380

Practical Urology: EssEntial PrinciPlEs and PracticE

penis, thus drawing blood into the penis,

The prevalence of PD among men is estimated

which is then retained by the application of an

at 0.4–8.9% usually affecting men between 40

elastic band at the base of the penis.6 Penile

and 70 years of age.28 Microtraumatic lesions of

pain and the tedious use of VCDs limit a wider

the tunica represent generally accepted causes

use.

of PD resulting in the initiation of a cascade of

connective tissue reactions and scarification.29-31

However, the exact pathophysiology of PD

Surgical Therapy

appears to be complex32,33 and has not been elu-

cidated to date. The unknown pathophysiology

As ultimate option, malleable (semirigid) or

of the process has prevented the development of

inflatable (twoor three-piece) penile prosthesis

causal therapy strategies, and in fact, most med-

may be offered. Prosthesis implantation has one

ical approaches towards PD can actually be con-

of the highest satisfaction rates (70–87%) among

sidered ineffective.34

treatment options for ED. Main complications of

penile prosthesis implantation are mechanical

failures and infection (1–5%). Mechanical fail-

Clinical Appearance and Diagnostic

ures are now less than 5% in the first year, about

20% at 5 years, and 50% at 10 years.

Workup

PD results in a variety of penile symptoms:

Conclusion

Penile nodes and plaque formation, penile pain,

painful erections, penile angulation, deformity,

The majority of patients suffering from erec-

and erectile dysfunction that is prevalent in up

to 60% of all patients.30,31 Clinical workup in

tile dysfunction will benefit from oral PDE5-

patients includes measurement of plaque dimen-

inhibitors. The selection of the drug has to be

sion, determination of penile length in the flac-

based on personal preferences and efficacy of

cid and erectile status, and determination of

the individual substance. Great emphasis by

angulation. Sonography of the plaques is sug-

the practicing physician should be laid on the

gested and – in elderly men – erectile hemody-

evaluation of potential risk factors. Due to the

namics should be

evaluated

by color duplex

evident association of cardiovascular disease

ultrasound. The IIEF is used for erectile func-

and erectile dysfunction, a careful assessment

tion assessment;

however,

particularly in

is obligatory. In case of patients not respond-

patients with high-grade deformity of the penis,

ing to PDE5-inhibitors, optional

strategies

IIEF fails to describe erectile function due to the

include intracavernous or intrameatal injec-

nature of the questions. Patients frequently do

tion as well as vacuum constricting devices

not suffer from insufficient erectile status but

or, ultimately, the implantation

of penile

are unable to perform sexual intercourse due to

prosthesis.

mechanical reasons, e.g. immission of the

penis.31

In the early stages, PD appears as an inflam-

Peyronie´s Disease (PD)

matory disorder of the Tunica albuginea of the

corpus cavernosum clinically typified by penile

pain and discomfort. Painful erections are seen

Introduction

frequently. This early phase has been termed

“inflammatory phase” and usually lasts for

Peyronie’s disease (PD) is a localized disorder

6–12 months. After this interval, patients enter

of the connective tissue characterized by the

into a stable phase of the disease as indicated by

formation of fibrotic plaques in the tunica

the cessation of penile pain and lack of progres-

albuginea of the corpus cavernosum. PD

sion in penile curvature. Surgical corrections

appears as an inflammatory lesion in its first

are obsolete in the inflammatory phase but are

stages, but ultimately results in fibrosis and

possible and successful in the stable phase of the

calcification.27

disease.30