Peyronies Disease

Dr MJ EngelbrechtDept. Urology

University of Pretoria

Definition

Described by Francois Gigot de la Peyronie in 1743Also known as induratio penis plasticaFibrotic induration of the penis with concurrent curvature

Clinical presentation

Peak incidence4th to 6th decades

Pain and penile curvature during erectionDifficult intercourseImpotence in some casesA hard fibrotic mass is felt on palpation

Clinical presentation

Clinical presentation

Etiology

Fibrosing condition of the tunica albuginea Repetative microtrauma is most probably the inciting eventDupuytrans contracture has been associated with PD

Always examine the handsPossible genetic aetiology

Etiology

Clinical course

Most cases is self limitingDevided into acute and chronic phaseIn the acute phase

PainWorsening of the deformityEnlargement of the plaque12 to 18 months duration

Chronic phaseNo painStable deformity

Treatment

MedicalUsually during the acute phaseOral therapy

Vitamin EPotassium para-amino benzoateColchicineTamoxifenPentoxifylline

Treatment

Transdermal therapiesVerapamil

IntralesionalVerapamilINF alpha 2 betaSalineIntralesional therapies not for cure, but more for prevention of progression

Other therapiesESWL

Surgical treatment

Reserved for patients with PD for at least 12 months (chronic phase) and a stable deformity for at least 3 months3 groups of surgery

Penile shorteningPenile lengtheningPenile prostesis

Surgical Treatment

ED+ -

Penile Prostesis Normal length< 30 degrees

Short penis> 45 degrees

Penile shortening procedure

Penile lengtheningprocedure

Nesbit Graft

Surgical treatment

Penile Shortening (Nesbit Plication)

Surgical treatment

Penile prostesis