Commentary on the myths of Peyronie’s disease

Peyronie's disease refers to an acquired curvature, narrowing or shortening of the penis. Prevalence rates of 0.4-20% have been published (1). Development of Peyronie's disease is likely related to minor injury to the tunica albuginea, septum or intracavernous struts. In some men, the resulting inflammation is trapped between layers of the collagen bundles and becomes progressive. This leads to an inflammatory mass (lump) formation in the early stage. Continuing inflammation produces profibrotic cytokines such as transforming growth factor beta and deposition of large amount of collagen fibers. The inflammation can also produce metalloproteinases that break the elastic fibers. The irregularly compacted collagen fibers and disrupted elastic fibers create an inelastic " plaque, " the " incurable " component of Peyronie's disease. The loss of elasticity produces curvature, shortening, narrowing, distal flaccidity and erectile dysfunction depending on the location of the fibrotic process (2). In this article, we discuss the variable clinical presentation of and management of Peyronie's disease, illustrated by three cases. Up to now, Peyronie's disease has been considered an " incurable " disease because there is no medical treatment that can return the penis to its premorbid state. Nevertheless, we would like to revisit the anatomy of the disease, and propose a treatment to arrest the disease in its early stages. In more advanced stages, we recommend a combination of medication and physical force to restore penile anatomy, improve erectile function, and, thus, reduce the psychological devastation affecting the patient (3). A 60 year-old man presented to the Urology clinic with a complaint of three months of sudden onset painless penile deformity with curvature upwards and to the right. He denies any known history of trauma. He notes that he has 100% rigid erections, but is only able to penetrate 75% of the time due to his penile deformity (Comment 1). His past medical history includes depression, anxiety, herpes, and asthma. His surgical history includes orthopedic procedures to his right femur, and an appendectomy. He states that he is not in a stable relationship currently. He does not smoke or use any recreational drugs, and he drinks with moderation. On physical examination, he had an uncircumcised phallus, and a normal meatus. His testicles were bilaterally descended, and normal in size. A dorsal firm plaque could be palpated, about 2 cm in length. Further evaluation with penile ultrasound (GE logiq P5 device, 12 MHz) revealed a dorsal, midline plaque …