Peyronie’s Disease is an acquired condition characterized by the formation of scars in the tunica albuginea of the penis. These scars can be easily palpated as a lump and tend to be tender for a few months during the initial phase of the disease.

Peyronie’s Disease plaques cause loss of elasticity of the tunica of the penis and this reduces the capacity of the penis to stretch during erections. Patients therefore frequently report penile shortening and deformity such as curvature and narrowing of the shaft penis, which become visible during erections. In flaccidity the lumps can still be palpated, but the deformity is not visible.

Peyronie’s disease is frequently associated with other known cardiovascular risk factors, such as diabetes, high blood pressure, high cholesterol levels, obesity and tobacco smoke. It is now established that more than 60% of patients have at least one known cardiovascular risk factor.

Worsening of the quality of the erections is quite common in patients with Peyronie’s Disease; although this can be potentially caused by the plaque itself, as it allows the blood to be rushed out of the tunica of the penis, certainly also the cardiovascular risk factors play a role by causing obstruction to the arteries feeding the penis, thus reducing the blood inflow into this organ.

Since Peyronie’s Disease can be associated with penile pain, shortening, deformity and worsening of the quality of the erection, it can be cause of severe distress in both the patient and the partner.

At present, the actual mechanism causing Peyronie’s disease is still unknown. It is suspected that Peyronie’s Disease occurs in the genetically predisposed patient following trauma to the erect penis during sexual activity. It is believed that patients with Peyronie’s Disease present an imbalance in the factors that regulate the healing process following tissue damage and this leads to excessive local tissue proliferation.

Typically Peyronie’s Disease presents an initial acute and a chronic phase. The acute phase is characterized by the formation of the plaque, which is tender at palpation as there is an active local inflammatory process. During this phase, stretching of the plaques, as physiologically occurs during erections, elicits vivid pain. Plaque size and type of deformity tend to change over time during this phase. The chronic phase starts when the inflammatory process eventually settles, usually within 9 months from the onset of the condition. At this stage the pain generally settles and the deformity does not change any more in time. 

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.