Peyronies disease

Question 1

Definition

Answer 1

Disorder of the penile connective tissue

Question 2

Pathophysiology

Answer 2

Fibrous plaque formation occurs in the corpus cavernosum’s tunica albuginea. There is inflammatory thickening with fibrin deposition, increased collagen production, decreased quantity of elastic fibres and subsequent fibrosis ± calcification. This leads to penile angulation or an hourglass-like deformity with distal flaccidity. It usually affects only the erect penis. Sexual intercourse can become painfully difficult or impossible. It is thought to occur (but nobody really knows) as a result of one-off or repeated penile vascular trauma causing leakage and immunological reaction in the relatively avascular tunica albuginea.

Question 3

Epidemiology

Answer 3

3-9% of men, most commonly seen in the 5th decade

Question 4

Associated conditions

Answer 4

• Dupuytrens contracture
• DM
• hypertension
• lipid abnormalities
• ischaemic cardiopathy
• ED
• smoking
• XS alcohol

Question 5

Presentation

Answer 5

• penile pain during erections
• penile angulation
• palpable fibrous plaque

Question 6

Ix

Answer 6

History
Physical examination
Duplex ultrasonography

Question 7

Treatment

Answer 7

External penile contraction

Vacuum devices

Question 8

Medical treatment

Answer 8

PO: Tamoxifen, tocopherol
TO: verapamil
intralesional: verapamil, interferon

Question 9

Surgical treatment:

Answer 9

Extracorpeal shock wave therpay

Cold steel surgery