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Was discovered by Francois de la Peyronie in 1743.

The penis consists of three tubes of tissue, one containing the urethra and two long tubes filled with spongy tissue, called corpora, which swell if engorged with blood, producing an erection. These two tubes are contained within a thick elastic membrane, called the tunica albuginea. In Peyronie’s disease, a plaque or scar develops in the tunica and restricts elasticity of the penis, so that with erection a deformity is seen with the penis curving towards the side of the plaque. A narrowing or constriction is often felt at the site. With erection the penis may rotate in a twisting fashion, the so-called corkscrew penis. I have seen rotation so severe that when the patient looked down on his erect penis, he was actually viewing the underside.

Besides producing curvature and constriction, this scar tissue plaque may interfere with erections. Often the patient’s erection will be firmer on the body side of the plaque and softer beyond the plaque. The plaque may not be felt when the penis is flaccid but is readily demonstrated with erection.

It is found most frequently on the topside of the penis (dorsal); next, on one side (lateral); and least frequently on the bottom (ventral). It may be bilateral or nearly circumferential, then producing not curvature, but shortening.

The plaque is usually hard, sometimes lumpy, and about 25% will have calcium. I have biopsied one rock-hard plaque that showed actual bone formation (ossification).

The condition usually occurs in men 30 to 50 years of age and has been reported in all races. It may present first with pain which seldom lasts longer than six months. The condition usually stabilizes by 12-18 months and occasionally will regress. Complete disappearance is probably rare.

When curvature is marked, the patient may find penetration awkward and difficult and thrusting may cause pain to his partner. When shortening is marked, he may have trouble remaining inside during copulation.

The combination of soft erections and penile distortion is often devastating, and patients can become seriously depressed.

Cause: The cause of Peyronie’s disease is unknown but is associated in some cases with a history of penile trauma, including rough sex. In around 10% of patients a concurrent deformity of the palm is seen, called Dupuytren’s contracture, where scar tissue forms beneath the skin and causes flexion contractures, where the finger is locked downward towards the palm. Rarely, the same deformity may occur in the sole. In some cases the disease appears to be familial, particularly in men of Scandinavian descent. I have seen a Peyronie’s patient from a Swedish family whose father, brothers, uncles and male cousins all had the condition in the penis, palms and soles.

Diagnosis: By examining the erect penis, the diagnosis can be made. The mature plaque(s) can usually be seen on plain X-ray even when not calcified or ossified. CT and MRI scans are seldom necessary.

Treatment:

1. Incipent state:
   • Mild Curvature with good erections – no treatment is needed unless the patient insists on cosmetic improvement. This is handled by (1) making the long side shorter, with a series of plication sutures or, (2) making the short side longer by incising the plaque transversely. Usually nothing further is needed; a tissue graft is rarely necessary.
   • Mild curvature with poor erections – The erectile dysfunction is the chief problem here and can be treated by the intra-urethral pellet, Muse; Viagra; or a penile prosthesis. Intracavernosal self-injection teoretically could make the curviture worse, so I prefer to avoid it. Experience suggests that in these patients erectile dysfunction often worsens faster than might be expected. The penile prosthesis is an attractive option in these cases.
2. Advanced state:
   • Moderate to severe curviture with good erections – here the curvature is the problem. This is treated by making the short side longer or the long side shorter. The latter tends to shorten the penis, and patients do not happily accept a shorter penis. Therefore, the short side is made longer by exposing the plaque and making a series of short elliptical transverse incisions through the plaque down to but not into, the spongy tissue, making the plaque discontinuous – dividing it into disconnected segments- allows the penis to expand symmetrically on erection. To do this it may be necessary to elevate the neurovascular bundle. Temporary, patchy sensory loss may occur postoperatively but I have never seen it permanent, or even last longer than 3 months.
   • Moderate to severe curviture with poor erections – the penile prosthesis has been vary successful with these patients. Just by inflating the prosthesis alone, adequate straightening may occur. Often inflating the prosthesis by manually “molding” the penis gently but firmly bending it opposite the curve – additional straightening can nearly be obtained. If still more straightening is needed, an incision is made and the plaque exposed and incised or excised.

Information and details about tratment can also be found at The National Institutes of Health on Peyronie’s Disease

In those patients whose disease has left them with unacceptable shortening, we have obtained highly satisfactory results by combining the above procedures with a lengthening procedure. Significant length gain can be obtained in this manner.

Patients can go home the same day or the next day. Intercourse can take place in 6 weeks. Complications can include bleeding, infection, numbness, shortening, inadequate curvature correction, discomfort lasting more that a few days. We have never seenpermanent sensory loss, worsening of erections, or ejaculatory problems.

It is important for patients to unerstand that while penile curvature can be markedly improved and erectile fuction restored, once the patient has Peyronies’s disease, his penis will never be the same as before the disease developed.