Peyronie’s Disease

Definition/diagnostic criteria Peyronie’s disease is a condition characterised by the formation of fibrous plaques within the penile shaft, leading to penile curvature, painful erections and erectile dysfunction. The disease typically affects men aged 40-70. Diagnostic criteria include the palpable presence of plaques on the penile shaft, penile curvature during erection and associated pain.

Epidemiology The prevalence of Peyronie’s disease in the UK is estimated to range from 3-9% of the male population, with an increased incidence in older age groups. The condition is underreported, and actual prevalence may be higher. There is no clear racial or ethnic predilection.

Diagnosis
Clinical features: Patients typically present with penile pain, palpable penile plaques and curvature of the penis during erection. The disease can also cause psychological distress and impact sexual function.

Investigations: The diagnosis is primarily clinical, based on patient history and physical examination. Ultrasonography may be used to assess the presence and extent of plaques, and to evaluate penile vasculature, particularly if surgical intervention is being considered. The International Index of Erectile Function (IIEF) questionnaire can be utilised to assess erectile function.

Treatment The treatment of Peyronie’s disease is tailored to the stage of the disease and severity of symptoms.

Non-surgical management: This is generally preferred in the early, acute phase of the disease and includes oral agents such as pentoxifylline and vitamin E, although evidence for their efficacy is limited. Intralesional injections of collagenase clostridium histolyticum have been tried, but again the evidence base is not strong.

Surgical management: Indicated in the stable phase of the disease with significant penile curvature or erectile dysfunction not responsive to medical therapy. Options include plaque incision or excision with grafting, and penile prosthesis implantation for those with concomitant erectile dysfunction.

Prognosis The natural history of Peyronie’s disease is variable. Some men experience spontaneous improvement, while others progress to severe penile deformity and erectile dysfunction. The psychological impact of the disease can be significant, and referral to a counsellor or psychosexual therapist may be beneficial. Surgical intervention generally provides good outcomes in terms of straightening the penis and improving sexual function.