Peyronie's disease was first described in 1704. It is named for Francois de la Peyronie, who, in 1743, described a patient who had "rosary beads of scar tissue to cause an upward curvature of the penis during erection." The penile curvature of Peyronie's disease is caused by an inelastic scar, or plaque, that shortens the involved aspect of the tunica albuginea of the corpora cavernosa during erection.1,2 In approximately one third of patients, the scarring involves the dorsal and ventral aspects of the shaft. Such offsetting plaques may cause the penis to be straight but shortened or to have a lateral bend (Figure 1). The circumference of the shaft may also be reduced, resulting in an erect penis that is flail at the site of the constriction, firm proximal to the constriction and soft distally.3
The first symptom of Peyronie's disease may be focal pain with erection, new curvature with erection or inability to penetrate as a result of curvature or distal flaccidity.3,4 Some patients who do not have pain with erection have tenderness on palpation of the indurated plaque.
A number of authors believe that Peyronie's disease results, in part, from trauma.5-7 More than 75 percent of patients with Peyronie's disease are between 45 and 65 years of age, when elasticity of the collagen of the penis has diminished.5 Many patients recall an episode of penile trauma, such as an invasive procedure, blunt trauma or injury during intercourse, at the site of subsequent plaque formation. Up to 47 percent of patients with Peyronie's disease also had another condition associated with loss of elasticity, such as Dupuytren's contracture or Ledderhose's disease (fibrosis of the palmar and plantar fascias, respectively).8-11 Some authors5,12 suggest that either a single episode or recurrent episodes of flexion of the tunica albuginea may result in tears that bleed and form a clot, with subsequent fibrin deposition. Biopsy may demonstrate fibrin deposition and perivascular inflammation underlying the tunica albuginea and, occasionally, within and beneath Buck's fascia overlying the plaque.5
During the first year or so after formation of the plaque, while the scar in the tunica is undergoing the process of remodeling, penile distortion may increase, remain static or, as is most often the case in younger men, resolve and disappear spontaneously.3-5 In most patients the curvature remains static as the scar matures although, in some patients, it becomes worse as fibrosis ensues and the scar contracts. In 25 percent of these patients the scarring process progresses to calcification, and in 25 percent of those it progresses to bone formation.3,5
After the scar has matured, the configuration of the tunica albuginea is unlikely to be changed by nonsurgical treatments.4 However, many patients with advanced disease who have not sought surgical correction have been able to continue mutually satisfactory sexual intercourse with a partner. Approximately one third of patients with end-stage disease have a disabling curvature that requires surgical correction.
Pain that occurs in conjunction with Peyronie's disease may also progress with the onset of new injuries to the corpora cavernosa occurring as a direct result of the patient's attempts to correct or compensate for the original defect during sexual intercourse.5 One of the more common reasons for seeking treatment involves discomfort of the patient's partner during intercourse, which is associated with penile curvature.
Peyronies Diagnosis
The disease typically has a slow onset, and most men cannot identify a precipitating factor. Several theories exist as to the cause of Peyronie's disease; the most commonly accepted theory is that minor trauma during intercourse leads to minor tears in the tunica or rupture of small blood vessels. Bleeding and abnormal healing occurs after this injury and produces the plaque. In some men, there is a family history of Peyronie's disease, and 16% to 20% of men with Peyronie's have a disease called Dupuytren's contractures. Dupuytren's contractures is an inherited condition that causes contractures in the hands that pull the affected fingers inward. An increased incidence of arterial disease (30%) and diabetes with its associated small arterial disease (2.7% - 12%) has also been noted in men with Peyronie's disease.
The natural history of Peyronie's disease is variable. The disease is thought to have two phases: the acute phase, which usually lasts up to 18 months and is associated with pain, penile curvature, and plaque formation, and a more chronic phase, in which there is minimal or no pain, a palpable plaque, and residual penile curvature. Over time, the disease may progress in about 42% of men, improve in 13%, and remain the same in about 45%. In many cases, the disease produces few symptoms, the curvature does not prevent sexual performance, and there is no pain or associated erectile dysfunction. In such cases, reassurance that there is nothing bad going on is often all that is necessary.
Evaluating your Peyronie's disease?
As with any initial presentation, the evaluation of Peyronie's disease starts with a history of symptoms: duration and presence of pain; current erectile status and erectile status before the onset of the Peyronie's disease; whether symptoms are stable, progressing, or regressing; and degree of penile curvature and its effect on sexual function. The physician will ask about a history of prior penile trauma or manipulation.
Because the penile abnormality has a classic presentation and most men are able to accurately describe the symptoms, little investigation is needed initially. After the history is elicited, an examination will be performed. Examination of the hands will be performed to look for Dupuytren's contractures. Examination of the penis includes assessment of penile length and girth and palpation for penile plaques. In most cases, the physician will ask the man to bring in either a Polaroid photograph or digital picture of his erect penis to demonstrate the degree and the location of the curvature. If the patient is unable to obtain a photograph, the physician may induce an erection in the office by injecting a chemical that causes an erection in order to allow the physician to locate the area of curvature and to assess the degree of curvature. If the man has erectile dysfunction in addition to the penile curvature, further studies are needed to assess the cause of the erectile dysfunction.
Erectile dysfunction is found in about 19% of men with Peyronie's disease. The erectile dysfunction in Peyronies disease may be the result of:
·performance anxiety;
·the penile deformity preventing intercourse;
·a flail penis, whereby extensive Peyronies disease causes scarring in a segment of the penis that therefore does not become rigid, while the remainder is able to become rigid;
·an impaired erection, which may be related to concomitant arterial disease (36%) or veno-occlusive disease (59%)
Enzyme Therapy, a new approach to Peyronies Disease?
The definition of enzyme therapy is when a proteolytic enzyme or systemic is present in an enzyme formulation dissolution of fibrin occurs. Over time these enzymes can actually digest unwanted scar tissue. Many diseases in humans are associated with inflammatory reactions and scarring. Because both these conditions can be corrected by enzyme therapy there is great potential for improving health using systemic enzyme therapy. Among the conditions enzymes help are:
·Arteriosclerosis Excessive clotting and inflammation are routine in the developing arterial plaques. Enzyme therapy digests the fibrin and reverses the inflammation which results in decreasing the size of the artery obstructing plaques. Symptoms of angina, impaired blood flow to the brain, and poor circulation to the legs often disappear..
·Painful Conditions (Trauma) Enzymes can block the release of pain producing amines from tissues that are becoming inflammed. This means that early use of large doses of enzymes in broken bones, dislocated joints, sunburn, dental extractions, injuries, and migraine headaches have the capability of preventing swelling and pain from appearing.
·Keloids, some individuals develop greatly enlarged unsightly scars which can be prevented and dissolved with enzymes.
·Arthritic Diseases All joint diseases manifest swelling and pain. (osteoarthritis, rheumatoid arthritis, bursitis) which enzymes can alleviate. Systemic lupus erythematosus has circulating immune complexes and scleroderma has extensive scarring both of which respond to enzymes. Fibromyalgia patients have recovered using enzymes probably because of improving blood flow in the painful areas..
·Arteriosclerosis Inflammation plays a key role in causing artery plaques to appear. There is also a tendency to excessive clotting. Both these problems can be reversed by systemic enzymes permitting the existing plaques to slowly disappear with disappearance of symptoms (angina, exertional leg pain, brain dysfunction from poor blood flow).
