This document provides information about Peyronie's disease, including its symptoms, causes, diagnosis, and treatment options. It defines Peyronie's disease as the formation of scar tissue plaques within the penis that can cause penile curvature and pain during erections. Common symptoms are pain and curvature of the penis to one side. While small, asymptomatic cases may not require treatment, injection of medications into plaques or surgery to correct curvature may be options for more severe cases. The document also reviews normal penile anatomy and the erectile process.

1. DEPARTMENT OF UROLOGY EDUCATION
PEYRONIE’S DISEASE
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Dr Abraham Benjamin - Manager Medical Informatics
Mr. Naresh Kumar - Coordinator Medical Informatics

2. What is Peyronie’s Disease ?
 Peyronie's disease (also known as indurations plastica
penis) is an acquired inflammatory condition of the penis.
 The principal manifestation of Peyronie's disease is the
formation of a plaque (a segment of flat scar tissue) within
the tunica albuginea of the penis.
 This plaque can usually be felt through the penile skin. This
plaque is not a tumor but it may lead to serious problems
such as curved and/or painful erections.

3. Anatomy of the Male Reproductive System

4. How does the Penis become erect under normal
conditions ?
 The penis is a cylindrical organ consisting of three separate chambers. On the upper
(dorsal) portion of the penis there are two corpora cavernosae at are surrounded by
a tough but elastic layer of connective tissue called the tunica albuginea. The third
chamber is called the corpus spongiosum; it is located below the corpora cavernosa
and is surrounded by a thin connective tissue sheath. It contains the urethra, the
narrow tube that carries urine and semen out of the body.
 These three chambers are made up of highly specialized, sponge-like erectile tissue
filled with thousands of venous cavities, spaces that contain very little blood when
the penis is soft. During erection, blood fills these cavities, causing the corpora
cavernosa to balloon and push against the tunica albuginea. While the penis
hardens and stretches, the skin and connective tissue of the penis remain loose and
elastic to accommodate the changes.

5. What are the symptoms of Peyronie’s Disease?
 The plaques of Peyronie's disease most commonly develop on the upper side of the
penis. Plaques reduce the elasticity of the tunica albuginea and may cause the penis to
bend upwards during the process of erection.
 Although Peyronie's plaques are most commonly located on the top of the penis, they
may also occur on the bottom (ventral) or side (lateral) of the penis, causing a downward
or sideways bend, respectively. Some men have more than one plaque, which may cause
complex curvatures.
 In some men an extensive plaque that goes all the way around the penis may develop.
These plaques typically do not cause curvature but may cause a "wasting" or
"bottleneck" deformity of the penile shaft.
 In other severe cases, the plaque may accumulate calcium and become very hard,
almost like a bone. In addition to penile curvature, many patients also report shrinkage
or shortening of their penis.

6. What causes Peyronie’s Disease ?
 Most experts believe that Peyronie's disease is likely
the consequence of a minor penile trauma. The most
common source of this type of penile trauma is
thought to be vigorous sexual activity (e.g., bending of
the penis during penetration, pressure from a partner's
pubic bone, etc.) although injuries from sports or
accidents may also play a role.
 Certain health conditions such as diabetes, tobacco
use, or a history of pelvic trauma may also lead to
abnormal wound healing and may contribute to the
development of Peyronie's disease.

7. How is Peyronie’s Disease diagnosed?
 A physical examination by an experienced
Urologist is usually sufficient to diagnose
Peyronie's disease. The hard plaques can usually
be felt with or without erection.
 It may be necessary to induce an erection in the
clinic for proper evaluation of the penile
curvature; this is usually done by direct injection
of a medication that causes penile erection.
 In some cases an ultrasound or x-ray examination
of the penis is used to characterize the plaque
and check for the presence of calcification.

8. How is Peyronie’s Disease treated?

Men with small plaques, minimal penile curvature, no pain, and satisfactory sexual function do not
require treatment. Men with active phase disease who do have one or more of the above problems may
benefit from medical therapy.
 Oral Medications
Oral vitamin E: An antioxidant that is a popular treatment for acute stage Peyronie's disease because of its mild
side effects and low cost.
 Potassium amino-benzoate:
Also known as Potaba. it is somewhat expensive and use of the medication requires taking 24 pills a day for
three to six months. This medication has also been associated with a high rate of stomach upset, which leads
many men to stop taking it.
 Penile Injections
Injecting a drug directly into the plaque of Peyronie's disease is an attractive alternative to oral medications.
Injection permits direct introduction of drugs into the plaque, permitting higher doses and more local effects.
To improve patient comfort a local anesthetic is usually given prior to the injection.

9. How is Peyronie’s Disease treated?
 Because plaque injection is a minimally invasive approach, it is a popular
option amongst men with active phase disease and men who are reluctant
to have surgery.
 Verapamil Injections:
Verapamil is a calcium channel blocker usually used in the treatment of high
blood pressure. It has also been shown to disrupt collagen production and
this property has made it of interest in the treatment of Peyronie's disease.
Several uncontrolled studies have suggested that verapamil injection is an
effective treatment for penile pain and curvature.
 Surgical Treatment of Peyronie's Disease:
Surgery is reserved for men with severe, disabling penile deformities that
prevent satisfactory sexual intercourse.

10. How is Peyronie’s Disease treated?


There are three general approaches to surgical correction of Peyronie's disease.
Procedures that shorten the side of the penis opposite the plaque/curvature

These procedures are generally safe, technically easy, and carry a low risk of complications such as
bleeding or worsening erectile function. One particular disadvantage of these approaches is that they tend
to be associated with some loss of penile length. For this reason shortening procedures are generally
preferred in men with mild or no ED, mild to moderate curvatures, and long penises.
Examples of this type of procedure include the Nesbit procedure, in which small pieces of tunica tissue are
excised from the convex (the side opposite the direction of the curvature) side of the penis. The edges of
the tunica are then sewed together, causing penile straightening.



Procedures that lengthen the side of the penis that is curved
These procedures are indicated when the curvature severe or there is significant indentation causing a
hinge-effect or buckling of the penis due to the narrowed segment in the penile shaft. In these cases, the
surgeon incises (cuts) the plaque to release tension. In some cases a segment of the plaque may be
removed. After the plaque has been incised, the resulting hole in the tunica must be filled with a graft.
These procedures can correct severe curvatures, in most cases without significant shortening of the penis.

11. Important things to know about Peyronie’s Disease?
Peyronie's disease is a poorly understood
urological condition characterized by
penile deformity and pain. Treatment for
this condition needs to be individualized
to each patient based on the timing and
severity of the disease.

12. Important Information
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