Peyronie’s disease (induratio penis plastica)
Explanation
Peyronie’s disease involves the formation of scar tissue (plaques) in the layer of tissue that surrounds the erectile tissue (tunica albuginea), leading to curvature of the penis. It is also known as induratio penis plastica (IPP).
The exact cause is unknown. One possible cause is repeated micro-injuries during sex, but there also seems to be some genetic component, with around 30% of patients also suffering from Dupuytren's contracture, in which the palmar fascia is shortened as a result of scarring.
It is most common in men between the ages of 50 and 60, affecting about 3% of men in this age group.
Symptoms
The condition progresses slowly in fits and starts over a long period. The initial stage involves the development of plaques, leading to pain followed by increasing curvature of the penis during an erection. This early, active phase is followed by a stable phase in which the degree of curvature remains the same and the condition becomes less painful. Depending on the extent of the condition, it can also cause erectile dysfunction. Where there is severe curvature (> 45°), patients are often no longer able to have sex.
In most cases, the condition progresses as described above, but in about 15% of men the condition may improve or regress on its own.
Treatment
During the active phase in particular, the condition can be treated conservatively. Unfortunately, currently available methods are not generally very effective. A number of drugs have been tested, but none have proven their worth in day-to-day clinical practice. These include para-aminobenzoic acid (Potaba®), vitamin E, acetyl-L-carnitine, diclofenac and colchicine.
Trials have been conducted using a semi-invasive treatment called extracorporeal shock wave therapy (ESWT). This involves treating the plaques with shock waves and is similar to treatments used to break up kidney stones (lithotripsy). This treatment failed to achieve any improvement in penile curvature, however.
Once it has entered the stable phase (when the condition has been present for at least 12 months and has not progressed further for at least 6 months), the condition can be treated surgically.
If curvature is slight, the layer of tissue that surrounds the erectile tissue (tunica albuginea) can be ‘bunched up’ on the opposite side of the plaque (a procedure known as plication). In contrast to simple bunching (Essed-Schroeder procedure), Nesbit’s procedure involves cutting out an oval piece of tunica albuginea tissue from the convex side. This prevents the formation of bulges. A modified version of Nesbit’s procedure is the tunica albuginea underlap (TAU) procedure. In this procedure, rather than removing tunica albuginea tissue, a u-shaped cut is made and the resulting flap inserted underneath the adjacent tunica albuginea tissue.
All of these techniques suffer from the disadvantage that they result in shortening of the penis.
In non-shortening surgical techniques, a cut is made into the plaque, which is then thinned out and the resulting gap filled either with graft material taken from the patient’s own body (usually veins taken from another part of the body) or off-the-shelf material. Complete removal of the plaque is no longer recommended as this produces a much larger gap, resulting in a much higher rate of erectile dysfunction.
Which procedure will be used in individual cases will need to be decided depending on the individual situation.
