Penile Incurvation (Peyronie's Disease)
Peyronie’s disease (PD) is a penile benign condition clinically characterized by penile
nodules and fibrosis of the tunica albuginea of the cavernous bodies, causing incurvation, shortening or slimming of the penis.
The cause of the disease remains uncertain, although there are several hypotheses that suggest an alteration of the healing process as the most likely cause.
The average age of onset is around 50 years of age and its prevalence increases with age; from 1.5% at 30 years of age to 6.5% at over 70.
Peyronie’s Disease (MP) typically occurs in 2 phases:
- Inflammatory phase (6-12 months): characterized by painful erections, progressive deformity and plaque and curvature development.
- Stable phase (after 12 months): diminishing penile pain, deformity stabilization and hardening of the plaques.
- Without treatment there is progression in 48%, stabilization in 40% and spontaneous improvement in 12%.
The PD treatment is performed in the stable phase, when the deformity can’t progress any longer. The treatment in the inflammatory phase is directed to pain control with analgesic medication.
During the stable phase, no oral treatments have been proven to diminish the degree of curvature. The most accepted treatments are the following:
- Intraplastic treatment:
Clostridium collagenase injection: indicated in light curvatures. It reduces the collagen content of the plaque decreasing the degree of the curvature up to 34%.
- Surgical treatment of PD:
- Plication surgery: indicated in light/moderate curvatures (<60º). A correction of penile curvature by various tunica albuginea plasties is done. The most commonly used techniques are: Nesbit, Yachia and the 16-dot plication procedure.
- Grafting surgery: indicated in severe curvatures (> 60º). A plaque incision is made and a graft is placed.
- Penile prostheses: indicated in severe curvatures with severe associated erectile dysfunction.