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PEYRONIE'S
DISEASE
OVERVIEW
& STATISTICS
Peyronie's Disease
Also known as: PD; indurato penis plastica, fibrous sclerosis of the penis,
chronic cavernositis, fibrous cavernositis, fibrous plaques of
the penis, penile fibrosis, penile induration, penile
fibromatosis, penile shaft thickening, painful erection,
curved penis, curvature of the penis, Van Buren’s disease
Overview
Peyronie’s (pay-ro-NEEZ) disease is named after Francois Gigot
de la Peyronie, a famed French physician and surgeon who cared
for many royalty of his era, including Peter the Great.
Francois Gigot de la Peyronie
Peyronie was the personal physician to French King Louis XV,
and achieved great wealth and popularity. He described, in
1743, the cases of three men with "rosary beads of scar tissue
to cause an upward curvature of the penis during erection."
Apparently his notoriety caused his name to be forever
connected to this mysterious problem, although it was well
known long before this and was described earlier. In 1587, Guilio Cesare Aranzi, a famed Italian anatomist from Bologna,
in his book "Tumores Praeter Naturam," gave a very accurate
description of the problem when he wrote that it was “palpable
like a bean in the flaccid penis, causing a deformity similar
to a ram horn during erection”.
Peyronie’s disease
(PD) can be considered an exaggeration of the wound healing
process. It is characterized by the presence of one or more
benign (non-cancerous) fibrous plaques or scars along the
shaft of the penis usually on the upper or lower side, as well as
painful erections and shortening. These plaques or scars are
flat and irregular; usually there is only one scar, but
multiple scars do occur.
As you read
the next few paragraphs, pay attention to the wide
variation and range of findings and complaints that are used
to attempt to define
PD. It is rather unique in medicine to have such great
variation and assortment of possibilities in a medical
condition, such as you will read here about PD. This
is the crux of the problem in dealing with PD, from both the
patient's and doctor's perspective.
Cases of PD range
from mild to severe; some cases are so mild as to be detected
only on autopsy, while others are so severe that surgery is
necessary to reduce painful distortion. The size of the scar
or fibrous plaque may range from a few millimeters or may
encompass the entire shaft of the penis. Associated pain,
hardened scar formation and/or distortion may develop slowly
or appear overnight in PD. In severe cases, the inelastic
plaque reduces flexibility of the underlying tissue, causing
pain and forcing the penis to bend or arc during erection.
Angulation of the erect penis from 10°- 45° is not uncommon,
and can be greater; deformities can advance to the degree they
are described as “J,” “cane handle” and “corkscrew.”
Distortion or angulation of the non-erect penis is rare.
Without treatment the pain often decreases over a variable
period of time, usually after 6-12 months. In a small
percentage of cases with a milder form of the disease,
inflammation may resolve without causing significant pain or
permanent bending. Sexual difficulty and impotency also range
from mild to severe, but at any level can disrupt a couple's
physical and emotional relationship, and lead to despondency
and lowered self-esteem in the man.(1)
Soon after penile
trauma an inflammatory reaction can occur, often first drawing
attention to the problem because of pain associated with
erection. Usual experience is that a man will tolerate
distortion of the penis and avoid medical investigation, but
will promptly seek assistance if pain develops. Over a period
of time that is variable from man to man, the inflammation
progresses and a dense nodule or band of scar tissue will
develop. Often the process heals without treatment after the
initial 12 months after the scar forms. These nodules of scar
tissue can impede full expansion of the penis during erection
resulting in various degrees and patterns of distortion.
Depending on the number, size and location of the scar nodules
within the penile tissue, the penis can be slightly to
severely distorted during erection, or not at all. In cases of
severe injury the scar formation can be extensive, becoming
progressively more obvious with greater curvature during
erection. In some extreme cases, the scars may create a
bottle-neck, collar-like, or hourglass-like appearance in the
erect penis. The presence of scar tissue in the normally
expansive penile tissue may cause the penis to be limp or soft
beyond the location of the nodule, leading to inability to
have sexual intercourse. At the extreme of distortion an erect
penis afflicted by PD may be so distorted (“J” or “corkscrew”)
making intercourse impossible or at least extremely painful
for both partners.
Statistics
Many surveys have been performed over recent years, with each
giving a different statistical overview of PD. Perhaps no one
will ever know the actual depth and breadth of this problem
due to the tendency of men for both reluctance and braggadocio
in this area. Data presented here is fairly representative of
the majority opinion in the various categories.
-
Primarily affects
men between 45 and 60 years of age, although an age range of
18 to 80 years has been reported (2), with an average age at
onset of 53.
-
In a survey of
4,432 men, with a mean age of 57: 3.2% had only plaque, and 1%
had plaque, pain and angulation. Symptoms included 84% with
angulation, 46% painful erection, 40% with erectile
dysfunction (ED).(3)
-
Almost all
affected are Caucasians, most common in northern Europeans or
Scandinavian descent. Much less common to rare in men of
African heritage; rare to unknown in men of Asian heritage.
When found in African heritage males, often associated with
preexisting diabetes mellitus.
-
30 percent of men
with PD develop fibrosis (hardened cells) in other elastic
tissues of the body, such as on the hand (Dupuytren’s
contracture) or foot (Ledderhose's disease), which suggests
genetic vulnerability.(1) However,
only 1 to 2% of individuals with Dupuytren's contracture ever
develop curvature of the penis.(4)
-
Estimated to
affect 0.4 to 3.5% of adult male patients worldwide.(5-7)
-
Approximately
one-third of patients with chronic late-stage disease have
such disabling curvature and pain that surgical correction is
performed.(2)
==================================
Peyronie’s disease
remains one of the most perplexing and difficult to treat
diseases in urology; it has been called “the doctor’s
nightmare”. It is a complex problem that is a lot more common
than most people realize. Most everything about it is variable
and unique to the man who has it. It is said that the single
constant factor from one case of PD to another is that it
changes so much. When you read about PD do not expect to find
too many things that are like your case, except the scar –
even the presence of pain and curvature can be quite variable.
________________________________________
1. NIH Publication
No. 04-3902, December 2003
2. Am Fam Physician 1999;60:549-54
3. Boston University Institute of Sexual Medicine “Treating
Peyronie’s Disease” – 11/29/03
4. U.S. National Library of Medicine, National Institute of
Health Updated by: Young Kang, M.D., Department of Urology,
Columbia University College of Physicians and Surgeons, New
York, NY. – 5-25-02
5. Carson C, Jordan G, Gelbard M: Peyronie’s disease: new
concepts in etiology, diagnosis and treatment. Contemp Urol,
11: 44, 1999.
6. Lindsay MB, Schain DM, Grambsch P, Benson RC, Beard CM,
Kurland LT: The incidence of Peyronie’s disease in Rochester,
Minnesota, 1950 through 1984. J Urol, 146: 1007-1009, 1991.
7. Schwarzer U, Klotz T, Braun M, Wassmer G, Englemann U:
Prevalence of Peyronie’s disease: results of an 8,000 men
survey. J Urol, 163: 167, 2000.
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