DIAGNOSTICS
Peyronie’s disease, Curvature of the Penis, Montreal & Quebec
The penis has two corpus cavernosum, which are sponge-like regions of erectile tissue that surround the urethra and extend from the base of the penis to the glans. The corpus cavernosum are covered with thick, elastic tissue called tunica albuginea. During an erection, as penis volume grows as a result of increased blood flow in the tissues, the tunica albuginea becomes stretched. Peyronie’s disease is caused by the formation of scar tissue in a specific area on the tunica albuginea. This scar tissue diminishes elasticity, causing curvature of the penis when erect.
The penis is comprised of two corpus cavernosum: sponge-like regions of erectile tissue that surround the urethra and extend from the base of the penis to the glans. The corpus cavernosum are covered with thick, elastic tissue called tunica albuginea. During an erection, the tunica albuginea stretches and increases in volume. Peyronie’s disease is caused by the formation of scar tissue on the tunica albuginea, causing curvature of the penis when erect.
What causes Peyronie’s disease?
No one cause has been specifically identified; however, there are many hypotheses. Among those:
37% of the time, trauma occurs during sexual activity, where the erect penis accidentally bends. This type of trauma is usually painful. The pinnacle of penile trauma is penile fracture; it then becomes ecchymotic and sometimes even colored like an eggplant.
External trauma to the penis is also possible.
The causes can be autoimmune, such as its link to Dupuytren's disease.
The causes can be vascular or ischemic due to lack of vascularity to the penis.
The causes are sometimes post-operative pelvic surgeries.
37% of the time, trauma occurs during sexual activity, where the erect penis accidentally bends. This type of trauma is usually painful. The pinnacle of penile trauma is penile fracture; it then becomes ecchymotic and sometimes even colored like an eggplant.
External trauma to the penis is also possible.
The causes can be autoimmune, such as its link to Dupuytren's disease.
The causes can be vascular or ischemic due to lack of vascularity to the penis.
The causes are sometimes post-operative pelvic surgeries.
What is the clinical portrait of the disease?
A slight to severe curvature of the penis, which may have different orientations; it can be up (dorsal) or down (ventral). It can also be towards the right or left. The most common curvature is dorsal.
A curvature can also be in both directions, such as dorsal and bent to the right.
Erect pain is also common in the first few months of the disease.
A lump is often palpable when resting inside the penis; it corresponds to a cavernous plaque. It is sometimes small, less than half a centimeter, but can reach 2 cm.
The site of curvature and cavernous plaque can also be variable; either distal near the glans or proximal near the base of the penis. However, it is most often in the middle.
Another clinical consequence of Peyronie’s disease is sometimes loss of erect length through stiffness of the plaque and loss of flexibility.
There is more rarely the possibility of internal deformation at the site of the plate (hourglass).
A curvature can also be in both directions, such as dorsal and bent to the right.
Erect pain is also common in the first few months of the disease.
A lump is often palpable when resting inside the penis; it corresponds to a cavernous plaque. It is sometimes small, less than half a centimeter, but can reach 2 cm.
The site of curvature and cavernous plaque can also be variable; either distal near the glans or proximal near the base of the penis. However, it is most often in the middle.
Another clinical consequence of Peyronie’s disease is sometimes loss of erect length through stiffness of the plaque and loss of flexibility.
There is more rarely the possibility of internal deformation at the site of the plate (hourglass).
What are the medical risk factors?
In 10% of cases, Peyronie’s disease is linked to Dupuytren’s disease. Additionally, diabetes, smoking, Paget’s disease, rheumatoid arthritis and the use of beta-blockers can all contribute to the development of Peyronie’s disease.
How common is Peyronie’s disease?
The prevalence of Peyronie’s disease in the general population is estimated to be about 7%. The average age of the onset of the disease is 53. The disease doesn’t typically develop in men under 40.
How does Peyronie’s disease develop?
The curved or crooked penis that’s characteristic of Peyronie’s disease can progress in a number of possible ways. In some cases, the curvature of the penis spontaneously corrects itself with time. In other cases, it develops into a major deformity. Moreover, it’s difficult to determine how the curvature will evolve in the early stages of the disease.
Typically, Peyronie’s disease develops in two stages.
In the acute or active stage, changes in the shape of the erect penis occur and the patient may experience penile pain and/or notice lumps in the penis. The pain may be spontaneous and felt either continuously or only during erections. In most cases, the pain goes away within 12 to18 months.
In the chronic or stable stage, curvature generally doesn’t change — it neither worsens nor improves. Typically, the patient no longer experiences any pain.
Typically, Peyronie’s disease develops in two stages.
In the acute or active stage, changes in the shape of the erect penis occur and the patient may experience penile pain and/or notice lumps in the penis. The pain may be spontaneous and felt either continuously or only during erections. In most cases, the pain goes away within 12 to18 months.
In the chronic or stable stage, curvature generally doesn’t change — it neither worsens nor improves. Typically, the patient no longer experiences any pain.
How is Peyronie’s disease diagnosed?
A physical examination and a medical history of the patient first enable a diagnosis to be made.
Also, it is often helpful to take pictures of the erect penis to get a better idea of the curvature and angle. The angle can even be roughly calculated from these photos, which can then be recorded in the electronic and confidential patient file. They can also be used to monitor and progress of the disease.
An erection can be induced artificially in the clinic, in order to better quantify the degree of curvature.
Doppler penile ultrasound with intracavernous injection may be performed, depending on the severity of the curvature.
Also, it is often helpful to take pictures of the erect penis to get a better idea of the curvature and angle. The angle can even be roughly calculated from these photos, which can then be recorded in the electronic and confidential patient file. They can also be used to monitor and progress of the disease.
An erection can be induced artificially in the clinic, in order to better quantify the degree of curvature.
Doppler penile ultrasound with intracavernous injection may be performed, depending on the severity of the curvature.
What medical treatments are available for Peyronie’s disease?
One of several treatments may be administered for Peyronie’s disease. Depending on its
stage of development, a doctor may recommend:
- Shock wave therapy. This is a non-surgical treatment that helps to reduce pain.
- Collagenase injections. This treatment has can decrease penis curvature as well as treat erectile dysfunction. It’s fairly costly, however, and involves about four treatment sessions.
- Platelet-rich plasma injections in conjunction with hyaluronic acid injections. This is a new treatment recently approved by Health Canada that involves drawing a blood sample from the patient, centrifuging the blood to separate the plasma and injecting the plasma into the scar tissue or plaques in the penis.
- Penile plication. This is a surgical procedure designed to straighten a bent penis
Is there a physical treatment for curvature of the penis?
Extracorporeal shock wave lithotripsy is a physical treatment that has been shown to
accelerate the resolution of pain in the initial phase of the disease. This treatment is offered at Dr. Carlos Marois’ private practice. It consists of one 30-minute appointment per week over four weeks.
What treatments for Peyronie’s disease are available at a urology clinic?
- Conventional treatments such as professional advice and penile traction therapy
- Drug injection
- Shock wave therapy
- Penile plication procedure
- Platelet-rich plasma injections