Sexually Transmitted Diseases - I. I. Mavrov 2005

Non-Venereal Inflammatory Diseases of the Reproductive Organs
Peyronie's Disease

Peyronie's disease, or penile fibromatosis (induratio Penis plastica), is a fibrosclerotic condition of the tunica albuginea and the septum of the corpora cavernosa that leads to penile curvature, particularly during erection, thereby interfering with sexual intercourse. The condition was first described in 1743 by F. de La Peyronie, after whom it is named. It occurs in men of various ages (rarely before 30, and most commonly between 40 and 60 years of age or older). Its Etiology AND Pathogenesis remain unclear.

Proposed causes and predisposing factors include homosexuality, a history of Gonorrhea, Syphilis, and even tuberculosis.

Some researchers attribute the disease to chronic and torpid urethral infections, while others point to a specific predisposition in certain individuals toward fibroconnective transformation (collagenosis). Pathogenetic factors—such as trauma, various urinary and systemic infections, Metabolic Disorders, and endocrine imbalances (predominantly involving the pituitary-adrenal system)—also contribute to The Development of the disease (see insert XVI, 3).

Clinical presentation. The disease begins insidiously and progresses slowly; consequently, patients usually seek medical attention only when they notice a loss of penile flexibility, most commonly manifesting as a progressive and worsening curvature during erection. The curvature typically occurs laterally, corresponding to the side with the larger lesion. Concurrently with the induration in the area of the corpus cavernosum, ejaculation becomes difficult and painful. Palpation reveals a flat nodule, located dorsally, centrally, or partially shifted to the side, either round or elongated in shape, with well-defined margins. The lesion is painless, semi-mobile relative to surrounding Tissues, and exhibits the hardness of Cartilage or even bone.

The overlying Skin is unchanged. As the condition progresses, the process may involve up to two thirds of the corpora cavernosa. In the flaccid state, no pain is reported.

This relatively rare penile disorder is occasionally accompanied by sclerofibrotic Changes in the aponeurosis, such as Dupuytren's Contracture or cutaneous keloids.

Sexual function is preserved in the Cytology/cytology/16.html">Early stages of the disease, but progressive forms eventually lead to impotence.

Histological studies indicate a distinct Connective Tissue and keloid transformation of the septa of the corpora cavernosa. Connective tissue Cells are modified, poorly stained, and densely packed within the Collagen matrix, which stains yellow-red with van Gieson's stain; thickening and fragmentation of elastic fibers are also observed.

Diagnosis is usually straightforward. In the flaccid state, one or more discrete plaques or a cartilage-like cord-like induration can be palpated extending along the dorsal surface of the penis from the base to the glans. The indurations may vary in size and can be longitudinal, rounded, or irregular in shape. The condition must be differentiated from chronic gonococcal and post-gonococcal cavernositis as well as certain urethral tumors.

Treatment is protracted and in most cases yields modest results. Therapy includes injections of lidase and aloe extracts, dietary management, Vitamins, Hormones, and physical therapy (ultrasound, diathermy, phonophoresis), as well as laser therapy. Local injections of anticoagulants (such as pelentan) and long-term vitamin E therapy (lasting up to 3–4 months) are recommended. Autohemotherapy and ultraviolet irradiation are indicated in combination with other therapeutic modalities.

Surgical treatment is reserved for cases unresponsive to conservative therapy. Various techniques exist, the most radical being the excision of the fibrous plaque.