Causes:
• Vascular trauma, e.g. vigorous sexual activity, ‘coital fracture’, kangaroo kick or idiopathic onset
• Vitamin E deficiency, Beta Blockers
• Autoimmune-Dupuytrens contracture-33% both, Lederhosen(plantar fascial fibromatosis) • Hereditary pre-disposition
• Surgery –hernia, abdominal, prostate,
• Anglo-Saxon race dominance, rarely in Asian or African-American races
• Blood type- A group
• 16-19% of men undergoing a radical prostatectomy develop Peyronies disease between 12-14 months post surgery. Potentially 1in 5 men.
Normally a man will have 4-8 nocturnal erections per night for 365 days of a year. After a prostatectomy a man can miss 2190 housekeeping erections in the first year after surgery. This results in reduced capacity to dilate and oxygenate the tissue essential for penile function. As a result of reduced local blood flow, the spongy tissue starts to shrink and fibrosis sets in the longer it continues.
Harder calcified plaques can start to form and with it an onset of pain and inflammation and curvature flow.
It can be avoid if a combination of medication known as PDE5 inhibitors (Viagra, Cialis, Levitra) are commenced within the first 4-5 weeks post operative together with the use of a vacuum compression device to stretch the penile tissues.
Intra cavernosal injection can give immediate erections which has a double effect of stretching and lengthening erectile tissue.
Treatment:
• Intra lesion injections- Xiaphlex, Prostaglandin E1, steroids(Dexamethasone), PDE5’s
• Surgery-plication, plaque excision
• Vacuum Pump 3-5x/week
• Traction devices
• Physiotherapy: to reduce the plaque formation
- Myofascial release
- Scar tissue massage, cross frictions to plaques
- Pubic symphysis alignment
- Therapeutic Ultrasound
- Extracorporeal shock wave therapy (ESWT)
