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Pyronise disease is a disorder affecting the penis that can cause:
o
A lump within the shaft of the penis.
o
Pain in the shaft of the penis
o
Abnormal angulations of the erect penis ('bent'
penis).
Not all of these features are necessarily
present, but, typically, a man would first
notice a tender lump in the penis, which might
later be followed by bending of the penis when
erect, sometimes at very odd angles. The flaccid
penis is not usually deformed. It is important
to remember that a degree of upward (towards the
head) angulations of the erect penis is quite
normal and not a feature of Pyronise disease.
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Not all of these features are necessarily
present, but, typically, a man would first
notice a tender lump in the penis, which might
later be followed by bending of the penis when
erect, sometimes at very odd angles. The flaccid
penis is not usually deformed.
It is important to
remember that a degree of upward (towards the
head) angulations of the erect penis is quite
normal and not a feature of
Pyronise
disease.
What is Peyronie’s
disease?
Peyronie’s disease is
characterized by a plaque, or hard lump,
that forms within the penis. The plaque,
a flat plate of scar tissue, develops on
the top or bottom side of the penis
inside a thick membrane called the
tunica albuginea, which envelopes the
erectile tissues. The plaque begins as a
localized inflammation and develops into
a hardened scar. This plaque has no
relationship to the plaque that can
develop in arteries.

Cases of Peyronie’s
disease range from mild to severe.
Symptoms may develop slowly or appear
overnight. In severe cases, the hardened
plaque reduces flexibility, causing pain
and forcing the penis to bend or arc
during erection. In many cases, the pain
decreases over time, but the bend in the
penis may remain a problem, making
sexual intercourse difficult. The sexual
problems that result can disrupt a
couple’s physical and emotional
relationship and can lower a man’s
self-esteem. In a small percentage of
men with the milder form of the disease,
inflammation may resolve without causing
significant pain or permanent bending.
The plaque itself is
benign, or noncancerous. It is not a
tumor. Peyronie’s disease is not
contagious and is not known to be caused
by any transmittable disease.
A plaque on the
topside of the shaft, which is most
common, causes the penis to bend upward;
a plaque on the underside causes it to
bend downward. In some cases, the plaque
develops on both top and bottom, leading
to indentation and shortening of the
penis. At times, pain, bending, and
emotional distress prohibit sexual
intercourse.
A cross-section of the
penis (left) displays the internal
cavity that runs the length of the penis
and is divided into two chambers—corpora
cavernosa—by a vertical connecting
tissue known as a septum. Scientists
theorize that, during trauma such as
bending, bleeding might occur at a point
of attachment of the septum to the
tunica albuginea lining the chamber wall
(center). The bleeding results in a hard
scar, or plaque, which is characteristic
of Peyronie’s disease. The plaque
reduces flexibility on one side of the
penis during erection, leading to
curvature (right).
Estimates of the
prevalence of Peyronie’s disease range
from less than 1 percent to 23 percent.1
A recent study in Germany found
Peyronie’s disease in 3.2 percent of men
between 30 and 80 years of age.2
Although the disease occurs mostly in
middle age, younger and older men can
develop it. About 30 percent of men with
Peyronie’s disease develop hardened
tissue on other parts of the body, such
as the hand or foot. A common example is
a condition known as Dupuytren’s
contracture of the hand. In some cases,
Peyronie’s disease runs in families,
which suggests that genetic factors
might make a man vulnerable to the
disease.
How does Peyronie’s disease develop?
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Many researchers
believe the plaque of Peyronie’s disease
develops following trauma, such as
hitting or bending, that causes
localized bleeding inside the penis. Two
chambers known as the corpora cavernosa
run the length of the penis. A
connecting tissue, called a septum, runs
between the two chambers and attaches at
the top and bottom of the tunica
albuginea.
If the penis is bumped
or bent, an area where the septum
attaches to the tunica albuginea may
stretch beyond a limit, injuring the
tunica albuginea and rupturing small
blood vessels. As a result of aging,
diminished elasticity near the point of
attachment of the septum might increase
the chances of injury. In addition, the
septum can also be damaged and form
tough, fibrous tissue, called fibrosis.
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The tunica albuginea
has many layers, and little blood flows
through those layers. Therefore, the
inflammation can be trapped between the
layers for many months. During that
time, the inflammatory cells may release
substances that cause excessive fibrosis
and reduce elasticity. This chronic
process eventually forms a plaque with
excessive amounts of scar tissue and
causes calcification, loss of elasticity
in spots, and penile deformity.
While trauma might
explain some cases of Peyronie’s
disease, it does not explain why most
cases develop slowly and with no
apparent traumatic event. It also does
not explain why some cases resolve or
why similar conditions such as
Dupuytren’s contracture do not seem to
result from severe trauma.
Some researchers
theorize that Peyronie’s disease may be
an autoimmune disorder.
How is Peyronie’s
disease evaluated?

