plaques in the soft tissue
Soft tissue
In anatomy, the term soft tissue refers to tissues that connect, support, or surround other structures and organs of the body, not being bone. Soft tissue includes tendons, ligaments, fascia, skin, fibrous tissues, fat, and synovial membranes , and muscles, nerves and blood vessels .It is sometimes...
of the penis
Penis
The penis is a biological feature of male animals including both vertebrates and invertebrates...
affecting up to 10% of men. Specifically, scar tissue forms in the tunica albuginea
Tunica albuginea
Tunica albuginea is an anatomy term that literally means "white covering."It is used to refer to three anatomical areas which include:*Tunica albuginea , the tough fibrous layer of connective tissue that surrounds the corpora cavernosa of the penis...
, the thick sheath of tissue surrounding the corpora cavernosa causing pain, abnormal curvature, erectile dysfunction, indentation, loss of girth and shortening. A variety of treatments have been used, but none have been especially effective. The most respected medical authority on Peyronie's Disease, Dr. Tom Lue of UCSF Medical Center
UCSF Medical Center
The University of California, San Francisco Medical Center is a world renowned hospital in research and a teaching hospital in San Francisco, California. It is one of the leading hospitals in the United States and with the UCSF School of Medicine has been the site of various breakthroughs in all...
, recommends only 400mg Pentoxifylline daily until injectible Collagenase becomes available.
Exception
A certain degree of curvature of the penis is considered normal, as many men are born with this benign condition, commonly referred to as congenital curvature.The disease may cause pain; hardened, big, cord-like lesion
Lesion
A lesion is any abnormality in the tissue of an organism , usually caused by disease or trauma. Lesion is derived from the Latin word laesio which means injury.- Types :...
s (scar tissue known as "plaques"); or abnormal curvature of the penis when erect due to chronic inflammation of the tunica albuginea (CITA). Although the popular conception of Peyronie's Disease is that it always involves curvature of the penis, the scar tissue sometimes causes divots or indentations rather than curvature. The condition may also make sexual intercourse
Sexual intercourse
Sexual intercourse, also known as copulation or coitus, commonly refers to the act in which a male's penis enters a female's vagina for the purposes of sexual pleasure or reproduction. The entities may be of opposite sexes, or they may be hermaphroditic, as is the case with snails...
painful and/or difficult, though many men report satisfactory intercourse in spite of the disorder. Although it can affect men of any race and age, it is most commonly seen in Caucasian
Caucasian race
The term Caucasian race has been used to denote the general physical type of some or all of the populations of Europe, North Africa, the Horn of Africa, Western Asia , Central Asia and South Asia...
males above the age of 40, especially those of blood type
Blood type
A blood type is a classification of blood based on the presence or absence of inherited antigenic substances on the surface of red blood cells . These antigens may be proteins, carbohydrates, glycoproteins, or glycolipids, depending on the blood group system...
A+, but has been seen in men as young as 18.
The disorder is confined to the penis, although a substantial number of men with Peyronie's exhibit concurrent connective tissue disorders in the hand, and to a lesser degree, in the feet. About 30 percent of men with Peyronie's Disease develop fibrosis
Fibrosis
Fibrosis is the formation of excess fibrous connective tissue in an organ or tissue in a reparative or reactive process. This is as opposed to formation of fibrous tissue as a normal constituent of an organ or tissue...
in other elastic tissues of the body, such as on the hand or foot, including Dupuytren's contracture
Dupuytren's contracture
Dupuytren's contracture , is a fixed flexion contracture of the hand where the fingers bend towards the palm and cannot be fully extended...
of the hand. An increased incidence in genetically related males suggests a genetic component.
Diagnosis
A urologist can diagnose the disease and suggest treatment, although it is easily diagnosed by general practitionerGeneral practitioner
A general practitioner is a medical practitioner who treats acute and chronic illnesses and provides preventive care and health education for all ages and both sexes. They have particular skills in treating people with multiple health issues and comorbidities...
s or family doctors. W.B..
