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CONGENITAL

CURVATURE
PEYRONIE’S DISEASE

&

PENILE FRACTURE

Source: Hatzimouratidis K et al: Eur Urol 2012; 62:543-52

Levine L and Burnett A: J Sex Med 2013; 10:230-44

TYPES OF PENILE CURVATURES
ACQUIRED
CURVATURE
(Peyronie’s disease)

SCAR

CONGENITAL
CURVATURE
(born with
curvature)

Curvatures -of different severity, deviation
angle and direction- appear only during
erection rendering sexual intercourse difficult
or impossible

Curvatures are anatomical -structural
alterations in the tunica albuginea, which
is the part of penis covering the 2
corpora cavernosa

CONGENITAL PENILE
CURVATURE
It is a rare condition
that does not affect
quality of erection

CONSEQUENCES
There are major psychological
consequences,
as it concerns young men who
avoid having a sexual life exactly
because of their aesthetic
problem

DIAGNOSIS
History and self-photography
of erect penis

TREATMENT
Exclusively surgical treatment
(plastic repair)

PEYRONIE’S DISEASE –
PENILE FRACTURE ETIOLOGY
CAUSE MECHANISM
The penis bends,
resulting in either
partial
(Peyronie’s
disease) or total
rupture (fracture)
of tunica
albuginea

Injury during sexual intercourse
ONLY

20-30%

of patients
remember it
Α. Failure of penis to insert the vagina
Β. Abrupt and violent movements
during sexual intercourse
or masturbation

CHARACTERISTIC FEATURES
It usually occurs after the 5th decade

What ca
n be obs
erved
in the pe
nis

Rare
spontaneous cure

In

3-9%

3-13%

of men
Pain during
erection
is the first
symptom
in

(only wh
e

n erect)

(10-180 ο)

Curvatur
e

Erectile
disorder in

Rotation

50%

(usually 13cm)

35-40%

Reductio
n
of length
Deformit
y
e.g. hourg
like inden lasstation)

Progression of the disease
with increase of penile
curvature
or rotation in

30-50%
of patients

(within 12 months)

Characteristic
in the final stage is
the palpable hard
plaque formation
inside the penis

RISK
FACTORS

PSYCHOLOGICAL
EFFECTS
Agitation- anxiety
about potential
progression
(fear for cancer)

Dupuytren’s disease
(collagen disease)
Diabetes
Mellitus

Emotional
problems
(his and his
partner’s)

Hypertension
Dyslipidaemia

DysthymiaDepression
(1 out of 2 men)

Smoking
Low
testosterone

Medical
history

Sexual
history
Patient selfphotography
of erect penis
Physical
examination

Penile
U/S
(ultrasound)
Penile Triplex
with drug-induced
erection

TREATMENT

Pharmacotherapy
IS INEFFECTIVE

Penile Traction Devices and
Vacuum Erection Device
MAY HELP PARTIALLY REDUCE
CURVATURE

Surgery PROVIDES THE
SOLUTION, in case
impairment is stabilized
for >3 MONTHS

THERE ARE 3 SURGICAL
OPTIONS:

1.

1.Excision or plication of tunica
albuginea - procedures that do not
usually affect penile function

2.

1.Placement of grafts within tunica
albuginea - this procedure though
often leads to relapse and may impair
erectile function

3.

1.Placement of penile prosthesis,
if patient has erectile dysfunction
that does not respond to
pharmacotherapy

TUNICA ALBUGINEA

PENILE
FRACTURE
Full rupture of tunica
albuginea, which
is rarely accompanied
by urethral injury

CAUSED BY

CHARACTERISED BY

CHARACTERISED BY

Injury of the erect penis during sexual
intercourse (usually with partner on
top) or during masturbation (rare
cases)

a cracking sound and
sudden sharp pain

a cracking sound and
sudden sharp pain

EMERGENCY

Conservative treatment
is usually accompanied in

6 to 8

hours
Within the first
it must be treated surgically
Immediate surgical treatment protects
erectile function

