By
Jihad Anad
EAU, Hinman atlas, web
Definition
Described by
Francois Gigot de la
Peyronie in 1743
Also known as
induratio penis
plastica
Fibrotic induration of
the penis with
concurrent curvature
Clinical presentation
Peak incidence
4th to 6th decades
Pain and penile curvature during erection
Difficult intercourse
Impotence in some cases
A hard fibrotic mass is felt on palpation
Etiology
Fibrosing condition of the tunica albuginea
Repetative microtrauma is most probably the
inciting event
Dupuytrans contracture has been associated
with PD
Always examine the hands
Possible genetic aetiology
most commonly associated comorbidities
and risk factors are :
diabetes, hypertension, lipid abnormalities,
ischaemic cardiopathy, erectile dysfunction,
smoking, and excessive consumption of
alcohol, paget disease
Clinical course
some cases is self limiting
Devided into acute and chronic phase
In the acute phase
Pain
Worsening of the deformity
Enlargement of the plaque
12 to 18 months duration
Chronic phase
No pain
Stable deformity
Spontaneous resolution is uncommon (3-13%)
most patients experience disease progression
(30-50%)
stabilisation (47-67%).
Pain is usually present during the early stages
of the disease but tends to resolve with time
in 90% of men.
Treatment
Medical
Usually during the acute phase
Oral therapy
Vitamin E
Potassium para-amino benzoate
Colchicine
Tamoxifen
Pentoxifylline
Intralesional
Verapamil
INF alpha 2 beta
Clostridial collagenase
Intralesional therapies not for cure, but more for
prevention of progression.
Topical therapies
Verapamil
Iontophoresis
Traction devices
Extracorporeal shock wave lithotripsy (SWL)
Vacuum devices
Vitamin E
tocopherol, a fat-soluble compound that
acts as a natural antioxidant
commonly prescribed by the majority of
urologists
once or twice daily doses of 400 IU because
of its wide availability, low cost and safety
doubleblind,placebo-controlled crossover
study failed to show a significant effect on
penile deformity or plaque size
Potassium paraaminobenzoate (Potaba)
exert an antifibrotic effect through an
increase in oxygen uptake by the tissues, a
rise in the secretion of
glycosaminoglycans, and an enhancement
of the activity of monoamine oxidases
improvement in penile curvature, penile
plaque size, and penile pain during
erection
Potaba (12 g/day for 12 months)
Tamoxifen
Tamoxifen is a non-steroidal oestrogen
receptor antagonist
modulation of TGF1 secretion by
fibroblasts.
reported that tamoxifen (20 mg twice daily
for 3 months) improved penile pain, penile
curvature, and reduced the size of penile
plaque.
Colchicine
treat acute attacks of gout
Peyronies disease on the basis of its anti-inflammatory
effect
given colchicine (0.6-1.2 mg daily for 3-5 months) found
that painful erections and penile curvature improved, while
penile plaque decreased or disappeared in 50%
combination of vitamin E and colchicine (600 mg/day and 1
mg every 12 hours, respectively) for 6 months in patients
with early-stage Peyronies disease resulted in significant
improvement in plaque size and curvature, but not in pain
compared to ibuprofen 400 mg/day for 6 months
Acetyl esters of carnitine
suggested that it can reduce intracellular
calcium levels in endothelial cells
patients were randomised to acetyl-Lcarnitine (1 g twice daily) compared to
tamoxifen (20 mg twice daily). After 3
months, acetyl-Lcarnitine was significantly
more effective than tamoxifen in pain and
curvature reduction and inhibition of
disease progression but not in penile plaque
size reduction
Pentoxifylline
non-specific phosphodiesterase inhibitor
which down regulates TGF1 and increases
fibrinolytic activity
(400 mg three times daily for 6 months)
improved penile curvature and the findings on
U/S of the plaque
Intralesional treatment
Steroids
Intralesional steroids are thought to act by
opposing the inflammatory effects responsible
for Peyronies plaque
progression via inhibition of phospholipase A2,
suppression of the immune response and by
decreasing
collagen synthesis
Verapamil
a calcium channel antagonist
increase in collagenase activity, a modification of
the inflammatory response in the early phase of
the disorder, and the inhibition of fibroblast
proliferation in the plaques
that intralesional verapamil injections (multiplepuncture technique, 10 mg of verapamil diluted to
10 mL, distributed throughout the plaque every 2
weeks for a total of 12 consecutive sessions
Clostridial collagenase
collagenase injections received FDA approval
for Dupuytrens contracture
lThe efficacy of intralesional collagenase
injections (three injections of clostridial
collagenase 10,000 unit/0.25 cm3 per
injection administered over 7-10 days and
subsequently administered over 7-10 days at
3 months
Interferon
decrease fibroblast proliferation
extracellular matrix production and
collagen production from fibroblasts
5 x 10^6 units of interferon -2b in 10 mL
saline, two times per week for 12 weeks
significantly improved penile curvature,
plaque size and density, and pain
compared to placebo
Iontophoresis
transdermal electromotive drug
administration or electromotive drug
administration [EMDA])
iontophoresis with verapamil 5 mg and
dexamethasone 8 mg resulted in a statistically
significant improvement in penile curvature
and plaque size
Extracorporeal shock wave
lithotripsy
unknown
first hypothesis, shock wave therapy works by
directly damaging and remodelling the penile
plaque.
The second SWL increases the vascularity of
the area by generating heat resulting in an
inflammatory reaction, with increased
macrophage activity causing plaque lysis and
eventually leading to plaque resorption
prospective, randomised, double-blind,
placebocontrolled study, four weekly
treatment sessions of SWL, with each session
consisting of 2000 focused shock waves,
resulted in significant improvement only for
penile pain
Surgical treatment
Reserved for patients with PD for at least 12
months (chronic phase) and a stable
deformity for at least 3 months
3 groups of surgery
Penile shortening
Penile lengthening
Penile prostesis
ED
-
+
Penile Prostesis
Normal length
< 60 degrees
Short penis
> 60 degrees
Penile shortening
procedure
Penile lengthening
procedure
Nesbit,16 dots
yachi
Graft
Penile shortening
procedures
Nesbit procedure
first to describe the removal of tunical
ellipses opposite a non-elastic corporal
segment to treat congenital penile curvature
This operation is based on a 5-10 mm
transverse elliptical excision of the tunica
albuginea or approximately 1 mm for each
10 degree of curvature
The overall short- and long-term results of
the Nesbit operation are excellent.
Recurrence of the curvature and penile
hypoesthesia are uncommon (about 10%)
Penile shortening is the most commonly
reported outcome of the Nesbit procedure
Nesbit P.
Nesbit P.
Plication
procedures(Yachi,Lue)
share the same principle as the Nesbit
operation but are simpler to perform.
They are based on single or multiple
longitudinal incisions on the convex side of
the penis closed in a horizontal way, applying
the Heineke- Miculicz principle
Yachia p.
Lue P.
16 dot technique
Penile lengthening
procedures
creating a tunical defect, which is covered by
a graft
plaque removal may be associated with high
rates of postoperative erectile dysfunction due
to venous leak
Autologous grafts
Dermis
Vein grafts
Tunica albuginea
Tunica vaginalis
Temporalis fascia
Buccal mucosa
Allografts
Cadaveric
Cadaveric
Cadaveric
Cadaveric
pericardium
fascia lata
dura matter
dermis
Xenografts
Porcine small intestinal submucosa
Bovine pericardium
Porcine dermis
Synthetic grafts
Gore-Tex
Dacron
Penile prostesis