Causes
The underlying cause of Peyronie's Disease is not well understood, but is thought to be caused by trauma or injury to the penis usually through sexual activity although many patients often are unaware of any traumatic event or injury.There is also an association that a class of anti-hypertensive drugs
Antihypertensive
The antihypertensives are a class of drugs that are used to treat hypertension . Evidence suggests that reduction of the blood pressure by 5 mmHg can decrease the risk of stroke by 34%, of ischaemic heart disease by 21%, and reduce the likelihood of dementia, heart failure, and mortality from...
known as calcium channel blockers may be a possible cause of or exacerbate the disease, although it has not been proven. However, all beta blocker
Beta blocker
Beta blockers or beta-adrenergic blocking agents, beta-adrenergic antagonists, beta-adrenoreceptor antagonists or beta antagonists, are a class of drugs used for various indications. They are particularly for the management of cardiac arrhythmias, cardioprotection after myocardial infarction ,...
drugs list Peyronie's disease as a possible side effect.
Treatment
Without treatment, about 12-13% of patients will spontaneously improve over time, 40-50% will get worse and the rest will be relatively stable.Medication and supplements
Many oral treatments have been studied, but results so far have been mixed. Some consider the use of non-surgical approaches to be "controversial".Vitamin E
Vitamin E
Vitamin E is used to refer to a group of fat-soluble compounds that include both tocopherols and tocotrienols. There are many different forms of vitamin E, of which γ-tocopherol is the most common in the North American diet. γ-Tocopherol can be found in corn oil, soybean oil, margarine and dressings...
supplementation has been studied for decades, and some success has been reported in older trials, but those successes have not been reliably repeated in larger, newer studies. A combination of Vitamin E and colchicine
Colchicine
Colchicine is a medication used for gout. It is a toxic natural product and secondary metabolite, originally extracted from plants of the genus Colchicum...
has shown some promise in delaying progression of the condition.
Some newer agents targeting the basic mechanisms of inflammation have been studied in larger clinical trials. These include potassium para-aminobenzoate (Potaba),, pentoxifylline (acting through TGFβ1 inhibition), , and Coenzyme Q10,. Other newer agents of interest include acetyl L-carnitine, propionyl L-carnitine, L-arginine, and sildenafil
Sildenafil
Sildenafil citrate, sold as Viagra, Revatio and under various other trade names, is a drug used to treat erectile dysfunction and pulmonary arterial hypertension . It was originally developed by British scientists and then brought to market by the US-based pharmaceutical company Pfizer...
(acting through phosphodiesterase-5 inhibition).
Interferon-alpha-2b has been proposed in recent publications.
Formulations of superoxide dismutase
Superoxide dismutase
Superoxide dismutases are a class of enzymes that catalyze the dismutation of superoxide into oxygen and hydrogen peroxide. As such, they are an important antioxidant defense in nearly all cells exposed to oxygen...
are also reported to be effective in Peyronie's disease.
Injection
Injection (medicine)
An injection is an infusion method of putting fluid into the body, usually with a hollow needle and a syringe which is pierced through the skin to a sufficient depth for the material to be forced into the body...
s to plaques (scar tissue formed by the inflammation) with Verapamil
Verapamil
Verapamil is an L-type calcium channel blocker of the phenylalkylamine class. It has been used in the treatment of hypertension, angina pectoris, cardiac arrhythmia, and most recently, cluster headaches. It is also an effective preventive medication for migraine...
may be effective in some patients, but a recent placebo controlled trial failed to show a significant improvement. Use of iontophoresis
Iontophoresis
Iontophoresis is a technique using a small electric charge to deliver a medicine or other chemical through the skin. It is basically an injection without the needle...
with Verapamil and Dexamethasone
Dexamethasone
Dexamethasone is a potent synthetic member of the glucocorticoid class of steroid drugs. It acts as an anti-inflammatory and immunosuppressant...
