Peyronie disease is scar tissue (a fibrous plaque) in the tunica albuginea of the penis that causes a bend, shortening or narrowing during erection. It likely follows small repeated injuries during sex and has an early painful active phase and a later stable phase.
Key symptoms
- Curved or bent erection
- Pain with erection in the early phase
- A firm lump along the shaft
- Shortening, narrowing or an hourglass shape
- Erectile dysfunction and emotional distress
What you find on exam
- Feel the flaccid penis for a firm plaque, most often on the top
- Measure stretched penile length
- Look for Dupuytren contracture of the hand, which is linked
- Review a home photo of the erection to estimate the curve
Tests
- Diagnosis is mostly clinical from history and exam
- Penile duplex ultrasound after an injected vasodilator to see the plaque and blood flow
- Measure the curve during an induced erection before any procedure
- Check for diabetes and heart risk factors if erectile dysfunction is present
Treatment basics
- Explain the natural course; some cases improve or stabilize
- NSAIDs for pain in the active phase; penile traction therapy
- Intralesional collagenase clostridium histolyticum or verapamil for a stable curve
- Surgery once stable for at least 3 months: plication, plaque incision with graft or penile prosthesis
- PDE5 inhibitor such as tadalafil for erectile dysfunction
Red flags
- Sudden pain with a popping sound and fast swelling during sex (possible penile fracture)
- A penile mass that grows quickly or does not fit a plaque (consider cancer)
- Severe distress or depression about the deformity
Practice it in Making Synapses
Making Synapses cases
Related guides
Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.