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Pyronise Disease   

Peyronie's (pa-ro-NEEZ) disease causes a bent penis during erection. A hard, fibrous layer of scar tissue (plaque) develops under the skin on the upper or lower side of the penis. When the penis is erect, the scar tissue pulls the affected area off at an angle, causing a curved penis. The plaque, formed by thickened layers of soft tissue in the penis is noncancerous (benign). The condition can cause pain and make sexual intercourse difficult.

Sometimes Peyronie's disease improves without treatment, so your doctor may initially recommend a wait-and-see approach. Treatments of Peyronie's disease involve nonsurgical and surgical approaches.

 

 

Pyronise disease is a disorder affecting the penis that can cause:

o        A lump within the shaft of the penis.

o        Pain in the shaft of the penis

o        Abnormal angulations of the erect penis ('bent' penis).

Not all of these features are necessarily present, but, typically, a man would first notice a tender lump in the penis, which might later be followed by bending of the penis when erect, sometimes at very odd angles. The flaccid penis is not usually deformed. It is important to remember that a degree of upward (towards the head) angulations of the erect penis is quite normal and not a feature of Pyronise disease.

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Not all of these features are necessarily present, but, typically, a man would first notice a tender lump in the penis, which might later be followed by bending of the penis when erect, sometimes at very odd angles. The flaccid penis is not usually deformed.

It is important to remember that a degree of upward (towards the head) angulations of the erect penis is quite normal and not a feature of
Pyronise disease.

What is Peyronie’s disease?

Peyronie’s disease is characterized by a plaque, or hard lump, that forms within the penis. The plaque, a flat plate of scar tissue, develops on the top or bottom side of the penis inside a thick membrane called the tunica albuginea, which envelopes the erectile tissues. The plaque begins as a localized inflammation and develops into a hardened scar. This plaque has no relationship to the plaque that can develop in arteries.

 

Cases of Peyronie’s disease range from mild to severe. Symptoms may develop slowly or appear overnight. In severe cases, the hardened plaque reduces flexibility, causing pain and forcing the penis to bend or arc during erection. In many cases, the pain decreases over time, but the bend in the penis may remain a problem, making sexual intercourse difficult. The sexual problems that result can disrupt a couple’s physical and emotional relationship and can lower a man’s self-esteem. In a small percentage of men with the milder form of the disease, inflammation may resolve without causing significant pain or permanent bending.

The plaque itself is benign, or noncancerous. It is not a tumor. Peyronie’s disease is not contagious and is not known to be caused by any transmittable disease.

A plaque on the topside of the shaft, which is most common, causes the penis to bend upward; a plaque on the underside causes it to bend downward. In some cases, the plaque develops on both top and bottom, leading to indentation and shortening of the penis. At times, pain, bending, and emotional distress prohibit sexual intercourse.

 

A cross-section of the penis (left) displays the internal cavity that runs the length of the penis and is divided into two chambers—corpora cavernosa—by a vertical connecting tissue known as a septum. Scientists theorize that, during trauma such as bending, bleeding might occur at a point of attachment of the septum to the tunica albuginea lining the chamber wall (center). The bleeding results in a hard scar, or plaque, which is characteristic of Peyronie’s disease. The plaque reduces flexibility on one side of the penis during erection, leading to curvature (right).

Estimates of the prevalence of Peyronie’s disease range from less than 1 percent to 23 percent.1 A recent study in Germany found Peyronie’s disease in 3.2 percent of men between 30 and 80 years of age.2 Although the disease occurs mostly in middle age, younger and older men can develop it. About 30 percent of men with Peyronie’s disease develop hardened tissue on other parts of the body, such as the hand or foot. A common example is a condition known as Dupuytren’s contracture of the hand. In some cases, Peyronie’s disease runs in families, which suggests that genetic factors might make a man vulnerable to the disease.

How does Peyronie’s disease develop?

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Many researchers believe the plaque of Peyronie’s disease develops following trauma, such as hitting or bending, that causes localized bleeding inside the penis. Two chambers known as the corpora cavernosa run the length of the penis. A connecting tissue, called a septum, runs between the two chambers and attaches at the top and bottom of the tunica albuginea.

