Peyronie’s disease forms fibrotic plaques on the penis. The most common symptoms are curvature of the penis during erection, with pain, penile deformity and erectile dysfunction. Although the treatments have been ineffective, there are currently used urological techniques that could replace surgery, such as intraplaque injection of Xiaflex and shock wave therapy.
Peyronie’s disease: what is it?
Peyronie’s disease consists of the formation of fibrous plaques in the so-called “tunica albuginea”, a layer of elastic tissue that surrounds the corpora cavernosa of the penis.
It is an acquired, localized and progressive disorder of unknown origin, which results in curvature of the penis during erection and may also be accompanied by pain, deformity or erectile dysfunction.
Phases of Peyronie’s disease and diagnosis
In Urology we differentiate two phases in the clinical evolution of this disease: acute and chronic. The acute phase, which usually lasts between 12 and 18 months, is characterized by painful erections, progressive curvature or deformity of the penis, palpable plaque and sometimes erectile dysfunction. In the chronic phase the deformity stabilizes and the pain disappears.
The diagnosis is usually evident from the patient’s history and clinical examination, in addition to the symptoms referred to above during the development of the disease.
Treatment of Peyronie’s disease
Medical treatment of Peyronie’s disease has been shown to be ineffective. Oral and topical drugs, intralesional injection, penile traction devices, among others, have been used. Intraplaque injection of Clostridium histolyticum collagenase, the first non-surgical treatment for this disease, and shock wave therapy have recently gained momentum.
Surgery is the only alternative in those cases in which there is significant penile incurvation. There are different surgical variants, but almost all of them try to straighten the penis by reducing the length of the convex part of the incurvation to make it equal to the concave part where the plaque is located, without acting on the plaque.
Another alternative is to resect the plaque with subsequent use of a graft to cover this defect. This alternative is frequently associated with impaired erectile function.