Dupuytren's contracture

Definition

Peyronie's disease is a condition characterized by a bent penis.

Description

The cause of Peyronie's disease is unknown and the disease is often difficult to treat. For some reason, a thick scar develops in the penis and bends it. Almost a third of patients with Peyronie's disease also have similar contracting scars on their hands, a disease called Dupuytren's contractures. Some cases are associated with diabetes, and others appear after prostate surgery. Because prostate surgery always requires a catheter in the bladder, there is some suspicion that catheters can cause the scarring. However, many cases of Peyronie's disease arise without any use of a catheter. There is also a congenital form of penile deviation, again with no known cause. Most of the scars are located in the mid-line, therefore most of the angulations are either up or down.

Causes & symptoms

Peyronie's disease occurs in about 1% of men, most of them between 45-60 years old. Although there is no good research data to back it up, the suspicion exists that Peyronie's disease is the result of injury. If not a catheter, then sudden, forceful bending during sexual intercourse could easily tear the supporting tissues and lead to scarring.

The symptom is bending of an erect penis, sometimes with pain. It often interferes with sexual intercourse. Erectile failure associated with the angulation often precedes it.

Treatment

Attempts have been made to reduce the angulation with injections of cortisone-like drugs directly into the scar, but they are rarely successful. Surgery seems to be the better answer. After the scar is removed, plastic repair of the penis is attempted, often with a graft of tissue from somewhere else on the body. The Nesbit procedure is one of the more successful methods of doing this. The other surgical approach is to implant a penile prosthesis that overcomes the angulation mechanically. Results with these procedures are reported to be 60-80% satisfactory, including the return of orgasm.

Prognosis

Sometimes the condition disappears spontaneously. A careful look for other causes of impotence should be done before surgery.

Key Terms

Catheter

A flexible tube placed into a body vessel or cavity.

Congenital

Present at birth.

Plastic surgery

The restoring and reshaping of the skin and its appendages to improve their function and appearance.

Prostate

A gland that surrounds the outlet to the male bladder.

Prosthesis

Artificial substitute for a body part.

Further Reading

For Your Information

Books

• Jordan, Gerald H., et al. "Surgery of the penis and urethra." In Campbell's Urology, edited by Patrick C. Walsh, et al. Philadelphia: W. B. Saunders, 1998, pp. 3376-3391.
• Lewis, Ronald. "Surgery for erectile dysfunction." In Campbell's Urology, edited by Patrick C. Walsh, et al. Philadelphia: W. B. Saunders, 1998, pp. 12115-12134.

  Periodicals

• Carrier, S., G. Brock, N. W. Kour, and T. F. Lue. "Pathophysiology of erectile dysfunction. Urology 42 (October 1993): 468-481.
• Morganstern, S.L. "Long-term Experience with the AMS 700CX Inflatable Penile Prosthesis in the Treatment of Peyronie's Disease." Techniques in Urology 3 (1997): 86-88.
• Poulsen, J. and H. J. Kirkeby. "Treatment of Penile Curvature--a Retrospective Study of 175 Patients Operated with Plication of the Tunica Albuginea or with the Nesbit Procedure." British Journal of Urology 75 (March 1995): 370-374.
• Vatne, V. and P.A. Hoeisaeter. "Functional Results after Operations of Penile Deviations: an Institutional Experience." Scandanavian Journal of Urology and hephrology Nephrol 179 (1996): 151-154.

Gale Encyclopedia of Medicine. Gale Research, 1999.