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Peyronie disease

Peyronie disease is a fibrous plaque in the tunica albuginea causing curvature, pain, shortening and sometimes erectile dysfunction; in the active phase treatment is conservative, and surgery is done only in the stable phase — plication for small curvature with good erections, plaque incision and grafting for large or complex curvature, and a prosthesis when there is also erectile dysfunction.

לקריאה בעברית

Why it matters in the exam

The exam shows a man in his fifties with new penile curvature, usually upward (dorsal), pain on erection and a palpable plaque. The right step at this point — when the disease is a few months old, there is pain and the curvature is changing — is conservative treatment and not surgery. The active phase usually lasts 12 to 18 months; the stable phase is defined when the pain has gone and the curvature has not changed for at least 3 months. There is an association with Dupuytren disease of the hand, diabetes and repeated minor trauma during erection.

In the active phase: anti-inflammatory analgesics for pain, and traction with a device that may reduce curvature and preserve length. Oral supplements such as vitamin E are not recommended because there is no proof of efficacy. Intralesional injections — collagenase, verapamil or interferon — are used for curvature of 30 to 90 degrees in stable disease. Curvature severity is measured in full erection, sometimes after intracavernosal injection, and erectile quality is also assessed.

Surgery is done when the disease has been stable for at least 3 to 6 months (and usually 12 months from onset): plication on the side opposite the curvature (Nesbit or "16-dot") when curvature is less than 60 degrees and erections are good — the operation is simple but shortens the penis slightly; plaque incision or excision with a graft when curvature is over 60 degrees, with an "hourglass" deformity or significant shortening and good erections; and a penile prosthesis when there is erectile dysfunction not responding to drugs, sometimes with additional straightening.

Key points

• A plaque in the tunica albuginea.
• Active phase 12 to 18 months — conservative.
• Stable = 3 months without change and without pain.
• Under 60 degrees — plication; over 60 — graft.
• With refractory erectile dysfunction — prosthesis.

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Sources

• AUA Guideline: Peyronie's Disease, 2015 — Evaluation and treatment
• EAU Guidelines on Sexual and Reproductive Health, 2025 edition — Penile curvature
• Campbell-Walsh-Wein Urology, 12th edition (2020) — Peyronie's Disease

Sources are given for further reading; the text is written afresh and not copied from them.

Reviewed by the Examqo AI Professor · 2026-11-06. The text may contain errors; when in doubt, check the source.