Peyronie’s Disease

Peyronie’s disease is an acquired fibrotic disorder affecting the tunica albuginea. It leads to deformity, a penile mass, penile pain or erectile dysfunction. It is more common than reported, probably due to embarrassment among patients.

Pathogenesis; the lesion is a fibrous plaque containing excess collagen and fibroblastic proliferation that alters the elasticity and anatomy of the penis. The area may calcify or even ossify.

Risk factors

• Family history
• Trauma to the genital area
• Urethral instrumentation
• Lipomas
• Gout
• Radical prostatectomy

Clinical presentation

• Penile pain
• Indentation
• Sexual dysfunction
• Curvature or deformity
• Shortening during erection

2 phases

1. Active phase- progressive deformity and painful erection
2. Stable phase- chronic stage associated with non-progression of pain and deformity

Diagnosis

A) Apparent from history and physical exam

B) Imaging

1. Ultrasound- highest sensitivity

Colour ultrasound- to guide management

2. Others – CT scan, MRI, Plain Xray

Differential diagnosis

• Chordee without hypospadias
• Curvature associated with epispadias
• Congenital ventral curvature
• Sclerosing lymphangitis
• Penile fracture

Management

Active phase

NSAIDS and pentoxifylline for three months

1. Improvement- observe and continue pentoxifylline for another six months or stop pentoxifylline and observe
2. No improvement- intralesional injections of collagenase Clostridium hemolyticum

Stable phase

1. Observation- those with curvature ≤30⁰ and satisfactory erectile function
2. Intralesional drug therapy- >30⁰ curvature and/ or erectile dysfunction
3. Surgery- unresponsive to medical therapy, severe indentation or hourglass deformity, and large calcification

Surgical procedure – exploration with the evacuation of the hematoma if present. Followed by urethral injury repair and possible stenting, then suturing of the rupture

Post-op care

• Analgesia and antibiotic prophylaxis
• Four weeks of sex abstinence
• Light compression dressing
• For those with urethral reconstruction, follow up with urethrography in 2 weeks

Complications

• Stenosis of the urethra
• Erectile dysfunction
• Painful erection