eMedicine Specialties > Dermatology > Benign Neoplasms

Peyronie Disease

Author: Jay W Zimmerman, MD, FAAD, Consulting Physician, Berman Skin Institute, Palo Alto
Coauthor(s): Anne Laumann, MB, ChB, MRCP(UK), FAAD, Associate Professor, Department of Dermatology, Feinberg School of Medicine, Northwestern University; Gregory Bales, MD, Associate Professor, Department of Surgery, Section of Urology, University of Chicago
Contributor Information and Disclosures

Updated: Feb 4, 2010

Introduction

Background

In 1587, Guilio Cesare Aranzi was the first to formally describe Peyronie disease (PD) in his book Tumores praeter naturam. He called Peyronie disease "a rare affection of the genitals in people with excessive sexual intercourse: a little penile tumor palpable like a bean in the flaccid penis causing a deformity similar to a ram horn during erection." The disease was not given its current name until 1743, when Francoise de La Peyronie described the cases of 3 men with fibrous thickening of the penile shaft, painful erections, and penile curvature, as demonstrated in the images below.

Lateral view demonstrates vertical curvature.

Lateral view demonstrates vertical curvature.

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Lateral view demonstrates vertical curvature.

Lateral view demonstrates vertical curvature.


Superior view shows a full erection.

Superior view shows a full erection.

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Superior view shows a full erection.

Superior view shows a full erection.


eMedicine's Urology article, Peyronie Disease, also may be helpful.

Pathophysiology

Although the exact etiology of Peyronie disease is not clear, trauma may cause perivascular inflammation.1 In ordinary tissue, the rupture of blood vessels leads to coagulation and fibrin deposition. Fibrinolysis of the deposited fibrin occurs as tissue cells proliferate to close the site of injury. In Peyronie disease, the tunica albuginea may initially undergo microvascular trauma during sexual intercourse. Adequate postinjury fibrinolysis is prevented because the tunica albuginea is hypovascular.

After multiple microvascular traumas, large quantities of fibrin accumulate in the form of a plaque, generally along the dorsal and ventral midline aspects of the penile shaft. This deposition appears to be immune mediated. Some people may be genetically predisposed to this reaction. The plaque prevents the adequate expansion of the tissue during erection, leading to penile curvature and pain. The relationship of this condition to other fibromatoses suggests a predisposition to fibrous proliferation. Although these microtraumatic events are implicated in the current theory of the pathogenesis of Peyronie disease, no etiology is proven.

Results of animal studies indicate that transforming growth factor-beta (TGF-beta) may be involved in the formation of the plaques via early inflammatory reactions. When TGF-beta analogs are injected into rat tunica albuginea, they form collagen bundles that are morphologically similar to those in Peyronie disease.

Peyronie disease starts in 1 of 2 ways. Most patients report the acute onset of pain accompanied by a lump in the shaft of the penis, followed by gradually increasing curvature with or without pain. Alternatively, a minority of the patients report curvature of the penile shaft that occurs suddenly, seemingly overnight, and remains stable once it occurs.

In the progressive form, the cycle of trauma, fibrin deposition, and attempts at fibrinolysis continue to escalate. Remodeling of the fibrin deposits can take as long as 2 years in the absence of further traumatic events.

Frequency

United States

  • The rate for Peyronie disease is 0.3-4% among white men.

International

  • Peyronie disease is less common in men of African or Asian heritage.

Mortality/Morbidity

  • The spectrum of Peyronie disease ranges from asymptomatic plaques to mild penile curvature or severe curvature that results in a complete inability to have sexual intercourse.
  • Erectile pain can range from none to severe, depending on the site and amount of plaque deposition.

Race

  • Peyronie disease is well documented in whites.
  • Peyronie disease may occur in black men, often in the presence of preexisting diabetes mellitus and erectile dysfunction.
  • To our knowledge, no cases in Asians have been documented.

Age

  • Peyronie disease predominantly occurs in men aged 40-60 years.
  • The age range of affected persons is 30-80 years.

