References include Oxford handbook of Urology (3rd Edition) Smith`s Urology (18th Edition) EAU Guidelines 2017

1. Dr. Muhammad Saifullah
Registrar UROLOGY
Madinah Teaching Hospital, Faisalabad
PEYRONIE`S DISEASE

2. PEYRONIE`S DISEASE?
• Acquired benign penile condition
Characterized by
• Deformity of penile shaft
• Secondary to a fibrous inelastic scar on the tunica
albuginea

3. PREVALANCE?
3-9 %
Commonest plaques at dorsum 66%

5. AGE?
40-60 years

6. PATHOPHYSIOLOGY?
Two phases
ACTIVE PHASE QUIESCENT PHASE
1. 1-6 Months 9-12 Months
2. Early Inflammatory Phase Inflammation settled
3. Painful Painless
4. Changing deformity Stabilized deformity

7. HISTOLOGY?
Fibrous tissue with increased cellularity
and random arrangement of collagen.

8. FATE?
Over 18 months
• Stable 47-67%
• Progression 30-50%
• Improvement 3-13%

9. ETIOLOGY?
Genetically predisposed person 
Penile trauma (Trivial) 
Microvascular injury 
Bleeding into tunica 
Inflammation  Fibrosis
(Whole process is aggravated by TGF-B)

10. ETIOLOGY?

11. PRESENTATION?
• Pain (resolves in 90% of men over time)
• Lump
• Curvature
• Erectile dysfunction
• Deformity (Shortening, Indentation,
Hourglass deformity)

12. PRESENTATION?

13. ASSOCIATED CO-MORBIDITIES?
• DM
• HTN
• ED
• Increased Cholesterol & TGs
• Decreased testosterone
• Dupuytren`s contracture
• Plantar fascial contracture (Ledderhose scarring)

14. DUPUYTREN`S CONTRACTURE?
• Dupuytren`s contracture is present in 9-39%
pinatients with peyronie`s disease
• Peyronie`s disease is present in 4% patients
with dupuytren`s contracture

15. EVALUATION?
• Complete medical and Sexual history (Especially
ED)
• Auto photographs (During Erection) to assess the
degree of curvature
• Intracavernosal PGE1 and examination
• Vacuum device assisted erection

16. EVALUATION?
• PLAQUE Examination (Tenderness and
Location)
• Recording Penile stretch length to assess the
penile shortening and counselling of the
patient.

17. INVESTIGATIONS?
• Color Doppler Ultrasound Scan for Plaque and
vascular abnormalities.

18. INVESTIGATIONS?

19. INVESTIGATIONS?
• MRI  Indicated for complex extensive
cavernosal fibrosis.

20. TREATMENT?
PEYRONIE`S DISEASE
ACTIVE PHASE
(ACUTE INFLAMMATION)
STABLE PHASE
(MATURE DISEASE)

21. ACTIVE DISEASE?
• Short symptom duration < 3 months
• Penile pain during erection
• Changing deformity (Recent change)
NON-OPERATIVE
MANAGEMENT

22. ORAL MEDICATION?
• Pentoxifylline (PDE/TGF Inhibitor)
• Cholchicine + Vitamin E (Decreases
pain, plaque size and curvature)
• Potassium paraaminobenzoate
• Tamoxifen

23. INTRALESIONAL INJECTION?
• Inj. Verapamil (10mg in 10ml N/Saline)
• Inj. Clostridium Collagenase (XIAFLEX)
• Inj. Interferon a2-B
• Inj. Steroids

24. TOPICAL TREATMENT?
• IONTOPHORESIS: Electric Currents used to
transfer verapamil, dexamethasone and
lidocaine transdermally (Transdermal EMDA)
• ESWL: Decreases pain but no effect on
deformity. 4 weekly
• VACUUM THERAPY: Mechanical therapy
• TRACTION DEVICES: FastSize penile extender
2-8 hours per day for 6 months.

25. NON-OPERATIVE MANAGEMENT?
ORAL MEDICATION INTRALESIONAL
INJECTIONS
TOPICAL TREATMENT
• Pentoxifylline (PDE/TGF
Inhibitor)
• Cholchicine + Vitamin E
(Decreases pain, plaque size
and curvature)
• Potassium
paraaminobenzoate
• Tamoxifen
• Inj. Verapamil (10mg in 10ml
N/Saline)
• Inj. Clostridium Collagenase
• Inj. Interferon a2-B
• Inj. Steroids
• IONTOPHORESIS: Electric
Currents used to transfer
verapamil, dexamethasone
and lidocaine transdermally
(Transdermal EMDA)
• ESWL: Decreases pain but
no effect on deformity. 4
weekly
• VACUUM THERAPY:
Mechanical therapy
• TRACTION DEVICES:
FastSize penile extender 2-8
hours per day for 6 months.

26. STABLE DISEASE?
• Stable for 3 months
• No penile pain
• Stable deformity (preventing intercourse)
OPERATIVE
MANAGEMENT

27. OPERATIVE MANAGEMENT?
STABLE
DISEASE
< 30O
No Treatment
Required
> 30O
ED +ve
Penile
Prosthesis
ED -ve
30O - 60O
NESBIT
PROCEDURE
> 60O
LUE
PROCEDURE

28. NESBIT PROCEDURE?
• After injecting intracavernosal saline
• 1mm for every 10O
• 88-94% Success

29. LUE PROCEDURE?
• Plaque incision and Grafting
• To lengthen the affected side
• 75-96% Success

30. PENILE PROSTHESIS?
• Moderate to severe ED
• Cavernosal Fibrosis and complex
deformities
• + Graft insertion

31. SURGICAL MANAGEMENT?
NESBIT PROCEDURE SIMPLE PLICATION LUE PROCEDURE
After injecting intracavernosal
saline
1mm for every 1O
88-94% Success
For more than 60O
40% Sucess
Plaque incision and Grafting
To lengthen the affected side
75-96% Success
PENILE PROSTHESIS
Moderate to severe ED
Cavernosal Fibrosis and
complex deformities
+ Graft insertion