Peyronie's Disease: Pathophysiology and Treatment

Peyronie's Disease: Pathophysiology and Treatment combines the basic research of Peyronie’s Disease with an overview of the clinical and practical management of the disease, providing the most comprehensive approach. Coverage includes etiology and psychological aspects of the disease, management according to European and US guidelines for both surgical and non-surgical treatments, and oral therapies and on-going research including stem cells. This book is perfect for urologists—particularly those who specialize in sexual medicine and/or infertility—and for Andrologists and Endocrinologists.

• Provides a clear understanding of the underlying pathological mechanisms present in Peyronie’s Disease
• Translates current research in the field into actionable items for a better understanding of the clinical aspects of Peyronie’s Disease
• Combines knowledge from the perspectives of Urologists, Andrologists and Endocrinologists, giving a comprehensive overview of Peyronie’s Disease

• Language: English
• Publisher: Academic Press
• Release date: May 13, 2020
• ISBN: 9780128205754

Book preview

Allen

Chapter 1

Introduction

Andrea Cocci¹ and Giorgio Ivan Russo²,    ¹Department of Urology, University of Florence, Florence, Italy,    ²Urology Section, University of Catania, Catania, Italy

Abstract

Peyronie’s disease (PD) is a common disorder that results in penile deformity making sexual intercourse difficult or impossible. PD typically affects men in their 50s and has an incidence of 3%–9%. This condition results from a fibrotic process of the tunica albuginea, developed into two phases, acute and chronic. During the initial acute inflammatory phase, the plaque starts to form and the curvature becomes evident, often accompanied by pain, particularly during erection. These deformities include penile curvature, penile length loss, narrowing and sometimes a variable degree of erectile dysfunction (ED). PD can be associated with significant psychological distress and bother, including emotional efforts and relationship with the partner. Symptoms associated with both acute and chronic phases of PD have been reported to potentially interfere with patients’ sexual function, leading to serious psychological distress that means that the Peyronie’s disease is a couple disease. The etiology of PD is still not clear, but it is believed that the primary predisposing factor can be trauma or microtrauma during sexual intercourse in genetically susceptible patients. The therapeutic options of stable PD are different, including pharmacologic and surgical approaches, based on the severity of penile curvature and symptoms associated.

Keywords

Peyronie’s disease; Erectile dysfunction; Penile; Psycho-sexual therapy; Common disorder; Etiology

Peyronie’s disease (PD) is a common disorder that results in penile deformity making sexual intercourse difficult or impossible. PD typically affects men in their 50s and has an incidence of 3%–9%. This condition results from a fibrotic process of the tunica albuginea, developed into two phases, acute and chronic. During the initial acute inflammatory phase, the plaque starts to form and the curvature becomes evident, often accompanied by pain, particularly during erection. These deformities include penile curvature, penile length loss, narrowing and sometimes a variable degree of erectile dysfunction (ED). PD can be associated with significant psychological distress and bother, including emotional efforts and relationship with the partner. Symptoms associated with both acute and chronic phases of PD have been reported to potentially interfere with patients’ sexual function, leading to serious psychological distress that means that the Peyronie’s disease is a couple disease. The etiology of PD is still not clear, but it is believed that the primary predisposing factor can be trauma or microtrauma during sexual intercourse in genetically susceptible patients. The therapeutic options of stable PD are different, including pharmacologic and surgical approaches, based on the severity of penile curvature and symptoms associated.

The present book collects the experiences of the most knowledgeable urologists and experts on Peyronie’s disease around the world. It analyzes the correct approach to the disease according to the indications of the different guidelines available, and the different therapies – physical, pharmacological and surgical– going through psycho-sexual therapy too. Finally, this book examines the most recent researches on this topic and the possible therapies that will be available in the near future. This book can be a valuable guide for all the clinicians that want to have a complete view of the disease, in order to provide patients with the best possible treatment.