, applied to the affected areas has been studied but the latest placebo controlled trial also failed to show a significant improvement. There are no clinical trials listed in the NIH trial registry.
Collagenase clostridium histolyticum (marketed as Xiaflex by Auxilium), a drug approved by the FDA to treat Dupuytren's contracture
Dupuytren's contracture
Dupuytren's contracture , is a fixed flexion contracture of the hand where the fingers bend towards the palm and cannot be fully extended...
, has been reported to break down the excess collagen that causes Peyronie's disease. According to Auxilium, "the first phase II trials...showed promising results." The drug has not been approved by the manufacturer or the FDA for the treatment of Peyronie's disease, and such treatments are currently considered off-label use
Off-label use
Off-label use is the practice of prescribing pharmaceuticals for an unapproved indication or in an unapproved age group, unapproved dose or unapproved form of administration...
, and are discouraged.
Surgery
Surgery, such as the "Nesbit operation", is considered a last resort and should only be performed by highly skilled urological surgeons knowledgeable in specialized corrective surgical techniques. A penile prosthesisPenile prosthesis
A penile prosthesis is a medical device implanted in the penis requiring a surgical procedure. The device is often used for men with organic or treatment-resistant psychogenic impotence who suffer from erectile dysfunction...
may be appropriate in advanced cases.
A European surgery called the Leriche technique, in which an 18 gauge needle is used to lacerate the plaque, has shown effectiveness at reducing curvature and returning sexual function.
Physical therapy and devices
Self-administered manual stretching techniques, as well as a number of devices which exert gentle longitudinal forces on the plaque, are currently being studied in clinical trials. However, these penis extenders are controversial and most doctors recommend staying away from them due to their unknown and potentially harmful side-effects. But there are a controversial minority who have endorsed such products.Doctors are starting to look into less intrusive forms of therapy as an alternative to surgery, which is becoming increasingly unpopular amongst both doctors and patients. Due to the very intrusive nature of penile curvature correction surgery, and the arguably scarce results that it provides at a very high economical, emotional, and physical cost, patient insatisfaction post surgery is very high. Most patients were unhappy with the results of the intervention due mostly to the penile shortening that happens after the surgery. As the scar retracts, the penis is pulled deeper into the body, eventually resulting in penile shortening. This was recorded in nearly 100% of the cases studied.
Although there is no cure for Peyronie's Disease or fibrotic disorders that are localized in different areas of the body (Fibrosis
Fibrosis
Fibrosis is the formation of excess fibrous connective tissue in an organ or tissue in a reparative or reactive process. This is as opposed to formation of fibrous tissue as a normal constituent of an organ or tissue...
), several clinical studies such as the one mentioned above point to penis extenders as the best treatment to correct curvature, or at the very least to impede the curvature from getting worse. According to Doctor Gontero, the leading Doctor of the above mentioned study which was published in the Journal of Sexual Medicine in 2009, "Overall results were self-reported as "acceptable", making this minimally invasive treatment modality a potential new treatment option in selected Peyronie's Disease patients." Several other studies exist reaffirming these types of results.
In 2009 Dr. Timothy Abreu of the Gush Institute and Dr. Keith Kwon Nguyen of the Eastern Australian Men's Health and Fitness Association debuted a new suction based treatment that shows promise in reducing the severity and discomfort of Peyronie's disease. Unfortunately the clinical trials were cut short after over 30 cases of necrosis, however Abreu and Nguyen hold several patents and are rumored to be working on a
Counseling
Peyronie's Disease can be a physically and psychologically devastating disease. While most men will continue to be able to have sexual relations, they are likely to experience some degree of deformity and erectile dysfunctionErectile dysfunction
Erectile dysfunction is sexual dysfunction characterized by the inability to develop or maintain an erection of the penis during sexual performance....
in the wake of the disease process. It is not uncommon for men afflicted with Peyronie's Disease to exhibit depression or withdrawal from their sexual partners.