Peyronie’s disease is epitomized by fibroblast proliferation in the tunica albuginea (a fascial structure in the penis), giving rise to a thick fibrous plaque that may result in pain, pathological penile curvature, as well as erectile dysfunction. Although trauma is considered a major causative factor, it is unlikely to be the sole culprit. The exact pathophysiological mechanisms that lead to aforementioned fibrosis and scarring are still a matter of debate.
Peyronie’s disease is highly characteristic for men in their sixth decade of life (with their usual age ranging from 52 to 57 years). Still, this condition can be seen at any point in adulthood, with a small fraction of patients presenting with the disease in their twenties. Moreover, the prevalence of Peyronie’s disease is much greater than initially thought.
Clinical Presentation of Peyronie’s Disease
The hallmark of the condition is acquired penile deformity that has to be distinguished from congenital curvatures of the penis and normal anatomical variants. Leading signs that point to the diagnosis of Peyronie’s disease are curving of the penis during erection (sometimes with hourglass deformity or tunical indentations), penile instability, as well as the loss of stretched penile length in flaccid state.
Contrary to congenital curvatures of the penis where a ventral curve predomination is observed, in Peyronie’s disease curvature may be in any direction, with either uniplanar or biplanar properties. Nevertheless, the most common type of curvature in this condition is dorsal, often coupled with more severe clinical presentations.
Erectile dysfunction is observed in 20-50% affected individuals due to a variety of factors. In a narrower sense, the disease itself may be responsible for deformity that prevents sexual intercourse, or for flail penis due to cavernous fibrosis. Impaired erections may also be a result of inadequate venous occlusion during erection or (in certain instances) psychological performance anxiety.
In any case, the quality of life of patients (but also their partners) may be substantially affected, since it has been shown that men with Peyronie’s disease are prone to lowered self-esteem, body-image issues, problems in the relationship, as well as true depression. This psychological burden is an important aspect of the disease which is often underestimated by urology specialist and primary care physicians.
Natural History of the Condition
The natural history of Peyronie’s disease incorporates both acute and chronic phases. The acute phase is marked by the progression of penile deformation, often associated with pains during the erect (but also flaccid) states. The length of this phase is variable, usually in the range of 6 to 18 months.
Conversely, the chronic phase is characterized by a stable penile deformity for at least three to six months, while pain improves or completely disappears. However, a common complaint of affected individuals is a subjective loss of penile length, sometimes more than one centimeter.
It is worth noting that some patients are completely unaware that they are affected by Peyronie's disease. One study found histological evidence of this condition in 23% of 100 performed autopsies, while the other study using phalloarteriography (a type of arteriography that uses X-rays to visualize the arteries supplying the penis) has shown that 20% of asymptomatic and unaware men presented with deformities typical for Peyronie’s disease.