Peyronie’s Disease (PD)
PD is thought to be a wound healing disorder of the thick outer layer of the penile shaft called the tunica albuginea that presumably occurs after an injury to the penis. This abnormal wound healing results in the formation of inelastic or fixed scar tissue or plaque. The plaque causes a deformity of the penis including curvature, indentation also referred to as an hourglass deformity, hinge effect during erection, shortening of erection and can be also be accompanied with erectile dysfunction. Once the scar or plaque is formed it does not change to become normal penile tissue and therefore the plaque and deformity become permanent. The exact mechanism behind the development of this abnormal wound healing remains unknown.
PD is not rare and occurs in 3 to 20% of the population and in certain populations such as men with diabetes and erectile dysfunction (ED) it can be even higher. Because of the inability to obtain a firm erection, PD is often concealed in men with ED and they are unaware that they have it. PD very rarely resolves on its own, and it is likely that within the first 12 to 18 months after presentation, up to 50% of men with PD will experience worsening of the deformity.
PD has an active phase during which scar tissue and plaque can grow. This results in an increase in pain and deformity followed by an inactive or mature phase during which further progression rarely occurs. During the mature or chronic phase the deformity becomes permanent and painful erections disappear. Spontaneous disappearance of the deformity however is very rare.
PD can occur in men of all ages, as early as in 30-year-old men, however there is an exponential increase of its prevalence at age 50 and higher. Medical conditions such as hypertension, hypercholesterolemia, diabetes and low testosterone are associated with an increased prevalence of PD. Up to 33% of men diagnosed with PD have diabetes. Also men undergoing open or robotic radical prostatectomy have a higher risk (16%) of developing PD. Low testosterone levels has been suggested to exaggerate the severity of PD and in one study testosterone supplementation seemed to improve the efficacy of the treatment of PD. PD is also associated with collagen disorders such as Dupuytren and Ledderhose disease, systemic fibrosis (scleroderma) and Lupus. PD can also be psychologically devastating. Men with PD have diminished self-esteem, shame, embarrassment, loss of sexual confidence and depression. This can affect their relationship at home, at work and in the bedroom. Penile shortening and deformity and the inability to perform intercourse are the most common risk factors for developing emotional distress.