Plastic penis induratio N48.6

Author: Prof. Dr. med. Peter Altmeyer

Last updated on: 29.10.2020

Synonym(s)

(de-la-)Peyronie's disease; De-la-Peyronie's disease; fibrosal cavernitis; Penis bones; Peyronie`s disease; Peyronie's disease; Sclerosis fibro pink penis; van Boer Disease

History
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De la Peyronie, 1743

Definition
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Gross, circumscribed, plaque or nodular, fibromatous alteration of the tunica albuginea of the corpora cavernosa of the penis.

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Dermatology

Dupuytren's contracture

Circumscribed connective tissue induration of the palmar aponeurosis with bending contracture of the finger...

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Etiopathogenesis
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Unexplained, probably genetic disposition.

Manifestation
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Mainly occurring between the ages of 40 and 60.

Localization
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Dorsal side of the shaft of the penis.

Clinical features
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Palpable, longitudinal, stripy, plate-shaped or knotty hardenings on the back of the penis. Painful kinking of the penis during erection (>80% of patients), pain (50-70%) as well as in the case of more severe erectile dysfunction (30%) with possible impotentia coeundi.

Side effects: 30% of patients may experience Dupuytren's contracture and keloids or knuckle pads. S.a.u. Polyfibromatosis.

Histology
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Inflammatory vasculitic changes. Initially, fibromatosis, which is rich in cells and later poor in cells and rich in fibers, is manifested as well as metaplastic calcification and possibly cartilage and bone formation.

General therapy
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The treatment is difficult and often unsatisfactory. A standstill of the disease can be considered a therapeutic success. The course of the disease cannot be estimated, but spontaneous remission is possible (even after years) (approx. 30%).

It is important to inform the patient about the course of the disease. If necessary, psychotherapeutic support should be considered.

Prior to surgery (removal of fibromatous changes), the change should have been clinically halted for 6-9 months (otherwise high recurrence rate).

Progression/forecast
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Often progression despite therapy. In up to 30% of cases, spontaneous regression is also possible (especially in younger patients).

Tables
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Therapeutic approaches in the treatment of induratio penis plastica

Indication	Example preparations and dosage		Remarks
Early stages	Antiphlogistic-externa like glucocorticoids and dexpanthenol cream	0.1% triamcinolone cream (e.g. triamgals)	Moderately helpful in initial stages
		0.25% prednicarbate (e.g. Dermatop cream)
		5% panthenol cream (Bepanthen)
	Intralesional glucocorticoids	Triamcinolone crystal suspension (e.g. Volon A 1:3 diluted with LA like scandicain) minimum amounts every 3 weeks	Especially in case of inflammatory changes
	X-ray soft X-rays	GD = 32 Gy, ED = 4 Gy at 8 week intervals	Especially helpful for pain relief; older, sharp-edged or calcified plaques are no longer accessible to X-ray therapy
Late stage (> 45%)	Operative penis straightening	e.g. Nespit process or ruffled plastic	Penis shortening + risk of surgically induced impotence
	Penile prosthesis		ultima ratio
Accompanying to all stadiums over 1-2 years	Vit. E high dosage	Vit. E 600-800 mg/day (e.g. Evion)	No adverse effects, but probably only little beneficial effects
	vitamin A	Retinol acetate 20 000 IU/day (e.g. retinol)
		12 g/day (e.g. Potaba-Glenwood)
	Potassium Paraaminobenzoate

Literature
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Alth G (1984) On the classification of induratio penis plastica (Peyronie's Disease). Vienna Clin Wschr 96: 854-857
Chen JY et al (2018) Objective Assessments of Peyronie's Disease. Sex Med Rev 6:438-445.
de la Peyronie F (1743) Sur quelqes obstacles, qui s' opposent à l' éjaculation naturelle de la semence. Mém Acad Chir 1: 425-434
Meineke V et al (2003) Malignant priapism as a sign of a recurrent prostate cancer. Differential diagnosis of induratio penis plastica. dermatologist 54: 541-543
Poulsen J et al (1995) Teratment of penile curvature - a retrospective study of 175 patients operated with plication of the tunica albuginea or with the nesbit procedure. Br J Urol 75: 370-374
Ralph-DJ et al (1995) The nesbit operation for Peyronie's disease: 16 year experience. J Urol 154: 1362-1363
Ralph DJ et al (2004) The management of Peyronie's disease. BJU Int 93: 208-215
Rodrigues CI et al (1995) Results of radiotherapy and vitamin E in the treatment of Peyronie's disease. Int J Radiat Oncol Biol Phys 31: 571-576
Usta MF et al (2004) Relationship Between the Severity of Penile Curvature and the Presence of Comorbidities in Men With Peyronie's Disease. J Urol 171: 775-779