Peyronie’s Disease

Peyronie’s disease, also called Induratio Penis Plastica, is an acquired fibrotic disorder of the tunica albuginea (the internal penile sheath delimiting the erectile tissue). The symptoms are penile pain in erection, penile deformity and mass, and in some men, erectile dysfunction. Also called Induratio Penis Plastica (IPP), its origin is unknown. It is progressive in its active stage, and the inflammation goes away after 12-18 months, leaving scars and deformities in the penis. The treatment focus on preventing the progression of the penile deformity in the active stage while, when the disease becomes inactive, it focuses on the curvature correction.

Natural history

We distinguish three stages of the disease: Early active, late active and inactive. The early (painful erection) and late active stage (onset and progression of penile curvature and plaque) usually last 12 to 18months. After that, the disease becomes inactive. In this stage, the penile curvature is stable and does not get worse (does not progress).

The active PD can resolve spontaneously, in a minority of cases, without or with minimal curvature and without any impact on sexual life. Others will have stable penile curvature. The treatment depends on the impact on the patient’s sexual life.

Symptoms

We distinguish symptoms of the early active stage, active late-stage and chronic stable-stage of the disease.

Symptoms of the early active stage

The first symptom is a painful erection. It can vary from minor and unremarkable to severe pain, impacting the ability to maintain an erection and the quality of the sexual life. Some patients avoid sexual intercourse because of pain. In this stage, the patient can feel a hard nodule commonly in the dorsal part of the penis. The penile curvature is minimal or absent.

Symptoms of the late active stage

The patient complains about nodule/plaque, indentation, curvature, deformity, shortening during erection and sexual dysfunction. These symptoms are usually progressive during the remaining active stage.

Symptoms of the inactive stage

The penile curvature, deformity or shortening becomes stable and will not progress. The resulting stable penile curvature might have no or severe impact on the patient’s sexual life because of curvature (impossible penetration) or erectile dysfunction related to the damage to the erectile mechanism.

Treatment

Treatment of Peyronie’s disease differs according to the disease’s stage. We distinguish between non-surgical and surgical treatment. Here is a detailed description of treatment options.

External resources

American Urological Association guidelines