Doctors can usually
diagnose Peyronie’s disease based on a
physical examination. The plaque can be
felt when the penis is limp. Full
evaluation, however, may require
examination during erection to determine
the severity of the deformity. The
erection may be induced by injecting
medicine into the penis or through
self-stimulation. Some patients may
eliminate the need to induce an erection
in the doctor’s office by taking a
digital or Polaroid picture at home. The
examination may include an ultrasound
scan of the penis to pinpoint the
location(s) and calcification of the
plaque. The ultrasound can also be used
to evaluate blood flow into and out of
the penis if there is a concern about
erectile dysfunction.
Good advice
Noticing a lump in the
penis can be a frightening experience. Men are
often concerned that they have developed a
cancer.
Cancer within the
penile shaft is very rare indeed, while
Pyronise disease is by far the most common
cause of such lumps. If you find a lump, it is
important to seek prompt medical advice, but you
should not be too fearful that a serious cause
will be found.
What causes
Pyronise
disease?
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The penis consists of basically three cylinders, covered by several
sheaths of tissue and, finally, by skin.
Running the length of each side of the
penis are spongy cylindrical structures
called the corpora cavernosa. These form
the erectile tissue that becomes
engorged with blood during erection,
acting like the inner tube of a tyre.
They are surrounded by the tunica
albuginea, a tough, inelastic, fibrous
sheath, which might be compared with the tyre itself.
When the penis becomes erect, the inner tubes (corpora cavernosa)
inflate, filling the space within the
tyre (tunica albuginea), making it more
rigid.
In
Pyronise disease, tough, fibrous plaques spontaneously appear
within the tunica albuginea, and are
felt as tender lumps. When the penis
becomes erect, it inflates unevenly and
tends to bend around the plaque, causing
the characteristic deformed appearance
of
Pyronise disease.
One in three men with
Pyronise have pain or penile bending when erect
as their principal symptom. Experts are
not certain why some men get
Pyronise
disease and others do not. Several
factors might be involved, including:
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Genetics:
occasionally the disease has a tendency to run in
certain families (inherited or genetic
predisposition), but this is not common.
o
Injury:
Pyronise
disease is more common after
injury to the penis, such as penile
fracture or forceful bending of the
erect penis. It also occurs more
frequently in men that give injections
into the penis for the treatment of
erectile dysfunction (impotence).
o
Circulatory disorders:
more men with
Pyronise
disease seem to
be affected by high blood pressure
(hypertension) and hardening of the
arteries (atherosclerosis), so these
conditions might possibly be involved in
its development.
Diabetes:
this is more common in men with
Pyronise disease. As a result diabetes
might also be involved in its
development.
What are the symptoms?
Pyronise disease
occurs at any time from adolescence onwards, but
most commonly in men aged 40 to 60 years. It
affects around 1 in a 100 (0.4 to 1.0 per cent)
of the middle-aged male population, but some
experts suggest up to 4 per cent of men aged
over the age of 40 may suffer from it.
The disease causes very variable degrees of
deformity and inconvenience.
Some men are barely
troubled by it, while others find sexual
intercourse physically impossible. Many men will
not require treatment, but all should seek
prompt medical advice.
The symptoms are:
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o
A lump within the shaft of the penis:
this can slowly develop over several
months and frequently takes 12 to 18
months to reach its full extent.
o
Pain in the shaft of the penis:
two-thirds of men with
Pyronise
disease will experience pain in the
penis. In most cases, it will gradually
settle down and disappear without
treatment in a few months.
o
Abnormal angulations of the erect penis
(bent penis):
during the 12 to 18 months that the
plaque or lump is developing, the
deformity of the erect penis can change
- 30 to 40 per cent get worse, 10 to 20
per cent get better and 50 per cent
remain the same.
Some men will
develop varying degrees of erectile
dysfunction (impotence) as a consequence
of
Pyronise disease. This can vary
from a complete inability to attain
and/or maintain an erection adequate for
satisfactory sexual experience to a
slight reduction in penile rigidity.
Some men
report a tendency for the penis to
buckle around the lump during sex. The
frequency of this problem has been
reported as between 4 and 80 per cent,
although experience suggests that the
true rate is towards the lower end of
this range.
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How is Pyronise disease diagnosed?
Pyronise disease is
diagnosed on the basis of the history (how the
problem has developed, as you describe it to
your doctor) and examination (what the doctor
can see and feel).
Between 10 and 25 per
cent of men with Pyronise disease have
Dupuytren's contracture, a claw-like deformity
in which the little finger, the ring finger and,
sometimes, other fingers bend over towards the
palm of the hand?
No special
investigations are needed and biopsy (surgically
removing a piece of the lump for examination
under a microscope) is only needed for rapidly
enlarging lumps that are not developing in the
usual manner. Ultrasound scanning can be used to
assess the exact size and position of the lump,
but is rarely necessary.
What else could it be?
Although extremely
rare, sarcoma of the penis (a form of cancer)
can present in a similar way. Your doctor will
consider this if the lump enlarges very rapidly
or develops in an unusual manner.
Prognosis
Pyronise disease
runs a very variable course. Many men with
Pyronise disease will not require or desire
treatment, and will enjoy very satisfactory sex
with their rather
unusually shaped penis.
Men who have had
Pyronise disease are more likely to have a
further episode in the future than the general
population. Nothing is proven to prevent a
recurrence.
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