If the penis is bumped or bent, an area where the septum attaches to the tunica albuginea may stretch beyond a limit, injuring the tunica albuginea and rupturing small blood vessels. As a result of aging, diminished elasticity near the point of attachment of the septum might increase the chances of injury. In addition, the septum can also be damaged and form tough, fibrous tissue, called fibrosis.

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The tunica albuginea has many layers, and little blood flows through those layers. Therefore, the inflammation can be trapped between the layers for many months. During that time, the inflammatory cells may release substances that cause excessive fibrosis and reduce elasticity. This chronic process eventually forms a plaque with excessive amounts of scar tissue and causes calcification, loss of elasticity in spots, and penile deformity.

While trauma might explain some cases of Peyronie’s disease, it does not explain why most cases develop slowly and with no apparent traumatic event. It also does not explain why some cases resolve or why similar conditions such as Dupuytren’s contracture do not seem to result from severe trauma.

Some researchers theorize that Peyronie’s disease may be an autoimmune disorder.

How is Peyronie’s disease evaluated?

 

Doctors can usually diagnose Peyronie’s disease based on a physical examination. The plaque can be felt when the penis is limp. Full evaluation, however, may require examination during erection to determine the severity of the deformity. The erection may be induced by injecting medicine into the penis or through self-stimulation. Some patients may eliminate the need to induce an erection in the doctor’s office by taking a digital or Polaroid picture at home. The examination may include an ultrasound scan of the penis to pinpoint the location(s) and calcification of the plaque. The ultrasound can also be used to evaluate blood flow into and out of the penis if there is a concern about erectile dysfunction.

Good advice

Noticing a lump in the penis can be a frightening experience. Men are often concerned that they have developed a cancer.
Cancer within the penile shaft is very rare indeed, while
Pyronise disease is by far the most common cause of such lumps. If you find a lump, it is important to seek prompt medical advice, but you should not be too fearful that a serious cause will be found.

What causes Pyronise disease?

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The penis consists of basically three cylinders, covered by several sheaths of tissue and, finally, by skin.

Running the length of each side of the penis are spongy cylindrical structures called the corpora cavernosa. These form the erectile tissue that becomes engorged with blood during erection, acting like the inner tube of a tyre. They are surrounded by the tunica albuginea, a tough, inelastic, fibrous sheath, which might be compared with the tyre itself.

When the penis becomes erect, the inner tubes (corpora cavernosa) inflate, filling the space within the tyre (tunica albuginea), making it more rigid.

In Pyronise disease, tough, fibrous plaques spontaneously appear within the tunica albuginea, and are felt as tender lumps. When the penis becomes erect, it inflates unevenly and tends to bend around the plaque, causing the characteristic deformed appearance of Pyronise disease.

One in three men with Pyronise have pain or penile bending when erect as their principal symptom. Experts are not certain why some men get Pyronise disease and others do not. Several factors might be involved, including:

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o        Genetics: occasionally the disease has a tendency to run in certain families (inherited or genetic predisposition), but this is not common.

o        Injury: Pyronise disease is more common after injury to the penis, such as penile fracture or forceful bending of the erect penis. It also occurs more frequently in men that give injections into the penis for the treatment of erectile dysfunction (impotence).

o        Circulatory disorders: more men with Pyronise disease seem to be affected by high blood pressure (hypertension) and hardening of the arteries (atherosclerosis), so these conditions might possibly be involved in its development.

Diabetes: this is more common in men with Pyronise disease. As a result diabetes might also be involved in its development.

What are the symptoms?

Pyronise disease occurs at any time from adolescence onwards, but most commonly in men aged 40 to 60 years. It affects around 1 in a 100 (0.4 to 1.0 per cent) of the middle-aged male population, but some experts suggest up to 4 per cent of men aged over the age of 40 may suffer from it.

The disease causes very variable degrees of deformity and inconvenience.

Some men are barely troubled by it, while others find sexual intercourse physically impossible. Many men will not require treatment, but all should seek prompt medical advice.