Visit

50-80%
by erectile dysfunction with
or without penile curvature

www.imop.gr

and get informed on SEXUAL
PROBLEMS and their solutions
www.facebook.com/imop.gr

youtube.com/imopgr

www.twitter.com/imop.gr

gplus.to/imop

linkedin.com/in/imop.gr

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Congenital curvature Peyronies disease and penile fracture

  • 1. CONGENITAL CURVATURE PEYRONIE’S DISEASE & PENILE FRACTURE Source: Hatzimouratidis K et al: Eur Urol 2012; 62:543-52 Levine L and Burnett A: J Sex Med 2013; 10:230-44 TYPES OF PENILE CURVATURES ACQUIRED CURVATURE (Peyronie’s disease) SCAR CONGENITAL CURVATURE (born with curvature) Curvatures -of different severity, deviation angle and direction- appear only during erection rendering sexual intercourse difficult or impossible Curvatures are anatomical -structural alterations in the tunica albuginea, which is the part of penis covering the 2 corpora cavernosa CONGENITAL PENILE CURVATURE It is a rare condition that does not affect quality of erection CONSEQUENCES There are major psychological consequences, as it concerns young men who avoid having a sexual life exactly because of their aesthetic problem DIAGNOSIS History and self-photography of erect penis TREATMENT Exclusively surgical treatment (plastic repair) PEYRONIE’S DISEASE – PENILE FRACTURE ETIOLOGY CAUSE MECHANISM The penis bends, resulting in either partial (Peyronie’s disease) or total rupture (fracture) of tunica albuginea Injury during sexual intercourse ONLY 20-30% of patients remember it Α. Failure of penis to insert the vagina Β. Abrupt and violent movements during sexual intercourse or masturbation CHARACTERISTIC FEATURES It usually occurs after the 5th decade What ca n be obs erved in the pe nis Rare spontaneous cure In 3-9% 3-13% of men Pain during erection is the first symptom in (only wh e n erect) (10-180 ο) Curvatur e Erectile disorder in Rotation 50% (usually 13cm) 35-40% Reductio n of length Deformit y e.g. hourg like inden lasstation) Progression of the disease with increase of penile curvature or rotation in 30-50% of patients (within 12 months) Characteristic in the final stage is the palpable hard plaque formation inside the penis RISK FACTORS PSYCHOLOGICAL EFFECTS Agitation- anxiety about potential progression (fear for cancer) Dupuytren’s disease (collagen disease) Diabetes Mellitus Emotional problems (his and his partner’s) Hypertension Dyslipidaemia DysthymiaDepression (1 out of 2 men) Smoking Low testosterone Medical history Sexual history Patient selfphotography of erect penis Physical examination Penile U/S (ultrasound) Penile Triplex with drug-induced erection TREATMENT Pharmacotherapy IS INEFFECTIVE Penile Traction Devices and Vacuum Erection Device MAY HELP PARTIALLY REDUCE CURVATURE Surgery PROVIDES THE SOLUTION, in case impairment is stabilized for >3 MONTHS THERE ARE 3 SURGICAL OPTIONS: 1. 1.Excision or plication of tunica albuginea - procedures that do not usually affect penile function 2. 1.Placement of grafts within tunica albuginea - this procedure though often leads to relapse and may impair erectile function 3. 1.Placement of penile prosthesis, if patient has erectile dysfunction that does not respond to pharmacotherapy TUNICA ALBUGINEA PENILE FRACTURE Full rupture of tunica albuginea, which is rarely accompanied by urethral injury CAUSED BY CHARACTERISED BY CHARACTERISED BY Injury of the erect penis during sexual intercourse (usually with partner on top) or during masturbation (rare cases) a cracking sound and sudden sharp pain a cracking sound and sudden sharp pain EMERGENCY Conservative treatment is usually accompanied in 6 to 8 hours Within the first it must be treated surgically Immediate surgical treatment protects erectile function Visit 50-80% by erectile dysfunction with or without penile curvature www.imop.gr and get informed on SEXUAL PROBLEMS and their solutions www.facebook.com/imop.gr youtube.com/imopgr www.twitter.com/imop.gr gplus.to/imop linkedin.com/in/imop.gr