Current concepts of Peyronie’s disease (clinical lecture)

Abstract

The article is presented in the format of a lecture. Peyronie’s disease (induratio penis plastica) is a progressive fibrotic disorder of the penile tunica albuginea that results in fibrotic penile plaques and can cause penile deformity. The issues of etiology, pathogenesis, clinical picture and diagnosis of Peyronie’s disease (PD) are reviewed in the lecture from the modern points of view. PD is frequently associated with penile pain, erectile dysfunction, and a secondary anxiety-depressive state. Despite the existence of this problem for several centuries, no unified concept of the Peyronie’s disease pathogenesis can be found in literature. A growing amount of research has shown that PD is a chronical disorder of local wound healing process within the tunica albuginea and the Smith’s space. Over the past 40 years, multiple lines of evidence have pointed to a genetic factor that predisposes some men to the development of Peyronie’s disease. Treating men with PD remains a challenging problem for clinicians working in urology. Given the high prevalence of PD and its significant impact on affected men, its better understanding is essential. Treatment methods for PD are varied and include oral, local, intralesional and traction therapy, and surgical treatment. Current clinical care standards for PD are aimed at the symptom suppression, as there are currently no treatment for PD that can eliminate its causes or progression. Clostridium histolyticum collagenase has shown its effectiveness in treating PD, but its efficacy and safety remain controversial. Surgery remains the most effective method for PD treatment and is considered to be “gold standard”. The choice of the surgical technique depends on the length of the penis, degree of deformity, erectile function, patients’ expectations and surgeon’s preferences. Various surgical techniques and grafting materials (autologous and non-autologous) can be used for the coverage of the tunica albuginea defect after partial plaque excision or incision.