Acquired Penile Curvature

The presentation of Peyronie's disease (IPP) can vary in severity. The acute form is characterized by pain in the penis and a fluctuating penile curvature. The curvature can be so pronounced that normal sexual intercourse is no longer possible or may cause pain to the partner (dyspareunia). The symptoms caused by Peyronie's disease can lead to anxiety, reduced self-confidence, and stress.

Symptoms

The symptoms of Peyronie’s disease (IPP) may develop either suddenly (acutely) or gradually over time.

• Scar tissue
  So-called plaque (hardened scar tissue) can be felt within the penis.
   
• Penile curvatur
  Due to the scarring, the penis may bend in any direction. In rare cases, an hourglass deformity may occur, which involves a narrowing of the penile shaft.
   
• Erection problem
  Erectile function may be impaired as a result of Peyronie’s disease.
   
• Shortening of penile lengt
  The scar-related curvature leads to a loss of penile length. A 60-degree curvature is typically associated with a reduction in length of two to three centimeters.
   
• Penile pain
  This can occur at any time but is most typical during the acute phase of the disease.

After the acute phase, during which typical Peyronie’s-related changes occur in the penis, the chronic phase follows. This is characterized by a stable curvature and reduced pain symptoms.

Causes

The exact cause of the development of Peyronie’s disease is unclear. Microtraumas to the penis, often caused by sexual activity, appear to play an important role in scar formation. However, in some cases, this connection cannot be identified, and an association with immune system disorders is considered to be a possible cause.

Risk Factors

Microtraumas are not solely responsible for the development of the disease. Various factors that impair wound healing can lead to scarring of the tunica albuginea of the penile erectile tissue. These include, for example:

• Diabetes mellitus

• Heredity: If your father or brother has Peyronie’s disease, your risk is increased

• Connective tissue disorders such as Dupuytren’s disease and Ledderhose disease

• Age-related changes in the connective tissue’s healing capacity

Complications

Depending on the severity, the following complications may occur:

• Difficulty with sexual intercourse

• Erectile dysfunction

• Anxiety and stress before or during sexual activity, as well as concerns about penile appearance

• Strain on the relationship or partnership

• Impaired fertility due to difficulties with unimpeded sexual intercourse

Diagnosis

The basis of the diagnosis is a detailed medical consultation. In addition, the degree and nature of the penile curvature should be assessed using an artificially induced erection. An ultrasound examination of the penis is used to detect the scar tissue in the erectile tissue that causes the curvature. It can also help identify other vascular causes of erectile dysfunction, such as venous leak.

Therapy

During the acute painful phase, surgical correction should be avoided, as the remodeling processes are still ongoing and may alter the appearance of the penis.

While various approaches exist for the acute phase, none have been shown to halt disease progression. However, some may help alleviate pain symptoms. Efforts have been made to establish therapies such as shockwave therapy, iontophoresis, injections of verapamil, collagenase, POTABA, and others as standard treatments. Today, it is known that no method is sufficiently effective in treating the acute phase of Peyronie’s disease.

According to the guidelines of the European Association of Urology, surgical correction of the curvature should only be considered during the stable phase of the disease. In this phase, there should be no further changes in curvature, and penile pain must have clearly decreased or disappeared. This stable condition should be maintained for at least three months before surgical treatment is undertaken.