Peyronies disease

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^T^^B^D: The formation of fibrotic plaques in the penis resulting in pain and abnormal curvature during erection.

A: Unknown.

A/R: Associated with HLA-B7, a family history of connective tissue disorders, vitamin E deficiency and 30% of patients suffer from other fibrotic conditions such as Dupuytren's contracture. DM and trauma to the penis are risk factors for disease development.

_E Relatively common, affecting 1-3% of men usually between 45 and 65 years.

H: Pain, abnormal curvature and distortion of the penis (indentation, shortening) during erection.

E: A firm plaque of tissue can be felt on the dorsal or ventral surface of the penis.

_P: Slowly progressive asymmetrical fibrotic plaques develop in the tunica albuginea that surrounds the corpora carvenosa of the penis.

I: Not normally needed.

Radiographs or USS: Can identify calcified plaques.

Plaque biopsy: For rapidly progressing disease to exclude malignancy.

M: Patients are not treated surgically initially as some experience spontaneous improvement and are advised to wait for 1-2 years.

Medical: Oral vitamin E supplements and para-aminobenzoate are used. Local injections of collagenase, steroids and calcium channel blockers into the plaque have all been attempted with inconclusive effectiveness. Low-dose radiation therapy can reduce pain but has no effect on the plaque. Surgical: Excision of the plaque and skin graft or the removal of tissue on the opposite side to the plaque to counteract the abnormal curvature (Nesbit procedure). Penile implants may be combined with the above procedures or may even be corrective alone.

C: In severe cases, erectile dysfunction may develop. Tissue atrophy may occur with some of the medical treatments. Excision of the plaque may result in partial loss of erectile function and rigidity, whereas Nesbitt procedure causes a shortening of the erect penis.

P: Good, with most patients maintaining good sexual function even without treatment.

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