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Peyronie's disorder (also known as "Induratio penis plastica"[1]) and more recently (CITA) Chronic Inflammation of Tunica Albugenia, is a connective tissue disorder involving the growth of fibrous plaques[2] in the soft tissue of the penis affecting as many as 1-4% of men. Specifically the fibrosing process occurs in the tunica albuginea, a fibrous envelope surrounding the penile corpora cavernosa causing an abnormal curvature of the penis.[3][4][5]
[edit] ExceptionA certain degree of curvature of the penis is considered normal, as many men are born with this benign condition, commonly referred to as congenital curvature. The disease, which is not a disease but a "disorder" of the immune system, may cause pain; hardened, cord-like lesions (scar tissue known as "plaques"); or abnormal curvature of the penis when erect due to chronic inflammation of the tunica albuginea (CITA). Although the popular conception of Peyronie's disorder, al is that it always involves curvature of the penis, the scar tissue sometimes causes divots or indentations rather than curvature. The condition may also make sexual intercourse painful and/or difficult, though many men report satisfactory intercourse in spite of the disorder. Although it can affect men of any race and age, it is most commonly seen in Caucasian males above the age of 40. Peyronie's Disorder is not contagious, hence the change away from the disease reference name to a accurate immune disorder nomenclature. Nor is it related in any way to cancer. The disorder only affects men and is confined to the penis, although a substantial number of men with Peyronie's exhibit concurrent connective tissue disorders in the hand, and to a lesser degree, in the feet. About 30 percent of men with Peyronie's disorder develop fibrosis in other elastic tissues of the body, such as on the hand or foot, including Dupuytren's contracture of the hand. An increased incidence in genetically related males suggests a genetic component.[citation needed] [edit] DiagnosisA urologist can diagnose the disease and suggest treatment, and it is best to seek out a urologist who specializes in Peyronie's Disorder, as the disease and its current treatments are not well understood by general practitioners or family doctors. [edit] CausesThe underlying cause of Peyronie's Disorder is not well understood, but is thought to be caused by trauma or injury to the penis usually through sexual activity although many patient's often are unaware of any traumatic event or injury.[6] There is also an association that a class of anti-hypertensive drugs known as calcium channel blockers may be a possible cause of or exacerbate the disease, although it has not been proven. However, all beta blocker drugs list Peyronie's disease as a possible side effect.[6] [edit] TreatmentWithout treatment, about 12-13% of patients will spontaneously improve over time, 40-50% will get worse and the rest will be relatively stable.[citation needed] [edit] Medication and supplementsMany oral treatments have been studied, but results so far have been mixed.[7] Some consider the use of non-surgical approaches to be "controversial".[8] Vitamin E supplementation has been studied for decades, and some success has been reported in older trials, but those successes have not been reliably repeated in larger, newer studies.[9] A combination of Vitamin E and colchicine has shown some promise in delaying progression of the condition.[10] Newer agents targeting the basic mechanisms of inflammation have not yet been studied in larger clinical trials. Such medications include potassium para-aminobenzoate (Potaba),[11] acetyl L-carnitine, propionyl L-carnitine, L-arginine, sildenafil (acting through phosphodiesterase-5 inhibition) and pentoxifylline (acting through TGFβ1 inhibition). Interferon-alpha-2b has been proposed in recent publications.[12] Formulations of superoxide dismutase are also reported to be effective in Pey.[13] Injections to plaques (scar tissue formed by the inflamation) with Verapamil may be effective in some patients. Use of iontophoresis with Verapamil and Dexamethasone, applied to the affected areas has been studied[14] but a recent placebo controlled trial failed to show a significant improvement. There are no clinical trials listed in the NIH trial registry. [edit] SurgerySurgery, such as the "Nesbit operation",[15] is considered a last resort and should only be performed by highly skilled urological surgeons knowledgeable in specialized corrective surgical techniques. A penile prosthesis may be appropriate in advanced cases.[16] A European surgery called the Leriche technique, in which an 18 gauge needle is used to lacerate the plaque, has shown effectiveness at reducing curvature and returning sexual function.[17] [edit] Physical therapy and devicesSelf-administered manual stretching techniques, as well as a number of devices which exert gentle longitudinal forces on the plaque, are currently being studied in clinical trials. Vacuum therapy devices (or penis pumps), which have traditionally been used to treat erectile dysfunction, are currently being prescribed to help correct the curvature of the penis associated with Peyronie's.[citation needed] Doctors are starting to look into less intrusive forms of therapy as an alternative to surgery, which is becoming increasingly unpopular amongst both doctors and patients. Due to the very intrusive nature of penile curvature correction surgery, and the arguably scarce results that it provides at a very high economical, emotional, and physical cost, patient insatisfaction post surgery is very high. Most patients were unhappy with the results of the intervention due mostly to the penile shortening that happens after the surgery. As the scar retracts, the penis is pulled deeper into the body, eventually resulting in penile shortening. This was recorded in nearly 100% of the cases studied.[18] Although there is no cure for Peyronie's Disorder or fibrotic disorders that are localized in different areas of the body (Fibrosis), several clinical studies such as the one mentioned above point to penis extenders as the best treatment to correct curvature, or at the very least to impede the curvature from getting worse. According to Doctor Gontero, the leading Doctor of the above mentioned study which was published in the Journal of Sexual Medicine in 2009, "Overall results were self-reported as "acceptable", making this minimally invasive treatment modality a potential new treatment option in selected Peyronie's disorder patients."[cite this quote] Similarly, after conducting two case studies, Urologist Wendy Hum of the British Royal Infirmary, came to the conclusion, "As patient and doctor discuss the possible treatment options, it is extremely important to exhaustively inform the patient that the treatment with the Andropenis (a brand of penile extender) has to be considered an overall effective and viable treatment." [19] Several other studies exist reaffirming these types of results.[20][21][22] [edit] CounselingPeyronie's Disease can be a physically and psychologically devastating disease. While most men will continue to be able to have sexual relations, they are likely to experience some degree of deformity and erectile dysfunction in the wake of the disease process. It is not uncommon for men afflicted with Peyronie's Disease to exhibit depression or withdrawal from their sexual partners. [edit] See also[edit] References
[edit] External links
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