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PubMed2001

The prevalence of Peyronie's disease: results of a large survey.

OBJECTIVES: To determine the prevalence of Peyronie's disease, a localized connective tissue disorder of the penile tunica albuginea, the symptoms of which include palpable plaque, painful erections and curvature of the penis, in a large sample of men in Germany. SUBJECTS AND METHODS: A standardized questionnaire was sent to 8000 male inhabitants (age range 30-80 years) of the greater Cologne area (approximately 1.5 million inhabitants). Three questions about the self-diagnosis of Peyronie's disease were previously assessed for validity on 158 healthy men and 24 patients with confirmed Peyronie's disease. To optimize the response rate, the questionnaire was mailed three times to all the men. RESULTS: The response rate after the third mailing was 55.4% (4432 men): 142 men (3.2%, mean age 57.4 years, SD 13.4) reported the new appearance of a palpable plaque which, from the previous validation, was the most sensitive question and the main symptom of the disease. In men aged 30-39 years only 1.5% reported localized penile induration, compared with 3.0% in those 40-49 and 50-59 years, 4.0% in those 60-69 years and 6.5% of those > 70 years old. Newly occurring angulation was reported by 119 of the 142 men (84%) and painful erection by 66 (46.5%). The combination of the three symptoms (plaque, deviation and painful erection) was reported by 46 of the 4432 respondents (1.04%), i.e. 32% of the 142 men with penile induration; 58 of the 142 men (41%) reported erectile dysfunction. CONCLUSIONS: This is the first large cross-sectional, community-based study to examine the prevalence of Peyronie's disease. Using previously validated questions the prevalence of Peyronie's disease in the sample was 3.2%; this is much higher than indicated in previous reports. A comparably high prevalence is reported for diabetes and urolithiasis, suggesting that this 'rare' disease is more widespread than previously thought.

Adult↗
PubMed1999

[A case of urothelial carcinoma associated with penile metastasis].

A 71-year-old man, who had been treated with continuous ambulatory peritoneal dialysis due to chronic renal failure for 5 months, visited our hospital with a complaint of penile induration in April, 1998. He underwent wedge biopsy of the penis. On the day after the biopsy, he had an episode of gross hematuria. Cystoscopy revealed a papillary tumor that seemed to have arisen from the right ureteral orifice and another in the trigone. Computed tomographic scan revealed the bladder tumors and swelling of the internal iliac lymph nodes. The bladder tumors were resected transurethrally. The pathological diagnosis of the specimen from the penile induration was metastatic transitional cell carcinoma.

Aged↗
PubMed2003

Epithelioid sarcoma of the penis--a rare differential diagnosis of Peyronie's disease.

We report on a case of penile epithelioid sarcoma in a 29-year-old man presenting with a dorsal penile plaque that primarily was misdiagnosed as Peyronie's disease. Although the initial clinical findings of these two different entities appear similar, the consequence for the patient is severe. The only way of differentiating these disorders are histological findings. The principal microscopic characteristics of epithelioid sarcoma are the distinctive nodular arrangement, central degeneration and necrosis of the tumor cells with epithelioid appearance and eosinophilia. Immunohistochemical data (cytokeratin, epithelial membrane antigen, vimentin, CD 34, desmin) confirm the diagnosis. We conclude that in cases with slightest doubts on the diagnosis of Peyronie's disease, especially in younger men suffering from a fast-growing penile induration, a bioptic clarification of the entity should be performed to exclude a high malignant disease that can be only treated as far as it is localized by radical surgery.

Adult↗
PubMed2003

[Propoleum and Peyronie's disease].

OBJECTIVES: Peyronie's disease is a plastic penile induration which represents a well-known problem affecting men in their middle age, who suffer penile incurvation during erections, pain and poor consistency at the site of incurvation. There is no satisfactory treatment for this disease. A patient with Peyronie's disease who received propoleum treatment for a giardiasis infection referred spontaneous improvement of this penile incurvation as treatment cycles were repeated. So, we decided to treat a group of patients with this pathologic entity with propoleum to evaluate its efficacy. METHODS: Initially, 25 patients were studied, only 13 completed the study 6 months later. VARIABLES: age, penile incurvation, presence or not of pain with erections, detection and measurement (cm) of the fibrous plaque on physical examination and ultrasound, and description of its radiologic characteristics. Propoleum powder (300 mg) was administered for 6 months. RESULTS: Patient age was predominantly between 51 and 60 years. Upward deviation was the most frequent presentation; it disappeared in 2 patients in the "Improved" group. Most patients had no pain. 3 patients out of 13 had no plaque on examination at the end of treatment. Regarding incurvation 10 patients improved, 2 improved slightly, and only one improved somewhat during the first three months but then after remained the same. Penile x-ray was not useful as a diagnostic test; penile ultrasound was greatly useful. CONCLUSIONS: Penile incurvation improved in 77% of the patients. Fibrous plaques were reduced more than 0.5 cm on ultrasound (average 0.64 cm).

Adjuvants, Immunologic↗
PubMed1988

Intracavernous self-injection for impotence: a long-term therapeutic option? Experience in 78 patients.

