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MikaRaitanen

Peyronie's Disease (Induratio Penis Plastica)

A fibrotic induration of corpus cavernosum
The aetiology is unknown; however, some patients (9-39%) have Dupuytren contracture of the palms.

The skin is normal and freely mobile at the site of induration.
The penis is curved in the direction of the induration during erection. In one third of the patients, the symptoms include erectile pain.
In differential diagnosis consider the spread of prostatic carcinoma into the penis (palpate the prostate).
Pictures taken by the patient showing the curvature of the penis during erection are very useful when evaluating the symptom.
Ultrasound imaging is usually not beneficial.

In a large share of patients, the condition remains the same or even improves over time.
The painful phase may last several months.
Most patients are capable of sexual intercourse and no therapy is then indicated.
Refer to a urologist if the penis is markedly curved.
There is no pharmacotherapy available in Europe, and in some other countries, after an injectable proteinase (collagenase clostridium histolyticum, injected into the induration) http://www.dynamed.com/condition/peyronie-disease-17#INTRALESIONAL_THERAPIES has left the market (see e.g. http://www.ema.europa.eu/en/medicines/human/EPAR/xiapex and http://health-products.canada.ca/dpd-bdpp/info.do?lang=en&code=87384). The drug is still available in the US, with warnings of potential serious adverse effects.
Possible corrective surgery is not performed until the painful phase is over and the condition has remained stable for at least 3 months http://www.dynamed.com/condition/peyronie-disease-17#SURGERY_AND_PROCEDURES.

Russo GI, Milenkovic U, Hellstrom W et al. Clinical Efficacy of Injection and Mechanical Therapy for Peyronie's Disease: A Systematic Review of the Literature. Eur Urol 2018;74(6):767-781. [PubMed]