Peyronie's Disease

Both Peyronie’s Disease and congenital penile curvature can be found in adolescents and young adults and therefore the age of onset is not a good criterion to distinguish between the two conditions. However, in patients with congenital penile curvature there is no palpable lump, which is instead indicative of Peyronie’s Disease.  Also, while most congenital curvatures are ventral, in most patients with Peyronie’s Disease the penis bends upward. Waist deformities are also absent in patients with congenital curvature, which tend to be more gentle and harmonic than the one of patients with Peyronie’s Disease.

While erectile dysfunction is a common finding in patients with Peyronie’s Disease, most patients with congenital penile curvature have adequate erections, as there is no association between cardiovascular risk factors and congenital penile curvature. To render the situation more confusing, some of the patients with congenital penile curvature may eventually develop Peyronie’s Disease later in life and therefore both conditions may coexist.

Peyronie’s Disease is a quite common condition as it affects around 10% of men. Although it is typically a condition of the fifth and sixth decade of life, Peyronie’s Disease can occur at any age. Usually in the adolescent the condition tends to be more aggressive in terms of size of the plaque and degree of deformity produced.

Potentially any male can develop Peyronie’s Disease, although the condition is more likely to occur in the fifth and sixth decade of life and in patients with cardiovascular risk factors.

Due to the strong link between Peyronie’s Disease and disease, patients presenting with this condition should always be actively screened for the known cardiovascular risk factors such as high blood pressure, diabetes and high cholesterol levels.

The initial, acute phase of Peyronie’s Disease is usually characterized by the formation of a tender nodule on the tunica of the penis. Erections at this stage tend to be painful and patients usually notice a penile deformity, which, at this stage, still changes over time.

The inflammatory process progressively settles and this leaves a non-tender nodule on the tunica of the penis. At this stage erections are generally not painful and patients usually complain of penile shortening and deformity, which become apparent during erections. Many patients also report a progressive worsening of the quality of the erections.

Peyronie’s Disease diagnosis is based on history taking and on the examination of the patient. Frequently patients report that the disease has started following a trauma to the penis during sexual activity. Examination of the penis will demonstrate the presence of a lump, which can be elastic or indurated in texture.

Deformity can be assessed only during erections, when the tunica albuginea of the penis is stretched to its maximum capacity. Self-photography of the erect penis can be a useful tool to identify the nature of the deformity. However, this can underestimate the exact tridimensional extent of the curvature, as the picture is by definition bi-planar. Also, an incomplete erection will make the deformity appear less pronounced.

Alternatively, an artificial erection can be induced in the office with the administration of a vasoactive medication. This allows the surgeon to assess more precisely the tridimensional extent of the curvature and better plan the treatment options.

As patients with Peyronie’s Disease frequently have cardiovascular disease, which might have produced a degree of obstruction of the arteries feeding the penis, a thorough assessment of the penile blood supply should be carried out performing an Eco Colour Doppler Ultrasound Scan. This investigation will provide the surgeon with extremely precious information that will also help to better decide which is the most appropriate treatment option for each specific patient.