The symptoms are:

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o        A lump within the shaft of the penis: this can slowly develop over several months and frequently takes 12 to 18 months to reach its full extent.

o        Pain in the shaft of the penis: two-thirds of men with Pyronise disease will experience pain in the penis. In most cases, it will gradually settle down and disappear without treatment in a few months.

o      Abnormal angulations of the erect penis (bent penis): during the 12 to 18 months that the plaque or lump is developing, the deformity of the erect penis can change - 30 to 40 per cent get worse, 10 to 20 per cent get better and 50 per cent remain the same.
Some men will develop varying degrees of erectile dysfunction (impotence) as a consequence of
Pyronise disease. This can vary from a complete inability to attain and/or maintain an erection adequate for satisfactory sexual experience to a slight reduction in penile rigidity.
Some men report a tendency for the penis to buckle around the lump during sex. The frequency of this problem has been reported as between 4 and 80 per cent, although experience suggests that the true rate is towards the lower end of this range.

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How is Pyronise disease diagnosed?
Pyronise disease is diagnosed on the basis of the history (how the problem has developed, as you describe it to your doctor) and examination (what the doctor can see and feel).

Between 10 and 25 per cent of men with Pyronise disease have Dupuytren's contracture, a claw-like deformity in which the little finger, the ring finger and, sometimes, other fingers bend over towards the palm of the hand?

No special investigations are needed and biopsy (surgically removing a piece of the lump for examination under a microscope) is only needed for rapidly enlarging lumps that are not developing in the usual manner. Ultrasound scanning can be used to assess the exact size and position of the lump, but is rarely necessary.

 

What else could it be?
Although extremely rare, sarcoma of the penis (a form of cancer) can present in a similar way. Your doctor will consider this if the lump enlarges very rapidly or develops in an unusual manner.
Prognosis
Pyronise disease runs a very variable course. Many men with Pyronise disease will not require or desire treatment, and will enjoy very satisfactory sex with their rather
unusually shaped penis.

Men who have had Pyronise disease are more likely to have a further episode in the future than the general population. Nothing is proven to prevent a recurrence.

 

Symptoms

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The signs and symptoms of Peyronie's disease may appear overnight or develop more slowly. These may include:

1. Painful erection

2. A bend or curve in your penis during erection

3. A thick band of hard tissue on one or more sides of your penis

4. Indentation, or an "hourglass-shaped" penis during erection

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5. Impaired ability to obtain an erection (erectile dysfunction, or ED)

6. Shrinking or shortening of your penis

7. Scar tissue that develops on the top of the penis will cause the penis to bend upward. Plaque on the underside of your penis will cause it to bend downward. Sometimes scar tissue occurs on both sides of the penis, causing an indentation or "bottleneck."

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In many cases, pain caused by Peyronie's disease may decrease after a short period of time. However, the curvature may persist even if the pain subsides. In some men with a milder form of the disease, inflammation may improve without causing a lot of pain or permanent bending.

The Basic Facts

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§  1. Men with Peyronies disease generally seek medical attention for pain or bending of the penis during erection, which results from inflammation and scarring in a particular part of the male anatomy known as the tunica albuginea.

§  2. Francois de la Peyronie, surgeon to Louis XIV of France, first described treatment for this disorder in 1743.

§  3. This condition is most commonly acquired at about age 55. A man can be born with curvature of the penis, though this is not Peyronies disease.

§  4. Severity varies - only a minority of the men afflicted with this problem are unable to engage sexually. Through an effect on the erection mechanism it can reduce rigidity (hardness), but it rarely causes impotence.

§  5. It is somewhat uncommon, affecting somewhere between one and three men in a hundred.

§  6. In addition to producing curvature, Peyronies disease may change the shape of the erection in other ways: indentation, diameter reduction, or loss of length.

§  7. Peyronies disease can have a strong psychological impact.

§   

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§  8. Some cases are mild, healing without treatment within a year of onset. Most cases produce at least some degree of persistant curvature.

§  9. A noticeable lump, or plaque within the penis is commonly detected. Contrary to prevalent anxieties, it is noncancerous, and unrelated to cholesterol – containing arterial plaque

§  10. Peyronies disease can run in families, though most cases do not appear to be hereditary.

§  11. This condition is not associated with serious internal disorders. 10 –20% of men develop scarring of either the hands (Dupuytren’s contractures) or of the feet.

§  12. The goal of therapy is to maintain sexual function. In some cases, education about the disease and reassurance is all that is required. Rarely, when long-term deformity prevents intercourse, surgery is recommended.

