Peyronie’s disease is a connective tissue disorder characterized by the formation of flat scar tissue, known as plaque, within the penis. This condition primarily causes a noticeable curvature or bend in the penis, typically during erection. While most attention focuses on its impact on sexual function, the disorder can also directly lead to urinary problems. The physical changes caused by the plaque may obstruct or alter the flow of urine, resulting in a range of lower urinary tract symptoms.
Understanding the Physical Mechanism
Peyronie’s disease involves the formation of hard, fibrous plaque within the tunica albuginea, the tough, elastic sheath surrounding the erectile chambers of the penis. This plaque is composed largely of collagen, replacing the normal, flexible tissue. The scar tissue does not stretch during erection, unlike the surrounding healthy tissue. This lack of elasticity pulls on the shaft, causing the characteristic curvature, shortening, or sometimes an indentation. If the plaque forms on the ventral side or wraps circumferentially, it can mechanically interfere with the urethra, the tube that carries urine.
Specific Urinary Symptoms and Causes
The urinary issues associated with Peyronie’s disease are often grouped as lower urinary tract symptoms (LUTS), stemming from the physical obstruction or distortion of the urethra. A direct cause is the mechanical compression of the urethra by a ventrally located plaque, narrowing the channel and impeding urine flow. Resulting symptoms include a weakened or intermittent urine stream, the need to strain, and a feeling of incomplete bladder emptying. Furthermore, significant penile curvature can cause flow deviation, where the urine stream is bent or sprayed. During the acute, or inflammatory, phase of the disease, inflammation may spread to the peri-urethral tissues, triggering symptoms like urinary urgency and frequency.
Evaluating Urinary Flow Issues
When a patient with Peyronie’s disease reports urinary difficulty, a urologist conducts a focused evaluation to determine if the plaque is the cause. The diagnostic process begins with a physical examination, where the doctor can palpate the hard plaque under the skin. Standardized questionnaires, such as the International Prostate Symptom Score (IPSS), quantify the severity of urinary symptoms. Uroflowmetry is a non-invasive test that objectively measures the speed and volume of urine flow, providing data on the degree of obstruction. This test is followed by a measurement of the post-void residual volume, which checks how much urine remains in the bladder after voiding. Imaging techniques like dynamic penile ultrasound visualize the plaque’s exact location, size, and proximity to the urethra, confirming if the scar tissue is physically compressing or distorting the urinary tract.
Treatment Approaches for Associated Urinary Problems
Treatment for urinary issues caused by Peyronie’s disease is tailored to the severity of the obstruction and the phase of the disease. For milder symptoms, conservative management may be employed, sometimes involving oral medications like pentoxifylline, which is thought to reduce inflammation and scarring. Mechanical therapies, such as the daily use of penile traction devices, aim to stretch the tissue and minimize the curvature, indirectly alleviating pressure on the urethra.
Surgical Interventions
If the urinary obstruction is more severe, surgical intervention may be necessary to correct the underlying deformity. Procedures like plication involve shortening the side opposite the plaque to straighten the penis and reduce the distorting effect. Plaque excision and grafting is a technique where the scar tissue is removed and replaced with a patch of tissue, which can directly address the compression on the urethra. For men who also experience severe erectile dysfunction, a penile implant may be the best option, as it addresses both the curvature and provides rigidity, often correcting the urinary flow simultaneously.