�UroToday.com Peyronie's disease is a scarring phenomenon poignant the tunica albuginea of the phallus. Scar tissue paper forms "plaques" that can buoy result in pain with erection, penial deviation, penial shortening, indenture, and/or erectile dysfunction. It is associated with difficulty with sexual intercourse and as such it is associated with loss of self-esteem and depression on the role of the patient and often on the region of the patient's partner. There are no approved medical therapies for the treatment of Peyronie's disease. Surgical discourse of Peyronie's disease must be highly individualized, and various surgeons all have their "best way" of dealing with the trouble.
Peyronie's disease was described by Francois de la Peyronie in 1743. Fallopius in 1561 probably described the entity that bares Peyronie's name. Peyronie's disease is incurable, patients require reassurance, they may benefit from medical therapy, and fortunately few require surgery. As mentioned, the scar tissue impedes the expansion of the corpora cavernosa.
Peyronie's disease has been associated with some medications. Beta blockers have been implicated, however, subsequent studies have non verified that relationship, and if in that respect is a relationship to beta blockers, it is probably via erectile disfunction, and not cause and effect of the beta blocker itself. The association with phenytoin has ne'er been founded and is probably non real. A very nice study by Lyles from the University of North Carolina has associated Peyronie's disease with patients world Health Organization have Padgett's disease of the osseous tissue. Diabetes mellitus has been implicated, and it is probably again via erectile dysfunction. About 40% of patients with Peyronie's disease will read evidence of Dupuytren's disease, albeit many will be non-contractile. A lesser part will show evidence of Ledderhose's disease, and a very little number will have tympanosclerosis.
Peyronie's disease is a disease of patients betwixt 45 and 65 age with a mean onset of 53 years old. The asymptomatic prevalence has been estimated to be as heights as 20-25%. The old age of bloom incidence of Peyronie's disease as it turns out are besides the geezerhood during which the body begins to age, tissues lose elasticity, and hands note the onset of erectile dysfunction.
The flow theory with regards to the aetiology of Peyronie's disease involves trauma to the insertion of the septal fibers. The back appears to be peculiarly vulnerable. To this day of the month, there is no firm association to HLA subtypes, autoimmune disease, but Peyronie's disease is certainly a disease of hyperactive wound healing.
The scar tissue paper is composed of dense collagen with decreased elastin. Patients can buoy demonstrate dystrophic calcification and in some cases cartilaginous metaplasia. TGF�1 has been implicated as a part of the process involving the aetiology of Peyronie's disease. Other gross factors are as well expressed, those being platelet derived growth factors A and B. TGFb1 has been concerned with former soft tissue fibrosis. It is concerned in ED. TGF�1 increases the synthesis of fibroblasts; and in short, it causes increased connective tissue paper as it governs the scarring litigate. It inhibits collagenase, and because of the singular anatomy of the insertion of the septal fibers, may be involved in a march of self-induction. All agree that Peyronie's disease is a disease of two phases, an active or immature phase and a mature or quiescent phase. What the practitioner does for Peyronie's disease is in many cases stage specific.
The physician visual perception a affected role with Peyronie's disease cannot underestimate the psychological shock on the patient and on his partner. With regards to medical management, the place of vitamin E, potaba, Colchicine, Tamoxifen, Carnitine, Pentoxifylline, and PDE5 inhibitors testament be discussed. Where there are pertinent randomized controlled trials, those will be reviewed. It is clear that tight well-designed controlled studies have in the past not been uniformly done. They are required, and we are in an earned run average where that deficiency is being addressed. Intralesional injectant will be addressed as will the randomized controlled trials associated with that. The station of topical therapy will be addressed, along with innovative legal transfer mechanisms such as iontophersis and electromotive therapy. The literature will be reviewed with regards to lithotripsy, and the place of combined medical therapy alike reviewed.
A patient becomes a surgical candidate when he has stable and quiescent disease and that usually is a time that is greater than a year from onslaught of symptoms. The misshapenness should be stable for at least 3-6 months. The patient should be erectile pain sensation free. These patients expect detailed judgment of their erectile subprogram, and it is imperative that a true informed consent be conducted with the patient. Surgical management options admit the flexure or corporoplasty techniques. I will revue my techniques for these procedures. The place of excision or incision with grafting will be demonstrated and reviewed and the place of prosthetic placement likewise will be reviewed. As mentioned, surgery for Peyronie's disease must be highly personalised, and in most cases, lecturers focal point on those procedures that they take had the best success with.
Presented by: Gerald H. Jordan, MD, FACS, FAAP, at the Masters in Urology Meeting - July 31, 2008 - August 2, 2008, Elbow Beach Resort, Bermuda
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