Clinical

History

  • Usually in Peyronie disease, the penis hurts only during an erection. This pain occurs in one third of patients and is pathognomonic for Peyronie disease.
  • Penile curvature of varying degrees may be observed, only during an erection.
  • No history of a congenital malformation of the penis or a metastatic cancer is present.

Physical

  • On palpation, a fibrotic plaque, usually greater than 1.5 cm in diameter, is felt over the midline of the penile shaft, either ventrally or dorsally.
  • The erect penis may be curved, or it may have an hourglass deformity with flaccidity of the distal penis.
    • The patient can obtain photographs of the erect penis in private to demonstrate the increased curvature.
    • Self-taken photographs can be used to establish a reference point for subsequent observation or treatment.
  • Evidence suggests that pain tends to improve with time, but fibrosis and/or deformity tend to worsen or persist. Waiting 12-24 months for the plaque to stabilize before surgical intervention is typical.

Causes

Although microtraumatic events are implicated in the current theory of the pathogenesis of Peyronie disease, no etiology is proven. No risk factors are known, but associations do exist. Research has demonstrated increased expression of hypoxia-inducible target genes in lesional tissue, suggesting hypoxic injury may be involved in the pathogenesis.2

  • Peyronie disease occurs in men, particularly in older men with weak erections, who engage in frequent and vigorous intercourse (>4 times per wk).
  • In some studies, HLA-B7 and HLA-DQ5 appear to be correlated with the incidence of Peyronie disease. Results of recent studies have not confirmed this finding.3
  • Peyronie disease may be associated with erectile dysfunction, diabetes mellitus, and hypertension. Resultant partial erections may lead to buckling during intercourse.
  • Peyronie disease is associated with Dupuytren contracture. Among patients with Peyronie disease, 10% have Dupuytren contracture, and 3% of patients with Dupuytren contracture have Peyronie disease.4
  • Aponeurotic plantar fibrosis (ie, Ledderhose disease) may be found.
  • Peyronie disease is associated with sporadic and familial knuckle pads, which are circumscribed fibromatous thickenings overlying the finger joints.
  • Systemic sclerosis has been seen with Peyronie disease.5
  • Occasionally, Peyronie disease is associated with fibromatous degeneration of the external ear cartilage.
  • Antielastin antibodies, anti-DNA antibodies, and elevated antinuclear antibody (ANA) levels have been found in association with Peyronie disease.6
  • Peyronie disease itself is not associated with penile fracture.

More on Peyronie Disease

Overview: Peyronie Disease
Differential Diagnoses & Workup: Peyronie Disease
Treatment & Medication: Peyronie Disease
Follow-up: Peyronie Disease
Multimedia: Peyronie Disease
References
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References

  1. Devine CJ Jr, Somers KD, Jordan SG, Schlossberg SM. Proposal: trauma as the cause of the Peyronie's lesion. J Urol. Jan 1997;157(1):285-90. [Medline].

  2. Lucattelli M, Lunghi B, Fineschi S, et al. A new mouse model of Peyronie's disease: an increased expression of hypoxia-inducible factor-1 target genes during the development of penile changes. Int J Biochem Cell Biol. 2008;40(11):2638-48. [Medline].

  3. Nachtsheim DA, Rearden A. Peyronie's disease is associated with an HLA class II antigen, HLA-DQ5, implying an autoimmune etiology. J Urol. Oct 1996;156(4):1330-4. [Medline].

  4. Nyberg LM Jr, Bias WB, Hochberg MC, Walsh PC. Identification of an inherited form of Peyronie's disease with autosomal dominant inheritance and association with Dupuytren's contracture and histocompatibility B7 cross-reacting antigens. J Urol. Jul 1982;128(1):48-51. [Medline].

  5. Gualdieri L, Valentini G, Lupoli S, Giordano M. Peyronie's disease in systemic sclerosis. Report of two cases. J Rheumatol. Feb 1988;15(2):380-1. [Medline].

