Peyronie’s Disease is an acquired fibrotic disorder of the tunica albuginea leading to abnormal penile curvature, shortening, and sometimes pain during erection.
First described by François Gigot de la Peyronie in 1743 🇫🇷.
Prevalence ~1% (likely underestimated as many do not present). Most common in men > 40 years old, especially middle-aged.

🔗 Associations

Diabetes mellitus 🍬
Connective tissue disorders (Dupuytren’s contracture 🤲, Plantar fasciitis 👣, Scleroderma)
Post-prostate cancer treatment (e.g. radical prostatectomy)
Hypertension & smoking (vascular risk factors)
Sometimes associated with erectile dysfunction (due to psychological or vascular mechanisms)

🧬 Aetiology & Pathophysiology

Believed to result from repeated microtrauma during sexual activity → aberrant wound healing response.
Inflammatory cascade → fibrosis and plaque formation in tunica albuginea → inelastic scar tissue prevents normal penile expansion.
Curvature develops opposite to plaque location; pain and deformity usually appear during the active (acute) phase.

🩺 Clinical Features

Usually presents in men > 40 years.
Penile curvature visible during erection ➡ may be dorsal, lateral, or ventral.
Painful erections (especially in acute phase).
Penile shortening and palpable fibrous plaque within shaft.
Erectile dysfunction in up to 50% of cases.
Sexual difficulties: intercourse may be painful, mechanically difficult, or impossible in severe cases.

🧪 Investigations

Primarily a clinical diagnosis based on history + examination.
Palpation of fibrous plaque along shaft.
Photographs or vacuum-induced erection test to document curvature (for surgical planning).
Doppler penile ultrasound if vascular involvement suspected.

💊 Management

Conservative (first-line):
- Observation in mild cases (pain often improves spontaneously after 12–18 months).
- Optimise vascular risk factors: stop smoking, control diabetes, manage hypertension, improve nutrition.
Medical & Injectable Therapies:
- Collagenase Clostridium histolyticum (FDA approved) – breaks down fibrotic collagen.
- Intralesional verapamil or interferon – can reduce plaque size & pain.
- Oral therapies (vitamin E, tamoxifen, colchicine) have limited evidence.
Mechanical Therapies:
- Vacuum devices or penile traction devices may reduce curvature if used consistently.
Surgical (for severe, stable disease >12 months):
- Indicated if deformity prevents sexual intercourse.
- Options:
  - Plication (Nesbit’s procedure) – straightens by shortening contralateral side.
  - Incision/excision + grafting – lengthens contracted side.
  - Penile prosthesis – in refractory cases with ED.

📊 Phases of Disease

Phase	Features
Acute / Active (6–18 months)	Painful erections, evolving curvature, soft plaque, inflammatory activity
Chronic / Stable	Pain settles, fibrotic plaque stabilises, curvature fixed, ED more common

📚 References

Peyronie’s Disease (NIDDK)
BAUS Patient Information
Campbell-Walsh Urology, 12th Edition – Peyronie’s disease chapter

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Peyronie’s Disease

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