Peyronie's disease

Question 1

What is peyronies disease?

Answer 1

• Acquired curvature of penis due to fibrosis of tunica albuginea
• Middle aged men mostly

Question 2

3 groups of peyronies disease

Answer 2

• Asymptomatic - does not limit sexual function
• Moderate to severe curvature causing pain or impeding sexual function
• Erectile dysfunction

Question 3

Pathophys of peyronies disease

Answer 3

• Acute inflammatory phase then chronic stable phase
• Acute phase - minor trauma causes release of cytokines –> acute inflammation but fibrotic healing process occurs instead, disrupting normal architecture via over production of collagen
• Chronic - fibrotic plaques develop on dorsum of penis and restrict its ability to stretch during erections = painful shortening and curvature, can also reduce blood flow –> ED

Question 4

RF for peyronies disease

Answer 4

• Increasing age
• Diabetes mellitus
• IHD
• Hypertension
• Medications - beta blockers, PPIs, antidepressants, antihistamines

Association with dupeytrens but no genetic link found

Question 5

Symptoms of peyronies

Answer 5

• Significant curvature and shortening of penis
• Severe cases - hinge deformity and erectile dysfunction
• Psychological distress - from functional and aesthetic impact
• Acute phase - painful erections 12-18 months
• Chronic - absent pain, curvature stable

Question 6

Examination of peyronies

Answer 6

• If chronic, plaques can often be palpated

Question 7

Differential

Answer 7

Congential curvature
Penile #
Penile cancer

Question 8

Investigations peyronies

Answer 8

• Clinical usually
• USS can identify plaques in certain cases

Question 9

Management of peyronies - non surgical

Answer 9

• PDE5 inhibitors eg Sildenafil
• Intracavernosal injections of vasoactive medications eg alprostadil
• Mechanical traction apparatus or vaccum erection pumps - regular use reduces curvature, increase flaccid lenth and reduce pain

Question 10

Surgical managment of peyronies disease

Answer 10

• Tunical plication - small sections of tunica albuginea resected and sutured on long side, opposite to plaque
• Plaque incision and grafting
• Penile prostheses - severe cases and ED, abnormal corpora cavernosa removed and replaced with prosthesis

Question 11

Complications of peyronies disease

Answer 11

• High psychological burden - emotional stress
• Screen for anxiety and depression