  6. Stewart S, Malto M, Sandberg L, Colburn KK. Increased serum levels of anti-elastin antibodies in patients with Peyronie's disease. J Urol. Jul 1994;152(1):105-6. [Medline].

  7. Hricak H, Marotti M, Gilbert TJ, et al. Normal penile anatomy and abnormal penile conditions: evaluation with MR imaging. Radiology. Dec 1988;169(3):683-90. [Medline].

  8. Erdogru T, Boz A, Koksal T, et al. Penile scintigraphy with 99mTc-human immunoglobulin G: a novel method for distinguishing the unstable and stable phases of Peyronie's disease. BJU Int. Nov 2002;90(7):703-6. [Medline].

  9. Waldhauser M, Schramek P. Efficiency and side effects of prostaglandin E1 in the treatment of erectile dysfunction. J Urol. Sep 1988;140(3):525-7. [Medline].

  10. Auxilium Pharmaceuticals. Xiaflex.com. Xiaflex.com. Available at http://www.xiaflex.com/docs/pi_medguide_combo.pdf. Accessed February 3, 2010.

  11. Safarinejad MR, Asgari MA, Hosseini SY, Dadkhah F. A double-blind placebo-controlled study of the efficacy and safety of pentoxifylline in early chronic Peyronie's disease. BJU Int. Oct 26 2009;[Medline].

  12. Biagiotti G, Cavallini G. Acetyl-L-carnitine vs tamoxifen in the oral therapy of Peyronie's disease: a preliminary report. BJU Int. Jul 2001;88(1):63-7. [Medline].

  13. Di Stasi SM, Giannantoni A, Stephen RL, et al. A prospective, randomized study using transdermal electromotive administration of verapamil and dexamethasone for Peyronie's disease. J Urol. Apr 2004;171(4):1605-8. [Medline].

  14. Levine LA, Merrick PF, Lee RC. Intralesional verapamil injection for the treatment of Peyronie's disease. J Urol. Jun 1994;151(6):1522-4. [Medline].

  15. Levine LA, Goldman KE, Greenfield JM. Experience with intraplaque injection of verapamil for Peyronie's disease. J Urol. Aug 2002;168(2):621-5; discussion 625-6. [Medline].

  16. Ahuja S, Bivalacqua TJ, Case J, Vincent M, Sikka SC, Hellstrom WJ. A pilot study demonstrating clinical benefit from intralesional interferon alpha 2B in the treatment of Peyronie's disease. J Androl. Jul-Aug 1999;20(4):444-8. [Medline].

  17. Dang G, Matern R, Bivalacqua TJ, Sikka S, Hellstrom WJ. Intralesional interferon-alpha-2B injections for the treatment of Peyronie's disease. South Med J. Jan 2004;97(1):42-6. [Medline].

  18. Polat O, Gul O, Ozbey I, Ozdikici M, Bayraktar Y. Peyronie's disease: intralesional treatment with interferon alpha-2A and evaluation of the results by magnetic resonance imaging. Int Urol Nephrol. 1997;29(4):465-71. [Medline].

  19. [Guideline] Montague DK, Jarow JP, Broderick GA, et al. Erectile Dysfunction Guideline Update Panel. The management of erectile dysfunction: an update. National Guideline Clearinghouse. May 2006.

  20. Montorsi F, Salonia A, Guazzoni G, et al. Transdermal electromotive multi-drug administration for Peyronie's disease: preliminary results. J Androl. Jan-Feb 2000;21(1):85-90. [Medline].

  21. Morgan RJ, Pryor JP. Procarbazine (Natulan) in the treatment of Peyronie's disease. Br J Urol. Apr 1978;50(2):111-3. [Medline].

  22. Oosterlinck W, Renders G. Treatment of Peyronie's disease with procarbazine. Br J Urol. Apr 1975;47(2):219-20. [Medline].

