PS 09. The challenges of Peyronie's disease

Peyronie's disease is traditionally known as a localized contracture of the tunica albuginea that may result in penile curvature, shortening, indentation, hour-glass deformity and erectile dysfunction. There are probably two variant: traumainduced and genetically related such as in me with Dupuytren's contracture. Analysis of hundred of penile ultrasound images, we realized that Peyronie's disease may also involve the septum, and the intracavernosal struts in addition to the tunica albuginea. It is a benign condition with huge impact on the patient's psychological wellbeing. From the patient's prospective, the most devastating aspect in Peyronie's disease is the shortening of the penis that greatly affects the patient's self image.

Theoretically, excision of Peyronie's plaque and grafting of the defect to restore penile anatomy should be the ideal surgical treatment. However, both recurrence and ED rate are high and some patients may experience permanent loss of penile sensation. Plication surgery has the most reliable outcome and the least possibility of ED but is not acceptable to many patients because the "loss" of penile length. Current medical therapies may halt the progression of the disease but have very modest success in restoring "normal" anatomy and length. What are the challenges to medical therapy? In the early stage, we need a therapy to: 1. Stop the inflammatory process, 2. Preserve destruction of elastic fibers, 3. Prevent deposition of new scar. In the late stage, we need to: 1. Break-up the existing non-compliant scars, 2. Restore the elasticity/length, 3. Prevent deposition of new scars. The author strategy will be discussed.