The disorder is characterized by the formation of fibrous plaques (sclerostenosis) in the penile tunica albuginea. Plaques cause painful and curved erection, which in neglected cases makes sexual intercourse roughly difficult or even impossible. Curvature can be simple (up/down/right/left) and complex (loop-shaped penis, curvature in the form of “sand glass”, etc.); narrowing, shortening of the penis are also possible.
Penile curvature does not pose a threat to the patient’s life, but significantly impairs the quality of life of men with high levels of sexual activity. In addition, curvature leads to mutual difficulties in the relationship of sexual partners, is a risk factor for the deterioration of the psychoemotional state of the couple (according to some reports, about 50 % of the patients with Peyronie’s disease show evidence for depression).
Two-thirds of patients with fibroplastic penile induration have risk factors for development of penile arterial dysfunction, and therefore, long-term deterioration of erectile function.
How does the disorder develop?
Peyronie’s disease is a progressive illness, and in the absence of treatment, the curvature gradually increases in 30-50% of cases. Disorder stabilization is observed in about 47-67% of cases. Spontaneous healing in case of penile curvature is not common and is observed in less than 13% of cases. In case of curvature improvement typically takes place in the early stage of the ailment, but not in advanced stage, when the plaque is already formed and calcified (i.e. hardened).
There are three stages in the course of the ailment: subclinical, acute (inflammatory), chronic.
The subclinical stage is the period from the beginning of abnormal changes in the penile tunica albuginea of the cavernous bodies till the appearance of clinical symptoms (pain, curvature).
During the acute stage, pain in the penis and the progression of the curvature can be observed. Generally, at this stage of the disorder, there is an inflammatory component that causes painful erection. Pain concerns 35-45 % of patients during the acute stage of impairment.
In the majority of patients (in 90% of cases), the pain passes spontaneously within 6-18 months from the onset of the illness, which indicates chronification of the ailment. Penile curvature is set.
The chronic stage of Peyronie’s disease can be divided into sub-stages:
- — the stage of stabilization (pain gradually passes, curved erection ceases to progress;
- — regression of symptoms (since pain is fully relieved and progression of penile curvature is ceased);
- — the stage of exacerbation (transition of the chronic stage back to acute (inflammatory) stage as a consequence of the disorders progression and/or lack of appropriate non-surgical treatment).
Fibroplastic penile induration is often associated with erectile dysfunction, and often develops on the background of other associated disorders: diabetes mellitus, hypertension, atherosclerosis, gout, low testosterone, etc. Possible risk factors are also smoking, alcohol abuse, injuries and penile surgeries.
How common is Peyronie’s disease?
Fibroplastic penile induration is a fairly common condition among middle-aged men, and its morbidity increases with age. According to recent studies, the illness occurs in 3-9 % of the adult male population.
How to treat Peyronie’s disease?
To this day many surgeons, urologists wrongly assume that Peyronie’s disease cannot be effectively treated, and therefore, mark it as a hopeless case, when patients cannot be helped and treatment is just a waste of time and effort.
At the same time, today there are effective methods of both active (surgical) treatment and non-surgical treatment. In both cases, the main task of therapy is to restore the ability to have sexual intercourse by reducing the curvature, improving the erectile function.
Thus, if the patient is sexually passive and is not going to change his mind, active (surgical) treatment is inexpedient and pointless.
Non-surgical treatment includes a variety of drug therapy and physiotherapy and is prescribed to patients with Peyronie’s disease both in the active acute (inflammatory) stage of the illness for therapeutic purposes, and in the stabilization stage to prevent relapse or progression of penile curvature.
A qualified urologist is responsible for mapping out the Peyronie’s disease treatment strategy (surgical or non-surgical). A urologist decides on treatment methods in accordance with cumulative data on the individual characteristics of the disorder course and the condition of a specific patient.