  23. Hauck EW, Altinkilic BM, Ludwig M, et al. Extracorporal shock wave therapy in the treatment of Peyronie's disease. First results of a case-controlled approach. Eur Urol. Dec 2000;38(6):663-9;discussion 670. [Medline].

  24. Husain J, Lynn NN, Jones DK, Collins GN, O'Reilly PH. Extracorporeal shock wave therapy in the management of Peyronie's disease: initial experience. BJU Int. Sep 2000;86(4):466-8. [Medline].

  25. Incrocci L, Hop WC, Seegenschmiedt HM. Radiotherapy for Peyronie's Disease: a European survey. Acta Oncol. 2008;47(6):1110-2. [Medline].

  26. Furlow WL, Swenson HE Jr, Lee RE. Peyronie's disease: a study of its natural history and treatment with orthovoltage radiotherapy. J Urol. Jul 1975;114(1):69-71. [Medline].

  27. Trussell JC, Brien JC. Straightening out Peyronie's: a medical and surgical approach to the patient. Can J Urol. Jun 2008;15(3):4047-55. [Medline].

  28. Devine CJ Jr, Horton CE. Surgical treatment of Peyronie's disease with a dermal graff. J Urol. Jan 1974;111(1):44-9. [Medline].

  29. Gangai MP, Rivera LR, Spence CR. Peyronie's plaque: excision and graft versus incision and stent. J Urol. Jan 1982;127(1):55-6. [Medline].

  30. Wild RM, Devine CJ Jr, Horton CE. Dermal graft repair of Peyronie's disease: survey of 50 patients. J Urol. Jan 1979;121(1):47-50. [Medline].

  31. Knoll LD, Furlow WL, Benson RC Jr. Management of Peyronie disease by implantation of inflatable penile prosthesis. Urology. Nov 1990;36(5):406-9. [Medline].

  32. Fournier GR Jr, Lue TF, Tanagho EA. Peyronie's plaque: surgical treatment with the carbon dioxide laser and a deep dorsal vein patch graft. J Urol. May 1993;149(5 Pt 2):1321-5. [Medline].

  33. Zarafonetis CJ, Horrax TM. Treatment of Peyronie's disease with potassium para-aminobenzoate (potaba). J Urol. Jun 1959;81(6):770-2. [Medline].

  34. Akkus E, Carrier S, Rehman J, Breza J, Kadioglu A, Lue TF. Is colchicine effective in Peyronie's disease? A pilot study. Urology. Aug 1994;44(2):291-5. [Medline].

  35. Ralph DJ, Brooks MD, Bottazzo GF, Pryor JP. The treatment of Peyronie's disease with tamoxifen. Br J Urol. Dec 1992;70(6):648-51. [Medline].

  36. Bruschini H, Mitre AI. Peyronie disease: surgical treatment with muscular aponeurosis. Urology. May 1979;13(5):505-6. [Medline].

  37. Bruskewitz R, Raz S. Surgical considerations in treatment of Peyronie disease. Urology. Feb 1980;15(2):134-6. [Medline].

  38. Bystrom J, Alfthan O, Johansson B, Korlof B. Induratio penis plastica (Peyronie's disease). Results after excision and dermo-fat grafting. Scand J Plast Reconstr Surg. 1973;7(2):137-40. [Medline].

  39. Campbell MF, Retik AB, Vaughan E, Walsh PC, eds. Campbell's Urology. 7th ed. Philadelphia, Pa: WB Saunders; 1997.

  40. Cavallini G. Towards an evidence-based understanding of Peyronie's disease. Int J STD AIDS. Mar 2005;16(3):187-94; quiz 94-5. [Medline].

  41. Colletta AA, Wakefield LM, Howell FV, et al. Anti-oestrogens induce the secretion of active transforming growth factor beta from human fetal fibroblasts. Br J Cancer. Sep 1990;62(3):405-9. [Medline].

  42. Cotran RS, Collins T, Robbins SL, eds. Robbins' Pathologic Basis of Disease. 6th ed. Philadelphia, Pa: WB Saunders; 1998.

