Induratio Penis Plastica (IPP) 

or

Peyronie’s Disease, Morbus Peyronie

What is Induratio Penis Plastica (IPP) or Peyronie’s disease?

IPP or Peyronie’s disease was described as early as 1743 by Francois Gigot de la Peyronie, the personal physician to the French King Louis XV. Peyronie’s disease is a disease of the penis in which first fibrous and later calcified nodules (so-called plaque) form under the skin in the region of the thick membrane (tunica albuginea) which surrounds the spongy chambers.
The male member is a cylindrical organ and contains spongy chambers in pair formation (corpora cavernosa). These are covered in a very dense layer of thick, white connective tissue, about 1mm thick (tunica albuginea). The chambers are made of a highly specialised tissue, arranged in a kind of honeycomb pattern and filled with thousands of tiny cavities which are relatively empty in the unaroused state. During erection the blood flows into these cavities and inflates the chambers like a balloon, pressing them against the tunica albuginea. As the penis becomes harder and straighter, the skin above remains elastic and flexible and adapts to the change.  

How common is the disease? 

Older studies report that about 1- 3.2 % of all men are affected by Peyronie’s disease. The disease appears most commonly in men between 40 and 60. An increased incidence of Peyronie’s disease is observed in combination with other fibrotic conditions e.g. on the palm-side finger tendons (Morbus Dupuytren) or more rarely on the soles of the feet (Morbus Ledderhose). An increased incidence of Peyronie’s disease is also reported for diabetics.

What causes Peyronie’s disease?

The aetiology of this disease remains unclear. One theory holds that as a result of very slight injuries, unnoticed by the patient, certain inflammatory reactions lead to increased circulation and the immigration of inflammatory cells in the dorsal region of the penis. This leads to a scarring of the tissue and calcification in the plaque. It has never yet been observed to develop into a malignant tumour (cancer).

Symptoms and progression of Peyronie’s disease:

Mostly the patients first notice a nodular hardening in the area around the penis shaft, causing pain especially during erection. 30% of patients are affected at the same time by an erectile disorder. Later stages often bring a growth of the plaque and curvature of the penis when erect, mostly upwards and less often to the side. Some patients develop a plaque which encircles the entire penis (“hourglass-deformity”). Later the pain often diminishes whereas the curvature may still increase. A penis curvature of more than 40 – 50° usually causes problems in sexual intercourse. In late-stage the disease often leads to curvature of the penis (see image). After 2-3 years there is almost always a still-stand of the disease, i.e. the expansion of the hardening and the extent of the penis curvature do not change anymore.

Treatment options:

As the aetiology of the disease remains unknown, there is also no etiological treatment method. A large number of substances are used in the treatment of IPP. Sometimes these medicines are given in tablet form, sometimes they are administered as injections into and around the hardened area. The most commonly used medicines are potassium para-aminobenzoate (POTABA®), vitamin E, colchicine and an anti-oestrogen medication (Tamoxifen®).
An alternative method of applying the medication is based on electro-motive transport of positively and negatively charged medication molecules (iontophoresis).
This administers a mix of anti-inflammatory and analgesic medications through the skin to the affected region of the penis.
The prerequisite for surgical correction in the case of Peyronie’s disease is at least 6 months still-stand of the disease, i.e. no further increase or decrease of the penis curvature. There are basically two different kinds of surgical procedure:  

1. The aim is to correct the bending of the penis and thus restore functionality. The most commonly used of these is the Nesbit procedure, which involves one or more wedge excisions on the opposite, healthy side of the penis to straighten it out. A disadvantage of this method is a relative shortening of the penis.  
2. The removal of the plaque from the corpus cavernosum, whereby the resulting gap is filled with foreign or autologous tissue. The complication rate for this method is significantly higher than for the simple straightening procedure. It should only be carried out in designated centres. In the case of Peyronie’s disease and simultaneously erectile disorder, the implantation of a semi-rigid or better hydraulic penis implant is sometimes the method of choice.