A total of 78 patients 17 to 84 years old reported their experience via questionnaire with the papaverine-phentolamine injection technique for impotence. The mean number of injections used was 30.7. Penile induration occurred in 13 patients (16 per cent) and it was generally of limited extent. A higher incidence of induration was observed in those with vasculogenic impotence. Prolonged erection was reported by 23 per cent of the patients, 8 per cent of whom experienced erection for more than 12 hours. Priapism occurred exclusively in diabetic patients and patients with a neurological etiology of impotence. A total of 22 per cent of the patients reported moderate to severe pain with injection, 35 per cent indicated decreased quality of erection with time in response to the vasoactive agents and 28 per cent believed this therapy to be unsatisfactory. Among those who discontinued the injections 5 cited variability of erectile response (duration or quality) as the reason for discontinuation. A decrease in the effectiveness of the injections with time may be anticipated among some patients. For patients who face a penile implant without other options penile self-injection with vasoactive drugs is a reasonable alternative in that complications do not prevent successful prosthetic implantation.

Consumer Behavior↗
PubMed1990

Intracorporeal calcifications after self-injection of papaverine.

Penile indurations were found at follow-up examination in six of 120 patients with erectile dysfunction who practice intracavernosal self-injection of papaverine-phentolamine. In four of these six, cavernosal calcifications were demonstrated by means of ultrasound (US) and radiography. Most of the calcifications were close to the site of injection, but some were more distant. Cavernosal calcifications must be considered a possible complication of self-injection of papaverine-phentolamine. Baseline US and radiographic studies of the penis are advisable before starting treatment.

Adult↗
PubMed1992

[The value of imaging procedures in the diagnosis and therapy follow-up of induratio penis plastica (Peyronie's disease)].

The diagnosis of penile induration (Peyronie's disease; IPP) requires an appropriate history, clinical examination, autophotography and plain films in cases of calcified plaques, but ultrasound is the modality of choice. Besides the benefit of an exact staging (Kelâmi method) high-frequency ultrasound probes offer the possibility of detecting nonpalpable plaques early detection of changes in the tunica albuginea. Evaluation of inflammatory changes and disappearance of hyperechoic signs around the plaques or an increasing density of the corresponding corpus cavernosum can be detected by ultrasound, but sometimes to a restricted extent. In selected cases MRI offers the additional benefit of early detection of inflammatory changes of the dependent corpus cavernosum. Our own experience in the diagnosis of Peyronie's disease by ultrasound and MRI in cases of inflammatory changes are presented, especially after administration of Gd-DTPA. For hemodynamic disorders causing erectile dysfunction, in 50% of cases with IPP combined, pharmacocavernosometry and pharmaco-cavernosography are of considerable value. The use of modern diagnostic imaging modalities, e.g. ultrasound and especially MRI, increases the diagnostic impact in cases of IPP.

Adolescent↗
PubMed1999

The perils and pitfalls of penile injections.

We describe a 45-year-old man who presented with an indurated penile nodule following self-injection of acyclovir tablets which he had dissolved in hydrogen peroxide solution. This is a hazardous procedure which may be complicated by permanent deformity and functional disability due to the irritant nature of the tablets' constituents and their propensity to cause foreign body reactions in the skin.

Acyclovir↗
PubMed1989

Pharmacologically induced prolonged erections produced by papaverine. Follow-up of injection therapy.

Over a 27 months period papaverine induced erections were routinely used in the treatment of erectile dysfunction (ED). A total of 53 patients, 29 with neurogenic, 20 with arteriogenic, one with a combined arteriogenic/neurogenic ED and 4 with ED of uncertain etiology, in total used 1149 injections, of which 1069 (93%) produced erections with a rigidity sufficient for vaginal penetration. Fifteen patients discontinued treatment during the observation period. Nine patients experienced sustained erections on 16 occasions; all cases were managed by aspiration of blood and/or injection of adrenergic drugs. Penile indurations occurred in three cases, one of which resolved spontaneously. Papaverine induced erections was found to be an effective and well tolerated tool in the treatment of erectile dysfunction.

Adult↗
PubMed2000

[Penile metastasis from renal cell carcinoma: a case report].

Penile metastasis is rare. It occurs in the advanced stage of genitourinary cancer, with many other metastases in various organs. All 7 patients with penile metastasis of renal cell cancer, reported in the Japanese literature, died within a year. Our case was not the exception. A 69-year-old male presented with right flank pain and penile induration. Right renal cancer with liver invasion and multiple pulmonary metastases were found. Microscopic examination revealed a sarcomatous pattern. He died 4 months later.

Aged↗
PubMed1988

Pharmacologically induced erection in patients with multiple sclerosis.

Intracavernous injection of papaverine was tested in a group of 29 patients with multiple sclerosis and erectile dysfunction. Acceptable rigidity was obtained in 27 patients of whom 23 started to use self-injections as treatment. During an observation period of 5-12 months (mean 8.5 months) a total of 297 injections (3-35 per patient) were reported and 272 injections (92%) produced rigidity in 8-480 min. One case of priapism was seen. Minor haematomas or ecchymoses were reported in 16 cases. Two patients developed penile indurations after 6 and 19 injections respectively; one of these indurations resolved spontaneously. Self-injection with papaverine was found to be a safe and well-accepted treatment of erectile dysfunction in multiple sclerosis but long term side effects need further elucidation before the treatment is to be used as a routine procedure.

Adult↗
PubMed1991

Metastasis to the penis. Case reports and review of the literature.

Metastasis to the penis is rare, despite rich vascularization and complex circulation. Less than 200 cases have been reported. Three new cases of penis metastasis from primary tumours in the bladder and prostate, respectively, are described. The most common symptoms are penile induration and swelling. Treatments, all of which must be considered merely palliative, consist of local tumour excision, radiation therapy, cytostatic and hormone therapy, possibly with partial or total penis amputation. The prognosis is poor, irrespective of the therapy and site of the primary tumour. More than 80% of the patients die within six months after the occurrence of penis metastasis, as a result of disseminated cancer disease.

Adenocarcinoma↗