Peyronie's Disease

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Peyronie's disease is a psychologically and physically devastating disorder that is manifest by a fibrous inelastic scar of the tunica albuginea, resulting in palpable penile scar in the flaccid condition and causing penile deformity, including penile curvature, hinging, narrowing, shortening, and painful erections. Peyronie's disease remains a considerable therapeutic dilemma even to today's practicing physicians.

Section snippets

History

Francois de la Peyronie was a French Barber Surgeon who practiced from 1693 until his death in 1747 [2]. His career was prolific; he acted as the commander of the medical corps under Louis XIV, founded the Royal Academy of Surgery in 1737, and became a famous surgeon in Paris, caring for prominent Parisians and the kings of Poland and Prussia [2]. His most famous contribution to medical history is his classic paper on induratio penis plastica [1], describing “disfiguring knobs” [1] and

Etiology and molecular mechanisms

The etiology of PD is the subject of much scientific research. Historically described etiologies included the patient's sexual history or a history of “deviant behavior” [4], [5]. Forceful penetration and penile trauma have long been thought to be causative factors [6], and although other investigators have questioned their causality [7], it is likely that they remain an important triggering or epigenetic event in the development of the disease. More contemporary thinking would consider PD as a

Epidemiology

Epidemiologic data on PD are limited and inconsistent. The first published epidemiology report on PD was by Pokley in 1928 [21] and consisted of 550 patients. The historically accepted (although likely incorrect) prevalence of 1% in the American male population was popularized by studies from Ludvik and Wasserburger [22] and Devine [23]. In 1991, Lindsay and colleagues [24] reported an overall prevalence of 0.38% based upon hospital record review, estimating that at that time there were 423,000

Evaluation of the patient who has Peyronie's disease

Thorough evaluation of the patient who has PD is essential not only to diagnose the disease correctly but also to guide treatment. No universally accepted standardized evaluation for the PD man exists, nor has a validated questionnaire been developed. A suggested guideline for initial evaluation of the patient who has PD, including history, physical examination, and imaging analysis, has been published [36] and is outlined below. Subjective and objective data gathering remains discordant among

Nonsurgical therapy for Peyronie's disease

Since the first description of PD in the literature, physicians have been searching for medical therapy options with little confirmed success. Consistent successful medical therapies continue to evade the practicing urologist, although current research into the molecular pathophysiology of PD may lead to a medical cure. Several nonsurgical options are available and may stabilize or reduce deformity and improve sexual function. The evaluation of their efficacy has been compromised by small

Surgical treatment of Peyronie's disease

Surgery remains the gold standard treatment for PD. Surgery should be performed only when the disease is stable enough to ensure long-term efficacy. In general, surgery should be considered only when disease duration is 9 months to 1 year and when the disease has remained stable for at least 6 months.

Preoperative history, physical examination, and duplex ultrasonography are essential to formulating a treatment plan. A treatment algorithm was developed at Rush University Medical Center in

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      Peyronie's disease (PD) is a connective tissue disorder of the penile tunica albuginea, causing penile deformity, shortening, pain, and sexual dysfunction.1

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    Dr. Levine is a Consultant with Pfizer, Lilly, American Medical Systems, Auxilium, Coloplast; Speaker for Pfizer, Lilly, Coloplast, Auxilium; Investigator with fsPhysioMed and Auxilium.

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