The Nodules of the Penis
(Induratio Penis Plastica "or Peyronie's disease")

The autopalpation of the area of hardening, a form of a nodule or plaque at the penis level, with pain and curvature in the erection, often brings about a series of strong worries, such as the fear of being infected by a pathological tumour (it not a tumour, a lesion which could transform itself into a tumour!), of having to give up normal sexual activity or in having a future difficult in urinating.

The first signs of the disease were made by Andrea Vesalio in 1550, but the first substantial clinical description is found in one of the writings of Francois de la Peyronie, surgeon of the army of Louis XV in 1743.
The disease occurs at its maximum to those between 50 and 65 years of age but may also appear at a young age. It is accompanied with diabetes with a certain frequency, and gout, hypertension, and ateroscelerosis. Moreover, there may be a series of microtraumas or traumas due to the penis; sometimes subsequent traumatism occurs during sexual activity. The disease more frequently occurs together with other pathologies of the connective tissue (for example, Dupuytren disease or obvious fibrosis, the fibrosis of the auricular cartilage, timpanosclerosis and arthritis, etc.).

The causes are not completely clear; the diseases is thought of as an auto-immunity phenomenon, which arouses a chronic, inflammatory reaction. In one of the initial phases of the disease, the Patient feels a moderately painful sensation in the penis accentuated by an erection. It appears in area of local hardening (plaque, nodule) and the penis tends to curve according to the plaque.
Then the pain spontaneously tends to become reduced. The dimensions of the plaque stabilise and the curvature blocks. But this entails only an apparent, spontaneous improvement. In reality, with the involvement of the cavernosal walls opposite, the penis can straighten, to the detriment of its lengthening, often accompanied by shrinkage to an hourglass shape or a formation of a new nodularity.
The capacity of the erection can become progressively reduced up until impotence, which could also become absolute. This is as a result of the alterations that meet with the tunic of the corpus cavernosis, interfering with the mechanism of getting rid of the blood inside (erectile dysfunction from "venous leakage").

With time, the plaque tends to calcify and the penis can get shortened or thinner. These modifications come with a cruel trend, generally in the space of several months or sometimes even slower, accompanying periods of rapid and acute progression. Deep psychological discomfort is inevitably tied to the disease from the difficulty in having an erection or the "shame" of displaying a deformed penis; this poor psychological state of being can further amplify the disturbances of sexual functioning.

The diagnosis is based on Patient History, from the feelings during the andrological visit and from a dynamic, penile ecograph (penile scan) followed up on during an erection and induced by local medicines. The ecograph allows also for the evaluation of the phases of the disease (Stadiation) and the choice of the therapeutic strategy which would be most suitable.

Regarding the treatment, general pharmacological therapy and/or local treatment (laser-ultrasound; drug injections inside the plaque) are, above all, used for the objective of reducing the symptoms and holding the evolution of the disease in check.
In more advanced cases or those insensitive to pharmacology, one must resort to surgical therapy (removal of the plaque and the substitution of venal substances, or insertion of a penile prosthesis in selected cases) to correct the deformity and restore the normal capacity of the erection.

In general, the earlier the diagnosis and the commencement of treatment, the better the results can be expected from the applied cure. One must, however, turn to the specialist as soon as one finds the symptoms (painful erection, formation of nodules, acquiring of a curvature, erectile deficit).

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