Peyronie disease

Questionnaire

Peyronie disease

Peyronie’s disease (or Induratio penis plastica) involves the growth of fibrous plaques in the soft tissue –  i.e. the tunica albuginea – of the penis. The tunica is affected mainly in it’s dorsal and ventral surface.nosos peyronie

The plates cause bending of the erect penis, while in more severe cases, the bending can occur in relaxation. The final state of the disease is the calcification of plaque.

The disease got its name from the French Gigot de la Peyronie, surgeon of Louis XV in 1743, while historically the first described incident was in Fallopius in 1561.

The disease affects mainly men aged 40 to 70 years, on a ratio range of 0.39 to 3.2% in general population.

CAUSES

Disease’s aetiology is not completely known.

Possible incriminating factors, include:

– minor injury during sexual intercourse;

– micorbial factors;

– inflammation;

– autoimmune disorders;

– systemic vascular disease.

Transurethral Surgery

From the above, the most important cause of Peyronie diease appears to be trauma.

Thus, trauma or injury to the penis usually through sexual activity lead to fibrous tunic microtears and bleeding. As a result, liquid and fibrinogen is accumulated at the area while monocytes, macrophages and PLTs are activated, leading to cytokines and growth factors (PDGF-Α, PDGF-B, TGF-β1) release.

Subsequently, increased fibloblasts’ concentration along with increased synthesis and decreased cleavage of extracellular matrix result in the growth of fibrous plaques in the soft tissue of the penis and scar tissue formation in the tunica albuginea.

Clinical image

Symptoms may include:

-> Curvature of the penis;

-> Pain during erection;

-> Cord-like lesions of the penis;

-> Divots or indentations of the penis;

-> Penis increased sensitivity;

-> Loosen penis;

-> Erectile Dysfunction.

Erectile dysfunction in patients suffering from Peyronie’s disease may be due to:

-> Curvature of the penis;

-> Phycological factors;

-> Loosen penis;

-> Reduced blood flow.

Diagnosis

Α. History

-> Penis trauma;

-> Cord-like lesions of the penis;

-> Sexual behavior;

-> Painful erection;

-> Increase or decrease of penis’ size;

-> Vascular disease;

-> Drugs;

-> Family History (Peyronie disease, rheumatoid arthritis, Dupuytren disease).

Β. Clinical Exam

It is performed in both penis erectile and non-erectile state and the specialised urologist may locate:

-> number and position of penis’ fibrous plaques;

-> fibrous plaques’ hardness;

-> penis’ curvature;

-> penis’ length;

-> presence of pain or not during erection.

C. Imaging Methods

-> Colored doppler

-> Duplex Doppler Ultrasonography

-> X-ray

-> MRI

Σήμερα για τη διαγνωστική προσέγγιση της νόσου χρησιμοποιείται ερωτηματολόγιο, το οποίο απαρτίζεται από τρία (3) μέρη:

1. Ερωτήσεις σχετικές με τη νόσο Peyronie

2. Φυσική Εξέταση

3. Απεικονιστικός Έλεγχος

Εκτίμηση & παρακολούθηση ασθενών με νόσο Peyronie

Αξιολογούνται οι ακόλουθοι παράγοντες:

1. Πεϊκή κάμψη

2. Μέτρηση περιφέρειας

3. Μέγεθος της πλάκας

4. Στύση

5. Μήκος του πέους

6. Άλγος

ΔΙΑΦΟΡΙΚΗ ΔΙΑΓΝΩΣΗ

Πρέπει να γίνει από τις ακόλουθες καταστάσεις:

1. Νεόπλασμα

2. Σκληρυντική λεμφαγγειίτιδα

3. Θρομβωμένη φλέβα