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Peyronie's disease; penile induration; bent nail syndrome; induratio penis plastica

Decribed by French surgeon Francois de la Peyronie in 1743 Etiology: unknown Epidemiology: 1) uncommon, but not rare 2) 1-4% of men [3]; 3-10% [10]; 10% of men [12] 3) mean age 54 years [6] Pathology: 1) fibrosis of the sinusoidal spaces (tunica albuginea) of the corpora cavernosa 2) corporeal artery occlusion Clinical manifestations: 1) painful, fibrotic plaque on the dorsum of the penis 2) may progess to development of penile curvature & decreased rigidity of erection 3) penile curvature resolves or improves in 43%, remains stable in 37%, & worsens in 20% [11] 4) impotence, erectile dysfunction Complications: - 30% develop fibrosis in other elastic tissues, such as in hand or foot, including Dupuytren's contracture of hand - increased risk of cancer (RR=1.1), including gastric cancer (RR=1.4), testicular cancer (RR=1.4) & melanoma (RR=1.2) [12] - erectile dysfunction [10] Differential diagnosis: - penile fracture - rapid penile tissue hematoma - immediate loss of erection Management: 1) 67% of patients with no change in deformity over time, 12% improve & 21% worsen [6] - improvement generally within 1 year [10] 2) oral pentoxifylline may be of benefit 3) vitamin E 600-1000 IU QD in combination with colchicine 1 mg BID [4] 4) local interferon alpha-2b injections may be useful [5] - not recommended due to adverse effects [14] 5) collagenase clostridium histolyticum (Xiaflex) FDA-approved 2013 for local injection [7] 6) surgery, Nesbit operation - surgery that combines penile revascularization with penile corrective techniques [13] - indicated when plaque is calcified & patient is impotent 7) penile implantation

General

penile disorder chronic urogenital disease

References

  1. Harrison's Principles of Internal Medicine, 14th ed. Fauci et al (eds), McGraw-Hill Inc. NY, 1998, pg 287-88
  2. V Altebarmakian, Kaiser Permanente, Fresno CA, 1/2000
  3. Wikipedia, Peyronie's disease http://en.wikipedia.org/wiki/Peyronie%27s_disease
  4. Prieto Castro RM et al, Combining treatment with vitamin E and colchicine in the early stages of Peyronie's disease BJU Int 2003, 91:522 PMID: 12656907
  5. Trost LW et al, Pharmacological management of Peyronie's disease Drugs 2007, 67:527 PMID: 17352513
  6. Berookhim BM, Choi J, Alex B, Mulhall JP. Deformity stabilization and improvement in men with untreated Peyronie's disease. BJU Int. 2014 Jan;113(1):133-6. PMID: 24053665 Free Article
  7. Gelbard M, Goldstein I, Hellstrom WJ et al Clinical efficacy, safety and tolerability of collagenase clostridium histolyticum for the treatment of peyronie disease in 2 large double-blind, randomized, placebo controlled phase 3 studies. J Urol. 2013 Jul;190(1):199-207. Review. PMID: 23376148
  8. Shaw EJ, Mitchell GC, Tan RB et al The non-surgical treatment of peyronie disease: 2013 update. World J Mens Health. 2013 Dec;31(3):183-92. Review. PMID: 24459651 Free PMC Article
  9. Tapscott AH, Hakim LS. Office-based management of impotence and Peyronie's disease. Urol Clin North Am. 2013 Nov;40(4):521-43. Review. PMID: 24182973
  10. Geriatric Review Syllabus, 9th edition (GRS9) Medinal-Walpole A, Pacala JT, Porter JF (eds) American Geriatrics Society, 2016 - Geriatric Review Syllabus, 11th edition (GRS11) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2022
  11. Bassett M Untreated Penile Curvature Gets Better Over Time - Survey-based report offers insight on natural history of Peyronie's disease. https://www.medpagetoday.com/MeetingCoverage/AUA/65296 - Ziegelmann M et al The natural history of untreated Peyronie's Disease: Curvature, length, and pain. American Urological Association (AUA) 2017; Abstract PD31-01.
  12. Brooks M Cancer Risk Elevated in Men With Peyronie's Disease. Medscape - Oct 31, 2017. https://www.medscape.com/viewarticle/887838
  13. Boggs W Alternative Surgery for Peyronie's Disease Avoids Prosthesis Implant Medscape - Jan 10, 2018. https://www.medscape.com/viewarticle/891131
  14. Schwartz B Fast Five Quiz: Penis Conditions and Disorders Medscape. Nov 29, 2022 https://reference.medscape.com/viewarticle/984322
  15. NEJM Knowledge+