|
Peyronie's Disease Fact Book
|
|
|
|
| Peyronie's disease, a condition of uncertain
cause, is characterized by a plaque, or hard lump, that forms on the
penis. The plaque develops on the upper or lower side of the penis in
layers containing erectile tissue. It begins as a localized inflammation
and can develop into a hardened scar.
Cases of Peyronie's disease range from mild to severe. Symptoms may
develop slowly or appear overnight. In severe cases, the hardened plaque
reduces flexibility, causing pain and forcing the penis to bend or arc
during erection. In many cases, the pain decreases over time, but the bend
in the penis may remain a problem, making sexual intercourse difficult.
The sexual problems that result can disrupt a couple's physical and
emotional relationship and lead to lowered self-esteem in the man. In a
small percentage of patients with the milder form of the disease,
inflammation may resolve without causing significant pain or permanent
bending.
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.
|
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.
Keeping on Top of Your Condition
Keeping in tune with your disease or condition not only makes treatment less intimidating but also increases its chance of success, and has been shown to lower a patients risk of complications. As well, as an informed patient, you are better able to discuss your condition and treatment options with your physician.
A new service available to patients provides a convenient means of staying informed, and ensures that the information is both reliable and accurate. If you wish to find out more about HealthNewsflash's innovative service, take the tour.
|
For More Information
American Foundation for Urologic Disease
1128 North Charles
Street
Baltimore, MD 21201
Phone: 1-800-242-2383 or (410)
468-1800
Email: admin@afud.org
Internet: http://www.afud.org/
National Organization for Rare Disorders
P.O. Box 8923
New
Fairfield, CT 06812-8923
Phone: 1-800-999-6673
Email: orphan@nord-rdb.com
Internet: http://www.rarediseases.org/
|
|
|
|
