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CAUSE
oF
PEYRONIE'S
DISEASE
Overview
Although the cause of Peyronie’s disease (PD) is still unknown
almost 375 years after Peyronie first wrote about the
condition, it is now generally agreed there are
multi-factorial issues that contribute to this problem. While
the cause is unknown, this does not mean there is no cause. An
undetermined cause
is only a reminder of the complexity of this condition, and
that more needs to be done to unravel its many mysteries.
Cause
As a general statement, all authors and clinicians maintain
that the single most likely factor causing PD is direct or
indirect trauma. More than 75% of men with PD are between 45
and 65 years of age, when the collagen of the penis is less
elastic and more susceptible to injury.(1) This ties in neatly
with injury as the primary causation. Of those men who recall an event
of penile trauma, it is often reported to be something like an invasive examination procedure,
blunt trauma or a bend-injury during intercourse, at the site
of subsequent plaque formation. While the evidence for trauma
to the penis as the total or partial cause of PD is strong,
clinicians admit that many times no injury can be recalled
prior to the onset of the condition. This then leads to
speculation about the minor nature of injury, one so small –
even a bump – as to be easily forgotten, that can start the
problem.
While significant trauma might explain the sudden onset of PD,
it does not explain why most cases develop slowly and with
absolutely no memory of trauma, even minor. Further, trauma
does not explain why some cases of PD disappear rather
quickly, or why similar conditions such as Dupuytren's
contracture of the hand do not start after trauma.(1-4)
Genetic predisposition is a possible cause of PD, because it
is fairly common for men with PD to also have health problems
from a particular list of conditions. The most common
condition found in association with PD is Dupuytren’s contracture. This
is a similar problem of excess dense tissue formation in which a
cord-like hardening develops across the palm of the
hand, usually at the 4th and 5th digit. In fact, up to 47% of
men with PD also had another condition associated with loss of
soft tissue elasticity, such as Dupuytren's contracture or Ledderhose's disease (fibrosis of soft tissue on the bottom of
the foot). Other less common conditions and situations that
occur with PD are diabetes, tympanosclerosis, Paget’s disease,
hypertension and gout.(9,10) Studies of Peyronie’s patients
have even implicated an autoimmune component.(11,12) This
gives support to the theory that men with genetic
predisposition to these conditions respond to mechanical
injury and micro-hemorrhage of the tunica albuginea with an unusually excessive wound healing
reaction.(1, 3-15) Thus, men with these particular conditions
could possess a genetic background that causes excess scar
development and predisposes to development of Peyronie’s
plaques.
Medication is also related to occurrence of PD, although not
as a significant factor since the type of drugs implicated
were not known or used in the time of Peyronie when the
condition already existed. The drugs suggested as a possible
cause belong to a class of blood pressure and heart
medications called beta blockers. These drugs are also used to
treat glaucoma, multiple sclerosis and seizures. Developing PD
as a side effect of these drugs is rare. Check with your
doctor before discontinuing any prescribed drug.(16)
==================================
Along with the
reduced soft tissue elasticity that is associated with the
aging process, there is another factor that could contribute
to PD that does not seem to appear in the medical literature.
That factor is reduced blood circulation in the older male,
including the penis. If about 75% of the men with PD are
between 45-65 years of age, these men could also have reduced
blood flow and poor oxygen supply to the penis as well as
other parts of the body. If you recall from the pathology
section of this website, you learned that “lack of oxygen
would therefore increase collagen (scar) formation.” So if
oxygen is critical in keeping scar development in check, and
oxygen is carried by the blood, then anything that increases
blood flow and oxygen to the penis can decrease scar
development of PD, and maybe even cause elimination of
existing scar tissue in the latter phase. Keep this in mind as
we discuss treatment ideas in other sections, and how it
nicely ties a few treatment ideas together.
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1. Devine CJ Jr,
Somers KD, Jordan SG, Schlossberg SM. Proposal: trauma as the
cause of the Peyronie's lesion. J Urol 1997;157:285-90.
2. NIH Publication No. 04-3902 – December 2003
3. Van de Water L. Mechanisms by which fibrin and fibronectin
appear in healing wounds: implications for Peyronie's disease.
J Urol 1997;157:306-10.
4. Jarow JP, Lowe FC. Penile trauma: an etiologic factor in
Peyronie's disease and erectile dysfunction. J Urol
1997;158:1388-90.
5. Desanctis PN, Furey CA Jr. Steroid injection therapy for
Peyronie's disease: a 10-year summary and review of 38 cases.
J Urol 1967;97:114-6.
6. Somers KD, Dawson DM. Fibrin deposition in Peyronie's
disease plaque. J Urol 1997;157:311-5.
7. Rodriques CI, Njo KH, Karim AB. Results of radiotherapy and
vitamin E in the treatment of Peyronie's disease. Int J Radiat
Oncol Biol Phys 1995;31:571-6.
8. Morales A, Bruce AW. The treatment of Peyronie's disease
with parathyroid hormone. J Urol 1975;114:901-2.
9. Carrieri MP, Serraino D, Palmiotto F, Nucci G, Sasso F: A
case-control study on risk factors for Peyronie’s disease. J
Clin Epidemiol, 51: 511-515, 1998.
10. Nyberg LM Jr., Bias WB, Hochberg MC, Walsh PC:
Identification of an inherited form of Peyronie’s disease with
autosomal dominant inheritance and association with
Dupuytren’s contracture and histocompatibility B7
cross-reacting antigens. J Urol, 128: 48-51, 1982.
11. Schiavino D, Sasso F, Nucera E, Alcini E, Gulino G, Milani
A, Patriarca G: Immunologic findings in Peyronie’s disease: a
controlled study. Urology, 50: 764-768, 1997.
12. Stewart S, Malto M, Sandberg L, Colburn KK: Increased
serum levels of anti-elastin antibodies in patients with
Peyronie’s disease. J Urol, 152: 105-106, 1994.
13. Devine CJ Jr., Somers KD, Jordan SG, Schlossberg SM:
Proposal: trauma as the cause of the Peyronie’s lesion. J Urol,
157: 285-290, 1997.
14. Devine CJ Jr., Horton CE: Peyronie’s disease. Clin Plast
Surg, 15: 405-409, 1988.
15. Diegelmann RF: Cellular and biochemical aspects of normal
and abnormal wound healing: an overview. J Urol, 157: 298-302,
1997.
16. 1998-2004 Mayo Foundation for Medical Education and
Research (MFMER).
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