Peyronie's Disease
Peyronie’s Disease (AUA Guideline) is scar tissue (plaque) inside the penis that causes curvature, pain, or deformity with erection.
Symptoms
A palpable lump or band under the skin of the penis, curvature or narrowing during erection, and sometimes pain, especially in the earlier, active phase.
Causes and risk
The exact cause isn't fully understood, but repeated minor trauma during sex in a genetically susceptible man is the leading theory. It's more common with age, Dupuytren's contracture, and diabetes.
How it is evaluated
Diagnosis is by history and exam; an in-office injection test (with or without ultrasound) can help characterize the plaque and curvature when planning treatment.
Treatment
Collagenase clostridium histolyticum (Xiaflex) is the only FDA-approved injectable for a palpable plaque with 30 degrees or more of curvature, with efficacy data from the IMPRESS trials. Traction therapy is a non-invasive option. Surgery is reserved for stable disease -- meaning the deformity hasn't changed for at least 3-6 months -- and generally gives more reliable curvature correction than injections.
When to seek care
Peyronie's disease itself is not an emergency. A sudden cracking sensation with pain and swelling during sex (suggesting penile fracture) or an erection lasting more than 4 hours are the related emergencies that need immediate care.