Penile fibrosis, formally known as Peyronie’s disease, is a non-cancerous disorder affecting the male anatomy. This condition involves the development of a hard, inelastic scar tissue, or plaque, within the tunica albuginea, the fibrous sheath encasing the erectile chambers. When this plaque forms, it prevents the sheath from stretching properly during an erection, causing structural deformities and functional issues. Prevalence estimates suggest this condition affects between 3% and 9% of men in the general population, with a higher rate in middle-aged and older individuals.
Understanding the Formation of Scar Tissue
The formation of the fibrous plaque is attributed to a localized defect in the body’s wound-healing process. The leading hypothesis suggests the condition begins with micro-trauma or injury to the erect or semi-erect penis, often occurring during sexual activity. This injury causes damage to the tunica albuginea, resulting in bleeding and inflammation. Instead of normal tissue repair, an abnormal cascade is triggered, characterized by the overexpression of pro-fibrotic signaling molecules like Transforming Growth Factor-beta 1 (TGF-β1).
This causes fibroblasts to differentiate into myofibroblasts, which excessively produce Type I and Type III collagen. The resulting collection of disorganized, inelastic collagen fibers forms the dense, fibrous plaque. Certain risk factors increase the likelihood of developing this condition, suggesting a genetic predisposition alongside the trauma hypothesis. Men with a family history have an elevated risk, and it is frequently associated with other fibroproliferative conditions, such as Dupuytren’s contracture affecting the hand. Additional risk factors include advancing age, diabetes mellitus, and a history of certain pelvic surgeries.
Key Signs and Physical Changes
The signs of penile fibrosis typically unfold in two distinct stages: the acute phase and the chronic phase. The acute phase, which can last from six to eighteen months, involves active inflammation and progressive symptom development. During this time, the patient typically experiences pain, especially during an erection, and the shape or curvature of the penis begins to change.
The most recognizable sign is a palpable lump or firm band of tissue—the developing fibrous plaque—felt just beneath the skin. As the plaque forms, it causes the erect penis to progressively bend or curve toward the scar tissue, since the inelastic plaque cannot stretch like the healthy tissue on the opposite side. Curvature direction depends on the plaque’s location, which can be dorsal, ventral, or lateral.
The chronic, or stable, phase begins when inflammation subsides and the plaque matures, stabilizing the symptoms. Pain during erection often resolves or becomes minimal, but the physical deformity remains. This stable deformity manifests as significant curvature, loss of penile length, or complex shape changes, such as an “hourglass” appearance. The resulting loss of elasticity can lead to erectile dysfunction or make sexual penetration difficult or impossible.
How Doctors Confirm the Diagnosis
Diagnosis of penile fibrosis begins with a thorough medical and sexual history, focusing on the onset of pain and any changes in penile shape or function. A physical examination is then conducted to palpate the penile shaft for the presence, location, and size of the fibrous plaque. The standard imaging test used to confirm the diagnosis and plan treatment is a penile duplex Doppler ultrasound.
This specialized ultrasound is often performed after a medication is injected into the penis to induce a full erection. Imaging the penis in an erect state allows the physician to accurately measure the degree of curvature and precisely map the plaque’s location and extent. The ultrasound provides objective information by distinguishing between soft, non-calcified plaque and hard, calcified plaque. The Doppler component also assesses blood flow dynamics within the penile vessels, which is important for evaluating any associated erectile dysfunction and determining the appropriate management strategy.
Managing and Treating the Condition
Management of penile fibrosis is determined by the disease phase and the severity of the symptoms. Treatment in the acute phase, characterized by pain and changing curvature, is typically conservative and focused on halting the progression of the plaque.
Acute Phase Treatments
Oral medications like pentoxifylline are sometimes prescribed to manage inflammation, though their effectiveness in reversing curvature is often limited. A more targeted approach involves intralesional injections directly into the fibrous plaque. Collagenase Clostridium Histolyticum (CCH) is a medication approved for use in men with a specific degree of curvature, as it works by breaking down the excessive collagen that forms the plaque. Other injectable agents, such as interferon and verapamil, are also utilized, sometimes helping to reduce pain and curvature. Non-invasive mechanical therapies, such as vacuum erection devices or penile traction devices, are also recommended to help stretch the tunica albuginea and minimize length loss.
Chronic Phase Treatments (Surgery)
Surgical intervention is reserved for men in the chronic, stable phase whose curvature is severe enough to interfere with sexual function.
Plication: One surgical option is plication, where the surgeon places sutures on the side opposite the plaque to shorten the longer, unaffected side, thus straightening the shaft. This procedure is best suited for less severe curvatures but may result in some loss of penile length.
Grafting: For more complex deformities, a grafting procedure may be performed, involving the incision or removal of the plaque and then covering the resulting defect with a patch of tissue. While this technique aims to restore length, it carries a higher risk of postoperative erectile dysfunction compared to plication.
Penile Prosthesis Implantation: The implantation of a penile prosthesis is often the best choice for men who have both significant curvature and moderate-to-severe erectile dysfunction that has not responded to other treatments.