The plaque
itself is benign, or noncancerous. A plaque on the top
of the shaft (most common) causes the penis to bend upward;
a plaque on the underside causes it to bend downward. In some
cases, the plaque develops on both top and bottom, leading to
indentation and shortening of the penis. At times, pain, bending,
and emotional distress prohibit sexual intercourse.
One study
found Peyronie's disease occurring in 1 percent of men.
Although the disease occurs mostly in middle-aged men, younger
and older men can acquire it. About 30 percent of people with
Peyronie's disease develop fibrosis (hardened cells) in other
elastic tissues of the body, such as on the hand or foot. A
common example is a condition known as Dupuytren's contracture
of the hand. In some cases, men who are related by blood tend
to develop Peyronie's disease, which suggests that familial
factors might make a man vulnerable to the disease.
Men with
Peyronie's disease usually seek medical attention because
of painful erections and difficulty with intercourse. Since
the cause of the disease and its development are not well understood,
doctors treat the disease empirically; that is, they prescribe
and continue methods that seem to help. The goal of therapy
is to keep the Peyronie's patient sexually active. Providing
education about the disease and its course often is all that
is required. No strong evidence shows that any treatment other
than surgery is effective. Experts usually recommend surgery
only in long-term cases in which the disease is stabilized and
the deformity prevents intercourse.
A French
surgeon, François de la Peyronie, first described Peyronie's
disease in 1743. The problem was noted in print as early as
1687. Early writers classified it as a form of impotence, now
called erectile dysfunction (ED). Peyronie's disease can be
associated with ED; however, experts now recognize ED
as only one factor associated with the disease--a factor that
is not always present.
Course
of the Disease
Many researchers
believe the plaque of Peyronie's disease develops following
trauma (hitting or bending) that causes localized bleeding inside
the penis. Two chambers known as the corpora cavernosa run the
length of the penis. The inner-surface membrane of the chambers
is a sheath of elastic fibers. A connecting tissue, called a
septum, runs along the center of each chamber and attaches at
the top and bottom.
If the penis
is abnormally bumped or bent, an area where the septum
attaches to the elastic fibers may stretch beyond a limit, injuring
the lining of the erectile chamber and, for example, rupturing
small blood vessels. As a result of aging, diminished elasticity
near the point of attachment of the septum might increase the
chances of injury.
The damaged
area might heal slowly or abnormally for two reasons: repeated
trauma and a minimal amount of blood flow in the sheath-like
fibers. In cases that heal within about a year, the plaque does
not advance beyond an initial inflammatory phase. In cases that
persist for years, the plaque undergoes fibrosis, or formation
of tough fibrous tissue, and even calcification, or formation
of calcium deposits.
While
trauma might explain acute cases of Peyronie's disease,
it does not explain why most cases develop slowly and with no
apparent traumatic event. It also does not explain why some
cases disappear quickly, and why similar conditions such as
Dupuytren's contracture do not seem to result from severe trauma.
Some researchers
theorize that Peyronie's disease may be an autoimmune
disorder.
A number
of drugs list Peyronie's disease as a possible side effect.
Most of these drugs belong to a class of blood pressure and
heart medications called beta blockers. One beta blocker is
an eye drop preparation used to treat glaucoma. Other drugs
that may cause Peyronie's disease are interferon, used to treat
multiple sclerosis, and phenytoin, an anti-seizure medicine.
The chances of developing Peyronie's disease from any of these
medicines are very low. Patients should check with their doctor
before discontinuing any prescribed drug.
Peyronies
Treatment
Because
the course of Peyronie's disease is different in each
patient and because some patients experience improvement without
treatment, medical experts suggest waiting 1 to 2 years or longer
before attempting to correct it surgically. During that wait,
patients often are willing to undergo treatments whose effectiveness
has not been proven.
Some
researchers have given men with Peyronie's disease vitamin
E orally in small-scale studies and have reported improvements.
Yet, no controlled studies have established the effectiveness
of vitamin E therapy. Similar inconclusive success has been
attributed to oral application of para-aminobenzoate, a substance
belonging to the family of B-complex molecules.
Researchers
have injected chemical agents such as verapamil, collagenase,
steroids, and calcium channel blockers directly into the plaques.
These interventions are still considered unproven because studies
have included low numbers of patients and have lacked adequate
control groups. Steroids, such as cortisone, have produced
unwanted side effects, such as the atrophy or death of healthy
tissues. Another intervention involves iontophoresis, the use
of a painless current of electricity to deliver verapamil or
some other agent under the skin to the plaque.
Radiation
therapy, in which high-energy rays are aimed at the plaque,
has also been used. Like some of the chemical treatments, radiation
appears to reduce pain, but it has no effect at all on the plaque
itself and can cause unwelcome side effects. Although the variety
of agents and methods used points to the lack of a proven treatment,
new insights into the wound healing process may yield more effective
therapies in the near future.
Peyronie's
disease has been treated with some success by surgery.
The two most common surgical methods are removal or expansion
of the plaque followed by placement of a patch of skin or artificial
material, and removal or pinching of tissue from the side of
the penis opposite the plaque, which cancels out the bending
effect. The first method can involve partial loss of erectile
function, especially rigidity. The second method, known
as the Nesbit procedure, causes a shortening of the erect
penis.
Some
men choose to receive an implanted device that increases rigidity
of the penis. In some cases, an implant alone will straighten
the penis adequately. In other cases, implantation is combined
with a technique of incisions and grafting or plication (pinching
or folding the skin) if the implant alone does not straighten
the penis.
Most
types of surgery produce positive results. But because complications
can occur, and because many of the phenomena associated with
Peyronie's disease (for example, shortening of the penis) are
not corrected by surgery, most doctors prefer to perform surgery
only on the small number of men with curvature so severe that
it prevents sexual intercourse.
