Peyronie's Disease

Aka: Peyronie's Disease, Peyronie's Syndrome, Plastic Induration of the penis, Induratio Penis Plastica, Strabismus Penis

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II. Epidemiology

  1. Males aged 45 to 65 years old

III. History

  1. Named for Italian physician to King Louis XIV of France

IV. Pathophysiology

  1. Diminished elasticity of Collagen of penis
  2. Irregular fibrosis of the corpora cavernosa of penis
    1. Fibrosis of septum or sheath
    2. Extends into tunica albuginea
  3. Spares corpus cavernosum Urethra

V. Associated Conditions: Dupuytren's Contracture (47%)

  1. Palmar Fibrosis
  2. Plantar Fibrosis

VI. Differential Diagnosis

  1. Tertiary Syphilis Gumma
  2. Scleroderma
  3. Alcohol Abuse
  4. Diabetes Mellitus
  5. Local Trauma
  6. Gouty Tophi

VII. Symptoms

  1. Focal pain with Erection (50 to 66%)
    1. Pain resolves as inflammation subsides
  2. Lateral curvature of the penis during Erection
  3. Penis flail distal to lesion

VIII. Signs

  1. Firm, nontender Plaques
  2. Location
    1. Lateral corpora cavernosa
    2. Dorsal over intercorporeal septum

IX. Course

  1. Penile Plaque forms, scars and remodels over first year
  2. Spontaneous resolution in 20 to 50% of younger men
  3. Scarring progresses to calcification in 25% of men
  4. Calcification progresses to bone in 25% of men

X. Management: Non-surgical

  1. Vitamin E 100 mg PO tid for over 4 months
    1. Evidence suggests no better than Placebo
  2. Verapamil intralesional injection
  3. Potassium Aminobenzoate 2 g PO 6x/day for 6-12 months
  4. Corticosteroid intralesional injection
    1. Use small gauge needle with no Anesthetic
    2. Most effective if used early in Peyronie's Disease
    3. Decadron 0.2-0.4 mg per Plaque weekly for 10 weeks
    4. Aristospan 2 mg per Plaque every 6 weeks for 36 weeks
  5. Avoid intercourse during treatment to avoid Trauma

XI. Management: Surgical

  1. Nesbit Procedure
    1. Plaque excision with patch grafting of defect

XII. References

  1. Degowin (1987) Diagnostic Exam, Macmillan, p. 606-7
  2. Fitkin (1999) Am Fam Physician 60(2): 549-52 [PubMed]

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