Table of Contents
Overview – Peyronie’s Disease
Peyronie’s disease is a localized fibrotic condition affecting the tunica albuginea of the penis, leading to abnormal curvature during erection. It is a relatively common urological condition that can cause significant sexual dysfunction and psychological distress. Management is often challenging and recurrence is frequent despite surgical intervention.
Definition
Peyronie’s disease is a connective tissue disorder characterized by focal fibrosis of the tunica albuginea, resulting in penile curvature, particularly noticeable during erection.
Aetiology
- Unknown cause (idiopathic) in most cases
- Notably associated with Dupuytren’s contracture in approximately 25% of patients
- Possible triggers include:
- Repetitive microtrauma to the penis (during intercourse)
- Genetic predisposition
- Local ischaemia leading to abnormal wound healing
Pathogenesis
- Fibrous plaque formation in the tunica albuginea (surrounding the corpora cavernosa)
- This inelastic plaque limits expansion during erection → curved penis
- Angulation often occurs dorsally, but may vary depending on plaque location
- The curvature may worsen over time and impair penetrative intercourse
Morphology
- Visible deformity: bent or curved penis (especially when erect)
- Palpable plaque: a firm area on penile shaft
- Fibrotic tissue replaces the normal elastic structure of the tunica albuginea
Clinical Features
Symptoms
- Curved or bent penis during erection
- Penile pain (typically early in disease course)
- Erectile dysfunction
- Shortened penis
- Palpable fibrous plaques
- Psychological distress (due to sexual dysfunction or cosmetic concern)
Disease Course
- Acute phase: painful erections and evolving deformity
- Chronic phase: pain resolves, curvature stabilizes
- Often recurs after surgical removal of plaque
Investigations
- Clinical diagnosis via history and physical examination
- Ultrasound or MRI may help delineate the plaque and guide treatment
- International Index of Erectile Function (IIEF) score to assess sexual dysfunction
Management
Conservative (First-line)
- Watchful waiting (if mild and non-disruptive)
- Oral agents (limited evidence):
- Vitamin E, Potaba, tamoxifen
- Intralesional injections:
- Collagenase Clostridium histolyticum
- Verapamil or interferon
Surgical (For severe or persistent cases)
- Plaque incision/excision + grafting
- Penile plication (Nesbit procedure)
- Penile prosthesis for concurrent erectile dysfunction
Summary – Peyronie’s Disease
Peyronie’s disease is a penile condition caused by fibrosis of the tunica albuginea, resulting in painful erections and penile curvature. Though its exact cause remains unknown, it is linked to Dupuytren’s contracture and abnormal healing after trauma. Management includes both conservative and surgical approaches, though recurrence is common. For a broader context, see our Reproductive Health Overview page.