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Peyronie’s disease, a condition of uncertain cause, is characterized by a plaque, or hard lump, that forms on the penis. The plaque develops on the upper or lower side of the penis in layers containing erectile tissue. It begins as a localized inflammation and can develop into a hardened scar.

Cases of Peyronie’s disease range from mild to severe. Symptoms may develop slowly or appear overnight. In severe cases, the hardened plaque reduces flexibility, causing pain and forcing the penis to bend or arc during erection. In many cases, the pain decreases over time, but the bend in the penis may remain a problem, making sexual intercourse difficult. The sexual problems that result can disrupt a couple’s physical and emotional relationship and lead to lowered self-esteem in the man. In a small percentage of patients with the milder form of the disease, inflammation may resolve without causing significant pain or permanent bending.

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The plaque itself is benign, or noncancerous. A plaque on the top of the shaft (most common) causes the penis to bend upward; a plaque on the underside causes it to bend downward. In some cases, the plaque develops on both top and bottom, leading to indentation and shortening of the penis. At times, pain, bending, and emotional distress prohibit sexual intercourse.

One study found Peyronie’s disease in 1 percent of men. Although the disease occurs mostly in middle age, younger and older men can develop it. About 30 percent of men with Peyronie’s disease develop fibrosis (hardened cells) in other elastic tissues of the body, such as on the hand or foot. A common example is a condition known as Dupuytren’s contracture of the hand. In some cases, men who are related by blood tend to develop Peyronie’s disease, which suggests that genetic factors might make a man vulnerable to the disease.

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Men with Peyronie’s disease usually seek medical attention because of painful erections and difficulty with intercourse. Since the cause of the disease and its development are not well understood, doctors treat the disease empirically; that is, they prescribe and continue methods that seem to help. The goal of therapy is to keep the Peyronie’s patient sexually active. Providing education about the disease and its course often is all that is required. No strong evidence shows that any treatment other than surgery is effective. Experts usually recommend surgery only in long-term cases in which the disease is stabilized and the deformity prevents intercourse.

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A French surgeon, François de la Peyronie, first described Peyronie’s disease in 1743. The problem was noted in print as early as 1687. Early writers classified it as a form of impotence, now called erectile dysfunction (ED). Peyronie’s disease can be associated with ED; however, experts now recognize ED as only one factor associated with the disease—a factor that is not always present.

 

A cross-section of the penis (left) displays the internal cavity that runs the length of the penis and is divided into two chambers (corpora cavernosa) by a vertical connecting tissue known as a septum. It is believed that, during trauma such as bending, bleeding might occur at a point of attachment of the septum to tissue lining the chamber wall (center). The bleeding results in a hard scar, which is characteristic of Peyronie’s disease. The scar reduces flexiblility on one side of the penis during erection, leading to curvative (right).

Causes of the Disease

Many researchers believe the plaque of Peyronie’s disease develops following trauma (hitting or bending) that causes localized bleeding inside the penis. Two chambers known as the corpora cavernosa run the length of the penis. The inner-surface membrane of the chambers is a sheath of elastic fibers. A connecting tissue, called a septum, runs between the two chambers and attaches at the top and bottom.

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If the penis is abnormally bumped or bent, an area where the septum attaches to the elastic fibers may stretch beyond a limit, injuring the lining of the erectile chamber and, for example, rupturing small blood vessels. As a result of aging, diminished elasticity near the point of attachment of the septum might increase the chances of injury.

The damaged area might heal slowly or abnormally for two reasons: repeated trauma and a minimal amount of blood flow in the sheath-like fibers. In cases that heal within about a year, the plaque does not advance beyond an initial inflammatory phase. In cases that persist for years, the plaque undergoes fibrosis, or formation of tough fibrous tissue, and even calcification, or formation of calcium deposits.

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While trauma might explain acute cases of Peyronie’s disease, it does not explain why most cases develop slowly and with no apparent traumatic event. It also does not explain why some cases disappear quickly or why similar conditions such as Dupuytren’s contracture do not seem to result from severe trauma.

 Some researchers theorize that Peyronie’s disease may be an autoimmune disorder.