  43. Das S. Peyronie's disease: excision and autografting with tunica vaginalis. J Urol. Dec 1980;124(6):818-9. [Medline].

  44. Devine CJ Jr, Somers KD, Wright GL. A working model for the genesis of Peyronie's disease derived from its pathobiology. J Urol. 1998;19:495.

  45. Devine CJ, Jordan GH, Somers JD. Peyronie's disease: Cause and surgical treatment. AUA Today. 1989;2.

  46. Fitkin J, Ho GT. Peyronie's disease: current management. Am Fam Physician. Aug 1999;60(2):549-52, 554. [Medline].

  47. Frank IN, Scott WW. The ultrasonic treatment of Peyronie's disease. J Urol. Dec 1971;106(6):83-7. [Medline].

  48. Geertsen UA, Brok KE, Andersen B, Nielsen HV. Peyronie curvature treated by plication of the penile fasciae. Br J Urol. May 1996;77(5):733-5. [Medline].

  49. Gelbard MK, Dorey F, James K. The natural history of Peyronie's disease. J Urol. Dec 1990;144(6):1376-9. [Medline].

  50. Gelbard MK, James K, Riach P, Dorey F. Collagenase versus placebo in the treatment of Peyronie's disease: a double-blind study. J Urol. Jan 1993;149(1):56-8. [Medline].

  51. Gelbard MK, Lindner A, Kaufman JJ. The use of collagenase in the treatment of Peyronie's disease. J Urol. Aug 1985;134(2):280-3. [Medline].

  52. Gholami SS, Lue TF. Peyronie's disease. Urol Clin North Am. May 2001;28(2):377-90. [Medline].

  53. Goodwin RA Jr, Shapiro JL, Thurman GH, Thurman SS, Des Prez RM. Disseminated histoplasmosis: clinical and pathologic correlations. Medicine (Baltimore). Jan 1980;59(1):1-33. [Medline].

  54. Hauck EW, Weidner W. François de la Peyronie and the disease named after him. Lancet. Jun 23 2001;357(9273):2049-51. [Medline].

  55. Horrax TM. Presented at: American Urological Association's Annual Meeting. In: Peyronie's disease, scientific exhibit. 1965:New Orleans, La.

  56. Kelâmi A. Treatment of morbus Peyronie--how I do it? Twenty years of experience. Int Urol Nephrol. 1991;23(6):589-93. [Medline].

  57. Levine LA, Lenting EL. A surgical algorithm for the treatment of Peyronie's disease. J Urol. Dec 1997;158(6):2149-52. [Medline].

  58. Lindsay MB, Schain DM, Grambsch P, Benson RC, Beard CM, Kurland LT. The incidence of Peyronie's disease in Rochester, Minnesota, 1950 through 1984. J Urol. Oct 1991;146(4):1007-9. [Medline].

  59. Melman A, Holland TF. Evaluation of the dermal graft inlay technique for the surgical treatment of Peyronie's disease. J Urol. Oct 1978;120(4):421-2. [Medline].

  60. Mosby's Drug Consult. 2001 Mosby's GenRx: A Comprehensive Reference for Generic and Brand Name Prescription Drugs. Available at http://www.genrx.com/Mosby/PhyGenRx/index.html.

  61. Nelson PF. Peyronie's disease. Dermis. 1982;1:13.

  62. Nesbit RM. Congenital curvature of the phallus: Report of three cases with description of corrective operation. J Urol. Feb 1965;93:230-2. [Medline].

  63. Norton SA. Fijian penis marbles: an example of artificial penile nodules. Cutis. Apr 1993;51(4):295-7. [Medline].

  64. Ralph DJ, Mirakian R, Pryor JP, Bottazzo GF. The immunological features of Peyronie's disease. J Urol. Jan 1996;155(1):159-62. [Medline].

  65. Raz S, Dekernion JB, Kaufman JJ. Surgical treatment of Peyronie's disease: a new approach. J Urol. May 1977;117(5):598-601. [Medline].