Chapter 2

Epidemiology and etiology

Marina di Mauro¹, Andrea Cocci² and Giorgio Ivan Russo¹,    ¹Urology Section, University of Catania, Catania, Italy,    ²Department of Urology, University of Florence, Florence, Italy

Abstract

The peak incidence of Peyronie’s disease is between the ages of 45 and 60 years Mulhall et al. reported in the literature review of more than 1500 patients with PD and the mean reported age at disease presentation was 53.5 years. Despite the incidence is higher in older men, PD can affect men of all ages, from teenagers to men over 70 years old. Once thought to be rare, it is estimated that PD is present in around 0.3%–13.1% men around the world. The prevalence may increase further in certain sub-populations, like men operated for radical prostatectomy which the prevalence of PD in is up to 16% or diabetic patients. An association with Dupuytren’s disease (DD), fibro proliferative condition of the palmar fascias in the hand, typically resulting in progressive contracture of one or more fingers, is also well acknowledged. The association between PD and DD was first recognized in 1828 and reported by Abernethy. The etiology of PD is unknown but realistically involves abnormal wound healing and development of fibrotic plaque. In this chapter we illustrate epidemiology and etiology of Peyronie’s disease

Keywords

Peyronie’s disease; Etiology; Pathogenesis; Inflammation; Autoimmune theory; Oxidative damage

The peak incidence of Peyronie’s disease is between the ages of 45 and 60 years [1] Mulhall et al. reported in the literature review of more than 1500 patients with PD and the mean reported age at disease presentation was 53.5 years [2]. Despite the incidence is higher in older men, PD can affect men of all ages, from teenagers to men over 70 years old [1,3]. Once thought to be rare, it is estimated that PD is present in around 0.3%–13.1% men around the world. The prevalence may increase further in certain sub-populations, like men operated for radical prostatectomy which the prevalence of PD in is up to 16% [4] or diabetic patients [5]. An association with Dupuytren’s disease (DD), fibro proliferative condition of the palmar fascias in the hand, typically resulting in progressive contracture of one or more fingers, is also well acknowledged [6,7]. The association between PD and DD was first recognized in 1828 and reported by Abernethy [8]. DD is thought to be the most common hereditary connective tissue disorder in Caucasians and according to the literature there is a 3–15% chance that a man with DD will have PD [9,10]. Nugteren et al. [11] conducted a single-center study in Dutch, which shown that in PD patients coexisting DD in 20% of cases [11].

Various studies have hypothesized that PD remains underdiagnosed for psychological implications in the disease and for the patient’s reticence. Many data are available regarding the prevalence of PD in the scientific literature and the rate of this may differ by age, geographic location, comorbidities, and socioeconomic status of the population examined. The prevalence of PD is between 0.4% and 3.2% of men in the United States [3,4,12]. In a Japanese study in 2012, there is a rate of 0.6% of men who reported to be affected by PD [13]. In a survey study of Italian men, a higher percentage of PD was found equal to 7.1% [14]. In Germany the prevalence rate was investigated, and 8000 men were interviewed of which 3.2% reported having a palpable plaque. Schwarzer et al. [3] analyzed the increase in the prevalence of PD compared to age, with only 1.5% of men between the ages of 30 and 39 reporting PD against 6.5% of men of 70 years [11890244]. Levine et al. [15] investigated the characteristic features of young men with PD and reported that only 7% of the patients had severe deformities [15]. Similarly, Kadioglu et al. [16] provided strong evidence that aging was a positive predictive factor on the severity of the penile deformity [16].

After the introduction of Clostridium Histolyticum Collagenase (CCH) on the market, a minimally invasive treatment, the prevalence of PD was expected to increase. A recent study by Sun et al. [17] shows that the prevalence of PD has remained at about 0.3% before and after the release of CCH in market. Their prevalence of 0.3% is lower compared to recently published estimates, although they are close to 0.5% prevalence reported in studies by Dibenedetti et al. [4] and Arafa et al. [4,5]. Furthermore, the results of this study also show that the prevalence of PD increases with age of 0.48% in the age group between 60 and 69 years. However, the prevalence in patients over the age of 70 has decreased [17]. Congenital curvature is rare: indeed one well-performed study reports an incidence of less than 1% [18].

Etiology

The etiology of PD is unknown but realistically involves abnormal wound healing and development of fibrotic plaque [19]. Penile trauma is considered to be a major causative factor [20] and it might be caused by conditions like accidents or surgical procedure, or it may be due to repetitive microtrauma during coitus, but a history of remembered penile trauma is reported by only about 10% of patients with Peyronie’s disease [21], generally younger patients. Scanning electron microscopy evaluation of PD plaques shows an alteration of the normal collagen architecture within the tunic, with excessive deposition of collagen I and III and disordered fibrin and elastic fibers. The deposition of scar tissue inside the albuginea tunic reduces its elasticity, subsequently limiting the normal lengthening and causing the curvature of the penis