The Very BIG Problem

Peyronie's disease

Peyronie's disease or fibroplasticheskaya induration of the penis, is characterized by the formation of plaques in the stiff albuginea of the corpora cavernosa, again leading to the outbreak of painful erections and curvature of the erect penis.

Peyronie's disease was named after the founder of the Paris Academy of Surgical Francois de la Peyronie (Francois de la Peyronie), who in 1743 described 3 patients with a "necklace-like scar tissue, which was the cause of the curvature of the penis, upward during an erection."

Peyronie's disease most often affects men aged 40-60 years, mean age - 53 years, but sometimes occurs in older men or younger. At the very young patient Peyronie's disease was diagnosed at the age of 18 years. Most men suffering from Peyronie's disease - white, however, described several cases of men blacks and rarely - the inhabitants of the East.

The prevalence of the disease according to different authors - from 0,3 to 1%, although it may be higher due to the fact that patients are delaying the date of the initial survey by an average of 15 months. The leading reason for the visit to the doctor - the presence of painful erections that are not constant symptom of the disease.
Etiology

Despite the large number of surveys to the etiology of Peyronie's disease is still not completely clear. Many scientists have shown that Peyronie's disease - this infiltration, resulting from chronic microtrauma. Currently, most researchers attribute to a group of Peyronie's disease, connective tissue disease, as well as development, clinical manifestations and treatment principles are similar to other diseases from the group of connective tissue disease. In 16% of patients with Peyronie's disease have contractures Dyupuitrena.
Clinical picture

The most common symptoms of Peyronie's disease - the presence of palpable plaque - 78-100%, the curvature of the penis - 52-100%, painful erections ~ 70%. Size plaques ranging from a few millimeters to the length of the penis, on average, from 1.5 to 2 centimeters. Depending on the localization of lesions are distinguished: dorsal curvature, ventral curvature and lateral bending.

The circular plaque can cause narrowing of the diameter of the penis - the curvature of the type "hourglass" or "bottle-narrowing", resulting in a marked decrease in rigidity of the penis further damage.

In many patients the first symptom of the disease is painful erection, which usually disappear when the stabilization process.

The natural development of Peyronie's disease different, the active phase of the disease lasts from 6 to 18 months, after which may occur spontaneous regression of symptoms. However, most patients continue to harass the symptoms of the disease and suggest a need for therapeutic or surgical treatment.

Since this disease is not malignant degenerating, in the treatment of indigent patients with erection problems and who need correction of deformation penis.
Treatment

Despite the large number of medical and surgical treatments for Peyronie's disease, the choice of method of treatment of this disease is a big dilemma for the practicing urologist. At the moment there are 2 directions - conservative treatment and operative.

As conservative therapy used a variety of pharmaceutical and natural products. The mechanism of action of many of them - the dissolution of collagen fibers that make up the plaque, thereby reducing its density and distribution.

Physiotherapy is a great niche in the treatment of Peyronie's disease - are used ultrasound method, phonophoresis (combining ultrasound with application of medications), laser-magnetic therapy, etc. The effect of these methods is based on the acceleration of biochemical reactions and vibrating massage of tissues.

However, the effectiveness of conservative treatment does not exceed 10-25%, depending on the method, and therefore have to decide on the application of operational methods of treatment.
Indications for surgical treatment:

1. Not less than 6 months. from onset
2. 3-month period of stabilization of symptoms
3. The ineffectiveness of conservative therapy
4. Curvature of the penis, preventing sexual intercourse
5. Understanding the patient and his partner all the advantages and disadvantages of the operation

Methods proposed surgical treatment depends on the characteristics of the disease in a patient personal experience of the surgeon and the clinical features, which will run the operation. The essence of all surgical techniques is to eliminate distortions in combination with or without the actual removal of damaged tissue (plaque). In the presence of deformation and erectile dysfunction may need simultaneous falloprotezirovaniya. After 4 - 6 weeks after surgery, the patient again has the opportunity of successful sexual intercourse.

Relapse and the need for repeated surgical treatment almost does not exist.
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