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Diagnosis

Peyronie's disease can be confirmed by a qualified urologist, without recourse to expensive tests or xrays. It has a characteristic history:

1. Pain with erection

2. Bending and or indentation of the erection

3. Loss of penile length

4. In some cases, pain is absent

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There are specific findings on examination:

1. One or more hardened areas, or plaques, within the wall of the erection chamber

2. Reduced elasticity of the flaccid penis

The most common angle is between 0 and 60 degrees :              example60°:  

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Photographs, usually taken at home by the patient, can establish the degree and type of distortion present. They become an important record of the condition, and are helpful for tracking response to therapy.

Xrays or ultrasound pictures are not madatory, but they can show when plaque calcification has occurred. This finding, which relates to the potential reversibility of the condtion, is also important when surgery is being considered.

 

Testing the integrity of the erection mechanism is occasionally recommended prior to surgery.

Anatomy

The penis has two major internal divisions, each responsible for a different function. The corpora cavernosa, which can be likened to hydraulic cylinders, create structural rigidity. The corpus spongiosum contains the urethra, or excretory channel.

The corpora cavernosa are cigar-shaped tubes of strong connective tissue, filled with spongy muscle-lined cavities. Relaxation of vascular muscle causes inflow of blood and expansion of the corpora’s inner sponge during erection. As a result its wall, the tunica albuginea, is stretched tightly enough to produce rigidity. In addition to defining the shape of the erect penis, the tunica also has a key role in limiting blood outflow during erection.

The paired corpora are joined within the penis, but separate at its junction with the body. At its base they diverge right and left, and attach to the corresponding pelvic bones. These two points, along with a midline suspensory ligament between the joined corpora and the pubic bone, form a sturdy three-point anchor.

The urinary channel or urethra runs under the corpora cavernosa, while most of the penile blood vessels and nerves run along the top side.

 

Producing An Erection

In simple terms, this consists of trapping pressurized blood within the confines of a limited space. The chambers that accomplish this anatomically are known as the corpora cavernosa. Given the proper signal the spongy, blood filled spaces relax and open up, allowing the free inflow of blood.

 

The chambers expand, pulling the tunica albuginea tight. It's tension makes the corpora hard (resistant to indentation) and rigid (resistant to flexion). Secondarily, it pinches off the veins that normally let blood exit the chambers, trapping blood inside and contributing to the state of engorgement.

 

Can Peyronie’s disease cause impotence?

Impotence, defined as the inability to maintain a hard enough erection to have intercourse, is uncommon in Peyronie’s disease. Yet it frequently affects the erection mechanism in a less serious way. Scientific studies have shown that at some point in time, up to 40% of men with Peyronie’s disease have experienced some degree of erectile dysfunction. Usually, this consists of a reduction in maximum hardness. It is usually a temporary effect, and rarely causes enough softening to preclude normal intercourse. When associated with severe bending however, it can be a problem. Persistant difficulty with erectile rigidity can usually be treated medically

 

 The cause for the erectile dysfunction of Peyronie’s disease is "venous leakage." In other words, the blood that should normally be trapped within the taut confines of the tunica albuginea is leaking slowly out. By locally hardening the tunica, plaques may prevent the exit veins from pinching off in the normal fashion.

Damaging effects of mechanical stress

When fully expanded, the rigid corpora cavernosa forms something like an inflatable I beam. Mechanical forces on this structure will create a unique region of tissue stress at the top of the "I". The majority of the tunica albuginea compresses with stretch during erection, but the topmost strip is subject to an opposite, delaminating force.

 

Fibrin deposition, the first step in the wound healing process and the precursor to Peyronie’s plaque, usually develops in this area. The mid- topof the penis is the area most commonly involved by Peyronie’s disease.

 

If Peyronie’s plaque forms in the hoop (circumfrential) direction, it causes indentation or segmental loss of penile diameter. These so-called hourglass areas have a profound effect on over all penile rigidity. The resistance to bending of an inflatable tube is related to its cross sectional area. Because of this, indented areas make the erect penis easier to bend, even at high internal fluid pressures.

 

By looking at the expanding corpora as a series of stacked elements, it is possible to calculate how much tunica must lose its elasticity to produce a given amount of bending. A plaque about six centimeters long is required in order to produce a 90 degree bend. In other words, little plaques cannot cause big bends.

 

Treatment for  Pyronise disease  by Dr. Tariq Mehmood Taseer

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