  66. Schiavino D, Sasso F, Nucera E, et al. Immunologic findings in Peyronie's disease: a controlled study. Urology. Nov 1997;50(5):764-8. [Medline].

  67. Scott WW, Scardino PL. A new concept in the treatment of Peyronie's disease. South Med J. 1948;41:173.

  68. Walsh PC, Stamey TA, Perlmutter AD, eds. Campbell's Urology. 5th ed. Philadelphia, Pa: WB Saunders; 1986.

  69. Weidner W, Schroeder-Printzen I, Weiske WH, Vosshenrich R. Sexual dysfunction in Peyronie's disease: an analysis of 222 patients without previous local plaque therapy. J Urol. Jan 1997;157(1):325-8. [Medline].

  70. Williams JL, Thomas GG. The natural history of Peyronie's disease. J Urol. Jan 1970;103(1):75-6. [Medline].

  71. Wooldridge WE. Four related fibrosing diseases. When you find one, look for another. Postgrad Med. Aug 1988;84(2):269-71, 274. [Medline].

  72. Zarafonetis CJ. Treatment of scleroderma. Ann Intern Med. Feb 1959;50(2):343-65. [Medline].

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Further Reading

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Keywords

Peyronie disease, PD, Peyronie's disease, plastic induration of the penis, penile fibromatosis, fibrous sclerosis of the penis, penile shaft thickening, painful erection, penile curvature, curved penis

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Contributor Information and Disclosures

Author

Jay W Zimmerman, MD, FAAD, Consulting Physician, Berman Skin Institute, Palo Alto
Jay W Zimmerman, MD, FAAD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, and California Medical Association
Disclosure: Allergan Consulting fee Consulting; Centocor Consulting fee Consulting; Galderma Consulting fee Consulting

Coauthor(s)

Anne Laumann, MB, ChB, MRCP(UK), FAAD, Associate Professor, Department of Dermatology, Feinberg School of Medicine, Northwestern University
Anne Laumann, MB, ChB, MRCP(UK), FAAD is a member of the following medical societies: American Academy of Dermatology, Association of Professors of Dermatology, Chicago Dermatological Society, Chicago Medical Society, Illinois Dermatological Society, Illinois State Medical Society, Illinois State Medical Society, Medical Dermatology Society, and Society for Investigative Dermatology
Disclosure: Boerhinger-Ingelheim Consulting fee Consulting; Pfizer Consulting fee Consulting; Astellas Consulting fee Consulting; Alza J and J Grant/research funds Other; Amgen Grant/research funds Other; Basilea Grant/research funds Other; OSI Pharmaceuticals  Other; Centocor Grant/research funds Other; Lilly-ICOS Grant/research funds Other; Bavarian Nordic Grant/research funds Other

Gregory Bales, MD, Associate Professor, Department of Surgery, Section of Urology, University of Chicago
Gregory Bales, MD is a member of the following medical societies: American Urological Association
Disclosure: Nothing to disclose.

Medical Editor

Terry L Barrett, MD, Clinical Professor of Dermatology and Pathology, University of Texas Southwestern School of Medicine; Director, ProPath Dermatopathology, Dallas, Texas
Terry L Barrett, MD is a member of the following medical societies: American Academy of Dermatology, American Dermatological Association, American Medical Association, American Society of Dermatopathology, College of American Pathologists, and United States and Canadian Academy of Pathology
Disclosure: Nothing to disclose.

Pharmacy Editor

David F Butler, MD, Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic
David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Managing Editor

Jeffrey P Callen, MD, Professor of Medicine, Chief, Division of Dermatology, University of Louisville School of Medicine
Jeffrey P Callen, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and American College of Rheumatology
Disclosure: Amgen Honoraria Consulting; Abbott Honoraria Consulting; Electrical Optical Sciences Honoraria Consulting; Centocor Honoraria Consulting; Medicis Honoraria Consulting; Celgene Honoraria Consulting

CME Editor

Catherine M Quirk, MD, Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania
Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology
Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
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